scholarly journals Expert-Performed Endotracheal Intubation-Related Complications in Trauma Patients: Incidence, Possible Risk Factors, and Outcomes in the Prehospital Setting and Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Yuko Ono ◽  
Takeyasu Kakamu ◽  
Hiroaki Kikuchi ◽  
Yusuke Mori ◽  
Yui Watanabe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Glasgow Coma Scale ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Trauma Patients ◽  
Coma Scale ◽  
Injured Patients

The aim of this study was to determine complication rates and possible risk factors of expert-performed endotracheal intubation (ETI) in patients with trauma, in both the prehospital setting and the emergency department. We also investigated how the occurrence of ETI-related complications affected the survival of trauma patients. This single-center retrospective observational study included all injured patients who underwent anesthesiologist-performed ETI from 2007 to 2017. ETI-related complications were defined as hypoxemia, unrecognized esophageal intubation, regurgitation, cardiac arrest, ETI failure rescued by emergency surgical airway, dental trauma, cuff leak, and mainstem bronchus intubation. Of the 537 patients included, 23.5% experienced at least one complication. Multivariable logistic regression analysis revealed that low Glasgow Coma Scale Score (adjusted odds ratio [AOR], 0.93; 95% confidence interval [CI], 0.88–0.98), elevated heart rate (AOR, 1.01; 95% CI, 1.00–1.02), and three or more ETI attempts (AOR, 15.71; 95% CI, 3.37–73.2) were independent predictors of ETI-related complications. We also found that ETI-related complications decreased the likelihood of survival of trauma patients (AOR, 0.60; 95% CI, 0.38–0.95), independently of age, male sex, Injury Severity Score, Glasgow Coma Scale Score, and off-hours presentation. Our results suggest that airway management in trauma patients carries a very high risk; this finding has implications for the practice of airway management in injured patients.

Assessing the Use of Venous Thromboembolism Risk Assessment Profiles in the Trauma Population: Is It Necessary?

2011 ◽  
Vol 77 (6) ◽  
pp. 783-789 ◽  
Author(s):  
David L. Acuña ◽  
Gina M. Berg ◽  
Bridget L. Harrison ◽  
Trenton Wray ◽  
Diane Dorsch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Significant Risk ◽  
Cost Of Care ◽  
Trauma Patients ◽  
Coma Scale

Deep venous thrombosis (DVT) and the subsequent development of venous thromboembolism (VTE) are a significant cause of mortality, morbidity, and cost of care in trauma patients. This study aims to: 1) validate 5 as a critical threshold for high risk; 2) validate risk factors associated with DVT/VTE development; 3) evaluate exogenous estrogen and smoking as risk factors; and 4) analyze daily risk assessment profile (RAP) score changes. We performed a retrospective chart review of trauma patients admitted from January 2001 through December 2005. Univariate odds ratios were performed to assess potential risk factors for VTE. Of the 110 charts reviewed, 31 patients had confirmed DVT/VTE. Three of 26 patients with an RAP score < 5 suffered a VTE; one resulted in death. Significant risk factors included femoral venous line insertion, operation longer than 2 hours, head abbreviated injury score > 2, and Glasgow Coma Scale score < 8. RAP fluctuations were due to a changing Glasgow Coma Scale score, and whether the patient received more than four transfusions, was in surgery for more than 2 hours, or required a femoral venous catheter or major venous repair. The RAP critical value (5) was not validated. We recommend all trauma patients be treated with prophylactic anticoagulants throughout the hospital stay unless clear contraindications exist.

Glasgow Coma Scale Score, Mortality, and Functional Outcome in Head-Injured Patients

2004 ◽  
Vol 56 (5) ◽  
pp. 1084-1089 ◽  
Author(s):  
Pascal Udekwu ◽  
Sharon Kromhout-Schiro ◽  
Steven Vaslef ◽  
Christopher Baker ◽  
Dale Oller
Keyword(s):  
Glasgow Coma Scale ◽  
Functional Outcome ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Coma Scale ◽  
Head Injured ◽  
Injured Patients

Head-injured patients who talk and deteriorate into coma

1991 ◽  
Vol 75 (2) ◽  
pp. 256-261 ◽  
Author(s):  
Ramiro D. Lobato ◽  
Juan J. Rivas ◽  
Pedro A. Gomez ◽  
Mario Castañeda ◽  
José M. Cañizal ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Epidural Hematoma ◽  
Head Injuries ◽  
Mass Lesion ◽  
Content Type ◽  
Coma Scale ◽  
Injured Patients ◽  
Fine Print

✓ Of 838 patients with severe head injuries admitted since the introduction of computerized tomography, 211 (25.1%) talked at some time between trauma and subsequent deterioration into coma. Of these 211 patients, 89 (42.2%) had brain contusion/hematoma, 46 (21.8%) an epidural hematoma, 35 (16.6%) a subdural hematoma, and 41 (19.4%) did not show focal mass lesions. Thus, four of every five patients who deteriorated into coma after suffering an apparently nonsevere head injury had a mass lesion potentially requiring surgery; the mass was intracerebral in 52.3% of the cases and extracerebral in 47.6%. Patients aged 20 years or less had a 39% chance of having a nonfocal mass lesion (diffuse brain damage), a 29% chance of having an epidural hematoma, and a 32% chance of having an intradural mass lesion; patients over 40 years had only a 3% chance of having a nonfocal mass lesion, an 18% chance of having an epidural hematoma, and a 79% chance of having a intradural mass lesion. Sixty-eight (32.2%) patients died and 143 (67.8%) survived. The following were independent outcome predictors (in order of significance): Glasgow Coma Scale score following deterioration into coma, the highest intracranial pressure during the patient's course, the degree of midline shift, the type of intracranial lesion, and the age of the patient. In contrast, the mechanism of injury, the verbal Glasgow Coma Scale score during the lucid interval, and the length of time until deterioration or until operative intervention did not influence the final result.

scholarly journals How to interpret urine toxicology tests

2019 ◽  
Vol 105 (2) ◽  
pp. 84-88 ◽  
Author(s):  
Emma M Dyer ◽  
Sormeh Salehian
Keyword(s):  
Emergency Department ◽  
Glasgow Coma Scale ◽  
Social Services ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Coma Scale ◽  
Urine Toxicology ◽  
The Family ◽  
Rule Out

A 13-year-old girl presents to the emergency department for the second time with an unresponsive episode. She has a GCS (Glasgow Coma Scale) score of 11 on arrival and all other observations are normal. The story is unclear, but there are ongoing safeguarding concerns and the family are known to social services. All investigations are normal. After a period of observation on the ward, her GCS returns to normal and she appears well. Both on the first presentation and this presentation ingestion of a toxin was suspected. However, this was denied by the patient and urine toxicology screen was negative. Does this rule out toxin ingestion? Will this change your management?

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