scholarly journals Craniocerebral Injuries and the Glasgow Coma Scale Score in the Patients under the Influence of Alcohol Admitted to Hospital Emergency Department

2015 ◽  
Vol 4 (2) ◽  
pp. 56-61
Author(s):  
Małgorzata Kołpa ◽  
Aneta Grochowska ◽  
Agnieszka Gniadek ◽  
Beata Jurkiewicz ◽  
Marta Gondek
Keyword(s):  
Emergency Department ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
Coma Scale ◽  
Craniocerebral Injuries

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?

scholarly journals Validation of the Full Outline of Unresponsiveness score coma scale in patients clinically suspected to have acute stroke in the emergency department

2017 ◽  
Vol 24 (5) ◽  
pp. 230-236 ◽  
Author(s):  
Tommy Kwok Ping Lee ◽  
Abdul Karim Bin Kitchell ◽  
Axel Yuet Chung Siu ◽  
Ngan Kwan Chen
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Glasgow Coma Scale ◽  
Hospital Mortality ◽  
Acute Stroke ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Interrater Reliability ◽  
Coma Scale ◽  
Point Increase

Introduction: The Full Outline of Unresponsiveness score coma scale is a recently introduced coma scale. The objectives of this study were to assess the interrater reliability of the Full Outline of Unresponsiveness score coma scale when physicians and nurses in the emergency department apply the Full Outline of Unresponsiveness score on patients clinically suspected to have acute stroke and to look for any association between Full Outline of Unresponsiveness score coma scale and in-hospital mortality. Methods: Prospective study of 105 patients clinically suspected to have acute stroke recruited in an emergency department in a 4-month period. The Full Outline of Unresponsiveness score coma scale and Glasgow Coma Scale of each patient were assessed by one doctor and one nurse independently. The interrater reliability between physicians and nurses using the Full Outline of Unresponsiveness score and Glasgow Coma Scale score was assessed. The association between the Full Outline of Unresponsiveness score coma scale and in-hospital mortality was analysed using logistic regression, controlled for age, sex and diagnosis. Results: Full Outline of Unresponsiveness score had a good interrater reliability when applied to patients suspected to have acute stroke (kappa = 0.742, 95% confidence interval = 0.626–0.858). This was comparable to Glasgow Coma Scale score with a kappa = 0.796 (95% confidence interval = 0.694–0.898). For every 1-point increase in Full Outline of Unresponsiveness score coma scale, a reduction in in-hospital mortality was observed with an odds ratio of 0.76 (95% confidence interval = 0.63–0.91, p = 0.003), controlled for age, sex and diagnosis. Conclusion: The Full Outline of Unresponsiveness score may be a tool that can be used by emergency department doctors and nurses in assessing clinical stroke patients.

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.

Retroclival Epidural Hematomas

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 404-407 ◽  
Author(s):  
R. Shane Tubbs ◽  
Christoph J. Griessenauer ◽  
Todd Hankinson ◽  
Curtis Rozzelle ◽  
John C. Wellons ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Pediatric Patients ◽  
Motor Vehicle ◽  
Coma Scale ◽  
Presenting Symptoms ◽  
Cord Injury ◽  
The Mean

Abstract BACKGROUND Retroclival epidural hematomas (REDHs) are infrequently reported. To our knowledge, only 19 case reports exist in the literature. OBJECTIVE This study was performed to better elucidate this pathology. METHODS We prospectively collected data for all pediatric patients diagnosed with REDH from July 2006 through June 2009. Data included mechanism of injury, Glasgow Coma Scale score, neurological examination, treatment modality, and outcome. Magnetic resonance imaging was used to measure REDH dimensions. RESULTS Eight children were diagnosed with REDH, and the hematomas were secondary to motor vehicle–related trauma in all cases. The mean age of patients was 12 years (range 4–17 years). The mean REDH height (craniocaudal) was 4.0 cm, and the mean thickness (dorsoventral) was 1.0 cm. At presentation, the mean Glasgow Coma Scale score was 8 (range 3–14), and there was no correlation between hematoma size and presenting symptoms. Two patients died soon after injury, and 2 additional patients had atlanto-occipital dislocation that required surgical intervention. No patient underwent surgical evacuation of the REDH. The mean follow-up was 14 months. At most recent follow-up, 4 patients are neurologically intact, 1 patient has a complete spinal cord injury, and 1 patient has mild bilateral abducens nerve palsy. CONCLUSION To our knowledge, this study of 8 pediatric patients is the largest series of patients with REDH thus far reported. Based on our study, we found that REDH is likely to be underdiagnosed, atlanto-occipital dislocation should be considered in all cases of REDH, and many patients with REDH will have minimal long-term neurological injury.

Epidural Hematoma

Neurotrauma ◽  
2019 ◽  
pp. 35-44
Author(s):  
Lydia Kaoutzani ◽  
Martina Stippler
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Epidural Hematoma ◽  
Emergency Situation ◽  
Intracranial Injury ◽  
Coma Scale ◽  
Sagittal Sinus ◽  
Interosseous Artery ◽  
Neurologically Intact

Although epidural hematomas (EDH) are not frequently seen with intracranial injury in trauma, they present an emergency situation that can result in significant mortality if not diagnosed and treated in a timely manner. EDH stems from bleeding from the bone rupturing an interosseous artery, the bone itself, or from a venous sinus laceration. Most EDH present with a classic biconvex shape on CT images. Venous EDH can cross the midline and are often found under the transverse or sagittal sinus. The current school of thought is that patients who present with a small (<10 mm maximal thickness) EDH with no neurological symptoms can be treated conservatively. Patients neurologically intact with a normal Glasgow Coma Scale score but an EDH of greater than 30 cc should undergo surgery.

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