Faculty Opinions recommendation of Waiting for the patient to "sober up": Effect of alcohol intoxication on glasgow coma scale score of brain injured patients.

✓ 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.

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

Emergency Medicine International ◽

10.1155/2018/5649476 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 8

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.

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A retrospective study on the safety and effectiveness of olanzapine versus midazolam for pre-hospital management of excited delirium syndrome

Hong Kong Journal of Emergency Medicine ◽

10.1177/10249079211020868 ◽

2021 ◽

pp. 102490792110208

Author(s):

Wai Ling Lo ◽

Ka Leung Mok ◽

Ying Ying Poon

Keyword(s):

Adverse Event ◽

Adverse Events ◽

Glasgow Coma Scale ◽

Airway Obstruction ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Alcohol Intoxication ◽

Hospital Management ◽

Coma Scale ◽

Excited Delirium

Objective: To evaluate the safety and effectiveness of olanzapine compared to midazolam for the pre-hospital management of excited delirium syndrome. Methods: A retrospective review of patients who were treated by ambulance crew for excited delirium syndrome from 2016 to 2019 was performed. The drug of choice was given per Fire Service Department’s paramedic protocol (intramuscular midazolam January 2016 to October 2018 and intramuscular olanzapine October 2018 to December 2019). The primary outcome was the proportion of patients experienced at least one adverse event. The secondary outcome was the successful sedation rate. Results: A total of 201 patients were included in the study. Ninety-nine patients had pre-hospital midazolam and 102 received olanzapine. Thirty-one patients experienced adverse event after arrival to A&E, including a drop of Glasgow Coma Scale score to below 8 (90%), hypotension (6%), and airway obstruction (3%): 17 (17% patients; 1 airway obstruction and 16 Glasgow Coma Scale score below 8) in midazolam group and 14 (14% patients; 2 hypotension and 12 Glasgow Coma Scale score below 8) in olanzapine group (p = 0.41). Sixty-eight patients (69%) in midazolam group achieved successful sedation, compared with 79 (77%) in olanzapine group (p = 0.20). More adverse events were seen with midazolam than olanzapine in alcohol intoxication subgroup with statistical significance (12 vs 2, p = 0.03). Conclusion: Both midazolam and olanzapine can achieve a satisfactory success rate of sedation. More adverse events are associated with midazolam use in patients with acute alcohol intoxication, especially over-sedation and airway compromise. Olanzapine would be a safer choice in the pre-hospital setting where the resource is limited, and differentiation of underlying causes is not always possible.

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Retroclival Epidural Hematomas

Neurosurgery ◽

10.1227/01.neu.0000372085.70895.e7 ◽

2010 ◽

Vol 67 (2) ◽

pp. 404-407 ◽

Cited By ~ 29

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.

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Epidural Hematoma

Neurotrauma ◽

10.1093/med/9780190936259.003.0005 ◽

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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The Association of Glasgow Coma Scale Score With Clinically Important Traumatic Brain Injuries in Children

Pediatric Emergency Care ◽

10.1097/pec.0000000000001701 ◽

2019 ◽

Vol Publish Ahead of Print ◽

Cited By ~ 1

Author(s):

M. Austin Johnson ◽

Daniel K. Nishijima ◽

Nathan Kuppermann

Keyword(s):

Glasgow Coma Scale ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Brain Injuries ◽

Traumatic Brain Injuries ◽

Coma Scale

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Comparison of AVPU Scale and the Glasgow Coma Scale Score in Assessing Encephalitis in Children

Pediatric Infectious Diseases Open Access ◽

10.21767/2573-0282.100029 ◽

2016 ◽

Vol 01 (04) ◽

Author(s):

Nguyen Thi Huyen Sam ◽

Pham Ngoc Toan ◽

Truong Thi Mai Hong ◽

Le Thanh Hai

Keyword(s):

Glasgow Coma Scale ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Coma Scale

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Devastating Consequences of Subway Accidents: Traumatic Amputations

The American Surgeon ◽

10.1177/000313480607200118 ◽

2006 ◽

Vol 72 (1) ◽

pp. 74-76 ◽

Cited By ~ 3

Author(s):

Alexandra A. Maclean ◽

Andrea M. O'Neill ◽

H. Leon Pachter ◽

Maurizio A. Miglietta

Keyword(s):

New York ◽

Glasgow Coma Scale ◽

Limb Salvage ◽

Scale Score ◽

Glasgow Coma Scale Score ◽

Injury Severity ◽

Vital Signs ◽

Wound Infection Rate ◽

Operative Procedures ◽

Coma Scale

The efficiencies of the subway system are tempered by the occurrence of accidents, some with devastating injuries. The purpose of this study is to examine our experience with traumatic amputations after subway accidents. A retrospective trauma registry review (1989–2003) of 41 patients who presented to Bellevue Hospital, New York City, with amputations from subway accidents was undertaken to examine the following end points: age, sex, Injury Severity Score, time and mechanism of accident, history of psychiatric disorders and alcohol use, admission vital signs, Glasgow Coma Scale score, amputation type, associated injuries, limb salvage rate, operative procedures, mortality, and disposition. Elevated alcohol levels and prior psychiatric diagnoses were present in 39 per cent and 17 per cent of the patients, respectively. Patients were stable on admission with a mean systolic blood pressure of 114 mmHg, hematocrit of 32, and Glasgow Coma Scale score range of 13 to 15. The most common amputation was below knee, and patients underwent an average of three operative procedures. Limb salvage was attempted in eight patients with no successes. Amputation wound infection rate was 32 per cent and mortality rate was 5 per cent. Victims of subway trauma who arrive at the hospital with devastating amputations have an excellent chance of surviving to discharge.

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