Mandated Prehospital Triage to Stroke Centers
Daniel J. Pallin, MD, MPH
How Often Do We Place Intravenous Catheters We Don't Use?
Daniel J. Pallin, MD, MPH
Metoclopramide plus Diphenhydramine Superior to Ketorolac for Nonmigraine Headaches
Daniel J. Pallin, MD, MPH
Some Patients with Isolated Traumatic Intracranial Hemorrhage May Not Need Neurosurgical Evaluation
. . . or even transfer to a trauma center.
Current practice for patients with isolated traumatic intracranial hemorrhage includes emergent neurosurgical evaluation and transfer to a trauma center, yet few patients end up needing any intervention. These authors assessed predictors of clinical deterioration requiring intervention or neurosurgical evaluation in a retrospective cross-sectional study of 404 adult patients who presented to a single trauma center with traumatic intracranial hemorrhage, isolated blunt head injury, and Glasgow Coma Scale (GCS) scores 13.
Probably, if you choose carefully.
Investigators at a teaching hospital in France developed and prospectively evaluated a protocol for outpatient management of patients with transient ischemic attack (TIA). All patients with an emergency department (ED) diagnosis of TIA who met the following criteria were discharged home on antiplatelet therapy: total recovery from symptoms; normal physical examination; normal blood tests; head computed tomography negative for blood; and electrocardiogram negative for atrial fibrillation. All patients received ultrasound of supra-aortic arteries and vascular neurology consultation within 8 to 15 days.
The combination of TIMI score and HEART score identifies patients at less than 1% risk for death or cardiac events within 30 days.
Patients with "low-risk" chest pain consume enormous resources with extremely low yield from observation and testing such as exercise tolerance testing. Decision aids could be useful in such cases; however, neither the Thrombolysis in Myocardial Infarction (TIMI) score nor the HEART score is sufficiently sensitive to predict 30-day cardiac events (missing 2% to 3% of such events). Both scores consider symptoms, age, risk factors, and electrocardiogram findings, and the HEART score also incorporates troponin testing.
Direct Laryngoscopy and Intubation Cause Significant Hypertensive Response in Head-Injured Patients
Heart rate, mean arterial pressure, and systolic blood pressure all increased by more than 20% after intubation.
Heliox Therapy for Bronchiolitis: Delivery Method Matters
Heliox delivered via face mask, but not nasal cannula, reduced duration of treatment in infants hospitalized for bronchiolitis.
Pediatric Emergency Medicine Physicians Are at Risk for Deterioration of Procedural Skills
Over a 1-year period, 61% of PEM faculty at a tertiary care pediatric emergency department did not perform any critical procedure.
Decline in Adequate Chest Compressions Is Similar in Children and Adults
In a simulation study, percent adequate chest compressions performed by in-hospital providers fell below 70% within 120 seconds in child and adult manikins.
