EMERGENCY MEDICINE UPDATE
DON'T LET THIS BE YOUR LAST ISSUE OF EMU-IF YOU ARE AFINISHING RESIDENT SEND US YOUR NEW E MAIL ADDRESS!
Traumatic brain injury is catastrophic- just ask Marie Antoinette(true, that was a dislocation and not a true head injury). The questionin this study was whether patients did worse if there was a 60 minutetransit time, or they did worse when there was a need to be broughtto a level one trauma center, hypoxia, hypotension, hyperventilation,or tachycardia. They claimed they did not ( Acta Anes Scand55(8)944). The take home point here is that it really doesn't matterwhat intervention is done in head injury- they all do pretty poorly. Theproblems with his study were they only had 46 patients in 3 years, andI did not see a definition of what is a severe head injury (I am not abig lover of the GCS scale). However, where this can be relevant isthat your trauma center can function fine even if you do not haveneurosurg backup. Of course, it is the few that are not that severethat may respond well if you have neurosurg backup but those inmany cases can just be transferred. TAKE HOME MESSAGE: Severehead injury does poorly no matter what factors are involved.
A call for doing surgical airways, I was waiting for the answerwhy we are so reluctant to do these airways and finally found it in thelast line of the abstract- because of the perception that if you can'tintubate a particular patient- you must be an idiot. The truth is exactlyopposite. No, not that if you can intubate you are an idiot but rather if you can't do a surgical airway you are an idiot. A few of you may beidiots no matter what you do (no, I do not mean you; but I do meanyour boss). But if at least you know how to properly do a surgicalairway you will be an intelligent idiot. And probably save some one's