The Resus Room January 2024; papers of the month
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Jan 1, 2024 This podcast delves into key papers on airway management in comatose patients with poisoning, diagnostic abilities for dissociative seizures, and prognostic scores for out-of-hospital cardiac arrests. They explore a study comparing conservative care in acute poisoning, the challenges of distinguishing seizures, and the Miracle-2 score for predicting neurological outcomes post cardiac arrest.
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Selective Airway Rather Than Automatic Intubation
- Avoid routine intubation for all poisoned patients with GCS<9 and instead use a selective, conservative airway strategy when no other indications exist.
- Monitor closely for four hours and intervene if respiratory distress, ongoing vomiting, seizures, hypoxia, or shock develop.
Conservative Strategy Improved System Outcomes
- Withholding intubation reduced ICU and hospital length of stay and lowered pneumonia rates in the conservative arm.
- The trial reported a win ratio favoring conservative care (1.85) with no in-hospital deaths in either group.
Keep High-Risk Patients Under Critical Monitoring
- Do not apply the trial to patients with immediate indications for intubation like refractory hypoxia, uncontrolled seizures, vomiting, or shock.
- Ensure these patients receive critical care-level monitoring rather than merely leaving them in ED until they awaken.