This month in Emergency Care, the podcast covers papers on outcomes for non-conveyed patients by EMS, prevalence of midline C-spine tenderness in non-trauma population, and the risk of laryngospasm in pediatric sedation.
Non-conveyed patients by emergency medical services in Sweden had a significant rate of reattendance, hospitalization, and mortality, emphasizing the need for careful evaluation and follow-up care.
Non-trauma patients have a high prevalence of midline C-spine tenderness, indicating potential bias in assessing neck injuries and the importance of standardized examination techniques.
Deep dives
Ambulance Non-Conveyance: Study Finds Outcomes for Patients Not Conveyed to Hospital
A study published in the Scandinavian Journal of Trauma, Emergency Medicine revealed the outcomes for patients who were not conveyed by emergency medical services in Sweden's Oribro County. The study analyzed nearly 31,000 cases over a one-year period and found that 17% of non-conveyed patients visited the emergency department within seven days. Furthermore, 5% of patients were hospitalized and 18% died within that timeframe. The study also identified older age as a risk factor for hospitalization and death. The findings highlight the importance of carefully evaluating non-conveyance decisions and providing appropriate follow-up care and resources to ensure patient safety.
Midline C-Spine Tenderness in Non-Trauma Population: Study Shows Higher Prevalence
A study published in the Emergency Medicine Journal examined the prevalence of midline C-spine tenderness in a non-trauma population. The study involved 478 patients aged 18 to 64 years without any trauma, chronic neck pain, or other exclusions. The results revealed that nearly 60% of the patients had midline C-spine tenderness upon examination, with a majority reporting tenderness in the middle third of the neck. Factors associated with increased odds of tenderness included lower BMI and skate-foid tenderness on palpation. The study raises awareness about the potential bias in assessing C-spine tenderness and emphasizes the need for consistent and standardized examination techniques.
Laryngospasm During Pediatric Procedural Sedation: Study Uncovers Incidence and Risk Factors
A secondary analysis of the US Pediatric Sedation Research Consortium's multi-center database revealed insights into laryngospasm during pediatric procedural sedation. The study analyzed over 276,000 episodes of sedation and identified 913 cases of laryngospasm, resulting in an unadjusted prevalence of approximately 3 per 1000 patients. Younger age, higher ASA category, concurrent upper respiratory infection, and airway procedures were found to increase the risk of laryngospasm. The study also examined different medications used and found that intravenous ketamine had a similar likelihood of causing laryngospasm compared to propofol alone, while some propofol combination regimens had increased odds. The study highlights the importance of anticipating and managing laryngospasm during pediatric procedural sedation to ensure patient safety.
Welcome back! This month we take a look at 3 papers covering the breadth of Emergency Care.
First up we look at a paper evaluating outcomes for patients discharged on scene by an EMS service; how many reattend ED, how many require ICU care and what is the associated mortality rate?
NEXUS and Canadian c-spine rules both incorporate the presence of c-spine tenderness when deciding whether to image the neck as a result of trauma. But what is the prevalence of c-spine tenderness without trauma and how might that affect our clinical assessment?
Finally we take a look at a paper focussing on the risk of laryngospasm in paediatric sedation; what is the risk, which factors make it more likely to occur, and what can we do to mitigate it's risk?
Enjoy!
Simon & Rob
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