The Resus Room October 2024; papers of the month
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Oct 1, 2024 Tom Roberts, an Emergency Medicine Registrar and collaborator on the SHED study, dives into the critical world of subarachnoid hemorrhage diagnosis. He discusses how non-invasive blood pressure readings can mislead in pre-hospital settings, raising important clinical questions. The conversation also explores the SHED study's findings on CT scan accuracy for SAH detection and the vital role of naloxone in improving outcomes during out-of-hospital cardiac arrests. It's a captivating blend of research insights and practical implications for emergency medicine.
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Cuffs Can Normalize Extreme BP
- Non-invasive BP often misrepresents extremes, overestimating hypotension and underestimating hypertension in pre-hospital critical care.
- Pereira et al. found acceptable agreement in only ~55–76% of paired measures, so interpret cuff readings cautiously.
Always Contextualise Cuff Readings
- Never interpret NIBP in isolation; correlate with clinical exam, ETCO2 and perfusion signs during transport.
- Re-check and seek invasive monitoring if readings conflict with overall clinical picture.
Choose Arterial Lines Selectively
- Consider arterial lines for unstable pre-hospital patients when resources, skill and time allow to improve measurement accuracy.
- Balance benefits against risks (bleeding, infection, delays) and the impact on definitive care transfer.