The Resus Room
October 2024; papers of the month
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.
37:36
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Quick takeaways
- Non-invasive blood pressure readings can often mislead clinicians in critically ill patients, necessitating cautious interpretation and possible invasive monitoring.
- The SHED study emphasizes the importance of timely CT imaging for accurately diagnosing subarachnoid hemorrhage, particularly within the first six hours of symptom onset.
Deep dives
Non-Invasive vs. Arterial Blood Pressure Monitoring
The accuracy of non-invasive blood pressure measurements compared to invasive arterial pressure monitoring in critically ill pre-hospital patients is examined, highlighting the limitations of the former. A study involving nearly 2,400 paired measurements from 220 patients found that non-invasive systolic blood pressure readings aligned with invasive measurements only 64% of the time. The study found that non-invasive methods tend to overestimate systolic and mean arterial pressures during hypotensive events and underestimate them during hypertensive episodes. Consequently, the study emphasizes the need for clinicians to interpret non-invasive readings cautiously and consider invasive monitoring when appropriate.
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