Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning
Would you intubate a 37 years old who presented with acute alcohol intoxication and GCS of 7 but adequate oxygenation and ventilation?
Research Question:
What is the effect of withholding intubation compared to routine practice on clinical outcomes in comatose patients with acute poisoning and a Glasgow Coma Scale score of less than 9?
Hyponatremia, characterized by low plasma sodium concentration (pNa), is the most prevalent electrolyte disorder in hospitalized patients, affecting about 15%. While the majority of cases are mild, with pNa levels at or above 130 mmol/L, about 4% of patients experience severe hyponatremia with pNa dropping below 130 mmol/L. The leading cause of this significant drop in pNa is the Syndrome of Inappropriate Antidiuresis (SIAD), which occurs due to an excessive release of arginine vasopressin (AVP) despite low serum tonicity. In cases of severe symptomatic hyponatremia, which may present with symptoms like vomiting, seizures, and a reduced conscious state, it is considered a medical emergency. Immediate treatment with a bolus of hypertonic saline, specifically 100 mL of 3% NaCl for up to three doses, is recommended to increase pNa by 4 to 6 mmol/L, aiming to reduce intracranial pressure (ICP).
For chronic or uncertain-duration hyponatremia, to prevent osmotic demyelination syndrome (ODS),…
In Disseminated Intravascular Coagulation (DIC), patients may present with both necrotic and hemorrhagic skin lesions, reflecting the complex and severe nature of this condition. The necrotic lesions arise from widespread microthrombi formation in small blood vessels, leading to impaired blood flow and subsequent tissue death, manifesting as purplish, black, or red patches on the skin. Concurrently, hemorrhagic lesions occur due to the significant depletion of platelets and clotting factors, a result of the excessive clotting process, leading to spontaneous bleeding under the skin. These may appear as petechiae, purpura, or ecchymoses, scattered across various parts of the body.
@Everyone
https://www.annemergmed.com/article/S0196-0644(23)01281-7/fulltext
This study aimed to evaluate the effectiveness of tranexamic acid (TXA) in reducing mortality in emergency trauma cases. A systematic review and meta-analysis of randomized controlled trials were conducted, focusing on TXA's impact compared to a placebo. The main outcome was 1-month mortality. Seven trials met the criteria, and the results showed an 11% decrease in death risk at 1 month with TXA use. There was also a reduction in 24-hour mortality, and no significant increase in vascular occlusive events was observed.
It gets easier as you practice more, I do this almost on every patient post resuscitation. Variability or pulsatility of lesss than 30% indicates no venous congestion.
