NICE guidelines on Prehospital TXA → Yes
Spinal Immobilisation Study (SIS): Multicentre RCT
- Is movement minimisation non-inferior compared to triple immobilisation in relation to functional outcome (as assessed by the Functional Independence Measure motor scale) at hospital discharge and at 30 days
Impact brain apnea: when you have head injury you stop breathing,
- Intubation
- Depressed level of consciousness (patient cannot protect airway): usually GCS<8 or who remain hypoxic despite supplemental O2
- Need for hyperventilation (HPV)
- Severe maxillofacial trauma: patency of airway tenuous or concern for inability to maintain patency with further tissue swelling and/or bleeding
- Need for pharmacologic paralysis for evaluation or management
- Significantly deteriorating conscious level (e.g., a fall in GCS of two points or more, or a fall in motor score of one point or more)
- Loss of protective laryngeal reflexes
- Failure to achieve PaO₂ ≥ 13 kPa; a lower oxygen target can be accepted in patients with AIS (aim for peripheral oxygen saturation ≥ 95%)
- Hypercarbia (PaCO₂ > 6 kPa)
- Spontaneous hyperventilation (PaCO₂ < 4.0 kPa)
- Bilateral fractured mandible
- Copious bleeding into the mouth (e.g., from skull base fracture)
- Seizures
- Presence of basal skull fracture through cribriform plate
- Avoid nasotracheal intubation → orotracheal intubation
- Prevents assessment of patient’s ability to verbalize: for determining Glasgow Coma Scale score.
- This ability should be noted (none, unintelligible, inappropriate, confused, or oriented) prior to intubation
- Risk of pneumonia:
- Periprocedural antibiotics for endotracheal intubation
- Reduce the risk of pneumonia,
- Do not alter length of stay or mortality
- Bernard 2010: Prehospital intubation has better neurological outcome than in hospitable outcome with no difference in length of ITU stay or survival
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