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Plasma:red cell transfusion ratio in trauma

In major trauma patients who require blood transfusion, fresh frozen plasma (FFP) to packed red blood cell (RBC) ratios of up to 1:1 have been associated with reduced mortality in retrospective studies, which may be in part due to survival bias (some patients die before they can be given as much FFP as the survivors).

To eliminate this bias, Australian researchers reviewed 331 trauma patients receiving at least 5 units of red cells in the first 4 hours, with a median Injury Severity Score of 36. When deaths in the first 24 hours were excluded, FFP:RBC ratio had no association with mortality. They conclude that prospective randomised controlled trials are needed.

Fresh frozen plasma (FFP) use during massive blood transfusion in trauma resuscitation
Injury. 2010 Jan;41(1):35-9

Self-extrication with a collar on

Using a sophisticated infrared six camera motion capture system, investigators demonstrated decreased cervical spine movement when collared volunteers self-extricated from a mock smashed up Toyota Corolla, when compared with extrication by paramedics using a backboard.

The authors conclude that in ambulatory subjects who do not complain of back pain, the least motion of the cervical spine may occur when the subject is allowed to exit the car in a c-collar without backboard immobilisation.

Cervical spine motion during extrication: a pilot study
West J Emerg Med. 2009 May;10(2):74-8

Full text article

Standard medication kit for prehospital and retrieval physicians

A very comprehensive (hence the title of the paper) review of medications required for pre-hospital & retrieval medicine missions was undertaken, resulting in recommendations. While the casemix seen by various services may be influenced by local geography or tasking restrictions, the list provides an excellent standard from which locally appropriate modifications can be made.

Defining a standard medication kit for prehospital and retrieval physicians: a comprehensive review.
Emerg Med J. 2010 Jan;27(1):62-71

Self-extrication with a collar on

Using a sophisticated infrared six camera motion capture system, investigators demonstrated decreased cervical spine movement when collared volunteers self-extricated from a mock smashed up Toyota Corolla, when compared with extrication by paramedics using a backboard.

The authors conclude that in ambulatory subjects who do not complain of back pain, the least motion of the cervical spine may occur when the subject is allowed to exit the car in a c-collar without backboard immobilisation.

Cervical spine motion during extrication: a pilot study
West J Emerg Med. 2009 May;10(2):74-8

Full text article

Best way to insert NG tube in intubated patients

A randomised controlled trial on 200 anaesthetised, tracheally intubated adults compared four methods of nasogastric tube placement, looking at success rates, time to insertion, and complications.

The four groups were: control, using a ureteral guidewire as stylet, a slit endotracheal tube as an introducer, and head flexion with lateral neck pressure. All intervention groups were more successful than the control group. The time necessary to insert the NG tube was significantly longer in the slit endotracheal tube group, which also had the highest bleeding rate. Complications were fewest in the flexion group.

Nasogastric tube insertion using different techniques in anesthetized patients: a prospective, randomized study
Anesth Analg. 2009 Sep;109(3):832-5

Heliox in COPD exacerbation

A 65:35 helium-oxygen mix was compared with 35% oxygen in air in patients with COPD exacerbations requiring non-invasive ventilation. In this RCT there was no difference in intubation rates between the heliox or air/oxygen groups.

A multicenter, randomized trial of noninvasive ventilation with helium-oxygen mixture in exacerbations of chronic obstructive lung disease
Crit Care Med. 2010 Jan;38(1):145-51