Treating neurological injury in the field

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Veneficus

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First question:

I anyone part of a study involving EMS administration of Estrogen/progesterone to suspected or confirned neurological insults?


Second question:

Is anyone administering glucocorticoids for neurologic injury?


Third:

Is your serive using hypothermia therapy for trauma or other neurological insults?


Fourth:

Has your service reduced the use of O2 by non rebreather for treating most pathologies?


Fifth:

Are you providing any treatment other than these as either protocol or as a trial that I haven't listed?

(I guess I could have made a poll, but it never works for me)


amost forgot, sixth:

Is anyone carrying mannitol out of the hospital?


thanks
 
Veneficus said:
First question:

I anyone part of a study involving EMS administration of Estrogen/progesterone to suspected or confirned neurological insults?
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No, but would be interested in hearing more. I'm aware of the putative neuroprotective actions of estrogen, but haven't seen anything in the pre-hospital field yet.

Second question:

Is anyone administering glucocorticoids for neurologic injury?
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No. Increased risk of death, sepsis and GI bleeding, no improvement in mortality/morbidity shown to date.

Third:

Is your serive using hypothermia therapy for trauma or other neurological insults?
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Trial about to start later this year on induced hypothermia for isolated traumatic brain injury. It will take a while to run I imagine as most of our TBIs are in the setting of polytrauma, so will be excluded.

Fourth:

Has your service reduced the use of O2 by non rebreather for treating most pathologies?
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Never had them. Now working on stopping people throwing the standard O2 mask on all and sundry too :)

Fifth:

Are you providing any treatment other than these as either protocol or as a trial that I haven't listed?

(I guess I could have made a poll, but it never works for me)
Click to expand...

RSI used routinely in TBI and other neurological injury by all road based ALS paramedics. 97% first attempt intubation success rate, no crics done as a result of failed RSI, roughly 1000 patients a year getting this done. Bernard has run a trial 'down under' that showed that the appropriate use of RSI in neurological injury resulted in clear benefit to outcomes when done in the field.

amost forgot, sixth:

Is anyone carrying mannitol out of the hospital?


thanks
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No. Lack of evidence for it's efficacy and concerns over the numerous deleterious effects means we probably never will.
 
Wow, maybe we are cutting edge after all!

What does everyone else do for neurological injury? Burr holes? Nasal inubation? Cupping? Leeches?
 
Not much to be honest; best tools we have are an accurate GCS and good airway control.

Obviously we have intubation for airway control (we also have LMAs too) and midazolam for seizures but that's it.

We've been dishing out conservative low dose oxygen for at least a while 98% people who get oxygen are given 2-3 litres on a cannula.

For the zillionth time there is nothing magic about putting everybody on fifteen bloody litres!
 
just trying to get a feel for what people are doing out there, not suggesting anything.
 
This is the first time i've seen anyone talk about the efficacy of low dose oxygen, can you go into more detail?
 
8jimi8 said:
This is the first time i've seen anyone talk about the efficacy of low dose oxygen, can you go into more detail?
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I think the issue is that high-flow O2 is frequently unnecessary and occasionally harmful in the setting of TBI/CVA. The RTs on this forum would know more about that.
 
Smash said:
Wow, maybe we are cutting edge after all!

What does everyone else do for neurological injury? Burr holes? Nasal inubation? Cupping? Leeches?
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I like to use the EZ-IO.... works perfectly.. just cant go TOO deep with the IO needle.. :unsure:
 
You mean the meninges CAN'T stop a needle?! :ph34r:


So much for being "Dura"ble...
 
FLEMTP said:
I like to use the EZ-IO.... works perfectly.. just cant go TOO deep with the IO needle.. :unsure:
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Cool! Do you do a bunch of them at the top of the head and then wrap the head tightly, so when you walk into ER you can pull it off and have a head fountain going? :D
 
There is a study here called POLAR (Prophylactic Hypothermia to Lessen Traumatic Brain Injury) that you may be aware of.

Its a multi-centre trial that will begin here in Melbourne and expand to a few other cities, and New Zealand if memory serves.

On inspection of my notes from a conference last year where it was presented, its 1.9 million project with a target of 512 pts over two years, excluding other traumatic injuries. The deal will be paramedic initiated hypothermia with 2L of cooled NS with a target of 35 degrees, then after an ED workup, further cooling to 33 with a progressive warming schedule extending to about a week.

Don't quote me on any of that though, they're just from hurriedly scribbled notes. :wacko: Very interesting project though - the guys at the Alfred seem to have their head screwed on pretty straight.
 
I've taken the class on it. Pretty interesting, tho, they were rewarming within 24 hours
 
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