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The effect of prehospital fluids on survival in trauma patients
ABSTRACTS
cluded that HSD was superior to HS in improving cardiovascular function over the first 30 minutes of resuscitation following hemorrhage. Conclusions based on this single hemorrhagic animal model should be limited.
Ron Genova, MD
organophosphorus compounds; atropine
Organophosphate poisoning: Grading the severity and comparing the t r e a t m e n t b e t w e e n atropine and glycopyrrolate Bardin PG, Van Eeden SF Crit Care Med 18:956-960 Sep 1990
This study compared the use of glycopyrrolate, believed to offer better control of secretions and fewer side effects, with atropine in acute organophosphate poisoning (OPP). It also evaluated a new grading system of OPP severity based solely on clinical findings, in contrast to previous s y s t e m s that i n c o r p o r a t e d s e r u m cholinesterase levels. Forty-four consecutive patients with acute OPP were clinically graded (0 to 3, ranging from history with no signs to stuporous with abnormal blood gases and c h e s t r a d i o g r a p h ) and randomized in a double-blinded fashion to receive equivalent doses of either atropine or glycopyrrolate. End point of therapy was control of secretions, absence of fasciculations, and heart rate above 60. Therapy was tapered following 24 hours of clinical stability. Supplemental atropine was given to both groups if heart rate dropped below 60. Eighteen patients had received obidoxime prior to enrollment in the study. A statistically insignificant trend toward increased respiratory infections was detected in the atropine group. No differences in level of consciousness or central nervous system side effects were found. None of the i3 patients classified as mildly poisoned (groups 0 and 1) required ventilatory support, whereas 14 of 26 patients classified as seriously poisoned (groups 2 and 3) required ventilatory support. There 154/436
were three deaths among the seriously poisoned and none in the other groups. The authors conclude that glycopyrrolate offers no clinical advantage to atropine in acute OPP. Paul Sovell, MD trauma, pediatric
Sledding related injuries in children Dershewitz R, Gallagher SS, Donahoe P Am J Dis Child 144:1071-1073 Oct 1990
The authors examined 211 sledand toboggan-related injuries in patients aged 19 years or younger requiring emergency department treatment. The cases were identified by the Massachusetts Statewide Childhood Injury Prevention Program between September 1979 and August 1982, covering a population of 87,022 children. Of the 211 patients, 19 required admission. In the sledding group, ages 5 to 9 had the highest rate of injuries, while in the toboggan group, ages 15 to 19 had the highest rate of injuries. Twenty-nine percent of all injuries were laceration, 26% were c o n t u s i o n s , and 19% were sprains or strains. One third of all sledding injuries were to the face or head, 30% to the lower extremities, and 16% to the fingers; the majority of the toboggan-related injuries were to the lower extremities. Serious injuries (defined as concussion, internal injury, or fractures) occurred in 21% of all sledding-related case s. The authors suggest that to reduce injuries, the child's head should be at the back of the sled and that a helmet and p r o t e c t i v e gloves s h o u l d be worn.
Jeff Burgess, MD trauma, prehospital fluids
The e f f e c t of prehospital fluids on survival in t r a u m a p a t ie nts Kaweski S, Sise M, Virgilio R J Trauma 30:1215-1219 Oct 1990
This study evaluated the impact of prehospital IV fluid administration
Annalsof EmergencyMedicine
on survival following trauma. Data obtained from the San Diego County Trauma Registry on 6,855 trauma patients between January 1, 1985 and July 31, 1987 were studied. Patients were divided into three groups based on the Injury Severity Score and then further divided into subgroups based on presence or absence of prehospital IV fluid administration. Mean prehospital time was 36 minutes in each group. Volume of fluid administered was not significantly different in survivors compared with nonsurvivors. Comparison of the groups with similar probability of survival according to the TRISS methodology also failed to show an influence of fluid administration on survival. Lack of effect of fluids was seen throughout range of severity of trauma as measured by the Injury Severity Score. Mortality rates increased significantly with higher Injury Severity Score and with hypotension at the scene. Administration of fluid had no influence on the rates, suggesting that mortality rate is related to the severity of underlying injuries and is not influenced by prehospital fluid administration.
Toni Brophy, MD CPR
In-hospital c a r d i o p u l m o n a r y resuscitation: Patient, arrest and resuscitation factors associated with survival Tortolani AJ, Risucci DA, Rosati RJ, et al Resuscitation 20:115-128 Oct 1990
Twenty-four hour survival rates, discharge survival rates, and correlates of survival were analyzed on 470 adults with single inhospital cardiac arrest. Logit analysis, X2 analysis, Scheffe's comparison, and oneway analysis of variance (ANOVA) were applied with the following results: 153 of 470 (33%) of patients were alive at 24 hours, and 69 of 153 (45%) of these were discharged alive. Neurologic outcome was not noted. Of all patients, 69 of 470 (14.7%) survived to hospital discharge alive. The following independently significant 20:4 April 1991
cluded that HSD was superior to HS in improving cardiovascular function over the first 30 minutes of resuscitation following hemorrhage. Conclusions based on this single hemorrhagic animal model should be limited.
Ron Genova, MD
organophosphorus compounds; atropine
Organophosphate poisoning: Grading the severity and comparing the t r e a t m e n t b e t w e e n atropine and glycopyrrolate Bardin PG, Van Eeden SF Crit Care Med 18:956-960 Sep 1990
This study compared the use of glycopyrrolate, believed to offer better control of secretions and fewer side effects, with atropine in acute organophosphate poisoning (OPP). It also evaluated a new grading system of OPP severity based solely on clinical findings, in contrast to previous s y s t e m s that i n c o r p o r a t e d s e r u m cholinesterase levels. Forty-four consecutive patients with acute OPP were clinically graded (0 to 3, ranging from history with no signs to stuporous with abnormal blood gases and c h e s t r a d i o g r a p h ) and randomized in a double-blinded fashion to receive equivalent doses of either atropine or glycopyrrolate. End point of therapy was control of secretions, absence of fasciculations, and heart rate above 60. Therapy was tapered following 24 hours of clinical stability. Supplemental atropine was given to both groups if heart rate dropped below 60. Eighteen patients had received obidoxime prior to enrollment in the study. A statistically insignificant trend toward increased respiratory infections was detected in the atropine group. No differences in level of consciousness or central nervous system side effects were found. None of the i3 patients classified as mildly poisoned (groups 0 and 1) required ventilatory support, whereas 14 of 26 patients classified as seriously poisoned (groups 2 and 3) required ventilatory support. There 154/436
were three deaths among the seriously poisoned and none in the other groups. The authors conclude that glycopyrrolate offers no clinical advantage to atropine in acute OPP. Paul Sovell, MD trauma, pediatric
Sledding related injuries in children Dershewitz R, Gallagher SS, Donahoe P Am J Dis Child 144:1071-1073 Oct 1990
The authors examined 211 sledand toboggan-related injuries in patients aged 19 years or younger requiring emergency department treatment. The cases were identified by the Massachusetts Statewide Childhood Injury Prevention Program between September 1979 and August 1982, covering a population of 87,022 children. Of the 211 patients, 19 required admission. In the sledding group, ages 5 to 9 had the highest rate of injuries, while in the toboggan group, ages 15 to 19 had the highest rate of injuries. Twenty-nine percent of all injuries were laceration, 26% were c o n t u s i o n s , and 19% were sprains or strains. One third of all sledding injuries were to the face or head, 30% to the lower extremities, and 16% to the fingers; the majority of the toboggan-related injuries were to the lower extremities. Serious injuries (defined as concussion, internal injury, or fractures) occurred in 21% of all sledding-related case s. The authors suggest that to reduce injuries, the child's head should be at the back of the sled and that a helmet and p r o t e c t i v e gloves s h o u l d be worn.
Jeff Burgess, MD trauma, prehospital fluids
The e f f e c t of prehospital fluids on survival in t r a u m a p a t ie nts Kaweski S, Sise M, Virgilio R J Trauma 30:1215-1219 Oct 1990
This study evaluated the impact of prehospital IV fluid administration
Annalsof EmergencyMedicine
on survival following trauma. Data obtained from the San Diego County Trauma Registry on 6,855 trauma patients between January 1, 1985 and July 31, 1987 were studied. Patients were divided into three groups based on the Injury Severity Score and then further divided into subgroups based on presence or absence of prehospital IV fluid administration. Mean prehospital time was 36 minutes in each group. Volume of fluid administered was not significantly different in survivors compared with nonsurvivors. Comparison of the groups with similar probability of survival according to the TRISS methodology also failed to show an influence of fluid administration on survival. Lack of effect of fluids was seen throughout range of severity of trauma as measured by the Injury Severity Score. Mortality rates increased significantly with higher Injury Severity Score and with hypotension at the scene. Administration of fluid had no influence on the rates, suggesting that mortality rate is related to the severity of underlying injuries and is not influenced by prehospital fluid administration.
Toni Brophy, MD CPR
In-hospital c a r d i o p u l m o n a r y resuscitation: Patient, arrest and resuscitation factors associated with survival Tortolani AJ, Risucci DA, Rosati RJ, et al Resuscitation 20:115-128 Oct 1990
Twenty-four hour survival rates, discharge survival rates, and correlates of survival were analyzed on 470 adults with single inhospital cardiac arrest. Logit analysis, X2 analysis, Scheffe's comparison, and oneway analysis of variance (ANOVA) were applied with the following results: 153 of 470 (33%) of patients were alive at 24 hours, and 69 of 153 (45%) of these were discharged alive. Neurologic outcome was not noted. Of all patients, 69 of 470 (14.7%) survived to hospital discharge alive. The following independently significant 20:4 April 1991