The American journal of emergency medicine
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Traumatic Brain Injury (TBI) remains a significant global health concern with significant impact on morbidity and mortality. This narrative review explores adjunctive pharmacologic agents to be employed by emergency medicine clinicians during Advanced Trauma Life Support (ATLS) in patients presenting with a TBI. Pharmacologic agents are commonly employed for the management of rapid sequence intubation and post-intubation analgosedation, hemodynamics, intracranial pressure, coagulopathy, seizure prophylaxis, and infection. This narrative review discusses current evidence and controversies to optimize adjunct pharmacotherapies during the acute management of TBI within the emergency department.
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A glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) blood biomarker panel can reliably eliminate the need to perform a head computed tomography (CT) scan in selected patients with traumatic brain injury (TBI). Currently, this FDA cleared panel can be run both on a core laboratory platform or a hand-held single-sample point of care platform. This study examined test characteristics of the panel as analyzed on a core lab-based fast high-throughput platform. ⋯ The biomarker panel, measured on this core lab-based fast high-throughput platform, had high sensitivity and negative predictive values. The core laboratory platform has the advantage of speed and the ability to analyze multiple samples simultaneously suggesting additional utility when there is high need for CT imaging such as mass casualty or emergency department volume overload situations.
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High quality chest compressions are essential for survival and good neurological outcome in out-of-hospital cardiac arrest (OHCA). Dispatcher- assisted CPR (DA-CPR) has led to increased survival in OHCA. Recently, additional verbal motivation has shown positive effects on CPR quality. The present randomized and controlled simulation trial investigates the effect of different intervals of verbal motivation during DA-CPR. ⋯ Verbal encouragement every 30 or 60 s combined with a metronome beat led to a significant augmentation of chest compression depth compared to standard DA-CPR.