Emergency medicine journal : EMJ
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A literature search was undertaken for evidence of the effect of succinylcholine (SCH) on the intracranial pressure (ICP) of patients with acute brain injury and whether pretreatment with a defasciculating dose of competitive neuromuscular blocker is beneficial in this patient group. The authors could find no definitive evidence that SCH caused a rise in ICP in patients with brain injury. ⋯ There is level 2 evidence that SCH caused an increase in ICP for patients undergoing neurosurgery for brain tumours with elective anaesthesia and that pretreatment with defasciculating doses of neuromuscular blockers reduced such increases. It is unknown if this affects neurological outcome for this patient group.
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A previously unreported cause of acute tongue swelling is presented and the airway issues discussed. Cases with different aetiology have been sporadically published however the consequent, and sometimes fatal, airway obstructions have been dealt with somewhat variably. The aetiogy of acute tongue swelling and modern emergency airway algorithms are discussed with reference to the literature.
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To review pre-burns centre management, including assessment, resuscitation, and transfer. ⋯ There has previously been considerable variation in the standard of initial burn management and there have been problems with burn percentage assessment and resuscitation formula application. A new proforma has been introduced to tackle these issues.