Russell Duncan1, Shobhan Thakore. 1. Department of Emergency Medicine, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
Abstract
BACKGROUND: Decreased consciousness is a common reason for presentation to the emergency department (ED) and admission to acute hospital beds. In trauma, a Glasgow Coma Scale score (GCS) of 8 or less indicates a need for endotracheal intubation. Some advocate a similar approach for other causes of decreased consciousness, however, the loss of airway reflexes and risk of aspiration cannot be reliably predicted using the GCS alone. STUDY OBJECTIVE: A survey of all poisoned patients with a decreased GCS who were admitted to an ED short-stay ward staffed by experienced emergency physicians, to establish the incidence of clinically significant aspiration or other morbidities and endotracheal intubation. METHODS: A prospective, observational study was conducted of all patients admitted to the ED short-stay ward with a decreased level of consciousness (GCS < 15). RESULTS: The study included 73 patients with decreased consciousness as a result of drug or alcohol intoxication. The GCS ranged from 3 to 14, and 12 patients had a GCS of 8 or less. No patient with a GCS of 8 or less aspirated or required intubation. There was one patient who required intubation; this patient had a GCS of 12 on admission to the ward. CONCLUSIONS: This study suggests that it can be safe to observe poisoned patients with decreased consciousness, even if they have a GCS of 8 or less, in the ED.
BACKGROUND: Decreased consciousness is a common reason for presentation to the emergency department (ED) and admission to acute hospital beds. In trauma, a Glasgow Coma Scale score (GCS) of 8 or less indicates a need for endotracheal intubation. Some advocate a similar approach for other causes of decreased consciousness, however, the loss of airway reflexes and risk of aspiration cannot be reliably predicted using the GCS alone. STUDY OBJECTIVE: A survey of all poisoned patients with a decreased GCS who were admitted to an ED short-stay ward staffed by experienced emergency physicians, to establish the incidence of clinically significant aspiration or other morbidities and endotracheal intubation. METHODS: A prospective, observational study was conducted of all patients admitted to the ED short-stay ward with a decreased level of consciousness (GCS < 15). RESULTS: The study included 73 patients with decreased consciousness as a result of drug or alcohol intoxication. The GCS ranged from 3 to 14, and 12 patients had a GCS of 8 or less. No patient with a GCS of 8 or less aspirated or required intubation. There was one patient who required intubation; this patient had a GCS of 12 on admission to the ward. CONCLUSIONS: This study suggests that it can be safe to observe poisoned patients with decreased consciousness, even if they have a GCS of 8 or less, in the ED.
Authors: Nir Samuel; Yoav Hoffmann; Stav Rakedzon; Ari M Lipsky; Aeyal Raz; Hen Ben Lulu; Hany Bahouth; Danny Epstein Journal: Eur J Trauma Emerg Surg Date: 2022-05-07 Impact factor: 3.693
Authors: Jonathan Elmer; Peter Hou; Susan R Wilcox; Yuchiao Chang; Hannah Schreiber; Ikenna Okechukwu; Octávio Pontes-Neto; Ednan Bajwa; Dean R Hess; Laura Avery; Maria Alejandra Duran-Mendicuti; Carlos A Camargo; Steven M Greenberg; Jonathan Rosand; Daniel J Pallin; Joshua N Goldstein Journal: Crit Care Med Date: 2013-08 Impact factor: 7.598