Decreased Glasgow Coma Scale Score Does Not Mandate Endotracheal Intubation in the Emergency Department

Duncan, Russell A.; Thakore, Shobhan

doi:10.1016/j.jemermed.2008.11.026

Cited by 77 publications

(74 citation statements)

References 10 publications

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“…, most of the previous studies have observed that the GCS is a useful tool in prediction models of TBI outcomes 18,19 . More recently, it was demonstrated that the motor component of the GCS together with pupillary reactivity provide a simple and feasible score to stratify the severity of patients with TBI, contributing to the early definition of prognosis and most appropriate intervention for neuroprotection 20 .…”

mentioning

confidence: 99%

Predictors of quality of life after moderate to severe traumatic brain injury

Weber

Guimarães

Pontes-Neto

et al. 2016

Arq. Neuro-Psiquiatr.

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Objective To verify correlations between age, injury severity, length of stay (LOS), cognition, functional capacity and quality of life (QOL) six months after hospital discharge (HD) of victims of traumatic brain injury (TBI). Method 50 patients consecutively treated in a Brazilian emergency hospital were assessed at admission, HD and six months after HD. The assessment protocol consisted in Abbreviated Injury Scale, Injury Severity Score, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Mini Mental Test, Barthel Index and World Health Organization QOL - Brief. Results Strong negative correlation was observed between LOS and GCS and LOS and RTS. An almost maximal correlation was found between RTS and GCS and functional capacity and GCS at HD. Age and LOS were considered independent predictors of QOL. Conclusion Age and LOS are independent predictors of QOL after moderate to severe TBI.

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mentioning

confidence: 99%

Predictors of quality of life after moderate to severe traumatic brain injury

Weber

Guimarães

Pontes-Neto

et al. 2016

Arq. Neuro-Psiquiatr.

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“…Furthermore, the GCS has been implemented as a stratification tool into several outcome and prediction models. 7,15 The presence of TBI in multiple injured patients leads to increased mortality, 4 and results of the present study reported a 3.5-fold higher mortality rate within the TBI collective compared with patients with extracranial injuries only. In this study, patients with TBI were five times more likely to be unconscious on the scene, presented higher ISSs, and two times higher intubation rates that might contribute to the reported increase in mortality.…”

Section: Tbi Predictionmentioning

confidence: 51%

Introduction of a novel trauma score

Hoffmann

Lehmann

Rueger

et al. 2012

Journal of Trauma and Acute Care Surgery

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“…Esto explica por qué la no mejoría en el estado de conciencia o el hallazgo de focalizaciones neurológicas al examen físico indicarían la necesidad de una imagen cerebral. Establecer en qué paciente se debe asegurar la vía aérea es causa de controversia puesto que por mucho tiempo se han utilizado valores menores o iguales a ocho en la escala de coma de Glasgow como uno de los criterios; sin embargo, no existe la suficiente evidencia para adaptar su uso en ámbitos diferentes al trauma 31 . La escala de coma de Glasgow fue diseñada en 1974 por los doctores Jennett y Teadsle, especialistas en neurocirugía de la Universidad de Glasgow en Escocia con el fin de evaluar el estado de conciencia en pacientes post trauma cráneo encefálico (TEC) y establecer de una forma sencilla la necesidad de intubación emergente, la gravedad del TEC, la intervención microquirúrgica y el Dentro de las medidas de descontaminación se debe recordar el riesgo de aspiración bronquial cuando se hace inducción del vómito o lavado gástrico en un paciente con alteración de conciencia.…”

Section: Acción Directa Acción Indirectaunclassified

Alteración del estado de conciencia en el paciente intoxicado

Mejía

Ramos

Calzada

2017

MedUPB

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Alteración del estado de conciencia en el paciente intoxicadoAlterations in the state of consciousness in intoxicated patients / Alteração do estado de consciência no paciente intoxicado Marie Claire Berrouet Mejía 1 Natalia Eugenia Pino Ramos 2 Marcela Castro Botero 3 Ubier Eduardo Gómez Calzada 4 RESUMEN La disminución del estado de conciencia, específicamente el coma, es un motivo de consulta frecuente en el servicio de urgencias y constituye un reto para el personal de salud por el número de condiciones amenazantes de la vida que se acompañan de este signo clínico. La toxicidad en el sistema nervioso central es una de las manifestaciones más comunes en el paciente intoxicado por cuanto se han encontrado signos y síntomas hasta en un 30%. Este porcentaje es considerable en personas en edad laboral pues la morbilidad derivada de un retraso en la atención y las lesiones secundarias, implican repercusiones sociales. Según su acción en el sistema nervioso central los xenobióticos se dividen en dos grupos: estimulantes que causan agitación, delirium o convulsiones y depresores que provocan grados variables de alteración en el estado de conciencia, desde la somnolencia hasta el coma. El propósito de este artículo es revisar las sustancias depresoras, con enfoque en el coma de origen tóxico. Además de la fisiopatología y los principales tóxicos implicados, se plantea, con base en la evidencia, la mejor aproximación a esta clase de pacientes con el objeto de favorecer el uso razonable de los recursos disponibles y evitar complicaciones y disminuir costos al sistema de salud. Palabras clave: conciencia; sistema nervioso central; coma; toxicidad; envenenamiento agudo; estado mental alterado. ABSTRACTDepression of consciousness -coma, specifically -is a frequent complaint in the emergency room consultation and is a challenge for health personnel, considering the number of life-threatening conditions that may be associated with this clinical sign. Toxicity in the central nervous system is one of the most common manifestations in the poisoned patient, where signs and symptoms have been found in up to 30%. This percentage is significant in working-age individuals as morbidity resulting from a delay in care and secondary lesions involves a social impact. According to their effect on the central nervous system, xenobiotics can be divided into two groups: stimulants that cause states of agitation, delirium or convulsions, and depressants that cause varying degrees of alteration in the state of consciousness, anywhere from drowsiness to coma. The purpose of this article was to review depressants, focusing on coma induced by intoxication. In addition to reviewing the pathophysiology and the main toxic substances involved, we consider the best approach to this class of patients based on the evidence, in order to favor the reasonable use of resources available, while avoiding complications and reducing health system costs.

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Decreased Glasgow Coma Scale Score Does Not Mandate Endotracheal Intubation in the Emergency Department

Cited by 77 publications

References 10 publications

Predictors of quality of life after moderate to severe traumatic brain injury

Predictors of quality of life after moderate to severe traumatic brain injury

Introduction of a novel trauma score

Alteración del estado de conciencia en el paciente intoxicado

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