ACLS REVISION: Post ROSC Care

Once we’ve achieved ROSC our job is not over. Good post-arrest care involves maintaining blood pressure and cerebral perfusion, adequate sedation, cooling and preventing hyperthermia, considering antiarrhythmic medications, optimization of tissue oxygen delivery while avoiding hyperoxia, getting patients to PCI who need it, and looking for and treating the underlying cause.

Priapism

 Non-ischemic (high-flow)Ischemic (low-flow)
Physical ExamTypically painless, not fully tumescentPainful, fully tumescent with corpus cavernosa rigidity without involvement of corpus spongiosum and glans penis
AetiologyHigh-flow priapism is extremely rare and most commonly associated with antecedent trauma including blunt trauma, or resulting from needle injury of the cavernosal artery.Low-flow priapism is caused by impaired relaxation and/or paralysis of cavernosal smooth muscle and in sickle-cell disease
ManagementNOT EmergencyEmergency
 
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Tranexamic Acid

TXA is a safe, inexpensive medication that prevents fibrin breakdown.  In traumatic bleeding, it conveys a significant mortality benefit with an impressive NNT for mortality between 7 and 67, depending on injury severity, without apparent serious safety issues.  This benefit is associated with early administration.  TXA should not be given more than three hours after injury as it may increase mortality after this timeframe.  It appears to have equal benefit in a variety of trauma practice environments.

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CRASH-3 Trial: Tranexamic Acid in Mild-Moderate Head Injury

CRASH-3 Trial examined the effect of tranexamic acid on head injury-related death in adults with TBI who were within 3 h of injury, had a Glasgow Coma Scale (GCS) score of 12 or lower or any intracranial bleeding on CT scan, and no major
extracranial bleeding.

The results indicated a reduction in the risk of head injury-related death with tranexamic acid in patients with mild-to-moderate head injury (RR 0·78 [95% CI 0·64–0·95]) but in patients with severe head injury (0·99 [0·91–1·07]) there was no clear evidence of a reduction (p value for heterogeneity 0·030).

The effect of tranexamic acid on head injury-related death stratified by time to treatment and recorded no evidence of heterogeneity (p=0·96). The RR of head injury-related death with tranexamic acid was 0·96 (95% CI 0·79–1·17) in patients randomly assigned within 1 h of injury, 0·93 (0·85–1·02) in those randomly assigned within more than 1 h and 3 h or fewer after injury, and 0·94 (0·81–1·09) in those randomly assigned more than 3 h after injury.

Machakos County: A Model for Emergency Care in the Counties

Machakos County is currently leading in the adoption of the Kenya Emergency Medical Care Policy 2020-2030 developed by the Ministry of Health. Based on the WHO Emergency Care Systems Framework, the Machakos County Emergency Medical Care System is proof that we can have a functioning emergency care system across the different Counties and across the Country.

Neonatal Resuscitation

Most infants transition from intrauterine to extrauterine life without any assistance. The term-infant with good tone, color, and respiratory effort requires no assistance and should be handed off to the mother after birth. However, approximately 10% of infants require some resuscitation and about 1% require extensive resuscitation.  The main priority in neonatal resuscitation is establishment of effective ventilation and oxygenation.

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