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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
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Mannitol dosing error during interfacility transfer for intracranial emergencies.

Cameron A Elliott1, Mark MacKenzie2, Cian J O'Kelly1

  • 1Division of Neurosurgery, University of Alberta, and.

Journal of Neurosurgery
|June 17, 2015
PubMed
Summary
This summary is machine-generated.

Mannitol dosing errors are common in peripheral hospitals for intracranial emergencies. A pretransport checklist could improve mannitol administration and patient safety during transfers.

Keywords:
BTF = Brain Trauma FoundationGCS = Glasgow Coma ScaleICP = intracranial pressureSTARS = Shock Trauma Air Rescue Societydosing errormannitolmedical evacuationtrauma

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Area of Science:

  • Emergency Medicine
  • Neurosurgery
  • Clinical Pharmacology

Background:

  • Mannitol is a crucial osmotic diuretic for managing elevated intracranial pressure (ICP).
  • Accurate mannitol administration is vital in critical care settings, especially during interfacility transfers for intracranial emergencies.
  • Adherence to established guidelines, such as the Brain Trauma Foundation guidelines, is essential for optimal patient outcomes.

Purpose of the Study:

  • To analyze the frequency and types of mannitol dosing errors in peripheral hospitals before transfer.
  • To evaluate the appropriateness of mannitol use in patients with intracranial emergencies based on 2007 Brain Trauma Foundation guidelines.
  • To identify potential strategies for reducing mannitol administration errors.

Main Methods:

  • Retrospective review of helicopter medical evacuation data from the Shock Trauma Air Rescue Society (STARS) database (2004-2012).
  • Included patients received mannitol prior to transfer for intracranial emergencies.
  • Data extracted included mannitol dosage, administration time, patient demographics, diagnosis, and neurological status (Glasgow Coma Scale, pupil status).

Main Results:

  • A 22% overall mannitol dosing error rate was observed in 120 patients.
  • Specific errors included underdosing (8.3%), overdosing (7.5%), and prolonged administration time (6.7%).
  • Despite errors, 72% of patients met criteria for mannitol use, including neurological deterioration, severe traumatic brain injury, or pupillary abnormalities.

Conclusions:

  • Mannitol administration in peripheral settings prior to transfer is associated with significant dosing errors.
  • Implementing standardized protocols, such as a pretransport checklist, may help reduce these errors.
  • Improving mannitol administration practices can enhance patient care during critical interfacility transfers.