Discussion: Tension pneumothorax is a life-threatening complication in open chest wounds. The task force recognized the limited evidence addressing this but noted that both evidence and the medical practice of treating a tension pneumothorax by creating an open wound to allow communication between it and the ambient air justified the benefit of non-occlusive dressings in open chest wounds. Further research into non-occlusive dressings is required due to the concern that they may inadvertently occlude open chest wounds, causing life-threatening complications.

Recommendation: First-aid providers should not apply occlusive dressings or devices in patients with open chest wounds.

Note from Dr. Smith: In the first-aid setting, occlusive dressings should not be placed on open chest wounds due to the possibility of doing harm by creating a tension pneumothorax.

Hypoglycemia (FA 795)

Recommendation Author: Derick D. Jones, MD

Dr. Jones is a member of the emergency medicine residency training class of 2018 at the Mayo School of Graduate Medical Education/Mayo Clinic.

Question: Among adults and children with symptomatic hypoglycemia (P), does administration of dietary forms of sugar (I) compared with standard dose (15–20 g) of glucose tablets (C) change time to resolution of symptoms, risk of complications (eg, aspiration), blood glucose, hypoglycemia, or hospital length of stay (O)?

Results: Three randomized control studies and one observational study that addressed the PICO were identified. All four studies were downgraded for risk of bias and imprecision. The three randomized studies were deemed low-quality evidence, while the observational study was deemed very low quality.

Outcomes: No study showed that any form of dietary sugar or glucose tablets improved the blood glucose before 10 minutes. The observational study showed fewer diabetic patients demonstrating a 20 mg/dL increase in blood glucose level 20 minutes after treatment when treated with dietary sugars compared to glucose tablets. Pooled data from the three randomized trials showed a slower resolution of symptoms 15 minutes after diabetic patients were treated with dietary sugars compared with glucose tablets. No studies assessed the risk of complications or assessed hospital length of stay.

Discussion: The current analysis evaluated glucose supplementation from glucose tablets compared with dietary sugars at equivalent doses of 15–20 g. Alternative dietary sugars and glucose gels/pastes may be effective. This study does not look at adverse effects of administering more sugar than needed.

Recommendation: In conscious individuals with symptomatic hypoglycemia, glucose tablets should be administered (strong recommendation, low-quality evidence). If glucose tablets are not available, dietary sugars can be used (weak recommendation, very-low-quality evidence).