Discussion: This review found evidence that use of a bronchodilator in asthmatics with acute difficulty breathing is effective for reducing wheezing, dyspnea, and respiratory rate while improving measures of effectiveness with few reported side effects.

Recommendation: When an individual with asthma is experiencing difficulty breathing, trained first-aid providers should assist the individual with administration of a bronchodilator.

Note from Dr. Stopyra: Inhaled bronchodilators are beneficial to patients and have very low risk of complication. If they are available outside of the hospital, they should be used.

CONCUSSION (FA799)
Recommendation Author: Heather Rybasack-Smith, MD
Dr. Rybasack-Smith is a member of the emergency medicine residency training class of 2017 the Warren Alpert Medical School of Brown University.

Question: Among adults and children with concussion defined as suspected head injury (P), does use of a scoring system (I) compared to standard first-aid assessment (C) change outcomes (O)?

Results: One retrospective observational study was identified that addressed the PICO and was deemed appropriate for first-aid providers. The study rescored prehospital Glasgow coma score (GCS) from trauma registry data with a simple motor score. Scores were compared to four outcomes. This study was deemed low-quality evidence.

Outcomes: For differentiation between minor and severe concussion and need for advanced care, no significant difference was observed between the motor score versus the GCS. For change in time to recognize clinical deterioration, time to transport, risk of poor neurologic outcome, and 30-day survival, no evidence was identified.

Discussion: Recognition of concussion by first-aid providers is difficult. Signs and symptoms of concussion are complex and may be subtle and progressive. Failure to recognize a concussion and refer for further evaluation, or failure to remove from sports activities, can result in significant morbidity and mortality. The use of a simple validated tool to identify concussions is valuable but would need robust evidence to support its use by first-aid providers. The task force identified several tools that used before-and-after assessments, but these were felt to be impractical for standard first-aid use. The task force found no evidence to support or refute the use of any simplified tool to identify significant concussion.

Recommendation: No recommendation.

Note from Dr. Smith: Individuals with head injury and any evidence of alteration of consciousness require evaluation by advanced health care providers or evaluation in an emergency department.

DENTAL AVULSION (FA 794)
Recommendation Author: Andrew Escamilla, MD
Dr. Escamilla is a member of the emergency medicine residency training class of 2017 at the Mayo Clinic School of Graduate Medical Education/Mayo Clinic.