Archive for the 'Emergency Medicine' category

Why patients linger……..

http://www.nytimes.com/2012/01/03/nyregion/nowhere-to-go-patients-linger-in-hospitals-at-a-high-cost.html?_r=1&nl=nyregion&emc=ura1

NYT

January 2, 2012
 
Nowhere to Go, Patients Linger in Hospitals, at a High Cost
By

“Hundreds of patients have been languishing for months or even years in New York City hospitals, despite being well enough to be sent home or to nursing centers for less-expensive care, because they are illegal immigrants or lack sufficient insurance or appropriate housing.

As a result, hospitals are absorbing the bill for millions of dollars in unreimbursed expenses annually while the patients, trapped in bureaucratic limbo, are sometimes deprived of services that could be provided elsewhere at a small fraction of the cost…..”

To steal an ambulance …..

http://www.ems1.com/ems-news/1211731-man-steals-ambulance-to-drive-himself-to-fla-hospital/

EMS1

13News, 1/1/12

TAMPA, Fla. — “The suspect who allegedly stole an ambulance in Tampa on Thursday night told officers he had been attacked and was driving himself to the hospital…..”

Herpes vaccine research

Primary source: New England Journal of Medicine
Source reference:
Belshe RB, et al “Efficacy results of a trial of a herpes simplex vaccine” N Engl J Med 2012; 366: 34-43.

In a study population that was representative of the general population of HSV-1– and HSV-2–seronegative women, the investigational vaccine was effective in preventing HSV-1 genital disease and infection but not in preventing HSV-2 disease or infection.

Infrascanner Model 1000

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm283520.htm

FDA NEWS RELEASE
For Immediate Release: Dec. 13, 2011
Media Inquiries: Erica Jefferson, 301-796-4988, erica.jefferson@fda.hhs.gov �
Consumer Inquiries: 888-INFO-FDA
FDA permits marketing of the first hand-held device to aid in the detection of bleeding in the skull
Helps to determine if immediate CT scan is needed

The U.S. Food and Drug Administration today allowed marketing of the first hand-held device intended to aid in the detection of life-threatening bleeding in the skull called intracranial hematomas, using near-infrared spectroscopy.

The device, called the Infrascanner Model 1000, can help health care providers identify patients with critical head injuries who need an immediate brain imaging study.

Intracranial hematomas occur when blood from a ruptured blood vessel collects within the brain or between the skull and the brain. As blood expands within the brain or in the narrow space between the brain and the skull, the brain becomes compressed. This can produce symptoms such as headaches, vomiting, dizziness, lethargy, weakness in the arm or leg on one side of the body, seizures, or unconsciousness. An intracranial hematoma can be life-threatening if it is not treated immediately.

According to the Centers for Disease Control and Prevention, each year about 1.7 million people in the United States experience a traumatic brain injury.

The Infrascanner, Model 1000, uses a scanner that directs near-infrared light, a wavelength of light that can penetrate tissue and bone, into the skull. Blood from intracranial hematomas absorbs the light differently than other areas of the brain. The scanner detects differences in light absorption (optical density) and transmits the information wirelessly to a display on a hand-held computer.

By comparing the optical density from a series of scans of specific areas on both sides of the skull, a trained health care provider can use the information provided by the device, in conjunction with other clinical information, to determine the likelihood of an intracranial hematoma and the need for further diagnostic procedures, such as a computed tomography (CT) scan.

“While patients with suspected brain injuries routinely receive a CT scan, this portable device offers emergency room physicians a non-invasive mechanism to aid in assessing whether an immediate CT scan is needed,” said Christy Foreman, director of the Office of Device Evaluation at FDA’s Center for Devices and Radiological Health.

The FDA reviewed data for the Infrascanner Model 1000 through the “de novo” classification process, a regulatory pathway for some low to moderate risk medical devices that are not comparable to a legally marketed device.

The FDA granted the de novo petition for the Infrascanner Model 1000 based on a review of data comparing results from 383 CT scans of adult subjects with Infrascanner scan results. The Infrascanner was able to detect nearly 75 percent of the hematomas detected by CT scan. When CT scans detected no hematoma, the Infrascanner detected no hematoma 82 percent of the time. The Infrascanner Model 1000, however, is not a substitute for a CT scan.

The FDA is specifying special controls in an accompanying regulation classifying the Infrascanner Model 1000 as a Class II device with special controls. The special controls provide information about specific risks that must be addressed by other manufacturers who may wish to market a similar device.

The Infrascanner Model 1000 is manufactured by InfraScan Inc. of Philadelphia.

For more information:

FDA: Medical Devices1
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Simultaneous T-Wave Inversions in Anterior and Inferior Leads

Simultaneous T-Wave Inversions in Anterior and Inferior Leads: An Uncommon Sign
of Pulmonary Embolism
Published online: 06 December 2011
Michael D. Witting, Amal Mattu, Robert Rogers, Christian Halvorson
DOI: 10.1016/j.jemermed.2011.07.026
Journal of Emergency Medicine, The, http://www.jem-journal.com/article/S0736-4679%2811%2900903-6/abstract

Simultaneous T-wave inversions in anterior and inferior leads were associated with PE but are seen in only 4–11% of cases.

Massive PE looking like an MI

Massive Pulmonary Embolism with Acute Coronary Syndrome-like Electrocardiogram
Mimicking Acute Left Main Coronary Artery Obstruction
Published online: 06 December 2011
Paolo Ciliberti, Claudio Rapezzi, Caterina Villani, Giuseppe Boriani
DOI: 10.1016/j.jemermed.2011.03.037
Journal of Emergency Medicine, The,

 http://www.jem-journal.com/article/S0736-4679%2811%2900891-2/abstract

H1N1 & Pneumococcal Pneumonia

Weinberger DM, Simonsen L, Jordan R, et al. Impact of the 2009 influenza pandemic on pneumococcal pneumonia hospitalizations in the United States. J Infect Dis 2011 Dec 7

http://jid.oxfordjournals.org/content/early/2011/12/07/infdis.jir749.abstract

The 2009 influenza pandemic had a significant impact on the rate of pneumococcal pneumonia hospitalizations, with the magnitude of this effect varying between age groups and states, mirroring observed variations in influenza activity.

Transcranial magnetic stimulation

http://www.medicalnewstoday.com/articles/239274.php

MNT

Magnetic Stimulation Of Brain For Stroke Recovery

“…..The study, published in Neurology……explains the use of transcranial magnetic stimulation, a treatment that involves placing large electromagnetic coils against the scalp. It creates electrical currents that stimulate nerve cells….The research so far has only involved 20 people, with…..hemispatial neglect…….
10 patients were treated for two weeks, while the other 10 received a placebo treatment. Tests on those who did not receive the real treatment showed little improvement, while those who underwent the real magnetic stimulation had a 16% improvement at the end of the two weeks and a 22% improvement two weeks later……”

14 California Hospitals Fined $850,000

http://www.healthleadersmedia.com/page-1/QUA-274180/Immediate-Jeopardy-14-CA-Hospitals-Fined-850000##

Immediate Jeopardy: 14 CA Hospitals Fined $850,000

Cheryl Clark, for HealthLeaders Media, December 12, 2011

Another 14 California hospitals have been ordered to pay fines totaling $850,000 in the latest round of medical errors involving immediate jeopardy to patients………

These incidents include seven retained foreign objects, including a 2.5 cm temporary pin used in a woman’s spine surgery……..

Other incidents that placed patients in immediate jeopardy of harm or death included a “Code Pink,” in which a newborn was abducted from a labor and delivery unit despite the use of a bracelet designed to signal an alarm if an infant is taken from the area; a morphine overdose which resulted in a patient’s death; and the administration of “compromised” medications and vaccines, which were incorrectly refrigerated to freezing temperatures, to an estimated 5,000 patients……”

Colorectal Cancer & Younger Adults

http://www.medpagetoday.com/Gastroenterology/ColonCancer/30182?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g380841d0r&userid=380841&email=ndmsmd@aol.com&mu_id=

By Shalmali Pal, Contributing Editor, MedPage Today
Published: December 12, 2011

“The incidence of colorectal cancer (CRC) among adults younger than 50 has increased by 2.1% in the past decade, according to results from a study of the National Cancer Database.

“The median age for young-onset CRCs was 44 years, with most (75.2%) occurring between ages 40 and 49 years…..”

IV Access & ERs

IV Access Difficulty: Incidence and Delays in an Urban Emergency Department
Published online: 05 December 2011
Michael D. Witting
DOI: 10.1016/j.jemermed.2011.07.030
Journal of Emergency Medicine, The, http://www.jem-journal.com/article/S0736-4679%2811%2900907-3/abstract

In an urban, tertiary care ED, mild and moderate IVAD (Intravenous access difficulty) was common and led to mild delays, but severe IVAD, requiring a physician, caused substantial delays.

Cerebrospinal Fluid Interleukin-6 Levels: Important?

Acute Meningitis Prognosis Using Cerebrospinal Fluid Interleukin-6 Levels
Published online: 06 December 2011
Vázquez Jorge Alejandro, Adducci Maria del Carmen, Coll Carlos, Godoy Monzón
Daniel, Kenneth V. Iserson
DOI: 10.1016/j.jemermed.2011.07.029
Journal of Emergency Medicine

http://www.jem-journal.com/article/S0736-4679%2811%2900906-1/abstract

In patients with acute bacterial meningitis, CSF cytokine concentrations are elevated. Measuring CSF inflammatory cytokine levels in patients with acute meningitis could be a valuable ED diagnostic tool. Using this tool could improve the prognosis of patients with bacterial meningitis by allowing more rapid initiation of antibiotic treatment.

Urgent care centers still thriving

http://yourlife.usatoday.com/health/healthcare/story/2011-12-07/Crowded-ERs-help-urgent-care-centers-thrive/51721010/1

Crowded ERs help urgent care centers thrive

By Phil Galewitz, Kaiser Health News

“….Across the U.S., an estimated 3 million patients visit these centers each week, according to the Urgent Care Association of America, a trade group based in Chicago. To meet demand, the number of facilities has increased from 8,000 in 2008 to more than 9,200 this year, the association said. About 600 urgent centers opened this year……Urgent care centers’ fees are at least half those charged at a hospital emergency department for the same condition, although they are similar to what physicians charge for office visits……

About half of the facilities are owned by doctors, according to the urgent care association and 28% are hospital-owned, the American Hospital Association reports…….”

More on pharmacists in the ER

http://www.medpagetoday.com/MeetingCoverage/ASHP/30046

ASHP: Pharm Residency Improves Care, Cuts Costs

Weant K, Baker S “Effect of residency training on clinical activities in an emergency department” ASHP 2011; Abstract 3-094.

By Nancy Walsh, Staff Writer, MedPage Today
Published: December 07, 2011

At the 2011 American Society of Health-System Pharmacists (ASHP):

“…..The society recommended in 2008 that pharmacy services should be available to all emergency departments, and the Institute of Medicine and the Joint Commission also have weighed in on the importance of having clinical pharmacists integrated into ED care…….”

“…….[There was] a retrospective analysis of clinical pharmacists’ activities among patients admitted to the University of Kentucky Chandler Medical Center from October 2008 to October 2010.

The hospital is a level 1 trauma center with a 65-bed emergency department that treats some 65,000 patients each year.

Two pharmacists are assigned to the department and provide coverage 12 hours per day every day of the week.

There were 5,986 clinical consultations during the study period, with the most common being for information on drug dosing (48%) and recommendations on therapeutic regimens (18%).

Each year, pharmacists with no residency training had a mean of 2,372 consultations, while residents overall had a mean of 3,029.

First-year residents had 2,664 consultations, while those in their second year had 3,467.

The average cost savings each day were:

  • No residency training, $2,642
  • Any residency program, $6,960
  • First-year residents, $3,271
  • Second-year residents, $9,058

 

And the mean cost savings per year were:

  • No residency training, $964,585
  • Any residency program $2,540,400
  • First-year residents, $1,193,915
  • Second-year residents, $3,306,280

 

Specific cost savings averaged $1,647 for each consultation that identified a potential drug interaction or incompatibility…….

For each consultation that prevented an adverse drug event, the cost saving was $1,098, while the cost avoidance whenever a medication error was prevented averaged $1,375.

“These data show support the concept that residency training can result in better patient care, provides a high-quality learning environment for pharmacists, and can be cost-effective for institutions…..”

An ER fighting bioterrorism & pandemic

http://www.chicagotribune.com/health/ct-x-1130-rush-tour-20111130,0,6874154.story

Chicago Tribune

New Rush hospital designed to treat infectious threats

Tower has features to address bioterrorism, deadly pandemic

By Bonnie Miller Rubin, Chicago Tribune reporter

November 30, 2011

“‘……The ambulance bays can convert into a large decontamination room. A surveillance system can track disease as it spreads across the city. Pillars in the gleaming new lobby look plain enough, but they’re equipped with hidden panels for easy access to oxygen and other gases.

Before patients can be moved there in January, hundreds of staff must be trained on all-new equipment — from a state-of-the-art patient lift to a trash chute that travels at 60 mph…..Still, it was the new ability to potentially handle a pandemic that was the most compelling aspect of the tour — and something that couldn’t have been envisioned when parts of Rush’s old ER were built more than a century ago………Three components make Rush’s ER one of the best-prepared in the nation to handle the next major infectious challenge:

• The scope and flexibility of its infrastructure, including 60 treatment bays that can be doubled to treat above and beyond the normal patient load and include public areas like the main lobby, which — thanks to those hidden panels — can accommodate even more beds.

• The ability to decontaminate large numbers of patients.

• The capability to isolate an entire quadrant, switching the airflow and pulling any killer viruses outside, high above street level, where they can’t be inhaled by humans……”