"CardioCerebral Resuscitation"

From MedPage Today:

When performed by EMS personnel, a new approach to cardiopulmonary resuscitation (CPR) substantially improves the survival rate for most patients with out-of-hospital cardiac arrest, according to researchers.

The new approach, dubbed cardiocerebral resuscitation (CCR), emphasizes fast, forceful chest compressions to get blood moving through the body over airway management, said Michael J. Kellum, M.D., of the University of Arizona College of Medicine here.

Compared with standard CPR, the new approach nearly tripled survival rates during a one-year study, Dr. Kellum and colleagues reported online in the American Journal of Medicine.

The Wisconsin Emergency Medical Services Bureau teamed with the University of Arizona researchers to test the new protocol in two Wisconsin counties during 2004 and 2005.

During the previous three-year control period, when standard CPR was used, there were 92 adult patients with witnessed cardiac arrests and an initially “shockable” rhythm. Eighteen of these patients (20%) survived, and 14 (15%) survived neurologically intact.

After the CCR protocol was initiated, there were 33 such patients. Nineteen (57%) survived, and 16 (48%) survived neurologically intact. The differences in both total survival and neurologically normal survival were statistically significant (P=0.001).

With CCR, first responders skip the first steps of the standard protocol: intubating the patient for ventilation and delivering a shock using a defibrillator. While still attaching the victim to a defibrillator, they do not wait for the device to analyze the patient’s heart rhythm, but start fast, forceful chest compressions.

"ERs Physicians Give Short Shrift to Out-of-Control Pain"

From MedPage Today:

Patients who go to emergency rooms for out-of-control pain perceive that the treatment they are offered lacks dignity, satisfaction, and effectiveness.

That became evident on the basis of a series of studied reported at the American Pain Society meeting here. The papers described the frustration and dissatisfaction and patients. Instead of obtaining relief, they are rebuffed, disbelieved, or made to wait hours to see a doctor and are sometimes sent away without treatment.

“Much remains to be done in this area,” said Knox Todd, M.D., director of the Pain and Emergency Medicine Institute at Beth Israel Medical Center in New York.

He found in a study that included 842 patients arriving at ERs in hospitals across the United States and Canada that:

Patients with pain often have pain score in the moderate to intense levels when presenting to the emergency department—yet it is uncommon that the clinical staff will reassess those pain levels during the hospital stay.

Of the 842 patients, medical records note a pain assessment in 83% of cases—but a second pain assessment occurred in only 31% of cases and just 14% had three assessments.

Analgesics are underutilized. Only 61% of the patients who were surveyed by emergency room personnel—doctors or nurses who contacted the patients to record their experiences—were given analgesics.

Delays to treatment are common. The mean ER wait was 90 minutes.