Chest compression alone effective during cardiac arrest, find studies

From MedGuru:

According to the results of twin studies, cardiopulmonary resuscitation (CPR) alone is a successful method of saving heart attack victims.

Researchers from University of Washington (UW) in Seattle, US and Karolinska Institute at Södersjukhuset, Sweden found in dual studies that CPR– rhythmic pressing on patients’ chest to physically pump blood through the heart–is as useful a way of rescuing heart attack patients as combination-CPR (involving chest compression and mouth-to-mouth respiration).

Testing of Low-Risk Patients Presenting to the Emergency Department With Chest Pain

From Circulation:

The management of low-risk patients presenting to emergency departments is a common and challenging clinical problem entailing 8 million emergency department visits annually. Although a majority of these patients do not have a life-threatening condition, the clinician must distinguish between those who require urgent treatment of a serious problem and those with more benign entities who do not require admission. Inadvertent discharge of patients with acute coronary syndrome from the emergency department is associated with increased mortality and liability, whereas inappropriate admission of patients without serious disease is neither indicated nor cost-effective. Clinical judgment and basic clinical tools (history, physical examination, and electrocardiogram) remain primary in meeting this challenge and affording early identification of low-risk patients with chest pain. Additionally, established and newer diagnostic methods have extended clinicians’ diagnostic capacity in this setting. Low-risk patients presenting with chest pain are increasingly managed in chest pain units in which accelerated diagnostic protocols are performed, comprising serial electrocardiograms and cardiac injury markers to exclude acute coronary syndrome. Patients with negative findings usually complete the accelerated diagnostic protocol with a confirmatory test to exclude ischemia. This is typically an exercise treadmill test or a cardiac imaging study if the exercise treadmill test is not applicable. Rest myocardial perfusion imaging has assumed an important role in this setting. Computed tomography coronary angiography has also shown promise in this setting. A negative accelerated diagnostic protocol evaluation allows discharge, whereas patients with positive findings are admitted. This approach has been found to be safe, accurate, and cost-effective in low-risk patients presenting with chest pain

Coma Scales Evaluated

From Neurocritical Care:

Numerous scoring scales have been proposed and validated to evaluate coma for rapid pre-hospital assessment and triage, disease severity, and prognosis for morbidity and mortality. These scoring systems have been predicated on core features that serve as a basis for this review and include ease of use, inter-rater reliability, reproducibility, and predictive value. Here we review the benefits and limitations of the most popular coma scoring systems. The methods include search of Medline, databases, and manual review of article bibliographies. Few of the many available coma scales have gained widespread approval and popularity. The best known and widely accepted scale is the Glasgow Coma Scale (GCS). The Reaction Level Scale (RLS85) has utility and proven benefit, but little acceptance outside of Scandinavia. The newer Full Outline of UnResponsiveness (FOUR) score provides an attractive replacement for all patients with fluctuating levels of consciousness and is gradually gaining wide acceptance.

One family grieves, another rejoices after tragic identity mix-up

From CNN:

The identities of two women involved in a horrific car crash in Arizona last week were mixed up, with one family receiving news that their daughter had died when in fact she was undergoing treatment for her injuries while another family kept watch at her side for six days.

Procedural Sedation in the ED, Part I

From The Central Line:

It seems the government and other specialties are trying hard to make sedation as difficult as possible in the ED.

We must persevere to provide the best procedural sedation for the maximal comfort and safety for our patients. This brief lecture was originally posted on the defunct EMCrit Lecture Site on 8/7/2009.

I’m reposting it here so that I can post part II sometime this week.

This episode, Part I, covers general concepts on sedation as well as ketamine and etomidate/fentanyl.

Alcohol exposure appears to increase mortality after injury

From the European Journal of Trauma and Emergency Surgery:

Objective: To determine the injury patterns, complications, and mortality after alcohol consumption in trauma patients.

Methods: The Trauma Registry at an American College of Surgeons (ACS) level I center was queried for all patients with a toxicology screen admitted between 1st January 2002 and 31st December 2005. Alcohol-positive (AP) patients were matched to control patients who had a completely negative screen (AN) using age, gender, mechanism, Injury Severity Score (ISS), head Abbreviated Injury Scale (AIS), chest AIS, abdominal AIS, and extremity AIS. Injuries and outcomes were compared between the groups.

Results: As many as 5,317 patients had toxicology data, of which 471 (8.9%) had a positive alcohol screen (AP). A total of 386 AP patients were then matched to 386 control (AN) patients. The AP group had a significantly higher mortality than the AN group overall (23 vs. 13%; p < 0.001), and by ISS stratification: ISS < 16 (6 vs. 0.4%; p < 0.001), ISS 16–25 (53 vs. 28%; p = 0.01), and ISS > 25 (90 vs. 67%; p = 0.01). AP patients had a higher incidence of admission systolic blood pressure < 90 (18 vs. 10%; p < 0.001) and Glasgow Coma Scale (GCS) score ≤ 8 (25 vs. 17%; p = 0.002). AN patients had a significantly higher incidence of hemopneumothorax (11 vs. 7%; p = 0.03), while AP patients had a higher incidence of cardiac arrest (8 vs. 3%; p = 0.004). There was no difference in intensive care unit (ICU) and hospital length of stay.

Conclusion: In a mixed population of trauma patients, an AP screen is associated with an increased incidence of admission hypotension and depressed GCS score. In this case-matched study, alcohol exposure appeared to increase mortality after injury.

Medical Device Problems Hurt 70,000+ Kids Annually

From NPR:

More than 70,000 children and teens go to the emergency room each year for injuries and complications from medical devices, and contact lenses are the leading culprit, the first detailed national estimate suggests.

About one-fourth of the problems were things like infections and eye abrasions in contact lens wearers. These are sometimes preventable and can result from wearing contact lenses too long without cleaning them.

Other common problems found by researchers at the U.S. Food and Drug Administration include puncture wounds from hypodermic needles breaking off in the skin while injecting medicine or illegal drugs; infections in young children with ear tubes; and skin tears from pelvic devices used during gynecological exams in teen girls.

IRS Refunds $20M to Resident Physicians and Hospital

From Modern Healthcare:

Nearly 1,000 former medical residents and a Cincinnati hospital will split $20 million in refunds from the Internal Revenue Service.

The IRS says stipends paid to former residents from 1997 to 2005 weren’t subject to Social Security taxes because the residents were students.

An attorney for University Hospital in Cincinnati says the refunds will total $20 million. The former residents will get half.

Students are usually exempt from taxes that fund Social Security and Medicare. The IRS conceded earlier this year that it collected taxes from medical residents and their employers on wages that should have been exempt.

CDC chief pushes for action to fight rising painkiller abuse

From NewsOK:

Emergency room visits linked to abuse of prescription painkillers have jumped 111 percent in five years, straining the nation’s public health system, a recent study revealed.

Urgent action is needed to address this health threat, Dr. Thomas Frieden, director of the national Centers for Disease Control and Prevention, said Thursday.

“Overdose with prescription drugs is one of the most serious and fastest-growing problems in this country,” he said.

Visits to hospital emergency departments for abuse of pain drugs more than doubled between 2004 and 2008, jumping from 144,644 to 305,885 visits annually, according to a study released last month by the CDC and the Substance Abuse and Mental Health Services Administration.

The dramatic rise occurred among both men and women, as well as people younger than 21 and those who are older.

“At the federal level, we need to look at action to target pill mills that distribute large amounts (of such drugs),” Frieden said. “There are law enforcement interventions that are needed there.

“At the state level, states need to look at the prescribing laws and ensure that they’re strong enough.”

Electronic record-keeping systems should be used to identify duplicate prescriptions and stop people from filling the same prescription multiple times, Frieden said.

“Doctors really need to not write prescriptions for more than is needed,” Frieden said.

“We may need to look at things like whether long-acting pain medication should ever be prescribed out of emergency departments.

“Police say patient traveled with stash”

From Online Athens:

An emergency room patient faces a drug charge after he brought a bag of marijuana with him in the ambulance early Saturday morning, according to an Athens-Clarke police report.

The marijuana was in a bag filled with other medications the man brought with him on the ambulance, though the report did not say why he needed medical attention or which hospital he was taken to.