Joplin: 45 Seconds: Memoirs of an ER Doctor from May 22, 2011

From The Central Line:

Then it was over. Just 45 seconds. 45 long seconds. We looked at each other, terrified, and thanked God that we were alive.  We didn’t know, but hoped that it was safe enough to go back out to the ED, find the rest of the staff and patients, and assess our losses.

“Like a bomb went off” — That’s the only way that I can describe what we saw next.

Endotracheal Intubation Tips

From JEMS:

Achieve 20/20 Glottic Visualization with These Tips

A review of clinical literature yields the following four steps, which have proved to consistently improve clinicians’ ability to visualize the glottis:

1. Place the patient level with the paramedic’s mid abdomen or lower chest;
2. Use a straight laryngoscope blade;
3. Anticipate difficult intubations; and
4. Respond to the predicted difficult intubation with use of the sniffing position, head and neck extension beyond the sniffing position, and the BURP maneuver.

“Free-standing emergency departments originally emerged to serve people in rural areas where access to emergency care was scarce.”

Huh?

From the Washington Post:

One increasingly popular option to improve access to services is the free-standing emergency department, a facility that, as its name suggests, isn’t physically located within a hospital.

Free-standing emergency departments originally emerged to serve people in rural areas where access to emergency care was scarce. But in recent years, free-standing EDs have often been cropping up in fast-growing suburban areas where the need isn’t always as clear. Sometimes, experts say, it’s as an effort by health systems to muscle in on a competing hospital’s ED and siphon off some of its patients.

Vasopression Shortage

From Medical Mews Today:

The University of Utah’s Drug Information Service informs that during the first quarter of this year there have been 89 drug shortages. Just on the 25th and 26th of May, 2011, the American Society of Health-System Pharmacists reported new shortages of the following medications – Ciprofloxacin Immediate-Release tablets, Magnesium sulfate injection, Paclitaxel injection, Aminocrapoix acid injection, Prochlorperazineedisylate injection, Triamterene and Hydrochlorothiazide capsules and tablets, and Vasopressin injection.

and

From the American Society of Health-System Pharmacists:

Reason for the Shortage

•   APP and JHP could not provide a reason for the shortage.
• American Regent has temporarily suspended manufacture of most drug products including vasopressin injection.
• American Regent has resumed shipping multiple products including vasopressin. These products were manufactured prior to the temporary manufacturing suspension in Shirley, New York, which is still in effect and the company cannot estimate when further manufacturing will resume.

Estimated Resupply Dates

• American Regent has available vasopressin 20 units/mL injection 1 mL multi-dose vials (NDC 00517-1020-25) and 10 mL multi-dose vials (NDC 00517-0410-10). The 0.5 mL multi-dose vials are on back order and the company cannot estimate a release date.
• APP has vasopressin 20 units/mL injection on back order and the company cannot estimate a release date.
• JHP has Pitressin on allocation.