Therapeutic Hypothermia in Burlington, NC

From the Times News:

A new therapy at Alamance Regional Medical Center is helping non-responsive cardiac arrest patients have a better chance of survival.

Doctors and nurses in the Emergency Department and Critical Care Unit have been using therapeutic hypothermia to cool cardiac arrest patients’ bodies to 92 to 94 degrees for 24 hours when treated. ARMC Critical Care Unit Medical Director David Kasa said about eight cardiac arrest patients had received the new therapy since it was first offered at the hospital in April.

“Studies show one out of eight patients survives,” Kasa said.

The lowering of the body temperature increases the chance of survival and decreases the probability of brain damage. During hypothermia therapy, the patient’s body temperature is lowered using cool IV fluids, a special cooling blanket and ice packs placed under the armpits and groin area. The patient is placed on a respirator and given medications to prevent shivering.

ER And Internal Medicine Docs Argue Over Admissions

From the Journal of Medicine:

Dr. Erdoc happened to look up when the internist walked into the emergency department.

“Oh no,” he murmured under his breath. The consulting psychiatrist was sitting next to him, typing a note. She looked at him and raised an eyebrow.

“I hoped it wouldn’t be him. Unlike his colleagues, Dr. Internist seems to have a deep loathing for us emergency docs,” Dr. Erdoc explained as he stood up. Dr. Internist was frowning as he approached.

Why Hospitalists And ED Doctors Don’t Communicate

From the Journal of Medicine:

Researchers who looked at transfers between the ED and the medical service in an urban academic center were surprised to find that problems went far beyond inaccurate or incomplete vital-sign information. Instead, they say it’s more often about system flaws—overcrowding, high workload and lagging technology—that intensify the pressure.

In a recent study 40 respondents described 36 specific incidents of errors in diagnosis, treatment and disposition that caused patients harm or a near miss.

Emergency rooms gearing up for holiday decorators

From KTAR:

Holiday decorators will be out in force and a lot of them will be making an unplanned trip to the emergency room.

A lot of people take to the rooftops of their home to put up holiday decorations or turn into an interior designer for the month and about 10,000 of them will be headed to the hospital after falling off of a ladder or cutting themselves on an ornament.

“It’s common when setting up decorations,” said Dr. Robert Fromm with the Maricopa County Medical Center. “People have problems falling off of ladders, falling off of rooftops as they prepare for the holidays.”

A big factor of many decorators heading to the hospital is drinking while decorating.

“It’s not surprising,” said Fromm. “Alcohol is involved in a lot of injuries, even drownings. But certainly among the holidays, celebrating with alcohol is not uncommon and it certainly can be a contributor to accidents that happen.”

American Beverage Association Refutes Report Linking Energy Drinks to Increased ER Visits

From Food Product Design:

The American Beverage Association (ABA) is calling the recently released report that the number of emergency department visits involving energy drinks increased approximately tenfold between 2005 and 2009 “a troubling example of statistics taken out of context.”

The report was conducted by the Drug Abuse Warning Network (DAWN) at the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) and published in the Nov. 22 “Dawn Report.” According to the report, ER visits involving energy drinks increased from 1,128 visits in 2005 to 16,053 and 13,114 visits in 2008 and 2009, respectively. A total of 52% of energy drink-related emergency department visits made by individuals ages 18 to 25 also involved alcohol or other drugs. Emergency department visits involving energy drinks were classified as adverse reactions in 67% of cases.

According to the ABA statement, “This paper is a troubling example of statistics taken out of context. The number of emergency room visits by people who consumed energy drinks, as reported in the paper, represented less than one one-hundredth of 1% of all emergency visits. In addition, this report shares no information about the overall health of those who allegedly consumed energy drinks, or even what symptoms brought them to the ER in the first place. Furthermore, it shows that nearly half of those who visited the emergency room had consumed alcohol or taken illegal substances or pharmaceuticals, making their consumption of energy drinks potentially irrelevant.

There is nothing unique about the ingredients in energy drinks, including caffeine. In fact, most mainstream energy drinks contain about half the caffeine of a similar size cup of coffeehouse coffee. So if you are enjoying a coffee at the corner coffeehouse, you are getting about twice as much caffeine as you would from an energy drink.”

Teleconsultation in pre-hospital emergency medical services: real-time telemedical support in a prospective controlled simulation study

From Resuscitation:

Background: Teleconsultation from the scene of an emergency to an experienced physician including real-time transmission of monitoring, audio and visual information seems to be feasible.

In preparation for bringing such a system into practice within the research project “Med-on-@ix“, a simulation study has been conducted to investigate whether telemedical assistance (TMA) in Emergency Medical Services (EMS) has an impact on compatibility to guidelines and timing.

Material and Methods: In a controlled simulation study 29 EMS teams (one EMS physician, two paramedics) ran through standardized scenarios (STEMI: ST-elevation myocardial infarction; MT: major trauma) on high-fidelity patient simulators with defined complications (treatable clearly following guidelines). Team assignments were randomized and each team had to complete one scenario with and another without TMA. Analysis was based on videotaped scenarios using pre-defined scoring items and measured time intervals for each scenario.

Conclusions: In simulated setting TMA was able to improve treatment and safety without decline in timing. Nevertheless, further research is necessary to optimize the system for medical, organizational and technical reasons prior to the evaluation of this system in routine EMS.

ED Blood Pressure Management In Acute Stroke Is Terrible

From Emergency Medicine Literature of Note:

This is a non-TPA article regarding the medical management of hypertension in acute ischemic stroke in the Emergency Department.

The authors remind us that for every 10 mmHg drop in SBP <150 mmHg, there is a 17.9% increase in risk for death at 14 days.  They additionally remind us that antihypertensive therapy is only recommended for BP >220/120 mmHg, with a 15-25% goal decrease in the first 24 hours.

This is a retrospective review of cases from 16 Cincinnati region hospitals looking at the blood pressure observed in the ED along with any treatment.  They found 1739 cases, 1520 of whom did not receive treatment and 219 who did.  It turned out that 2.6% of the non-treated patients should have had some blood pressure lowering – oops.  But, amazingly even worse, only 31.5% of patients who did receive treatment actually required lowering.

Of the 217 patients that were treated, 52 of them had greater than a 20% drop in blood pressure in the Emergency Department.  So, we treat a lot of blood pressure that shouldn’t be treated – and when we treat it, it is not uncommon to treat it too aggressively.

The rise of the freestanding emergency room

From the Washington Post:

Over the weekend, I wrote about the rise of retail health clinics, store-based medical facilities that many see as a promising path to delivering health care for less money. At the same time though, there’s a counter-trend getting less attention, that could mean delivering health care for much more money: the rise of the free-standing emergency room.

Freestanding emergency departments started as a way to serve rural areas, bringing some hospital-level services to communities that didn’t have them. But they only started to rise about a decade ago, growing to at least 222 facilities across 16 states, as hospitals build stand-alone emergency rooms that can treat a wide variety of medical conditions.

The Seattle Times’s Carol Ostrom had an important story Sunday that gets at why this could become problematic: Emergency rooms tend to have higher costs than other doctor’s offices, or even urgent care centers. “The ER reimbursement for a sprained ankle might be $700, three or four times that for a visit in a primary-care or urgent-care clinic,” an executive with Regence BlueShield tells her. “For hospitals, he says, ‘it’s a bonanza.’” Seattle, hardly a rural area, currently has three free-standing emergency rooms under construction. One that just opened an hour north of the city has more square footage than an NFL football field.

Hospital to open ‘race car pit’ style emergency department

From Lehigh Valley Live:

Patients will enter the ER through a small lobby where they will meet a registrar and be escorted to a new rapid-assessment hub where a doctor, nurse and others will focus on a patient for diagnosis and triage.

Buckenmyer said studies suggest the typical patient’s wait between entering the facility and speaking to a doctor will drop by 20 to 30 minutes. She added that 20 or 30 minutes doesn’t sound like much, but that front-end uptick in efficiency results in much better overall results for patients.

Hospital Transfers to Cath Lab Rarely Fast Enough

From MedPage Today:

Few heart attack patients get transferred from community hospitals for primary percutaneous coronary intervention (PCI) within the recommended 30-minute window, researchers found in a national study.

Only 9.7% of ST-segment elevation myocardial infarction (STEMI) patients transferred for PCI got in and out of the initial hospital within 30 minutes, Harlan M. Krumholz, MD, of Yale University, and colleagues reported in the Nov. 28 issue of the Archives of Internal Medicine.

The door-in to door-out time was at least an hour for most patients and exceeded 90 minutes for 31% in the analysis of hospital performance monitoring data from the Centers for Medicare and Medicaid Services (CMS).