"How to Survive Your Local ER"

From Parade magazine

How often do things go wrong? No one knows for certain: Because so many mistakes are minor and so few have clear causes, accurate statistics are difficult to maintain. According to one 1999 study, though, more than half of all preventable hospital-error claims result from mistakes made in the ER.

The main culprit isn’t incompetence but chaos: The nation’s emergency rooms are overburdened and underfunded, treating ever more patients with ever fewer resources. “You don’t want to scare the public, because hundreds of thousands of patients get cared for very well in emergency rooms every day,” says Gail Warden, president emeritus of Michigan’s Henry Ford Health System, who chaired a trio of studies of emergency care released in June by the National Academies’ Institute of Medicine. “But the system is stretched, and it could be at a breaking point in three to five years.”

AED’s in Texas Schools

From GruntDoc

DALLAS (AP) A group headed by the Dallas Mavericks team physician said Wednesday it plans to raise $1 million for at least one automated external defibrillator in every Texas public high school after a recent mandate requiring the device.

The donations would help solve how some cash-strapped school districts will afford the life-saving heart stimulator, also known as AED, which costs about $1,200.

The University Interscholastic League voted last week to require that all 1,300 public high schools have at least one AED on campus but did not address how schools would pay for them.

The Texas Sports Medicine Foundation has already raised about half its goal and will give priority to rural school districts with smaller budgets, said Dr. T.O. Souryal, the group’s founder.

New Spin on "Patient Dumping" (Alleged)

From CNN.com

LOS ANGELES, California (AP) — Authorities have launched a criminal investigation into suspected dumping of homeless people on Skid Row after police witnessed ambulances leaving five people on a street there during the weekend.

The city attorney’s office is reviewing police videotapes and photographs of the five suspected dumping cases to determine whether the patients were falsely imprisoned during their transfer and whether the hospital, Los Angeles Metropolitan Medical Center, violated any laws regarding the treatment of patients.

Electronically Guided Resuscitation Device

From Medgadget:

In a report by Human Factors and Ergonomics Society, a new prototype medical device, being created by the University of Utah researchers, could make it possible for anyone to perform life-saving actions for sudden cardiac arrest victims:

The just-in-time support, or JITS, device provides bystanders with guidance and information on how to administer CPR and assess the state and needs of the victim. The researchers will present their work at the HFES 50th Annual Meeting at the Hilton San Francisco Hotel on Wednesday, October 18. The meeting dates are October 16-20, 2006.
About 300,000 people a year suffer sudden cardiac arrest in the United States. Sometimes the victim’s life hinges on the help of bystanders, given that response time by paramedics following a 911 call is usually more than 6 minutes and that the probability of survival decreases 7-10% each minute after the incident. Studies show that less than 1% of bystanders have had CPR training, and of those, fewer than 10% retained the knowledge only a few months after training.

The JITS device prototype used in the study consisted of a dummy “victim,” a pressure-sensing headrest, an anesthesia mask, defibrillator pads, and a video screen and speakers that transmit audio and visual cues to tell the user what to do and give him or her feedback about actions taken. The cues were based on American Heart Association protocols.

Half the 40 participants used the JITS device and half did not. Those using the device not only surpassed the no-device group in every measure but performed to the level of the AHA guidelines.

If JITS devices were used, the number of people able to provide life-saving treatment would vastly increase and survival chances for sudden cardiac arrest victims could be significantly improved.

Human Factors and Ergonomics web site


From Medgadget:

DentaSafe™ is a disposable foam strip designed to prevent anesthesiologists, EMTs and ER personnel from eviscerating patients’ teeth. Your correspondent, an anesthesiologist himself, humbly recalls a recent fishing expedition to extract two fallen teeth from around a patient’s uvula.

From the product page:

This medical-grade, elastic, hypoallergenic, and latex free foam strip is designed to stretch and conform while providing the flexibility to maneuver intubations with ease, even for the most difficult intubations.
It prevents costly damage to the upper incisors, which are the most frequently affected teeth during intubation.

Single use, disposable foam strip attaches to the flange of the laryngoscope blade and prevents direct contact between the metallic blade and the patient’s upper teeth…

Simply peel the self-adhering DentaSafe™ strip using the grip tab and apply it to the flange of the laryngoscope blade. Press the strip against the blade.

GlideScope® Ranger, a portable video laryngoscope

Another Medgadget tip, this one about a video laryngoscope, designed for the military:

The GlideScope® Ranger provides a clear picture of the larynx and vocal cords on a display monitor, enabling visual control of the endotracheal tube in its trajectory toward the airway. With its patented 50 to 60 degree viewing range, integrated camera, and patented anti-fogging mechanism, the Ranger facilitates fast, accurate ETT placement even in difficult airways, and helps prevent improper ETT placement and related complications in emergency, out-of-hospital situations. The GlideScope® Ranger is compact for easy carrying and storage, measuring only 7 1/4 x 6 3/8 inches and weighing less than two pounds, and is operational in seconds. With its rugged, high-impact plastic construction, the Ranger was designed to be dependable in an array of field conditions, including temperatures of -4 degrees to +122 degrees F, humidity up to 100 percent, and altitude up to 20,000 feet. The integrated, rechargeable lithium polymer battery provides a minimum 90-minute continuous- use autonomy and allows for approximately 20 intubations per battery cycle (depending on usage).

MIT material stops bleeding in seconds

Tip of the cap to Medgadget, here’s an article from MIT

MIT and Hong Kong University researchers have shown that some simple biodegradable liquids can stop bleeding in wounded rodents within seconds, a development that could significantly impact medicine.

When the liquid, composed of protein fragments called peptides, is applied to open wounds, the peptides self-assemble into a nanoscale protective barrier gel that seals the wound and halts bleeding. Once the injury heals, the nontoxic gel is broken down into molecules that cells can use as building blocks for tissue repair.

“We have found a way to stop bleeding, in less than 15 seconds, that could revolutionize bleeding control,” said Rutledge Ellis-Behnke, research scientist in the MIT Department of Brain and Cognitive Sciences.

More on the Florida Med Mal Case

From InsuranceJournal.com

Fla. Jury Awards $217M to Misdiagnosed Stroke Patient

A Florida jury increased to nearly $217 million the damages awarded to a Tampa man who was left brain-damaged and disabled after hospital emergency room doctors misdiagnosed stroke symptoms.

The Hillsborough County jury added $100.1 million in punitive damages for Allan Navarro and his family after returning a verdict of nearly $116.7 million for compensatory damages a few days earlier, following testimony in a three-week civil trial.

Family attorney Steve Yerrid said he’ll pursue damages from the insurance company, which is now claiming in a lawsuit that it has no duty to defend Austin because the doctor breached his contract.

“We’re coming after them next,” vowed Yerrid, who was part of a team of lawyers that brought Florida’s landmark suit against tobacco companies and has won numerous other multimillion dollar verdicts.

“For all those people who believe in tort reform, they better find a new day job,” Yerrid said. “We’re here to stay.”

Medical Malpractice Case in Florida

From Law.com

Even before a jury had completed its deliberations, two Tampa, Fla.-area medical practices filed for bankruptcy after they were hit with a $116.7 million malpractice verdict in favor of a quadriplegic who blamed them for his condition.

The Chapter 7 bankruptcy filings — designed to avoid paying what attorneys called the largest medical malpractice award in state history — temporarily halted the trial. But U.S. Bankruptcy Judge Paul Glenn took the unusual action of setting aside the defendants’ petitions so the Hillsborough, Fla., circuit court jury could finish its work.

After the jurors reconvened Tuesday afternoon, they deliberated for three hours and returned a $100.1 million punitive damages verdict.

On Sept. 29, the Tampa jury reached a compensatory verdict that awarded 50-year-old Tampa resident Allan Navarro a total of $15.6 million for past and future medical bills, $616,000 for lost wages in the past and future, and $46.5 million for past and future pain and suffering. His wife was awarded $52.5 million for loss of her husband’s services, comfort, society and attentions. Navarro’s son, Scottie, was awarded $1.5 million for loss of his father’s services, comfort, companionship and society.

Navarro was paralyzed after physician’s assistant Mark Herranz, who attorneys said failed his state licensing test four times, and Dr. Michael Austin failed to realize he was experiencing a stroke when they treated him at Tampa’s University Community Hospital-Carrollwood in 2000. Navarro was diagnosed with sinusitis and sent home.

On Aug. 9, 2000, Navarro, who was a professional basketball player in his native Philippines, entered University Community Hospital-Carrollwood with a headache, nausea, dizziness, confusion and double vision. He described a personal medical history of hypertension, diabetes and elevated cholesterol plus a family history of strokes to the triage nurse. A different nurse than the triage nurse also noted he was unsteady on his feet.

When Navarro spoke with Herranz in the examination room, he mentioned the sudden onset of a headache earlier that day and that he had felt a “pop” in his head.

According to the 2005 second amended complaint, Herranz did not complete an adequate medical history of Narvarro, nor did he do a complete or adequate neurological exam.

Navarro spent about 5 1/2 hours at UCH-Carrollwood, during which time he had two CT scans of his brain and was diagnosed with “sinusitis/headache” by Austin, prescribed Vicodin for the pain and an antibiotic by the doctor and sent home. He was not told to watch for any stroke symptoms.

The suit alleged that Navarro presented classic stroke symptoms that Austin should have noticed. It further said that CT scans are not adequate diagnostic tools for ruling out the type of stroke Navarro had.

Early the next morning, Navarro woke with a severe headache, slurred speech, nausea, confusion and trouble walking. He was readmitted to the UCH-Carrollwood Emergency Room at 6:05 a.m. Upon his return, he was labeled “urgent,” but doctors still had not diagnosed a stroke. It wasn’t until he was transferred to Carrollwood’s sister hospital, UCH-Fletcher, that afternoon that surgery was finally performed. By then, the stroke had already left him paralyzed with mental disabilities. During surgery, he slipped into a four-month coma. He is now confined to a wheelchair.

So this dog walks into the Emergency Department…

Not a joke, a story:

Buddy the dog limped into emergency at Kaiser Permanente Hospital in Bellflower on Wednesday and sat in the waiting area at about 1 p.m., officials said.

“We were on a routine assignment, and we got a Code 2 that a dog had wandered into the hospital,” said Wendy Alexander of the animal control unit. “When we walked in, he was laying on his bad hip. At that time, we didn’t know that there was an injury. He was shaking. I thought, he knew he needed help, and he knew where to get it.”

Hospital officials called the Southeast Area Animal Control Authority in Downey, and agency officials picked up Buddy and brought him to the shelter for treatment of a fracture.

“We don’t know where he got hit by a car, but we’re happy he chose the right place to get help,” Capt. Aaron Reyes, SEAACA’s director of operations, told the Whittier Daily News.

Through an identifying microchip implanted in Buddy’s skin, SEAACA officials were able to locate his owner, who adopted him from the animal shelter about five years ago. Fabian Ortega, Buddy’s owner, owns a construction equipment rental business about a block from the hospital.

“We didn’t teach him that,” said Ortega. “I don’t know how he figured that one out.”

Ortega said he had been searching the area for his dog since he ran away about two weeks ago from the yard of the business while the fence was repaired.