AED’s in Schools

From the Dr. Wes blog

Just in time for the back-to-school season comes this report on the epidemiology of cardiac arrest in our schools.

The report adds much to our knowledge of the epidemiology of sudden death in schools from two large counties near Seattle, WA, USA. Of 3773 episodes of cardiac arrest in a public domain over 16 years, 97 arrests occurred in 671 schools but only 12 of these occurred in children.

The incidence of sudden death among (adult) school staff was 25-fold greater than that among students. Given the additional contribution of other adults not employed by the school, greater than 90% of cardiac arrests in schools occurred among adults. The finding supports the assertion that school-based CPR and AED programs would benefit faculty and staff members, as well as visitors to the school who, because of their age, are at greater risk of cardiac arrest than the students.

These data, in my view, make a compelling case for the wide availability of public access defibrillation. It is survival to discharge from a hospital that matters, and there is nothing that will improve survival in that setting better than a beating heart. The chest thumping of CPR, while helpful temporarily, only mildly improves the chance of survival following cardiac arrest until the coordinated contraction of the heart can be restored with defibrillation.

47 Million Uninsured

In a front-page article, the New York Times reports, “The nation’s median household income grew modestly in 2006, the Census Bureau reported yesterday, even as the percentage of people without health insurance hit a high.” Officials from the Census Bureau “attributed the rise in the uninsured — to 47 million from 44.8 million in 2005 — mostly to people losing employer-provided or privately purchased health insurance. The percentage of people who received health benefits through an employer declined to 59.7 percent in 2006, from 60.2 percent in 2005.” In addition, “The percentage of people with government-provided health insurance…dropped, to 27 percent from 27.3 percent.” The Times continues, “And the new data on the rise in the number of those uninsured prompted advocates for the poor to step up their call for Congress to reauthorize the State Children’s Health Insurance Program (SCHIP), which provides subsidized insurance to children of the working poor.”

The relationship between distance to hospital and patient mortality in emergencies: an observational study

From the Emergency Medicine Journal

ABSTRACT
Objectives: Reconfiguration of emergency services could lead to patients with life-threatening conditions travelling longer distances to hospital. Concerns have been raised that this could increase the risk of death. We aimed to determine whether distance to hospital was associated with mortality in patients with life-threatening emergencies.

Methods: We undertook an observational cohort study of 10 315 cases transported with a potentially life-threatening condition (excluding cardiac arrests) by four English ambulance services to associated acute hospitals, to determine whether distance to hospital was associated with mortality, after adjustment for age, sex, clinical category and illness severity.

Results: Straight-line ambulance journey distances ranged from 0 to 58 km with a median of 5 km, and 644 patients died (6.2%). Increased distance was associated with increased risk of death (odds ratio 1.02 per kilometre; 95% CI 1.01 to 1.03; p<0.001). This association was not changed by adjustment for confounding by age, sex, clinical category or illness severity. Patients with respiratory emergencies showed the greatest association between distance and mortality.

Conclusion: Increased journey distance to hospital appears to be associated with increased risk of mortality. Our data suggest that a 10-km increase in straight-line distance is associated with around a 1% absolute increase in mortality.

Capnometry in the prehospital setting: are we using its potential?

From the Emergency Medicine Journal:

Capnometry is a non-invasive monitoring technique which allows fast and reliable insight into ventilation, circulation, and metabolism. In the prehospital setting it is mainly used to confirm correct tracheal tube placement. In addition it is a useful indicator of efficient ongoing cardiopulmonary resuscitation due to its correlation with cardiac output, and successful resuscitation. It helps to confirm the diagnosis of pulmonary thromboembolism and to sustain adequate ventilation in mechanically ventilated patients. In patients with haemorrhage, capnometry provides improved continuous haemodynamic monitoring, insight into adequacy of tissue perfusion, optimisation within current hypotensive fluid resuscitation strategy, and prevention of shock progression through controlled fluid administration.

Medical Statistics Made Simple

From Medical Economics

Medical Studies: What You Need to Know

Americans are bombarded with news of medical breakthroughs every day. How can you judge which deserve your attention? The most meaningful studies are well-designed, include hundreds of patients similar to you (in age, sex, race, and stage of disease), and have clear, dramatic results.

Consider these results with your doctor, along with your own values and concerns. Tell your physician why you want a specific test or treatment, and share what you consider important in your healthcare, whether it’s quality of life, costs, or risks vs benefits.

Fast Relief, and Simple

From Surgeon’s Blog:

…the subject was a simple procedure bringing rapid and dramatic relief, commenters have mentioned other similar interventions. Seems like a fun topic. Here’s a list I can think of (a couple of which are those mentioned in the comments, by readers.) Anyone want to chime in with others?

Giving “Narcan” to an overdose patient: within seconds a moribund and blue, pin-point-pupilled addict is transformed to a yelling and screaming maniac.

Similarly: Dextrose IV for hypoglycemia rapidly raises from unconsciousness to lucidity.

Pain medicine use has nearly doubled

From Yahoo News:

The amount of five major painkillers sold at retail establishments rose 90 percent between 1997 and 2005, according to an Associated Press analysis of statistics from the Drug Enforcement Administration.

More than 200,000 pounds of codeine, morphine, oxycodone, hydrocodone and meperidine were purchased at retail stores during the most recent year represented in the data. That total is enough to give more than 300 milligrams of painkillers to every person in the country.