OTC Acetaminophen Meds OTS (off the shelf)?

From CNN:

A government advisory panel began voting Tuesday on recommendations for reducing the risk of serious liver injury associated with acetaminophen, found in over-the-counter drugs such as Tylenol and NyQuil.

The panel, assembled by the Food and Drug Administration, is weighing several options, including reducing recommended dosages of acetaminophen or pulling combination drugs, such as NyQuil, from stores’ shelves entirely.

After voting on nine options, the panel will be asked to rank the recommendations in order of importance for over-the-counter medications and, separately, for prescription medications.

Its final recommendations will come from that vote, the FDA said.

Although it is one of the most commonly used drugs in the United States for treating pain and fever, overdoses of acetaminophen have been linked to 56,000 emergency room visits, 26,000 hospitalizations and 458 deaths during the 1990s, according to the FDA, citing one study.

The agency cited another study, a 2007 Centers for Disease Control and Prevention population-based report, that estimated that acetaminophen was the likely cause of most of the estimated 1,600 acute liver failures each year.

The advisory panel could vote to pull over-the-counter drugs that use acetaminophen in combination with other ingredients that treat flu and cold symptoms, allergies or sleeplessness.

These combination drugs include NyQuil, Pamprin and Allerest.

The FDA is not required to follow the recommendations of its advisory committees, although the agency typically does.

Overweight, Critical Patients To Pay More For Ambulance Transports

From WIBW:

People who are overweight or critically injured will soon pay more for an ambulance ride in Shawnee County.

AMR’s Ken Keller told Shawnee County Commissioners Monday those patients take more manpower and equipment. Commissioners approved raising rates for critical care patients and patients who weigh more than 350-pounds from $629 to $1172.

The increase takes effect July 1. However, Medicare and Medicaid patients will not be charged the higher rate.

The Effects of Deep Breathing Training on Pain Management in the Emergency Department

From the Southern Medical Journal:

Purpose: The purpose of this study was to measure the impact of deep breathing exercises on the pain levels in patients who presented to the emergency department (ED) with pain as their chief complaint. A secondary purpose was to measure the impact of deep breathing teaching on indicators of patient satisfaction.

Methods: This was an observational study of patients who presented to the ED with pain as their chief complaint to an urban level one Emergency Department. Patients were randomized into a control group and an experimental group. The control group received the usual treatment for pain. The experimental group received the usual treatment for pain, but also received deep breathing exercises. For the measurement of pain prior to treatment, the brief pain inventory (BPI) was used. The visual analogy system (VAS) was used to measure pain prior to and after treatment and deep breathing were administered. For the measurement of patient satisfaction, the medical interview satisfaction scale (MISS) was used.

Results: There was no significant difference between those who received the deep breathing education and those that did not with regards to postmedication pain levels. There was however, a significant difference in customer service satisfaction within the area of doctor/patient rapport and intention to follow treatment.

Conclusion: The usefulness of deep breathing exercises was shown to be ineffective in reducing pain levels; however, the majority of those who received deep breathing education felt it was useful. The exercise was effective in increasing patient’s feelings of rapport and intentions to follow their doctor’s directives.

I avoided the Michael Jackson story until now…

From MedPage Today:
Cardiologists Question Jackson’s CPR in Bed

LITTLE FALLS, N.J., June 29 — Michael Jackson’s personal physician should not have performed CPR on the late pop star while he was in bed, if that was indeed the case, prominent cardiologists said today.

Standard procedure would have been to put Jackson on a hard surface and then start the compressions, said Michael R. Sayre, MD, chair of the emergency cardiovascular care committee for the American Heart Association.

“Providing chest compressions on a hard surface like the floor rather than on a soft bed will result in higher flow of blood to the victim’s brain and heart,” Dr. Sayre said.

The questions about Jackson’s CPR arose today on “Good Morning America,” where Dr. Murray’s attorney, Edward Chernoff, said the doctor began the procedure as soon as he found Jackson unconscious in bed, with a weak pulse, in his West Los Angeles home on June 25.

While Murray tried unsuccessfully to revive the singer, a security guard summoned an ambulance. Jackson was taken to Ronald Reagan UCLA medical center where he was pronounced dead.

Miranda Sevcik, a spokeswoman for Dr. Murray, said the physician braced one hand behind Jackson’s back and used the other to perform chest compressions.

She said Dr. Murray felt the procedure was adequate because “Mr. Jackson is a very small man.” Reports have put the former pop star at about 5’10” and between 110 and 125 pounds.

LUCAS 2 Automatic Chest Compressor Gets US Green Light

From Medgadget:

lucas2The LUCAS™ 2 chest compression system from Jolife AB, out of Lund, Sweden, has just been approved by the FDA. The battery powered unit can be taken directly to the patient without the need for a compressed air supply, unlike the last model. The system can then pump the chest for up to 45 minutes, saving paramedics’ time and much needed energy once the patient is revived and rushed to the hospital.

Ed. Be sure and check the link on this one – cool video.

FDA weighs options to reduce painkiller overdoses

From Business Week:

Tylenol, Excedrin, NyQuil. These household brands and others have come to symbolize safe, convenient relief from the aches and pains of everyday life. But this week the Food and Drug Administration is focusing on a seldom-discussed side effect of the medications: severe liver damage. Since the drugs first became widely available in the 1950s, the FDA has tried to minimize the risks of acetaminophen — the pain-relieving, fever-reducing ingredient in Tylenol and dozens of other prescription and over-the-counter medications.

Acetaminophen overdoses send an estimated 56,000 people to the emergency room each year, according to the FDA.

Despite decades of educational campaigns, bolstered warnings and other federal actions, acetaminophen continues to be the leading cause of liver failure in the U.S.

In documents posted online, the FDA said marketing of Tylenol and other medications emphasizes their safety, leading many consumers to assume they are “extremely safe and not likely to lead to serious injury.”

But the 4 gram-per-day maximum dose listed on many medications is just below levels that can cause potentially fatal liver injury.

During a two-day meeting that started Monday morning, the FDA is asking more than 35 experts what additional steps can be taken to reduce accidental overdose with the over-the-counter and prescription pain relievers.

Psychiatric services faulted at many hospitals in Iowa

From the Des Moines Register:

Several Iowa hospitals, including one at the center of a controversy involving the shooting death of a Parkersburg coach, have been accused in recent years of discharging psychiatric patients before they were stabilized.

The problems in Iowa are not unique. Nationally, patient access to hospital psychiatric services has long been an issue. Hospitals have been fined for discharging psychiatric patients prematurely and have faced lawsuits for boarding mental health patients in emergency rooms for days on end.

Hospital Worker Accused of Raping Unconscious Woman

From KTLA:

An emergency room technician accused for raping an intoxicated woman at an Orange County hospital is scheduled to be arraigned Monday.

Jesse Karim Pena, 31, was arrested Thursday at his mother’s home in Ontario after DNA evidence collected from the victim’s hospital gown was reportedly linked to him, according to Orange County Sheriff’s spokesman Jim Amormino.

Pena is accused of raping an intoxicated woman after she was brought by ambulance to Mission Hospital Regional Medical Center’s emergency room on February 21 just after midnight.

Pena allegedly logged himself into the room while on duty as an emergency room technician and raped the woman while she was unable to fight back.

Investigators had determined that three male workers were around the woman, and DNA samples were taken from each.

The results came back, and pointed to Pena, according to Amormino.

Pena was employed by a registry that supplies personnel to hospitals, and has worked at least three times at Mission in the past year, as well as at other hospitals in Orange, Riverside and San Diego counties.

Minnesota, Dakotas’ ERs among the fastest (… as is Iowa)

From Minnesota Public Radio:

Hospitals in five Upper Midwest states, including Minnesota, are among the country’s fastest in getting patients in and out of emergency rooms, according to a recent report by a leading adviser to health care organizations.

The Emergency Department Pulse Report by South Bend, Ind.-based Press Ganey Associates analyzed the experiences of nearly 1.4 million patients treated at 1,725 emergency departments nationwide in 2008.

The reports found that South Dakota residents spent the least amount of time in the emergency department, averaging 2 hours and 52 minutes.

North Dakota and Iowa came in fifth place, with a wait of 3 hours, 6 minutes. Minnesota ranked eighth, at 3 hours, 12 minutes. Wisconsin came in ninth with a time of 3 hours, 19 minutes.

Patients who arrived in the emergency department between 7 a.m. and 3 p.m. reported higher satisfaction than those who arrived in the evening or overnight hours, the report also found.

Prehospital Fibrinolytics

From the Peninsula Daily News:

PORT TOWNSEND — An 88-year-old man suffering a heart attack was the first to benefit from new protocols for paramedics in East Jefferson County.

The fire department, Jefferson Healthcare hospital, Port Ludlow Fire & Rescue, Harrison Medical Center, Kitsap Cardiology and the Poulsbo Doctors Clinic have created the protocols that allow paramedics to administer a host of drugs, including “clot busters” — which can destroy a blood clot blocking blood and oxygen to the heart — and provide immediate treatment during heart attacks.

The kits issued to paramedics beginning June 1 include blood thinners such as heparin, intravenous nitroglycerin and thrombolytics — or clot busters — that can lessen the long-term damage from a heart attack.