ACEP outlines plan for managing swine flu outbreak

From Modern Healthcare:

The American College of Emergency Physicians has released a national strategic plan on how to manage emergency departments during outbreaks of the H1N1 influenza virus, or swine flu. The plan was produced under contract with two offices under HHS—the Office of the Assistant Secretary for Preparedness and Response and the Emergency Care Coordination Center—and is intended to help the nation’s emergency departments and first responders plan for and manage a surge in H1N1 cases that could arrive as early as September, according to ACEP.

The 16-page plan said previous pandemic patterns of the 20th century show that healthcare providers should prepare for a higher level of virulence in the fall months, which occurred both in 1918 and 1957. The plan, titled the National Strategic Plan for Emergency Department Management of Outbreaks of Novel H1N1 Influenza, formed its management strategy based on these capabilities: situational awareness; protection of the emergency department infrastructure and personnel; prevention of disruptions in service delivery; organized, timely surge medical response; and recovery to the previous “steady state.” The plan includes 26 categories for managing an outbreak and includes specific action items for hospital emergency departments to follow within those categories.”

Should a Head-Injured Child Receive a Head CT Scan? A Systematic Review of Clinical Prediction Rules

From Pediatrics:

CONTEXT: Given radiation- and sedation-associated risks, there is uncertainty about which children with head trauma should receive cranial computed tomography (CT) scanning. A high-quality and high-performing clinical prediction rule may reduce this uncertainty.

OBJECTIVE: To systematically review the quality and performance of published clinical prediction rules for intracranial injury in children with head injury.

METHODS: Medline and Embase were searched in December 2008. Studies were selected if they included clinical prediction rules involving children aged 0 to 18 years with a history of head injury. Prediction-rule quality was assessed by using 14 previously published items. Prediction-rule performance was evaluated by rule sensitivity and the predicted frequency of CT scanning if the rule was used.

RESULTS: A total of 3357 titles and abstracts were assessed, and 8 clinical prediction rules were identified. For all studies, the rule derivations were reported; no study validated a rule in a separate population or assessed its impact in actual practice. The rules differed considerably in population, predictors, outcomes, methodologic quality, and performance. Five of the rules were applicable to children of all ages and severities of trauma. Two of these were high quality (≥11 of 14 quality items) and had high performance (lower confidence limits for sensitivity >0.95 and required ≤56% to undergo CT). Four of the 8 rules were applicable to children with minor head injury (Glasgow coma score ≥13). One of these had high quality (11 of 14 quality items) and high performance (lower confidence limit for sensitivity = 0.94 and required 13% to undergo CT). Four of the 8 rules were applicable to young children, but none exhibited adequate quality or performance.

CONCLUSIONS: Eight clinical prediction-rule derivation studies were identified. They varied considerably in population, methodologic quality, and performance. Future efforts should be directed toward validating rules with high quality and performance in other populations and deriving a high-quality, high-performance rule for young children.

New iPhone IV Dosage Calculator

From Medgadget (the post includes a cool video demo):

Deep Pocket Series just released a new helper iPhone application to help you calculate medicine dosages quickly. The Stat Meds app is specifically designed with a focus on emergency medicines during code situations.

Stat Meds contains a dose calculator, multiple medication doses, kilo, temp converter. The most popular feature is the ability for the user to have quick access to emergency meds. The user enters the weight and age press enter: then the next screen the calculator will yield: Defibrillation Dose, Cardioversion Dose, ET tube Size, Maintenance Fluids, Adenosine, Amiodarone, Atropine, Bicarbonate, Calcium Chloride, Dextrose, Epinephrine, Flumazenil, Lidocaine, Magnesium sulfate, Mannitol, Naloxone, Phenylephrine, Procainamide, VasopressinContinuous infusions: Epinephrine, Norephinephrine, Milrinone, Phyenylephrine, AMiodarone, Dopamine, Dobutamine, Nitroprusside, Nitrogylcyerine, Procainamide, Terbutaline, Lidocaine, Vasopressin.

Intubation Medications: Etomidate, Fentanyl, Ketamine, Midazolam, Rocuronium, Succinylcholine,Thiopental, Vecuronium.

The Program contains over 42 medication IV drips and when you combine the different concentrations it contains over 81 medications.

The program allows you to calculate: Dosed based, Flow based, Fixed concentration, or rule of six.

No Improvement In Survival with In-Hospital CPR

From MedPage Today:

Among elderly patients, survival after in-hospital cardiopulmonary resuscitation (CPR) hasn’t improved over a 15-year period, researchers say.

The proportion of hospital deaths among patients who had undergone in-hospital CPR has actually increased, while the proportion of survivors discharged home after having the procedure has decreased, William J. Ehlenbach, MD, of the University of Washington, and colleagues, reported in the July 2 New England Journal of Medicine.

The finding is concerning because it comes “during a time of more education and awareness about the limits of CPR in patients with advanced chronic illness and life-threatening acute disease,” the researchers said.

They said it has been unclear so far whether advances in CPR or in post-cardiac-arrest care have improved outcomes after in-hospital arrest, the researchers said.

In order to assess this, they looked at fee-for-service Medicare data from 1992 through 2005 for 433,985 patients age 65 and older who had CPR in U.S. hospitals.

Of those, 18.3% survived to discharge.

The researchers found that the rate of survival didn’t change substantially over the study period, and the incidence remained at 2.73 events per 1,000 admissions during that time.