Malpractice cases drop, but views on why differ

From the Des Moines Register:

Iowa patients are suing their doctors for malpractice half as often as they used to, which has helped drive down malpractice-insurance premiums for many physicians.

Doctors speculate that malpractice lawsuits are becoming rarer because they have cut down on medical mistakes. But plaintiffs’ lawyers say they’re filing fewer cases because it’s become more expensive to press lawsuits.

Despite the decline in cases, the two sides continue to debate whether malpractice lawsuits help drive up health care costs.

Australian Paramedics Want Pool Cues Banned from Pubs

From JEMS:

Queensland’s ambulance officers want licensed venues to stop using pool cues and glass ashtrays to reduce the risk of being assaulted.

Last year the State Government banned glasses from some pubs and clubs to stop so-called “glassing” attacks.

Now the union representing Queensland’s ambulance officers says pool cues and glass ashtrays have become a “weapon of choice” for drunken patrons who turn on paramedics.

Maryland Woman Bitten by Cobra; Assistant Curator Responds with Anti-Venom

From JEMS:

It was a strange story from start to finish, but the Philadelphia Zoo helped steer things toward a happy ending. A woman told fire department emergency responders in Baltimore that she was getting into her car at a shopping-center parking lot Sunday night when she was bitten on the hand by a cobra, which she had picked up thinking it was a stick.

The woman, who officials didn’t identify, apparently got the snake into a bag and brought it with her to a walk-in medical center, where it was isolated in a trash can, said Baltimore Fire Department spokeswoman Elise Amacost. Fire department personnel rushed the woman from the clinic to Johns Hopkins Hospital.

Hospital thanks backers of new Emergency Department

From the Carroll, IA Daily Times Herald:

Ed. ACUTE CARE, INC. is proud to be affiliated with St. Anthony’s.

The place hadn’t officially opened, yet the boss was already trying to drum up business.

As St. Anthony Regional Hospital dedicated its expanded Emergency Department, CEO Gary Riedmann jokingly took credit for the slick subzero conditions outside.

“Considering where we’re at tonight, I wanted to make it as icy, as slick, as possible for you to appreciate our product,” he kidded Tuesday night during a reception to thank contributors to the $4 million project.

St. Anthony renovated and enlarged its ER to address an increase in patients and privacy concerns for staff, those being treated and their families.

ER visits jumped from 5,767 in 2005 to an expected 7,140 this year.

ED staff erroneously assumed to obey administrators

From the Washington Post:

Ed. Sadly, not an Onion post.

A New York City woman pretended to be a hospital administrator, called an emergency room and tried to get hospital staff to take the baby of her husband’s mistress off life support, prosecutors said Thursday.

Need to find an AED? There’s an app for that.

From Medgadget:

First Aid Corps, an organization working on helping the public respond to sudden cardiac arrests, has unveiled an iPhone app that can pinpoint the location of the closest automatic external defibrillator (AED) within seconds.

Currently the database is just beginning to fill up but First Aid Corps has partnered with The Extraordinaries, a volunteer organization, to have people locate and photograph AED’s in their community.

The app is free and you can download it and get started mapping AED’s and maybe help save someone’s life.

Medical Simulation Training

From the New York Times:

Medical simulation training, which is similar to that used in aviation and in the military, uses mannequins, computers, virtual reality or actors posing as patients to teach doctors, nurses and other clinicians. While simulation training has been used in medicine for nearly 40 years, it has until recently been limited primarily to teaching standard techniques like chest compressions in cardiopulmonary resuscitation or pelvic exams.

But over the last few years, as the technology and training techniques have advanced, experts in the field have begun to broaden the scope of training. No longer confined to isolated procedures, simulation can now recreate entire clinical situations, giving clinicians the opportunity to develop skills in what is often identified as one of the major causes of errors and quality issues in health care: poor teamwork and communication.

Cardiac Arrest: Drug, then Shock or Shock, then Drug?

From Resuscitation:

Increase in pre-shock pause caused by drug administration before defibrillation: An observational, full-scale simulation study

Background: The importance of circulation during cardiopulmonary resuscitation has led to efforts to decrease time without chest compressions (“no-flow time”). The no-flow time from the interruption of chest compressions until defibrillation is referred to as the “pre-shock pause”. A shorter pre-shock pause increases the chance of successful defibrillation. It is unclear whether drug administration affects the length of the pre-shock pause. Our study compares pre-shock pause with and without drug administration in a full-scale simulation.

Methods: This was an observational study in an ambulance including 72 junior physicians and a cardiac arrest scenario. Data were extracted by reviewing video recordings of the resuscitation. Sequences including defibrillation and/or drug administration were identified and assigned to one out of four categories: Defibrillation only (DC-only) and drug administration just prior to defibrillation (Drug+DC) for which the pre-shock pause was calculated, and drug administration alone (Drug-only) for which pre-drug time was calculated.

Results: DC-only sequences were identified in 68/72 simulations, Drug+DC in 24/72, and Drug-only in 33/72. Median pre-shock pauses were 18s (DC-only) and 32 (Drug+DC), and median pre-drug pause 6. The variation between pauses was statistically significant (p≪0.001). DC-only and Drug+DC sequences was found in 22/72 simulations. A statistically significant difference of 8s was found between the median pre-shock pauses: 17s (DC-only) and 25 (Drug+DC) (p≪0.001). For un-paired observations, the pre-shock pause increased with 78% and for paired observations 47%.

Conclusions: Drug administration prior to defibrillation was associated with significant increases in pre-shock pauses in this full-scale simulation study.

Prehospital Portable Ultrasound

From the Journal of Emergency Medicine:

Portable Ultrasound for Remote Environments, Part II: Current Indications

Background: With recent advances in ultrasound technology, it is now possible to deploy lightweight portable imaging devices in the field. Techniques and studies initially developed for hospital use have been extrapolated out of the hospital setting in a wide variety of environments in an effort to increase diagnostic accuracy in austere or prehospital environments. Objectives: This review summarizes current ultrasound applications used in out-of-hospital arenas and highlights existing evidence for such use. The diversity of applications and environments is organized by indication to better inform equipment selection as well as future directions for research and development. Discussion: Trauma evaluation, casualty triage, and assessment for pneumothorax, acute mountain sickness, and other applications have been studied by field medical teams. A wide range of outcomes have been reported, from alterations in patient care to determinations of accuracy compared to clinical judgment or other diagnostic modalities. Conclusions: The use of lightweight portable ultrasound shows great promise in augmenting clinical assessment for field medical operations. Although some studies of diagnostic accuracy exist in this setting, further research focused on clinically relevant outcomes data is needed.

EMCrit Podcast 18 – The Infamous Awake Intubation Video

From EMCrit, via The Central Line:

Awake intubation can save your butt!

It requires forethought and humility–you must be able to say to yourself, “I am not sure I will be able to successfully intubate this patient.” However, the payoff for this thought process is enormous. You can attempt an intubation on a difficult airway with very few downsides. If you get it, you look like a star, if you don’t you have not made the situation worse.

Two of my critical care resident specialists, Raghu Seethala and Xun Zhong, volunteered to intubate each other awake. The purpose of this was to let them gain experience, understand what their patients would feel during the procedure, and to prove that awake intubation can be done without complicated nerve block injections or fragile equipment, such as a bronchoscope.