Point of Impact Therapeutic Hypothermia, Helmet Edition

From Gizmodo:

Here’s a pretty simple idea that may save a lot of lives: A motorbike helmet that cools down the rider’s head in case of impact. According to the manufacturer, their new ThermaHelm prevents overheating and swelling of the brain.

They also claim that there are head injuries in 80% of all motorbike accidents. When that happens, the brain usually starts swelling. Traditional helmets act as insulators, and the brain’s temperature may increase to the point in which it can cause death or permanent damage. The ThermaHelm prevents this by firing a chemical reaction on impact, which activates a layer that cools down the biker’s head.

Attrition From Emergency Medicine Clinical Practice in the United States

From the Annals of Emergency Medicine:

Study objective

We estimate the annual attrition from emergency medicine clinical practice.

Methods

We performed a cross-sectional analysis of the American Medical Association’s 2008 Physician Masterfile, which includes data on all physicians who have ever obtained a medical license in at least 1 US state. We restricted the analysis to physicians who completed emergency medicine residency training or who obtained emergency medicine board certification. We defined attrition as not being active in emergency medicine clinical practice. Attrition was reported as cumulative and annualized rates, with stratification by years since training graduation. Death rates were estimated from life tables for the US population.

Results

Of the 30,864 emergency medicine–trained or emergency medicine board-certified physicians, 26,826 (87%) remain active in emergency medicine clinical practice. Overall, type of attrition was 45% to non–emergency medicine clinical practice, 22% retired, 14% administration, and 10% research/teaching. Immediate attrition (<2 years since training graduation) was 6.5%. The cumulative attrition rates from 2 to 15 years postgraduation were stable (5% to 9%) and thereafter were progressively higher, with 18% having left emergency medicine clinical practice at 20 years postgraduation and 25% at 30 years postgraduation. Annualized attrition rates were highest for the first 5 years postgraduation and after 40 years postgraduation; between 5 and 40 years, the rates remained low (<1%). The overall annual attrition rate from emergency medicine clinical practice, including estimated death rate, was approximately 1.7%.

Conclusion

Despite the high stress and demands of emergency medicine, overall attrition remains low and compares favorably with that of other medical specialties. These data have positive implications for the emergency physician workforce and are important for accurate estimation of and planning for emergency physician workforce needs.

Therapeutic Hypothermia: 2 Year Survival

From Trauma, Resuscitation and Emergency Medicine:

2-year survival of patients undergoing mild hypothermia treatment after ventricular fibrillation cardiac arrest is significantly improved compared to historical controls

Background

Therapeutic hypothermia has been proven to be effective in improving neurological outcome in patients after cardiac arrest due to ventricular fibrillation (VF). Data concerning the effect of hypothermia treatment on long-term survival however is limited.
Material and methods

Clinical and outcome data of 107 consecutive patients undergoing therapeutic hypothermia after cardiac arrest due to VF were compared with 98 historical controls. Neurological outcome was assessed at ICU discharge according to the Pittsburgh cerebral performance category (CPC). A Kaplan-Meier analysis of follow-up data concerning mortality after 24 months as well as a Cox-regression to adjust for confounders were calculated.
Results

Neurological outcome significantly improved after mild hypothermia treatment (hypothermia group CPC 1-2 59.8%, control group CPC 1-2 24.5%; p<0.01). In Kaplan-Meier survival analysis hypothermia treatment was also associated with significantly improved 2-year probability for survival (hypothermia 55% vs. control 34%; p=0.029). Cox-regression analysis revealed hypothermia treatment (p=0.031) and age (p=0.013) as independent predictors of 24-month survival.
Conclusions

Our study demonstrates that the early survival benefit seen with therapeutic hypothermia persists after two years. This strongly supports adherence to current recommendations regarding postresuscitation care for all patients after cardiac arrest due to VF and maybe other rhythms as well.

Devout Catholics ‘Probably shouldn’t work in the emergency room’

From the Washington Times:

How can a Massachusetts Senate candidate possibly offend 39 percent of voters in her state? If it’s Democrat Attorney General Martha Coakley, she would tell devout Catholics not to bother working in an emergency room (H/T Jim Hoft – Big Government). In the audio clip below, Ms. Coakley chokes on a question from radio host Ken Pittman referring to the conscience clause. Under the conscience clause, workers in health-care environments ranging from doctors to maintenance men can refuse to offer services, information, or advice to patients on issues like contraception, blood transfusions, etc..if the workers are morally against it.