When are stroke patients more likely to receive tPA?

From MedPage Today, as published on KevinMD:

Patients suffering an acute ischemic stroke are about 20% more likely to receive clot-busting therapy with tissue plasminogen activator (tPA) if they arrive at the hospital on the weekend, a retrospective study showed.

However, there was no difference in rates of inhospital mortality based on the time of admission, Abby Kazley, PhD, of the Medical University of South Carolina in Charleston, and colleagues reported in the January issue of Archives of Neurology.

“Just because patients present on the weekend doesn’t necessarily mean that they’re going to get less aggressive or less quality care than they might otherwise,” Kazley said in an interview.

ED adds AutoPulse, Biosite and EZ-IO

From the Andalusia Star-News:

Emergency room personnel at Andalusia Regional Hospital said they have literally seen a new piece of ER equipment help them save lives.

Emergency room director Amy Herrington, R.N., explained that AutoPulse, one of three new pieces of technology in the ER at ARH, does that same thing as human-administered CPR, only faster and more efficiently.

Identity Theft in the ED

From KSMU:

It’s been said that during difficult times, good people will do bad things. One local hospital says it’s seeing examples of that on a regular basis now in its emergency department. KSMU’s Jennifer Moore has details.

Reporter standup: “Right now, I’m standing in the main doors of the Emergency Room at CoxSouth in Springfield. Officials say they have seen a spike in identity theft here in the emergency room—a trend which they attribute to the economy.”

Direct to the cath lab.. from the field

From Newswire:

Heart attack patients won’t go to the emergency room as part of a new University of Kentucky plan designed to reduce those patients’ risk of dying by nearly 8 percent for every half hour shaved off the time between the ambulance and treatment at the hospital.

In most cases, heart attack sufferers go straight to the cardiac catheterization lab in the UK Gill Heart Institute, where a specialized response team waits to break through the life-threatening blood clot that is causing the attack.

Feasibility and safety of combined percutaneous coronary intervention and therapeutic hypothermia following cardiac arrest

From Resuscitation:

Mild therapeautic hypothermia (MTH) has been associated with cardiac dysrhythmias, coagulopathy and infection. After restoration of spontaneous circulation (ROSC), many cardiac arrest patients undergo percutaneous coronary intervention (PCI). The safety and feasibility of combined MTH and PCI remains unclear. This is the first study to evaluate whether PCI increases cardiac risk or compromises functional outcomes in comatose cardiac arrest patients who undergo MTH.

Ninety patients within a 6-h window following cardiac arrest and ROSC were included. Twenty subjects (23%) who underwent PCI following MTH induction were compared to 70 control patients who underwent MTH without PCI. The primary endpoint was the rate of dysrhythmias; secondary endpoints were time-to-MTH induction, rates of adverse events (dysrhythmia, coagulopathy, hypotension and infection) and mortality.

Patients who underwent PCI plus MTH suffered no statistical increase in adverse events (P=.054). No significant difference was found in the rates of dysrhythmias (P=.27), infection (P=.90), coagulopathy (P=.90) or hypotension (P=.08). The PCI plus MTH group achieved similar neurological outcomes (modified Rankin Scale (mRS) ≤3 (P=.42) and survival rates (P=.40). PCI did not affect the speed of MTH induction; the target temperature was reached in both groups without a significant time difference (P=.29).

Percutaneous coronary intervention seems to be feasible when combined with MTH, and is not associated with increased cardiac or neurological risk.

Changing cardiac arrest and hospital mortality rates through a medical emergency team takes time and constant review

From Critical Care Medicine:

Objective: To determine the long-term impact of a medical emergency team on survival and to assess the utility of administrative data to monitor outcomes.

Design: Prospective study of cardiac arrests and survival. Retrospective study of administrative data.

Setting: University affiliated tertiary referral hospital in Melbourne, Australia.

Patients: All patients admitted to hospital in three 6-month periods between 2002–2007 (prospective) and 1993–2007 (retrospective).

Conclusions: The introduction of a medical emergency team was associated with a progressive decline of unexpected cardiac arrests within 2 yrs, and of unexpected mortality within 4 yrs. This suggests that changes to organizational practice take time and benefits may not be immediately obvious. Such changes are reflected in total hospital mortality measured from administrative data and make monitoring simpler in the longer term. Finally, efforts to increase calling of emergency teams should reduce cardiac arrests and mortality.

Massachusetts School Staff Mistakenly Injected with Insulin

From JEMS:

WELLESLEY, Mass. – Wellesley school officials say several staff members at an elementary school had to be taken to the hospital after being injected with insulin rather than the swine flu vaccine they were supposed to get.