Impact of transport to critical care medical centers on outcomes after out-of-hospital cardiac arrest

From Resuscitation:

Post-resuscitation care has emerged as an important predictor of survival from out-of-hospital cardiac arrest (OHCA). In Japan, selected hospitals are certified as Critical Care Medical Centers (CCMCs) based on their ability and expertise.

Hypothesis

Outcome after OHCA is better in patients transported to a CCMC compared a non-critical care hospital (NCCH).

Materials and methods

Adults with OHCA of presumed cardiac etiology, treated by emergency medical services systems, and transported in Osaka from January 1, 2005 to December 31, 2007 were registered using a prospective Utstein style population cohort database. Primary outcome measure was 1 month neurologically favorable survival (CPC≤2). Outcomes of patients transported to CCMC were compared with patients transported to NCCH using multiple logistic regressions and stratified on the basis of stratified field ROSC.

Results

10,383 cases were transported. Of these, 2881 were transported to CCMC and 7502 to NCCH. Neurologically favorable 1-month survival was greater in the CCMC group [6.7% versus 2.8%, P<0.001]. Among patients who were transported to hospital without field ROSC, neurologically favorable outcome was greater in the CCMC group than the NCCH group [1.7% versus 0.5%; adjusted odds ratio (OR), 3.39; 95% confidence interval (CI), 2.17–5.29; P<0.001]. In the presence of field ROSC, survival was similar between the groups [43% versus 41%; adjusted OR, 1.09; 95% CI, 0.82–1.45; P=0.554].

Conclusions

Survival after OHCA of presumed cardiac etiology transported to CCMCs was better than those transported to NCCHs. For OHCA patients without field ROSC, transport to a CCMC was an independent predictor for a good neurological outcome.

Medicaid Patients Accounting for More Emergency Visits

From MedPage Today:

Medicaid patient visits to the emergency department are on the rise nationwide in contrast to overall trends in emergency visits, according to a market analysis firm.

Emergency department visits covered by Medicaid rose more than 6% in 2009, whereas total hospital outpatient visits to the emergency department dropped 1.3%, SDI reported. The numbers are based on de-identified patient-level data that SDI provides to pharma and other companies in the healthcare industry.

Likewise, Medicaid patients entered the hospital via the emergency department in greater numbers in 2009, up more than 6% from 2008.

Kids with food allergies need two EpiPens

From the Boston Globe:

Many children with food allergies carry EpiPens, which are self-injectible doses of epinephrine that can halt a severe allergic reaction called anaphylaxis. A study of emergency room treatment of children with these life-threatening reactions supports recommendations that children carry two EpiPens, not just one.

Dr. Susan Rudders of Children’s Hospital Boston led a review of more than 1,200 medical charts over six years from the emergency departments at Children’s and Massachusetts General Hospital. A little over half of the children who were seen for allergic reactions to food were suffering from anaphylaxis, which can include low blood pressure, difficulty breathing, and gastrointestinal problems. Among the patients who were given epinephrine either before or during their ER visit, 12 percent received a second dose.

ERtexting Provides Live ER Status to Any Mobile Phone

From Medgadget:

Ertexting out of Miami, Florida is a new company that’s offering a mobile phone service to provide patients wait times at their local emergency rooms. The idea is very simple: in an emergency, patients send a text message with their zip code to 4ER411 (437411), and the system replies with a text message containing how many minutes you should expect to wait in nearby ERs. The service wants ER staff to provide live updates on the status of their departments in hopes that this will reduce the load by having patients triage themselves.

Asystole after ear suctioning

From the Journal of Primary Health Care:

The ENT doctor started cleaning with a suction device to clean the deep debris. The patient was compliant and keen on the procedure.

After a few seconds into the vacuum suctioning, the patient was nonresponsive. The doctor put up a crash call. The ECG read asystole and the patient was immediately resuscitated as protocol. The patient required two cycles of resuscitation after which he woke up.

Asystole is a quite common and dreaded complication in emergency. The common mnemonic of 6Hs and 5Ts are a useful reminder. This case was unusual in the sense that the patient already had a hyper–responsive vagus nerve but was not investigated for it. This case highlights the fact that there is no procedure with zero risk and, albeit in some cases patients describe symptoms vaguely, one must be wary that rare cases are unusual, but they do occur.

Maryland Paramedics Under Review After Incorrectly Pronouncing Man Dead

From JEMS:

The Prince George’s County Fire/Emergency Services Department is limiting the duties of two paramedics pending an investigation into how they walked away from the unconscious Waters at about noon on Friday after saying he was dead.

An hour and a half after the two medics left the Waters’ Glenarden Parkway home, forensics investigators saw signs of life in him and again called for EMS help. This time he was taken to the hospital.

It is not known if the delay had an adverse impact on Waters’ condition

Ammonia Leak Sends 15 to University of Iowa Hospital

From JEMS:

The fire department in West Liberty says a total of 15 people were transported to University of Iowa Hospitals and Clinics after an anhydrous ammonia leak at a meat processing plant there.

West Liberty Fire Department Assistant Chief Tom Christensen say the leak at West Liberty Foods was reported about 11:30 a.m. Friday and orginated with a tank on the plant’s roof.

Christensen says the 15 were treated for anhydrous ammonia inhalation, although no one was directly exposed to the chemical. He describes their injuries as minor to moderate and says they are all expected to recover.

The leak led to an evacuation of West Liberty Foods, which processes mostly turkey.

No Narcs

From the Mt. Vernon Register-News:

MT. VERNON — In an effort to address concerns and the potential for abuse of narcotics, St. Mary’s Good Samaritan Hospital has started a new policy in its emergency room.

“While these medicines are technically safe, they can, in specific instances, become counter-productive to treating painful conditions,” information from SMGS states. “In addition to potential side affects, they can lead to addiction, withdrawal and even, in some situations, prolonging pain.”

Under the new policy, patients with chronic pain will only receive non-narcotic pain medications as a temporary treatment.

“The aim of this policy is to encourage patients to maintain a more in depth and consistent treatment plan with their regular physician so they can have better, more consistent control of their pain and thus a better quality of life,” information states. “In addition, prescriptions for narcotic medications that have been lost, stolen or expired can not be refilled.”

The emergency room physicians will no longer write a refill of narcotic pain medication.

Doc Botched Gallbladder Op, Drops Patient Off Outside ER

From Fox News:

A 59-year-old woman was awarded $395,000 after a doctor botched her gallbladder operation and subsequently took her in his own car to another emergency room.

Juana Magnaye, a Medi-Cal patient, was hospitalized at California Hospital Medical Center in Los Angeles on April 13, 2007 for a routine gallbladder surgery.

However, when Dr. Morad Tourah botched the operation by obstructing the common bile duct, he drove her to the Los Angeles County-USC emergency room and left her out front.

New dummy for emergency room

Ed. Love the title.

From the Times:

Staff members at Kidz First at Middlemore were delighted when they were presented with the infant mannequin by representatives from local charity Kids in Cars.

Emergency nurse educator Cate Fleckney says the new training tool will give staff hands-on experience with procedures, including catheterisation, tracheotomies and intravenous insertion.

“We can do such a large variety of procedures on the baby, and it gives the staff an opportunity to practise procedures and build confidence,” she says. “Previously we used a small stuffed doll for training so this will make a huge difference.”