Can chest pain patients be evaluated in the ER waiting room?

From John Gever writing for Kevin MD:

Emergency department patients with chest pain may safely be evaluated in the waiting room when necessary, researchers said.

“Although waiting room evaluation is not ideal, it is a feasible contingency strategy for periods when ED crowding or volume surges lead to compromised access and delays to stretcher placement,” the researchers wrote.

More Detail on Maine Epi Overdose

From the Bangor Daily News:

Murray said the patient was given 0.3 milligrams of epinephrine, an appropriate amount, and the patient showed signs of improvement. It was while the man was being held for observation that some of his earlier symptoms recurred, he said.

Epinephrine, also known as adrenaline, can be re-dosed in the same amount as often as necessary to address a patient’s symptoms, Murray said, so another dose was administered by the medical provider. The second dose was too large.

When the patient later began to experience chest pain and shortness of breath, the medical provider reviewed the chart and realized the man had been given 3 milligrams of epinephrine, or 10 times the normal dose, according to Murray, who was summoned to the hospital at that time.

Maine Hospital Acknowledges Causing Man’s Death

Ed. Epi 1;1,00 vs 1:10,000?


Mayo Regional Hospital is acknowledging blame for the overdose death of a man who went to the emergency room suffering from an allergic reaction a week ago.

The middle-aged man, whose name the hospital did not release, died after emergency room workers gave a massive overdose of a medication aimed at helping the man, who was suffering symptoms of anaphylaxis. The man arrived at the hospital’s emergency room on the night of June 4.

Rollout Plan for the New American Heart Association Courses

October 2010
The 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care updates are predicted to be published in Circulation in October 2010. Available free of charge on the AHA Instructor Network and /or the AHA web site at

Nov-December 2010
Interim changes to current materials will be sent out

January-March 2011
Handbook of Emergency Care for Healthcare Providers
Family & Friends® CPR

March-April 2011
BLS for HCP’s

April-June 2011
BLS Heartsaver

July-September 2011

October-December 2011

First Quarter 2012

Suspended animation as emergency medicine?

From CNN:

A company co-founded by Roth, who is based at the Fred Hutchinson Cancer Research Center in Seattle, is working to develop a similar drug, hydrogen sulfide, into a therapy that would extend the window of survival for people suffering massive blood loss, stroke or cardiac arrest. The new paper suggests a potential link between this work and the expanding use of therapeutic hypothermia, in which doctors carefully cool patients to about 10 degrees below normal body temperature, a process that’s been shown to improve survival after cardiac arrest.

Deeper cooling – to around 60 degrees Fahrenheit – is reserved for risky heart or brain surgeries, where blood flow needs to be temporarily stopped. It’s considered a last resort, because extreme low temperatures carry a high risk of brain damage, heart arrhythmias and other problems. Outside the hospital, the lowest body temperature a person is known to have survived is 56 degrees.

Roth says a “suspended animation” drug might some day allow a way to get the full benefit from hypothermia, without dangerous side effects. “You can vastly increase survival limits of animals in the cold, if you put them in suspended animation, if you reduce oxygen consumption,” he says.