Joplin: 45 Seconds: Memoirs of an ER Doctor from May 22, 2011

From The Central Line:

Then it was over. Just 45 seconds. 45 long seconds. We looked at each other, terrified, and thanked God that we were alive.  We didn’t know, but hoped that it was safe enough to go back out to the ED, find the rest of the staff and patients, and assess our losses.

“Like a bomb went off” — That’s the only way that I can describe what we saw next.

Endotracheal Intubation Tips

From JEMS:

Achieve 20/20 Glottic Visualization with These Tips

A review of clinical literature yields the following four steps, which have proved to consistently improve clinicians’ ability to visualize the glottis:

  1. Place the patient level with the paramedic’s mid abdomen or lower chest;
  2. Use a straight laryngoscope blade;
  3. Anticipate difficult intubations; and
  4. Respond to the predicted difficult intubation with use of the sniffing position, head and neck extension beyond the sniffing position, and the BURP maneuver.

“Free-standing emergency departments originally emerged to serve people in rural areas where access to emergency care was scarce.”


From the Washington Post:

One increasingly popular option to improve access to services is the free-standing emergency department, a facility that, as its name suggests, isn’t physically located within a hospital.

Free-standing emergency departments originally emerged to serve people in rural areas where access to emergency care was scarce. But in recent years, free-standing EDs have often been cropping up in fast-growing suburban areas where the need isn’t always as clear. Sometimes, experts say, it’s as an effort by health systems to muscle in on a competing hospital’s ED and siphon off some of its patients.

Vasopression Shortage

From Medical Mews Today:

The University of Utah’s Drug Information Service informs that during the first quarter of this year there have been 89 drug shortages. Just on the 25th and 26th of May, 2011, the American Society of Health-System Pharmacists reported new shortages of the following medications – Ciprofloxacin Immediate-Release tablets, Magnesium sulfate injection, Paclitaxel injection, Aminocrapoix acid injection, Prochlorperazineedisylate injection, Triamterene and Hydrochlorothiazide capsules and tablets, and Vasopressin injection.


From the American Society of Health-System Pharmacists:

Reason for the Shortage

  •   APP and JHP could not provide a reason for the shortage.
  • American Regent has temporarily suspended manufacture of most drug products including vasopressin injection.
  • American Regent has resumed shipping multiple products including vasopressin. These products were manufactured prior to the temporary manufacturing suspension in Shirley, New York, which is still in effect and the company cannot estimate when further manufacturing will resume.

Estimated Resupply Dates

  • American Regent has available vasopressin 20 units/mL injection 1 mL multi-dose vials (NDC 00517-1020-25) and 10 mL multi-dose vials (NDC 00517-0410-10). The 0.5 mL multi-dose vials are on back order and the company cannot estimate a release date.
  • APP has vasopressin 20 units/mL injection on back order and the company cannot estimate a release date.
  • JHP has Pitressin on allocation.

Memorial Day

Video link doctor saves stroke victim

From The Argus:

Emergency workers at the Royal Sussex County Hospital in Brighton scrambled into action when a 56-year-old woman was taken into the accident and emergency unit showing symptoms that she was having a stroke.

The on-call stroke consultant was at home and would have had to travel to the Royal Sussex to assess the patient – potentially wasting vital minutes before any action could be taken.

Instead she logged onto the hospital’s pioneering Telemedicine system remotely.

It meant she was able, via a screen at the end of the patient’s bed, to see and talk to the patient and work with the senior nurse to assess her medical condition and suitability for thrombolysis.

Thrombolysis is a specialist treatment that breaks up a blood clot to minimise brain damage caused by a stroke.

The team decided this was the right course of treatment and by the next morning the patient was symptom free.

There are heroes around us all the time

From CNN:

From President Obama’s speech in Joplin today:

“There are heroes around us all the time. And so, in the wake of this tragedy, let us live up to their example, to make each day count, to live with a sense of mutual regard, to live with that same compassion that they demonstrated in their final hours. We are called by them to do everything we can to be worthy of this chance we’ve been given to carry on.”

Cincinnati pharmacist coaching program associated with decreased ED use


Insurer Anthem Blue Cross and Blue Shield and Kroger Co. have partnered on a two-year pharmacy coaching program, using more than 700 city of Cincinnati employees and family members to prove the point.

Those patients signed contracts pledging to see their pharmacist every one to three months. Cincinnati officials provided incentives to stay with the program and also paid about $50 each for the 30-minute sessions.

But the benefits extended to the finances. Emergency room visits were down nearly 40 percent, offset by the cost of increased pharmacy claims – people taking those medicines – and more regular office visits.

Assignment: Write about a new ED. Goal: Pulitzer.

New hospital allows paramedics to spirit patients to quicker care


You’ve been working for 18 hours when the break finally comes — time to check gear, re-stock supplies, grab a snack.

Then there’s the call — a single-vehicle rollover on Interstate 84 near Wendell. The driver, not wearing his seat belt, was thrown from his car. He’s alive, but won’t be for long if his battered body keeps bleeding into itself.

You’re a paramedic, and in the frantic minutes to come, your life will be an intense race against the clock. Whether you’re screaming across the blacktop in the back of an ambulance or high above the Magic Valley in a helicopter, every second counts when your patient is in critical condition.

Conflicting forces of utter exhaustion and the sharp, new hit of adrenaline thrash inside your body as you draw near the hospital. At this moment, the last thing you want to see is somebody’s Camry blocking the emergency room entrance.

Mid-levels in the ED

From Kevin MD (a guest post by the blooger  A Medical Resident’s Journey) :

Here is the bottom line, from my perspective as a health care provider: I think it is important for patients – and for residents, PAs, and NPs – to understand that the purpose of a hierarchy in medicine is to provide more support staff, not to compromise patient care. Our primary – and most important – job, as residents, PAs, and NPs, is to recognize our limitations and to ascertain whether one of our patients needs a higher level of care.