Studying Falls in the ED

From the Colorado Springs Business Journal:

When people fall in an emergency room, any medical treatment as a result of the fall is paid for by the hospital. Historically, there’s been no assessment tool to ascertain the risk level of falling in emergency departments — until Dr. Kathleen Flarity created one for Memorial Hospital.

“There was nothing in the United States and nothing worldwide,” said Flarity, 51, who has a doctorate of nursing practice. She practices and teaches at Memorial Hospital, and is a colonel in the U.S. Air Force Reserves.

“If a patient falls in our hospital, it’s our fault,” she said. “It’s a measurement of quality for most hospitals.”

Free Medical Clinics Might Save Millions

From The Street:

Many people who don’t have health insurance will wait until a health condition progresses to the point they can’t ignore it any longer. Then they usually visit the emergency room, which can’t turn anyone away regardless of insurance status, but an uninsured ER visit often is very costly for the hospital and patient. 

For the uninsured or underinsured who do not want to be hit with a big bill for an ER visit, treatment at a walk-in clinic could be the cheaper alternative.

recent study of a free clinic in Providence, R.I., showed it reaped big benefits by saving more than a million dollars in projected health care costs.

E.R. Costs for Mentally Ill Soar, and Hospitals Seek Better Way

From the NY Times:

The experiment in Raleigh is being closely watched by other cities desperate to find a way to help mentally ill patients without admitting them to emergency rooms, where the cost of treatment is high — and unnecessary.

Top 5 Emergency Medicine Ultrasound Apps

From iMedicalApps:

Ultrasound utilization by Emergency Medicine physicians has dramatically increased over the last several years (1). In the Emergency Room we use Ultrasound for a multitude of settings, ranging from FAST exams, to diagnosing hydronephrosis or evaluating for cardiac effusion (2).

As a majority of Emergency Rooms have started to store ultrasound machines in their department, it is essential physicians understand how to utilize these machines at the point of care. Mobile apps are fantastic tools for learning Ultrasound due to their ability to easily display pictures and videos — critical for Ultrasound learning.

The portability of these apps make them useful at the point of care when you are actively performing an Ultrasound, further boosting their clinical utility. The following are five of the best Ultrasound Apps currently available for Emergency Medicine.

Outcomes associated with amiodarone and lidocaine in the treatment of in-hospital pediatric cardiac arrest

From Resuscitation:

Aim

To determine the association between amiodarone and lidocaine and outcomes in children with cardiac arrest with pulseless ventricular tachycardia (pVT) and ventricular fibrillation (VF).

Background

Current AHA guidelines for CPR and Emergency Cardiovascular Care recommend amiodarone for cardiac arrest in children associated with shock refractory pVT/VF, based on a single pediatric study and extrapolation from adult data.

Methods

Retrospective cohort study from the Get With the Guidelines-Resuscitation database for in-patient cardiac arrest. Patients<18 years old with pVT/VF cardiac arrest were included. Patients receiving amiodarone or lidocaine prior to arrest or whose initial arrest rhythm was unknown were excluded. Univariate analysis was performed to assess the association between patient and event factors and clinical outcomes. Multivariate analysis was performed to address independent association between lidocaine and amiodarone use and outcomes.

Results

Of 889 patients, 171 (19%) received amiodarone, 295 (33%) received lidocaine, and 82 (10%) received both. Return of spontaneous circulation (ROSC) occurred in 484/889 (54%), 24-hour survival in 342/874 (39%), and survival to hospital discharge in 194/889 (22%). Lidocaine was associated with improved ROSC (adjusted OR 2.02, 95% CI 1.36-3), and 24-hour survival (adjusted OR 1.66, 95% CI 1.11-2.49), but not hospital discharge. Amiodarone use was not associated with ROSC, 24 hour survival, or survival to discharge.

Conclusions

For children with in-hospital pVT/VF, lidocaine use was independently associated with improved ROSC and 24-hour survival. Amiodarone use was not associated with superior rates of ROSC, survival at 24hours. Neither drug was associated with survival to hospital discharge.