Baxter, FDA Scramble to Overcome Nitroglycerin Shortage

From FiercePharma, via the New York Times:

A shortage of saline solution has already been hampering hospitals. Now emergency rooms are finding it difficult to get nitroglycerin, a drug they often turn to first when heart attack patients arrive.

According to The New York Times, Baxter International became the sole supplier of the drug last year when manufacturing problems sidelined supplies from Hospira and American Regent. Then in November, Baxter had to recall a lot of nitroglycerin in 5% dextrose when particulate was found in a vial. Unable to keep up with demand, Baxter has been rationing the drug to healthcare providers, the newspaper reported. It limited hospitals to 40% of their usual orders in January, then cut that to 20% this month, leaving doctors to figure out how to cope.

“It’s one of those drugs that in certain circumstances, there really is no substitute for,” Dr. Frederick Blum, an emergency room physician at Ruby Memorial Hospital in West Virginia, told the NYT. Supplies at his hospital are depleted to the point that if a couple of patients needed extended use, they would run out, he said.

A bulletin from the American Society of Health-System Pharmacists said American Regent has upgraded a plant and will be staging supplies as its production expands. Baxter spokeswoman Deborah Spak told the newspaper that it is ramping up production by the end of the week, allowing it to return to shipping at the same levels it had been in January. She noted that Baxter has been the one continuous supplier of nitroglycerin and was “hopeful that overall demand and supply will resume to a more predictable state within the next few months.”

Calif. doctors simulate trauma care with smartphones

From EMS1:

Before the car-wreck victim reached the emergency room, doctors, residents and nurses at Cedars-Sinai Medical Center knew what to expect by glancing at their smartphones.

The details came in the staccato of text messages: A 35-year-old man had driven head-on into a bus. He suffered major chest injuries. His vital signs were crashing.

This was not just another day in the hospital. It was a laboratory billed as the “OR of the future,” an ongoing experiment aimed at breaking down barriers that bog down care through open communication, better use of technology and teamwork.

In reality, trauma care is rarely this organized. But those who are prized for individual skills are increasingly learning that when it comes to treating trauma patients from accidents, natural disasters or terrorist bombings, communication and coordination can determine whether someone lives or dies.

Read more at:

RAND: EHRs ‘significantly worsened’ doc satisfaction

From FierceEMR:

Physicians’ views of electronic health records are still mixed despite widespread adoption, seen as good in concept but that they “significantly worsened” their professional satisfaction, according to a new RAND Health report.

Conducted at the request of the American Medical Association, the report focused on determining the factors that lead to physician fulfillment. Its authors found that EHRs were a source of both promise and frustration. While they enabled doctors to improve quality of care and remotely access medical records, EHRs also:

  • Required time-consuming data entry that could be better accomplished by clerks and scribes;
  • Were difficult to use;
  • Interfered with patient face to face interaction;
  • Lacked interoperability; and
  • Degraded clinical documentation

The report recommended that “better EHR usability should be an industry priority and a precondition for EHR certification.”

Reconsidering Epinephrine in Out of Hospital Cardiac Arrest


Clinical Question

Does epinephrine increase the rate of survival with good neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA)?


Sudden cardiac arrest is common and, obviously, very bad. In the US, there are about 500,000 cardiac arrests each year. About half of these cardiac arrests are OHCA and the survival rate is pretty poor. The most recent survival estimates put it at 7 – 9.5% in most communities. About 10-12 years ago, the American Heart Association built the 4-step “chain-of-survival.”

Step One – Early access to emergency care
Step Two – Early CPR
Step Three – Early defibrillation
In fact, in communities with high layperson BLS training and AEDs in the community, the rate of survival after OHCA is higher.

The 4th step in the chain, however is slightly more controversial; early advanced care. This basically means rapid access to ACLS type resuscitation skills.