What Is the Optimal Chest Compression Depth During Out-of-Hospital Cardiac Arrest Resuscitation of Adult Patients?

From Circulation:

Background—The 2010 American Heart Association guidelines suggested an increase in cardiopulmonary resuscitation compression depth with a target >50 mm and no upper limit. This target is based on limited evidence, and we sought to determine the optimal compression depth range.

Methods and Results—We studied emergency medical services–treated out-of-hospital cardiac arrest patients from the Resuscitation Outcomes Consortium Prehospital Resuscitation Impedance Valve and Early Versus Delayed Analysis clinical trial and the Epistry-Cardiac Arrest database. We calculated adjusted odds ratios for survival to hospital discharge, 1-day survival, and any return of circulation. We included 9136 adult patients from 9 US and Canadian cities with a mean age of 67.5 years, mean compression depth of 41.9 mm, and a return of circulation of 31.3%, 1-day survival of 22.8%, and survival to hospital discharge of 7.3%. For survival to discharge, the adjusted odds ratios were 1.04 (95% CI, 1.00–1.08) for each 5-mm increment in compression depth, 1.45 (95% CI, 1.20–1.76) for cases within 2005 depth range (>38 mm), and 1.05 (95% CI, 1.03–1.08) for percentage of minutes in depth range (10% change). Covariate-adjusted spline curves revealed that the maximum survival is at a depth of 45.6 mm (15-mm interval with highest survival between 40.3 and 55.3 mm) with no differences between men and women.

Conclusions—This large study of out-of-hospital cardiac arrest patients demonstrated that increased cardiopulmonary resuscitation compression depth is strongly associated with better survival. Our adjusted analyses, however, found that maximum survival was in the depth interval of 40.3 to 55.3 mm (peak, 45.6 mm), suggesting that the 2010 American Heart Association cardiopulmonary resuscitation guideline target may be too high.

Debriefing in the Emergency Department After Clinical Events: A Practical Guide

From the Annals of Emergency Medicine:

One vital aspect of emergency medicine management is communication after episodes of care to improve future performance through group reflection on the shared experience. This reflective activity in teams is known as debriefing, and despite supportive evidence highlighting its benefits, many practitioners experience barriers to implementing debriefing in the clinical setting. The aim of this article is to review the current evidence supporting postevent debriefing and discuss practical approaches to implementing debriefing in the emergency department. We will address the who, what, when, where, why, and how of debriefing and provide a practical guide for the clinician to facilitate debriefing in the clinical environment.

AVOID Oxygen? Evidence of Harm in MI

From Medscape:

Results of a new trial suggest supplemental oxygen therapy in patients with ST-elevation MI (STEMI) may actually be harmful for patients who are not hypoxic[1].

The Air Versus Oxygen in ST-Elevation Myocardial Infarction (AVOID) trial compared supplemental oxygen vs no oxygen unless O2 fell below 94%.

“The AVOID study found that in patients with ST-elevation myocardial infarction who were not hypoxic, there was this suggestion that, potentially, oxygen is increasing myocardial injury, recurrent myocardial infarction, and major cardiac arrhythmia and may be associated with greater infarct size at 6 months,” lead author Dr Dion Stub (St Paul’s Hospital, Vancouver, BC, and the Baker IDI Heart and Diabetes Institute, Melbourne, Australia) concluded.

Hospital to become community health clinic

From the WC Messenger:

Wise Regional Health System will convert its Bridgeport campus to an urgent care/ambulatory surgery center Jan. 1.

The change, which will shut down the emergency room, was discussed at Monday evening’s at a hospital board meeting and announced to employees Tuesday.

It was just a little more than two years ago, on Nov. 8, 2012, that North Texas Community Hospital in Bridgeport declared bankruptcy. The hospital, which opened in 2008, had been in default on $59.1 million in bonded debt for several years.

After submitting the only bid, Wise Regional bought the hospital in federal bankruptcy court for $20 million and took ownership March 24, 2013. It reopened May 7 as Wise Regional Bridgeport – a fully-staffed, fully-licensed inpatient hospital.

After continuing to absorb steep losses, they closed down the medical/surgical inpatient unit and the ICU last December, leaving only the ER and outpatient services in operation.

The latest move will close the ER and convert the facility to an urgent-care clinic, staffed by nurse-practitioners and operated under Wise Clinical Care Associates.

Meet Chicago’s real top ER doc… (Spoiler alert: He’s from Cork)

From the Journal:

Seeing more than 1,000 patients a year with gunshot wounds makes a person an expert on street violence and Dr John Barrett uses a medical analogy when talking about this week’s gun crimes in America.

“Guns are the vector of violence. Malaria is spread by mosquitos. What we say in this case is, ‘Control the vector – control the thing that spreads it and then you control it’. The same is true for weaponry.”

Dr Barrett is no ordinary voice on this issue.

The Cork native headed up the trauma unit of Cook County Hospital in Chicago for decades. That name may trigger bells in your head – it was the inspiration for ER’s County General in the same city.

Why The ER Doctor Asks Patients What’s Happening At Home

From IdeaStream:

Some would argue that the ER isn’t the right place to deal with people’s personal problems. But even now, many of our patients don’t see another doctor. These ER visits give us a chance to help them regain their health and also put them on the way toward addressing the underlying issues that affect their well-being.

Sometime we’re able to connect patients with people who can help them find safe housing, affordable medications and nutritious food. Often we’re able to identify those at risk for abuse and self-harm.

Mechanical CPR Takes a Thumping

From EP Monthly:

If you listen to proponents of auto-resuscitation devices, you’d think they’re clearly superior to manual CPR. A review of the literature suggests otherwise.

There are still arguments to be made for mechanical CPR devices – when longer transport times are anticipated, or when there are barriers to applying consistent, high-quality manual compression. But it’s flat-out wrong to assert superior outcomes with mechanical devices; the best evidence yet suggests only equivalency.

A neural “off-switch” for pain documented

From BoingBoing:

In Endogenous adenosine A3 receptor activation selectively alleviates persistent pain states, a paper in Brain by researchers led from the St Louis University Medical School, scientists document their work in switching off neural pain pathways by activating an adenosine receptor.

Pursuit and restraint raise police officers’ risk of sudden death

From Reuters:

Police officers are at increased risk for sudden cardiac death when performing stressful duties like chasing, restraining or fighting with suspects, researchers say.

Sudden cardiac death is up to 70 times more likely during those kinds of stressful activities, compared to when police officers perform routine duties, according a new study of U.S. law enforcement deaths.

‘Stroke robot’ helps improve treatment for stroke patients

From AZFamily:

The robot fills a critical need in stroke diagnoses, because there is a shortage of stroke doctors in this country, Dr. Zach explains. “To have a stroke doctor available in every Emergency Department is just physically impossible,” he explains. “So we are all over and scattered. So if a patient is brought into a center and they don’t have a stroke doctor, it becomes a problem.“

With his IPad, Dr. Zach controls the robot’s two cameras, “One of these cameras is a fish-eye camera so it shows us a really broad view of the entire room, and we get a very large visual field with that,” he explains. “So we are able to ask the patient things like, is there a clock in the room, and there is one over there, and we will be able to see it even though the camera is pointing over this way, you know, and we will be able to know whether the patient can see to that side or not. On the other hand the other camera is a very high quality zoom camera. We can actually zoom in on somebody’s pupil and actually check the pupil reactivity, see if the eye movements are ok.”

He can also read vitals on the screen, and follow the patient to a CT scan. “I will see the pictures come up on the CT scan hot off the presses,” he says.