Early Deterioration After Stroke a ‘Missed Opportunity’

From Medscape:

Neurologic deterioration in acute stroke patients in the “ultra-early” time window, defined as 3 to 4 hours after symptom onset and including the prehospital period, is common and represents a currently almost untapped opportunity to improve outcomes, the authors of a new study say.

The study, a secondary analysis of the FAST-MAG trial, which investigated the prehospital administration of magnesium to stroke patients, showed that ultra-early neurologic deterioration occurred in 1 in 3 patients with intracranial hemorrhage and in 1 in 16 patients with acute cerebral ischemia. This ultra-early neurologic deterioration was associated with markedly reduced functional independence and increased mortality.

The study was published online in JAMA Neurology on July 23.

UnityPoint warns 1.4 million patients their information might have been breached by email hackers

From the Des Moines Register:

One of Iowa’s main hospital and clinic systems has notified about 1.4 million patients that their personal information might have been breached.

UnityPoint Health officials said hackers used “phishing” techniques to break into the company’s email system. The company, based in West Des Moines, said the hackers could have obtained medical information, such as diagnoses and types of care, that was included in emails.

“While we are not aware of any misuse of patient information related to this incident, we are notifying patients about what happened, what information was involved, what we have done to address the situation, and what patients can do to help protect their information,” RaeAnn Isaacson, UnityPoint’s privacy officer, said in a press release Monday.

The hackers also might have obtained some patients’ financial information, such as bank account numbers, UnityPoint said.

Agitated Patients in the ED Face Wide Range of Risks

From HealthLeaders:

Agitated patients are a small but challenging portion of emergency department visits, researchers at an urban Level 1 trauma center found.

The researchers, who published their study this month in Annals of Emergency Medicine, screened 43,838 ER patients and 1,146 (2.6%) were in an agitated state.

A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest

From the NEJM:


Concern about the use of epinephrine as a treatment for out-of-hospital cardiac arrest led the International Liaison Committee on Resuscitation to call for a placebo-controlled trial to determine whether the use of epinephrine is safe and effective in such patients.


In a randomized, double-blind trial involving 8014 patients with out-of-hospital cardiac arrest in the United Kingdom, paramedics at five National Health Service ambulance services administered either parenteral epinephrine (4015 patients) or saline placebo (3999 patients), along with standard care. The primary outcome was the rate of survival at 30 days. Secondary outcomes included the rate of survival until hospital discharge with a favorable neurologic outcome, as indicated by a score of 3 or less on the modified Rankin scale (which ranges from 0 [no symptoms] to 6 [death]).


At 30 days, 130 patients (3.2%) in the epinephrine group and 94 (2.4%) in the placebo group were alive (unadjusted odds ratio for survival, 1.39; 95% confidence interval [CI], 1.06 to 1.82; P=0.02). There was no evidence of a significant difference in the proportion of patients who survived until hospital discharge with a favorable neurologic outcome (87 of 4007 patients [2.2%] vs. 74 of 3994 patients [1.9%]; unadjusted odds ratio, 1.18; 95% CI, 0.86 to 1.61). At the time of hospital discharge, severe neurologic impairment (a score of 4 or 5 on the modified Rankin scale) had occurred in more of the survivors in the epinephrine group than in the placebo group (39 of 126 patients [31.0%] vs. 16 of 90 patients [17.8%]).


In adults with out-of-hospital cardiac arrest, the use of epinephrine resulted in a significantly higher rate of 30-day survival than the use of placebo, but there was no significant between-group difference in the rate of a favorable neurologic outcome because more survivors had severe neurologic impairment in the epinephrine group.

Epinephrine Can Save Lives in Cardiac Arrest Cases, But at a Heavy Price

From HealthDay:

An adrenaline shot can restart your heart if it suddenly stops beating, but a new trial shows that chances are you might not return to much of a life if you survive.

People who suffered cardiac arrest and were resuscitated with adrenaline had an almost doubled risk of severe brain damage, researchers found.

“We found adrenaline does not increase your chances of surviving without severe brain damage,” said lead researcher Dr. Gavin Perkins. He is a professor of critical care medicine at the University of Warwick Medical School in England. “In fact, of the survivors, twice as many have severe brain damage.”

The findings should prompt major medical societies to rethink guidelines for using adrenaline ( or “epinephrine”) to restart a stopped heart, Perkins said.

A quarter of adults with sprained ankles were prescribed opioids in the ER

From the Post:

A quarter of the adults who went to hospital emergency departments with sprained ankles were prescribed opioid painkillers, a new study shows, in another sign of how commonly physicians turn to narcotics even for minor injuries.

The state-by-state review revealed wide variation in the use of opioids for the sprains, from 40 percent in Arkansas to 2.8 percent in North Dakota. All but one of the nine states that recorded above-average opioid prescribing are in the South or Southwest. None are in the parts of Appalachia or New England that have been hit hardest by the opioid epidemic.

Research investigates why medical errors occur in emergency department

From News-Medical:

Researchers looked at patients who came back to emergency departments a second time within 72 hours and were admitted to the hospital on their second visit – an indicator that care could have been improved during the first visit. A trained team of physicians looked at each case to determine whether the team during the patient’s first visit might have made a mistake, and if one was found, determined the type of mistake that was made.

The most frequently identified type of error (45% of cases) was problems with information processing, followed by problems with verifying information that was gathered (31%). Inadequate knowledge problems (6%) and inadequate information gathering (18%) occurred relatively infrequently. Misjudging how significant a finding was and prematurely deciding on an incorrect diagnosis were the individual errors that occurred most frequently (13% each).

The study also found that patients with abdominal complaints may be particularly vulnerable to these errors.

Giving Plasma During Air Transport May Save Trauma Patients

From ReachMD:

Giving blood plasma to seriously injured patients en route by helicopter to the hospital can improve their chances of survival, a new study suggests.

The study, led by the University of Pittsburgh School of Medicine, included 500 trauma patients with severe bleeding.

“These results have the power to significantly alter trauma resuscitation, and their importance to the trauma community cannot be overstated,” co-lead study author Dr. Jason Sperry said in a university news release. He is a professor in the departments of surgery and critical care medicine.

Investigation Sought in Minneapolis Prehospital Ketamine Trials

From MedPage Today:

Following revelations last month about two controlled trials of ketamine for treating severe agitation — with drugs injected by first responders without the patients’ individual consent — the consumer group Public Citizen and dozens of independent physicians are calling for a federal investigation.

The Minneapolis Star Tribune newspaper published a series of stories in June detailing the trials, which were the first quasi-randomized studies comparing ketamine with traditional medications (i.e., haloperidol and midazolam) used to sedate agitated patients in emergency settings. The trials had been approved under a “waiver of consent” process, under which the investigators said risks were minimal; they also consulted beforehand with community groups, including patients in a homeless shelter under treatment for substance abuse.

Rural America needs help solving its growing obesity crisis

From Quartz:

People living in rural America are more likely to suffer from obesity than those living in and near cities. And while there are a number of reasons for this, public health experts in the world’s largest economy say there aren’t enough programs being deployed to help people overcome the problem.

The finding, presented in a pair of newly published studies carried out by researchers at the US Centers for Disease Control and Prevention, raises more questions than it does offer answers. To be sure, these are not the first studies to identify a disparity in obesity rates between people living in cities with more than a million people and more sparsely populated rural areas. They add to a growing body of evidence showing as much, increasing pressure on the public health community to figure out why the disparity exists and how to best go about solving the problem.

Chart: https://www.theatlas.com/charts/H1RvslO-7