"Anesthetic jab treats headache in the ER"

From CNN.com

NEW YORK (Reuters) -- For patients suffering severe headaches who seek help in hospital emergency rooms, the painkiller bupivacaine injected into the muscles at the base of the neck provides safe and effective headache relief.

These are the findings of a look back at all 417 headache patients, 18 years of age or older, who received this treatment over a one-year period at a single emergency department.

Complete headache relief occurred in 65 percent and partial headache occurred in 20 percent of patients. Roughly 14 percent reported no significant headache relief and 1 percent reported a worsening of headache pain.

Overall, bupivacaine injections yielded a therapeutic response in 356 of 417 patients (85.4 percent), report Dr. Larry B. Mellick of the Medical College of Georgia in Augusta and colleagues in the journal Headache.

"Headache relief was typically rapid with many patients reporting complete headache relief in 5 to 10 minutes," the authors note. Headache relief was often accompanied by resolution of associated signs and symptoms such as nausea, vomiting, and sensitivity to sound and light.

Mellick and colleagues note that headache is a "common chief complaint" of patients who present to the emergency department. Many come to the ED as a last resort after other interventions have failed to provide headache relief.

The authors say that, based on their experience, bupivacaine injection "appears to be a safe and effective therapeutic intervention for the treatment of headache pain caused by a spectrum of etiologies" that arrive in the emergency room.

Hospital charged in alleged patient dumping on Skid Row

From CNN:

In an unprecedented crackdown on a practice experts say is shamefully common around the country, a major hospital chain was accused by prosecutors Thursday of ridding itself of a homeless patient by dumping her on crime-plagued Skid Row.

A surveillance camera at a rescue mission recorded the demented 63-year-old woman wandering around the streets in a hospital gown and slippers last March.

In announcing the criminal and civil charges, City Attorney Rocky Delgadillo said a Kaiser Permanente hospital put the woman in a taxi and sent her to the neighborhood even though she had serious, untreated health problems.

"Kaiser Foundation Hospitals, part of Kaiser Permanente, the largest HMO in the nation, will be held accountable for violating state law, its commitment to its patients, its obligations under the Hippocratic oath, and perhaps most importantly, principles of common decency," Delgadillo said.

No U.S. hospital has ever been prosecuted on criminal charges of patient dumping, said President Bush's homelessness czar, Philip F. Mangano.

Kaiser's Bellflower hospital, which discharged the woman, is among 10 Los Angeles-area hospitals under investigation on suspicion of discharging homeless patients onto the streets instead of into the custody of a relative or shelter

EM on NPR

From NPR Morning Edition November 14, 2006
U.S. Emergency Medicine Fails Patients by Arthur Kellerman

The American emergency care system is overloaded, overcrowded and unable to keep up with the needs of its patients. The author is a professor of emergency medicine.

See-Thru CPR from Zoll

From Medgadget:

Medgadget tipster Mark L. brings to our attention a new defibrillator from Zoll, featuring See-Thru CPR™, "software filter to get rid CPR artifact as it is being done."

Here's how the company explains its technology:

More than half of in-hospital codes involve non-shockable rhythms. In such cases, the only treatment for such rhythms is high-quality CPR, with minimal interruptions. The R Series offers See-Thru CPR™ functionality that helps clinicians minimize interruptions in CPR performance. While viewing the ECG on a monitor/defibrillator, artifact (i.e., "noise") from chest compressions make it difficult to discern the presence of an organized heart rhythm unless compressions are halted. See-Thru CPR filters out this artifact so clinicians can view an underlying rhythm without stopping chest compressions.
In addition to See-Thru CPR, the R Series offers a visual aid known as the CPR Index™ that allows clinicians to see how well they are performing the rate and depth of chest compressions in real time. This Index, along with audible prompts (i.e., "Push Harder" and "Good Compressions"), helps clinicians improve CPR performance by integrating rate and depth into a single indicator on an easy-to-read display. With this feedback, clinicians know how well they are performing compressions and can quickly adjust their compressions to improve blood flow.

Additionally, all CPR performance data and the entire resuscitation record, including the ECG , can be downloaded into ZOLL CodeNet® and reviewed for quality assurance and training purposes. CodeNet is the first system to help document, review, and manage a complete set of data for in-hospital resuscitation events, including both code event data and defibrillator data, on one synchronized timeline.

The R Series extends testing beyond shock delivery and checks more than 40 measures of readiness, including the presence of the correct cables and electrodes, the type of electrode, and other important electronics. The R Series can also verify the condition and expiration date of the electrode set. All of this testing occurs without disconnecting electrodes or paddles, or requiring additional equipment to test shock delivery.

Handheld Lasers in the ED

From Medgadget:

Apparently, using a handheld laser over the planned IV site will ablate the topmost layer of skin, allowing transdermal anesthetics to seep though. Patients reported less pain in this randomized controlled trial (the patients and researchers were also blinded, though it's not clear whether it was by design protocol, or from the power of the lasers).

Red Cross, Back Blows 2

From redcross.org (page 10)

Back Blows and Abdominal Thrusts
The responder should take a position slightly behind the victim. Provide support by placing one arm diagonally across the chest and lean the person forward.

The responder should firmly strike the person between the shoulder blades with the heel of the other hand five times. If the back blows do not dislodge the object, give five abdominal thrusts.
Continue to give sets of five back blows and five abdominal thrusts until the object is dislodged and the person can cough forcefully speak or breathe, or until the person becomes unconscious.

Red Cross: Add Back Blows to Heimlech?

From the Columbus Dispatch, via GruntDoc:

For decades, a hunk of pork chop stuck in your throat meant one thing: the Heimlich maneuver, a technique made famous in posters and first-aid classes.

It calls for a rescuer to wrap arms around the victim’s waist, make a fist below the rib cage and above the navel, grab the fist with the other hand and press the abdomen with quick upward thrusts until whatever is obstructing the airway is expelled.

But the American Red Cross now calls first for back slaps, a method the Heimlich maneuver’s namesake rejects as dangerous and deadly.

Dr. Henry Heimlich, 86, lives in Cincinnati.

Rescuers should start with five back blows and follow with five abdominal thrusts (the Heimlich maneuver), repeating the sequence, advises the Red Cross, which no longer uses the name Heimlich.

SIDS Research

From ScienceNow, via Medgadget:

Babies with SIDS suffocate while asleep, usually when they lie face-down and breathe in too much carbon dioxide. Normal infants would survive by reflexively gasping for air, but something about SIDS victims prevents them from doing this. That's why SIDS researchers have been focusing on serotonin, a chemical messenger in the brain that controls breathing and gasping. Autopsies have shown that SIDS babies have less serotonin bound to their serotonin receptors than did babies who died of other causes, but the exact nature of the serotonin problem in SIDS remained unclear.

To find out more, neuropathologist Hannah Kinney of Harvard Medical School in Boston and her colleagues autopsied the brains of 31 SIDS children. They found a lower concentration of a kind of serotonin receptor that specifically controls respiration (other serotonin receptors control sleep, anxiety, and a variety of other functions). The researchers also found nearly twice as many cells that make serotonin in the brain stem as in controls. That made sense: Studies with other chemical messengers often find a higher amount of the messenger can lower the number of its receptors. Furthermore, SIDS boys appeared to have less serotonin bound to serotonin receptors than did the SIDS girls, the team reports today in the Journal of the American Medical Association.

Study: ER docs do better with naps

From UPI:

STANFORD, Calif., Oct. 31 (UPI) -- Give emergency room doctors a nap, and they will do a better job and be nicer to you, according to a new U.S. study.

Emergency room physicians who were allowed a 40-minute nap showed an improved mood, a higher alertness level and the ability to complete a simulated I.V. insertion more quickly than their sleepier colleagues, Stanford researchers found in a study published in the November issue of Annals of Emergency Medicine.

"Napping is a very powerful, very inexpensive way of improving our work," said one of the study's authors, Steven Howard, associate professor of anesthesia and expert on sleep deprivation and fatigue.

To determine just how much a nap would help alleviate sleep deprivation, researchers recruited 49 subjects -- 24 nurses and 25 doctors -- who worked through the night from 7:30 p.m. to 7:30 a.m. in the emergency room at Stanford Hospital. They divided the subjects into two groups. One group worked straight through the night as usual, while the other subjects were allotted a nap break at 3 a.m. in the middle of their shift.

At the end of the shift, the subjects were given a series of tests of alertness. The nap-free emergency room workers showed signs of extreme fatigue such as eyelid drooping, and an inability to complete a driving simulation without crashing.

Emergency department visits continue to rise, AHA annual survey finds

From AHA News:

Hospitals treated more than 114 million patients in the emergency department in 2005, while inpatient visits remained constant at 35.2 million, according to the AHA's Annual Survey of Hospitals. ED visits have increased by about one-third since 1990 while the number of EDs has declined, increasing pressure on EDs that remain open. Worker shortages, challenges securing on-call coverage by specialty physicians, reduced behavioral health resources and ambulance diversions also posed challenges to hospital EDs. According to the survey, the financial state of hospitals remains fragile, with one-third of hospitals operating with negative margins. Medicare reimbursed 92 cents for every dollar hospitals spent caring for Medicare patients, while Medicaid reimbursement again dropped in 2005 to 87 cents on the dollar.

AHA President Dick Davidson said: "These are the numbers behind the reality that the women and men in America's hospitals face every day. Despite these many challenges, they manage to deliver the crucial services their communities need. The AHA and its ember hospitals are committed to working with legislators and others to solve emergency room overcrowding, workforce shortages, Medicare and Medicaid reimbursement shortfalls and the many other issues that stand in the way of a better health care system." The survey data can be found in AHA Hospital Statistics - 2007.