LidoPen

Part of a longer Medgadget post about a pocket 1-lead EKG:

LidoPen® auto-injector to self-administer lidocaine while the ambulance is en route. The LidoPen® can be crucial for saving a subscriber's life in cases where a severe arrhythmia is diagnosed by Monitor Center staff. LidoPen® is an automatic, patient-administered syringe containing a single 300-mg. dose of Lidocaine. Lidocaine provides immediate, reliable treatment to patients suffering from ventricular tachycardia until professional help arrives.

LidoPen® is designed to be used as part of a comprehensive remote cardiac monitoring and diagnostic service. The patient activates the Lidocaine self-injector only upon direct instructions from a physician at the monitor center, following definite diagnosis of ventricular tachycardia.

The patient transmits an ECG reading over the phone from a patient-level portable ECG transmitter, such as Shl's CardioBeeper® CB-12/12. A trained medical staff uses the ECG waveform together with the patient's self-described symptoms to reach a remote diagnosis in real-time.

Pre-Register for the ER

From Medgadet:

Einstein Helps You Pre-Register for the ER

Oh boy, who wouldn't love this idea? Security issues aside, how great would it be to be able to waltz into your local emergency room, flash some plastic and bypass the paperwork.

Faster emergency room care for you and your family. Imagine visiting an Emergency Room where they already know you! Your name, primary care physician, even insurance information is there ahead of time. That's the idea behind ER pre-registration at Einstein at Elkins Park.

Pre-register today. Less paperwork and delays.When you pre-register, your critical health information is logged in before you ever visit the ER, so you save time in an actual emergency. If you ever need to visit the emergency room, you'll avoid delays and tedious paperwork.

To pre-register, complete the online form or call 1-800-EINSTEIN today to set up an account. All of your information will be kept strictly confidential.

After you pre-register:We will send ID tags for you and each family member you pre-register. You should receive your ID tags within two weeks. We recommend that you keep them in a safe place, such as your wallet or on your key chain.

Should you ever need to visit the emergency department at Einstein at Elkins Park, simply present your ID tags. We'll swipe your tags and verify your information and you'll avoid paperwork and delays.

Einstein . . .

Robust Aussie Ambulance

From EMSResponder, as reported in Medgadget:

Tank-like Rescue Vehicles that Cut Through Concrete: Australian for Ambulance

In most countries/continents, a person might be satisfied with an ambulance that drove you from point A to point B. But In Australia, you have to be prepared for anything. EMSResponder has a report on the recent arrival of six state-of-the-art ambulances in the Camden area:

The new vehicles' lifesaving features include hydraulic struts to stabalise cars that have rolled onto their roof or side or to stabalise collapsed buildings and confined space rescue equipment.
Other features include concrete cutting tools, swift water rescue equipment, a remote controlled roof mounted lighting mast, and four external cameras to alleviate driver blind spots.

The only things missing seem to be mounted assault rifles and a George Foreman Grill.

Thearpeutic Hypothermia CME

Therapeutic Hypothermia Podcast Available

A clinical article about therapeutic hypothermia, part of the popular "Focus On" series from ACEP News, is now available online, both as a written article and an audio MP3 file. Read or listen to the article and then take the quiz to earn one hour of CME credit.

New Study Disputes Value of an Antibiotic Standard as a Quality Measure

An American College of Emergency Physicians (ACEP) press release:

Washington, DC- A requirement set in 2004 that emergency physicians administer antibiotics within 4 hours to adult patients admitted with pneumonia may not only be unfeasible, but may inadvertently overmedicate some patients and contribute to growing antibiotic resistance.

Two articles appearing online this week in Annals of Emergency Medicine raise doubts about the value of a Centers for Medicare and Medicaid Services (CMS) and The Joint Commission quality measure requiring emergency physicians to administer antibiotics within 4 hours to any patient with symptoms of pneumonia ("Identification of Ninety Percent of Patients Ultimately Diagnosed with Community-Acquired Pneumonia Within Four Hours of Emergency Department Arrival May Not Be Feasible," and "Measuring Antibiotic Timing for Pneumonia in the Emergency Department: Another Nail in the Coffin").

"There is growing concern that to achieve an arbitrarily established performance standard on the antibiotic timing measure, as set by The Joint Commission and CMS, unnecessary antibiotics will be administered to patients who do not actually have pneumonia," said Christopher Fee, MD, of the Department of Emergency Medicine at the University of California, San Francisco Medical Center. "This may needlessly expose patients to additional side effects, and could be a contributing factor to growing antibiotic resistance in the population at large."

Dr. Fee's study, conducted from January 1 through December 31, 2005, assessed a sample group of 152 emergency patients meeting The Joint Commission's and CMS's eligibility criteria. Of those patients, 99 (65.1 percent) received antibiotics within 4 hours of arriving at the emergency department. Of those patients who did not receive antibiotics within 4 hours of arrival ("outliers"), more than half (58.5 percent) did not have a final diagnosis of pneumonia. Among the outliers, only 43 percent had an abnormal chest X-ray compared with 95 percent of those who received antibiotics within 4 hours.

"It may be that, despite our best efforts, patients who get late antibiotics just take longer to diagnose because of atypical clinical presentations," said Jesse M. Pines, MD, of the Department of Emergency Medicine at the Hospital of the University of Pennsylvania, whose supporting commentary appears alongside Dr. Fee's study. "This study reflects the real-life challenge of diagnosing pneumonia in the emergency department. Most emergency patients do not come in the door with a sign on their foreheads that reads, 'I have pneumonia, give me antibiotics now!'"

Delays in administering antibiotics within 4 hours were attributed to a variety of factors, including emergency physicians' consideration of diagnoses other than pneumonia and the ongoing difficulties of providing emergency care in a timely fashion due to routinely overcrowded emergency departments. The study recommends that The Joint Commission and CMS establish more attainable goals or change the quality measure definition to include only those patients for whom objective clinical, laboratory and radiographic evidence is available during the emergency department stay, and the emergency physician includes pneumonia in the final emergency department diagnosis.

"The Joint Commission and CMS need to carefully test in a real clinical setting whether full compliance is feasible and set reasonable expectations for performance," said Dr. Pines. "Without consideration of these important factors, government quality measures will continue to serve as both folly and woe to health care providers, administrators and patients caught in the fray."

Compression Only CPR?

From CNN.com

(AP) -- Chest compression -- not mouth-to-mouth resuscitation -- seems to be the key in helping someone recover from cardiac arrest, according to new research that further bolsters advice from heart experts.

A study in Japan showed that people were more likely to recover without brain damage if rescuers focused on chest compressions rather than rescue breaths, and some experts advised dropping the mouth-to-mouth part of CPR altogether. The study was published in Friday's issue of the medical journal The Lancet.

Baby Simulator

From MedGadget:

BBC News is reporting that a computer-controlled simulator is now being used by trainee nurses at the Chatham campus of Canterbury Christ Church University. SimBaby infant simulator is a product of Laerdal Medical, a Orpington, Kent company.

Here's what the company says about the sim:

SimBaby is the portable advanced infant patient simulator for team training. SimBaby has realistic anatomy and clinical functionality that enables simulation training. SimBaby includes software with video debriefing and an interactive technologically advanced manikin allowing learners to practice the emergency treatment of infant patients.

Product features:
· Full scale infant patient simulator which allows the learner to perform relevant pediatric emergency skills and scenarios.
· Interactive manikin which gives you immediate feedback to interventions.
· Simulator utilises software generating automatic debriefing based on the event log synchronized with video pictures, which provides immediate, detailed feedback on performance to learners.
· Realistic airway system allows accurate simulation of all relevant difficult infant airway management and patient care scenarios.
· Realistic infant breathing patterns and complications bring realism to the infant simulation experience.
· IV training arm and IV/IO legs allows practise of peripheral intravenous and intraosseus therapy.

Product page...
Product brochure (.pdf)...

EMTALA Bill

From GruntDoc:

Many thanks to Aggravated Doc Surg for bringing this to my attention. I thought I was the only one with this idea, but clearly I’m not:

To my surprise, Congresswoman Mary Bono (the late Sonny’s wife) recently introduced a bill that would alter IRS rules to allow physicians to at least partially offset the cost of providing uncompensated emergency care mandated by EMTALA.

And goes on to quote parts of the bill (.pdf).

There are things to quibble about in this first draft; none are deal-breakers, but they should be modified to some degree. First is the “Board Certification” requirement: unless this is required by HCFA, it should be ‘credentialled provider in the Emergency Department’, and we can all avoid a food fight about Board Certification that serves only divisiveness.

Second, while basing any tax allowance on the Medicare fee schedule is a good place to start, I’m not sure we should aim that low. Every ED has a payor mix that’s at least somewhat above the medicare allowable; I’d prefer a calculation that takes that into account, so we’re not taking a tax allowance at 50 cents on the dollar, rather than a higher number that’s usual in most ED’s. (I know it’s not dollar for dollar, but it’s higher than the medicare allowable rate).

Congresswoman Bono is to be congratulated for at least introducing this legislation. I hope our EM professional societies see fit to support it as possible: the American College of Surgeons is already onboard.

Do You Know Where Your AED is At?

From MedGadget:

Richard Lazar, the inventor of the ResQPod Circulatory Enhancer for CPR, is continuing his efforts to improve the survival of cardiac arrest patients. Through his company, Atrus Inc., he is beginning to market new software that will help first responders to locate nearby AED's (Automated External Defibrillator).

When bystanders perform immediate CPR, it buys time until an AED can be retrieved to shock a heart back to a normal beat.

Though AEDs are more common in public places, they are often not used in an emergency. "People are dying in places where an AED existed, but it was not used," says Richard Lazar, a lawyer who specializes in AED legislation and is a member of the Take Heart America team.Austin has taken steps to fix the problem. When an Austin 911 dispatcher types in "cardiac arrest," an alert pops up on the computer screen if an AED has been registered at that address.
But if the cardiac arrest occurs next door or across the street, nobody knows an AED is nearby. For example, if a person collapses in a bank that does not have an AED but a defibrillator sits idle at the Starbucks next door, "that AED is invisible," Lazar says.

Lazar has developed a system sold through his company, Atrus Inc., that tracks AEDs and shows dispatchers where they are on a map. He estimates Austin now uses AEDs in public places to treat cardiac-arrest victims two to 10 times a year. If the city uses his system showing 911 dispatchers how close an AED might be to a person in cardiac arrest, he predicts, the city could use the same number of AEDs 89 times a year.