Rule for Termination of Resuscitation in Out-of-Hospital

The rule had a specificity of 90.2 percent for recommending transport of survivors to the emergency department and had a positive predictive value for death of 99.5 percent when termination was recommended. Implementation of this rule would result in a decrease in the rate of transportation from 100 percent of patients to 37.4 percent. The addition of other criteria (a response interval greater than eight minutes or a cardiac arrest not witnessed by a bystander) would further improve both the specificity and positive predictive value of the rule but would result in the transportation of a larger proportion of patients.

Conclusions
The use of a clinical prediction rule for the termination of resuscitation may help clinicians decide whether to terminate basic life support resuscitative efforts in patients having an out-of-hospital cardiac arrest.

The New England Journal of Medicine
Copyright © 2006 Massachusetts Medical Society. All rights reserved.

(click on the title to view the whole article)

Venipuncture

'A Little Sting' Can Become a Debilitating Injury

By ANN JAPENGA

Two things stood out on the day of the blood draw: the streets were flooded from a three-day downpour (not common in my desert town), and the needle hurt a lot more than usual. Like most of us, I'd been stuck dozens of times in my life without protest, but this time I glared at the offending instrument and said to the technician: "Ow, ow, ow! Are you using a really big needle?"

The phlebotomist assured me everything was fine: "Maybe a little alcohol got in there and made it sting." I drove home through the cloudburst and, a few hours later, peeled off the pressure bandage on my arm. Blood was still oozing from the puncture site. I put on a fresh Band-Aid and didn't think anything of it. It was only a blood draw.

In the following days my right arm throbbed as if it had been tenderized with a baseball bat. I held a pen clumsily, and my notes took on a drunken cast. I didn't know it at the time, but my penmanship was destined to get much worse. Over the next months the pain eased if I rested my arm, but it always came back: an aching in the inner elbow, numbness in my little finger and a sensation of cold in my hand. Eventually I had to give up swimming laps, and I could type and drive only in sprints. I made forays to doctors to find out what was wrong ” with inconclusive results” all the while thinking this was a temporary injury and it had to get better. But a year later I couldn't address an envelope without pain and needed help cutting a waffle. The most common and most seemingly harmless invasive procedure in medicine is not always harmless, I had discovered. There are no studies showing how often patients are hurt during routine blood draws, but a 1996 study of blood donors (a larger needle is used in blood donation than in routine venipuncture) found that 1 in 6,300 donors suffered a nerve injury.

Phlebotomy-related injuries have become common enough in recent years that there are now specialists who make a living teaching health care providers how to avoid lawsuits provoked by the procedure. (A lawsuit I filed as a result of my own injury was eventually resolved.)Dennis Ernst, director of the Center for Phlebotomy Education, says the risks of the procedure include nerve injuries and chronic pain syndromes that can render you disabled for life. He likes to warn patients that some technicians have only a weekend of training, practicing on a dummy arm on Saturday and sticking your vein on Monday. California, where I live, is the only state where phlebotomists must be licensed (although not the case at the time of my blood draw three years ago). But even then things can go wrong. After all, we're talking about hard steel entering soft flesh in an area of the body ”the inner arm” rich in nerves and arteries. If something does go wrong, patients have an added problem: very few health care providers have ever heard of phlebotomy injuries.I eventually found an arm surgeon, Dr. Trevor Lynch at the Southern California Orthopedic Institute, who was able to explain my pain: the needle had gone through my vein and caused dangerous but invisible bleeding into my arm. (Another common injury is caused by a direct hit to a nerve, producing an electric shock feeling in your arm or hand.) Dr. Lynch recommended surgery to prevent permanent loss of the use of my arm, as well as a condition called "claw hand" that causes your digits to curl up like a sea anemone. Seeing that my little finger was already starting its inward curl, I made the appointment. After surgery to repair damage to my ulnar nerve, tendon and bone, I was hooked up to two pain pumps and lived for months on a diet of pain pills and patches. Reduced to taking notes and eating with my clumsy left hand, I routinely watched in childish frustration as food dribbled off my fork. Today, I'm back to swimming laps, but my elbow aches if I type for too long or curry the dog with vigor. I've become an evangelist on the potential dangers of phlebotomy, rolling up my sleeve at every opportunity to display my six-inch scar and telling people to take unusual pain or prolonged bleeding at the time of a blood draw seriously.

If you think you've been injured, the first rule is to have the technician remove the needle immediately. Then seek help relentlessly. As Dr. Ernst says, "If a person acts quickly and goes to the right doctor ” a lot of ifs here” you can limit the damage."

Pediatric Emergency Myths and Misnomer

Myth:

It’s in the family and team’s best interest to have family members removed from an active resuscitation.

All respiratory distress needs a CXR.

All that wheezes needs steroids.

Narcotics are the ultimate pain killers.

Sterile saline is the only way to remove bacterial contamination of wounds.

Dr. Shauna Jain
http://meetings.acep.org/NR/rdonlyres/45C255A0-76F8-46BD-A76A-B31B84BD3A7C/0/TH63Final.pdf

Workout Tips to Help You Spring into Shape

No Pain, No Gain? Think Again!

I have a number of patients who are "weekend warriors"-people who don't exercise much during the week but go to the extreme on weekends. They'll engage in vigorous physical activities like mountain biking or high-impact aerobics-and then usually end up in my office with an injury. There is nothing wrong with these intense athletic activities, but when they are done infrequently, they often lead to injuries.

To reap the benefits of exercise, it isn't necessary to work out to the extreme or get your heart pumping to its maximum. On the contrary, many studies show that regular, moderate exercise does more for your health and waistline than periodic intense workouts.

I have found that many people exercise too frequently and too intensely - and consequently suffer from lactic acidosis - a state in which your body is full of the waste products of excessive muscle use, causing fatigue and aching in your muscles.

Also keep in mind, when exercising beyond a healthy level of heart rate, your body switches from burning fat to burning carbohydrates for energy. The old maxim of "no pain, no gain" is destructive, and the wear and tear of physical strain takes its toll.

http://health.yahoo.com/experts/drmao/13234/workout-tips-to-help-you-spring-into-shape/

"Cough CPR"

There are so many e-mails being forwarded or circulated and for sure you encountered this one too. Read on...

"How to survive a heart attack when alone"

Since many people are alone when they suffer a heart attack, this article seemed in order. Without help the person whose heart stops beating properly and who begins to feel faint, has only about 10 seconds left before losing consciousness. However, these victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and a cough must be repeated about every 2 seconds without let up until help arrives, or until the heart felt to be beating normally again. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating.

The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a phone and, between breaths, call for help.

http://www.snopes.com/medical/homecure/coughcpr.asp

Visine causes diarrhea?

It has been portrayed in a movie that it causes diarrhea when taken internally or if swallowed. It's undeniable that it can cause bad effects to humans such as nausea, vomiting, blurry vision, blood pressure problems, difficulty of breathing, etc but it hasn't proven yet or had a documented evidence that it will cause diarrhea.

"One thing tetrahydrozoline has not been known to do is to cause sudden onset bouts of severe diarrhea... there's no documented evidence the product would have that effect... yet if Visine doesn't cause diarrhea, it has done things far more terrible..." a scrip from urban legends.. see the link below for details...

http://www.snopes.com/medical/myths/visine.asp

Michael Israel (The Story Behind the video)

HERO explores commitment to an ideal. It asks the question: What endeavor would you undertake knowing full well that the odds are you will fail? What would you give your all to knowing it’s likely you will be severely injured or even die trying? What is the greatest possible reward and in that thought, what is the most valuable and priceless thing on earth?

Paul and Chrissie are a young couple, in their twenties, and have started a new family. Story as told by Chrissie

I’ll never forget that day. My husband Paul didn’t even eat breakfast, he was excited and wanted to get to the fire station early. It was his first week on the job. And there at the door, he stood he stood waiting for a hug from Jessie our adorable 3 year old. When Paul told that her he loved her, Jessie’s face lit up with a big smile and in her tiny voice she said “Daddy, will you play with me when you get home?”

Paul smiled and said “Of course.”

I hated that we both had to work, but I was glad that Jessie could go to Gail’s apartment to play her daughter Jen. When we got there Jessie and Jen started playing with dolls right away. And then on my way out the door I heard Jessie tell Jen that her daddy is a fireman. She sounded so proud. I left feeling happy and proud of both Jessie and Paul.

I didn’t know that that day would change my life forever.

They tell me that Jessie got up to go to the bathroom. Right after she closed the door there was huge explosion, the entire building shook. Gail said the apartment filled with smoke. Without even thinking Gail grabbed Jen and ran out.

Frantically she found the fire chief and told him that there was another little girl trapped in her apartment. But, the chief told her there was no way he could send anyone into that collapsing old building.

Then Gail heard Paul’s voice on the radio saying he was on the second floor. The chief told Paul to get out… that he had a family to think about, but Paul’s voice came back on the radio and said that he wouldn’t leave until he knew everyone was safe.

He said he heard there was a little girl trapped in one of the apartments. Little did he know…

The chief was yelling at him: “Are you insane, GET OUT OF THERE before the building collapses”, but Paul refused.

When I got there I didn’t see Jessie and just went crazy. I was going to go in there and get her myself. The chief had to grab me to stop me.

When he realized who I was he told me Paul was already in there. But when I asked him if they were OK, he just looked at me.

Then I heard Paul’s voice on the radio. It was broken up, but I heard him say it was really bad. He said he was going to try to get the child and make it to a window. He told the chief “You’d better call my wife. Tell Chrissie I love her and tell her to take good care of Jessie, and…” The radio went dead.

I screamed! All I could do was scream. “Paul, its Jessie! IT’S JESSIE! God, he doesn’t know!”

In my heart, I imagined he found her… That he hugged her and at least for a moment everything was OK.

There was another huge explosion, the ground shook more violently than ever and fire blew out the windows. I just fell to my knees. “Noooooo!”

The chief tied to tell me what a hero Paul was and that he went in there with good reason that day. I felt like someone had just punched me in the stomach. I was shaking, delirious about what had just happened. I started thinking “Oh my God, my life is over. Did I say the right things, did I do the right things? Did I tell them I love them?”

And then all of a sudden there they were jumping out of the fourth floor window. It was like a dream. There was Paul hanging on to Jessie with her arms wrapped around his neck.

Paul stood still holding Jessie, his head bowed in a silent pray of thanks. Jessie was hugging him, her head turned back with tear filled eyes watching as the rest of the building collapsed.

She said “Mommy, I wasn’t scared. I knew Daddy would come.

He’s my hero, isn’t he?”