Articles Posted in Emergency Medicine

suicide-300x154Moms, dads, grandparents, teachers, and coaches all may need to increase even more the attention and concern they devote to teen-agers, especially young women, as hospitals and emergency rooms report dramatic increases in their treatment of youthful suicides.

Multiple news organizations reported that, as the New York Times noted, “the proportion of emergency room and hospital encounters for …  suicide-related diagnoses almost tripled, from 0.66 percent in 2008 to 1.82 percent in 2015. And the rate of increase was highest among adolescent girls.”

NPR reported: “Children ages 5 to 17 visited children’s hospitals for suicidal thoughts or attempts about twice as often in 2015 as in 2008.”

odmapapp-150x300Ss the nation’s opioid crisis spirals into ever-more risky territory where synthetic painkillers get mixed with illegal drugs with fatal results, reporters are digging deeper into how drug companies got the country into this mess and cities now are stepping up with different approaches to curb deadly overdoses.

Vox, an online news and information site, reported that experts aren’t sure why, but they’re seeing an ugly trend in users and dealers mixing fentanyl, a synthetic opioid and sometimes legally prescribed painkiller, and other illicit narcotics, notably cocaine and heroin.

Vox reporter German Lopez, in interviews with drug experts, finds they are divided: Some think the deadly mixtures are occurring on purpose, with users seeking even greater intoxication or dealers promoting this to them. It may be that the mixtures are occurring unintentionally, as fentanyl, even in the tiniest amount as a residue, packs a wallop. Or it may be that authorities, as they try to get a better handle on the opioid crisis, have developed sharper data on drug abuses.

emergency-services_overviewResidents of the nation’s capital will participate in a public health test every time they pick up the phone to dial 911 for help. How their calls get answered says a lot about common sense, as well as the availability and affordability of medical services in Washington and the nation.

National Public Radio reported that a bunch of new faces now will join dispatchers in DC’s already hectic and often overloaded 911 center. They will be registered nurses specializing in urgent triage. And when 911 callers want what they claim is emergency medical help, dispatchers will hook in the nurses who will try to determine what kind of fast assistance might be appropriate.

This might raise hackles: Why can’t 911 dispatchers just get on with it and send ambulances with lights flashing whenever a caller reports an “emergency”? Here’s the problem, as NPR reported:

walmartclinic-300x209Americans are showing with their feet and their money how they feel about doctors’ offices and  shiny hospitals, places they’re shunning more and more. They’re racing to neighborhood clinics and urgent care centers that seem to be popping up on every suburban street corner and shopping mall.

Before these facilities transform U.S. health care, would it be worth asking what this trend might mean, not just for profit-seeking retailers, drug store chains, and, yes, also hospitals and doctors who are shifting into new lines of business?

The New York Times found that:

mom-300x171Big Medicine can paper over its troubles with basic fairness by slapping fancy terms on them: take “health and gender disparities,” for instance. But doctors, hospitals, and the rest of us can’t make medical care more equitable, accessible, safe, and affordable without looking at inequities, square on.

That’s why the New York Times, Washington Post, and Associated Press deserve credit for recent deep digs into the struggles of women, poor women, and especially black women with modern medicine:

FAST-infographic-2016-300x169It’s no April Fool joke: Emergency doctors across the country, according to the New York Times, have been defying widely accepted standards of care and withholding a drug that rigorous clinical trials and medical specialists long have recommended for stroke victims.

Administration of the drug, tPA or tissue plasminogen activator, helps to prevent brain injury after a stroke by dissolving the blood clot and opening up the blocked vessel. Neurologists and neurosurgeons as well as cardiologists, have campaigned for its aggressive use within hours after the onset of symptoms.  Indeed, hospitals nationwide have adopted speedy stroke care, including with tPA, under slogans like “Time is Brain.”

The drug’s fast use has become so accepted, the capacity to administer it is a keystone for hospitals to receive a much-sought designation as specialized stroke treatment centers. And though it has long been thought that tPA needed to be given within three or four hours from the start of stroke symptoms, new research funded by the National Institute of Neurological Disorders and Stroke has opened the strong possibility that many more patients could benefit from tPA and neurosurgery within 16 or even 24 hours after suffering a stroke.

medpricehikes-210x300With Americans spending more than $3 trillion annually on health care, the corrosive and crazy effects of all that big money can become almost common place. Even still, hospitals, doctors, and Big Pharma still manage to come up with plenty of, Aw, really, c’mon kinds of financial situations.

Recent news reports, for example, have focused on such dubious dollars and cents concerns like: bedside loans, disparities (price gouging) in cancer care, and, of course, skimpy health insurance plans.

Caveat emptor? Not already infuriated by some recent visual depictions of the upside-down state of costs in the U.S. health care system (see figures*) Read on:

stroke2-300x169Although medicine has made advances in treating strokes, more than 795,000 Americans suffer them annually, they kill 140,000 of us each year, and they’re a leading cause of disability. But medical experts, revising their care guidelines, say that patients with the most common kind of stroke —  a clot blocking blood flow to the brain — may be better treated in an expanded window of still urgent time.

This higher but still guarded optimism does not apply to all stroke cases and not to all ischemic strokes (the kind that come from blood vessel blockages). Doctors have known for awhile now that it is vital to bust the damaging clot — and they had thought their time to do so with drugs like tPA and surgeries was constrained to six or so hours. This led specialists to their axiom, “Time is brain,” and to crash responses.

But for many patients, the tight treatment time frame was unhelpful. They might not be discovered quickly after suffering a stroke and being incapacitated. They might have had their stroke while sleeping, and doctors had decided the timing of their care based on when they could last recall being well — often putting them outside the six-hour limit. Some patients also live far from hospitals that could provide clot-busting drugs, or, even more key, surgeries to implant stents or a thrombectomy, a procedure in which doctors use a small tool to grab the clot and remove it.

dui-300x150Politicians and policy-makers can’t ignore the rising number of vehicular deaths, and they must crack down fast and hard on the increasing road toll associated with alcohol abuse.

At the request of the National Highway Traffic Safety Administration, a blue-ribbon expert group has examined not only the overall increase in road deaths — to 37,461 in 2016, a 5.6 percent rise over the year previous. The panel from the National Academies of Sciences, Engineering, and Medicine also focused on the 10,000 deaths per year attributed to alcohol impairment. The experts called these road fatalities, which are increasing in number, “entirely preventable,” and recommended tough ways to reduce booze-related deaths.

They have recommended that a new national sobriety standard should be put in place, the Associated Press reported, reducing motorists’ allowable blood-alcohol concentration “from 0.08 to 0.05. All states have 0.08 thresholds. A Utah law passed last year that lowers the state’s threshold to 0.05 doesn’t go into effect until Dec. 30.”

intermountain-300x300Some big hospitals and  hospital chains are on the brink of expanding into another aspect of health care. Let’s give them a rare cheer, because they’re taking on Big Pharma and its skyrocketing drug prices and too frequent supply shortages.

Intermountain Healthcare, a nonprofit hospital chain based in Salt Lake City, is leading a well-publicized charge to get its peers nationwide to become part of a new nonprofit group that will make drug generics, products whose patent  protections have lapsed and, thus, are supposed to be cheaper and easier to get because buyers aren’t paying makers for brand names.

Unfortunately for hospitals and patients, Big Pharma sharks have bought up smaller companies that may be the sole makers of these off-patent drugs, which the new investors then jack up in price to reap profits that have outraged the public. Members of Congress expressed their fury in public hearings with Martin Shkreli, the former hedge fund manager and smirking so-called “Pharma Bro,” when he employed this tactic and pumped up the price of a decades-old, infection-fighting drug, Daraprim, to $750 a tablet in 2015, from $13.50.

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