PrairiEDocs e-newsletter #1

Other archived PrairiEDocs e-newsletters

Surveying the land (and web) for news (and more)
for the emergency medicine practitioner…

Issue #1 "fasten your seat belt and adjust your headrest as this
electronic ed-venture gets underway" June 13, 2000

In this issue:

Controversy in CPR? Look Ma!---just hands!

FDA Approves New, Single Injection Clot-Buster for Treatment of Heart Attack

A Chilling Fact

If You Don't Have a Sense of Humor, You Don't Really Have Any Sense at All!

Online Helpful Sites

Today's Cool Web Site (Peep surgery)

Quotable Quotes

Financial sponsorship statement & How to contact us

Controversy in CPR? Look Ma!---just hands

A new study, recently published in JAMA, has reported that cardiopulmonary resuscitation using compressions alone (no ventilations) in out-of-hospital cardiac arrest may be better than standard CPR. The findings have fueled much controversy on the eve of the issuance of the next major revisions of BLS, ACLS and PALS, scheduled for release in Circulation magazine in mid-September of this year. If the findings are borne out in subsequent study and adopted, at least for bystander-assisted resuscitation, it may encourage higher rates of assistance and possibly successful resuscitations. Fewer than 50% of the bystander witnessed cardiac arrests in Seattle receive bystander CPR.

This study was conducted in Seattle's urban, fire department EMS-based system utilizing dispatchers who gave telephone instruction in compression-alone or conventional CPR in a randomly assigned order of calls for assistance with apparent cardiac arrest. A total of 279 patients received conventional CPR and 241 received chest compressions alone.

There was no statistically significant difference in survival-to-discharge between the two groups (though it was slightly higher in the chest compressions only group, 14.6% to 10.4%). The investigators concluded that the simpler chest compression alone technique may be preferred by inexperienced bystanders. 
(N Engl J Med 2000;342:1546-53.) 

The Abstract

Background. Despite extensive training of citizens of Seattle in cardiopulmonary resuscitation (CPR), bystanders do not perform CPR in almost half of witnessed cardiac arrests. Instructions in chest compression plus mouth-to-mouth ventilation given by dispatchers over the telephone can require 2.4 minutes. In experimental studies, chest compression alone is associated with survival rates similar to those with chest compression plus mouth-to-mouth ventilation. We conducted a randomized study to compare CPR by chest compression alone with CPR by chest compression plus mouth-to-mouth ventilation. 

Methods. The setting of the trial was an urban, fire-department-based, emergency-medical-care system with central dispatching. In a randomized manner, telephone dispatchers gave bystanders at the scene of apparent cardiac arrest instructions in either chest compression alone or chest compression plus mouth-to-mouth ventilation. The primary end point was survival to hospital discharge. 

Results. Data were analyzed for 241 patients randomly assigned to receive chest compression alone and 279 assigned to chest compression plus mouth-to-mouth ventilation. Complete instructions were delivered in 62 percent of episodes for the group receiving chest compression plus mouth-to-mouth ventilation and 81 percent of episodes for the group receiving chest compression alone (P=0.005). Instructions for compression required 1.4 minutes less to complete than instructions for compression plus mouth-to-mouth ventilation. Survival to hospital discharge was better among patients assigned to chest compression alone than among those assigned to chest compression plus mouth-to-mouth ventilation (14.6 percent vs. 10.4 percent), but the difference was not statistically significant (P=0.18). 

Conclusions. The outcome after CPR with chest compression alone is similar to that after chest compression with mouth-to-mouth ventilation, and chest compression alone may be the preferred approach for bystanders inexperienced in CPR. (N Engl J Med 2000;342:1546-53.) 

From the Department of Biostatistics (A.H., E.J.) and the Department of Medicine (L.C., M.C.), University of Washington, and Medic I, Seattle. 
Address reprint requests to Dr. Hallstrom at 1107 NE 45th St., Suite 505, Seattle, WA 98105-4689.

FDA Approves New, Single-Injection Clot-Buster 
For Treatment Of Heart Attack

Genentech, Inc. announced on June 2, 2000 that its new single-bolus thrombolytic agent, TNKase™ (Tenecteplase), has been approved by the U.S. Food and Drug Administration for the treatment of acute myocardial infarction. TNKase is the first "clot-buster" that can be administered in a single dose (over five seconds), offering physicians the fastest administration of a cardiac thrombolytic. 

"TNKase represents an important advance in the speed with which heart attack treatment can be delivered to patients, offering physicians the most rapid administration available to date with a new, safe and effective therapeutic option," said Arthur D. Levinson, Ph.D., Genentech chairman and CEO. 

"The introduction of TNKase has the potential to significantly impact how heart attack patients are now treated due to the speed and ease with which it can be administered," said Christopher Granger, MD, FACC, associate professor of medicine and director of the cardiac care unit at Duke University Medical Center in Durham, NC, and lead U.S. investigator for ASSENT 2. 

The principal trial on which the approval was based was the ASsessment of the Safety and Efficacy of a New Thrombolytic Agent (ASSENT) involving some 17,000-patients. The study compared Genetech's Activase®‚ (Alteplase) using its 90-minute accelerated infusion schedule and TNKase, which was dosed in a weight-tiered fashion ranging from 30-50 mg based on actual or estimated weight. Alteplase is the most widely used thrombolytic in the past ten years. Results included identical mortality rates (6.2%), rates for intracranial hemorrhage (0.9%) and nearly identical stroke percentages (TNKase-1.8% Activase-1.7%). There were slightly lower percentages of noncranial major bleeding complications and need for transfusions in the Tenecteplase group.

According to Genentech, "TNKase is similar to Activase, which is a recombinant DNA-derived version of naturally-occurring tissue plasminogen activator (t-PA). TNKase has unique features specifically designed to prolong its half life, enabling single bolus dosing. It also has been designed to increase specificity for fibrin, a key component of intracoronary clots and results in less disturbance of the body's coagulation, or natural clotting, system."

TNKase (Tenecteplase) is currently under investigation in four ongoing clinical studies that began early this year, involving more than 9,000 patients, to evaluate various heart attack regimens in combination with other agents.

In another first, TNKase will be provided as part of a kit which will include a needleless injection system, the first thrombolytic to be packaged with this device. This system is designed to comply with new OSHA (Occupational  Safety and Health Administration) directives to protect health care workers.

A Chilling Fact

A 29-year-old Norwegian doctor recently set a rather dubious record-she has recovered after being revived from a record low body temperature. While skiing, the woman fell and was trapped under water for 40 minutes. Help was summoned via cellular phone and thirty-nine minutes later she was intubated and was receiving CPR during her one-hour helicopter flight to the hospital. Her body temperature was 13.7 degrees Celsius. She was admitted to the hospital and placed on cardiac bypass, rewarmed, put on a ventilator for the next 35 days and stayed in intensive care for two months. Statisticians report survival rates for anyone with a core temperature of less than 28 degrees Celsius to be between 10 and 30%. Five months after her accident the woman was again taking part in athletic events. (LANCET 2000 355)

If You Don't Have a Sense of Humor, 
You Don't Really Have any Sense at All!

from an anonymous e-mail author from the web...

Shouting to make your children obey is like using the horn to steer your car, and you get about the same results.

The smartest advice on raising children is to enjoy them while they are still on your side.

Raising a teenager is like nailing Jell-O to a tree.

Any child can tell you that the sole purpose of a middle name is so he/she can tell when they're really in trouble.

Cleaning your house while your kids are still growing is like shoveling the walk while it's still snowing.

Oh to be only half as wonderful as my child thought I was when she/he was small, and half as stupid as my teenager now thinks I am.

Adolescence is the age at which children stop asking questions because they know all the answers.

An alarm clock is a device for awakening people who don't have small children.

No wonder kids are confused today. Half the adults tell them to find themselves; the other half tell them to get lost.

Online Helpful Sites

The Merk Manual, or more accurately, Manuals, are available free of charge online. Included are the Merck Manual of Diagnosis and Therapy, as well as the "Merck Manual of Medical Information -- Home Edition" for the lay public (this version has been only available since 1997), and the Merck Manual of Geriatrics (Second Edition).
http://www.merck.com/pubs/


The Merriam-Webster Online Dictionary is located at 
http://www.m-w.com/

If you ever need a translation dictionary, consider Travlang's Translating Dictionaries site. It provides multilingual on-line dictionaries including German, French, Spanish, English, Portuguese, Dutch, Italian, Danish, Swedish, Norwegian, and more. Use this site to translate a single word from one language to another.
http://dictionaries.travlang.com/

If you need to translate entire sentences, AltaVista's Babelfish is a robotic translator, but it doesn't support as many languages as Travlang. 
http://babelfish.altavista.com/

Ever wonder what SNAFU means? AcronymFinder is a searchable database of over 100,000 acronyms, abbreviations and their meanings. There is coverage of many subjects, with a focus on computers, technology, telecommunications, and the military.
http://www.AcronymFinder.com/

the online equivalent to a reference librarian can be found at Refdesk. Refdesk.com's database in on three levels: quick, studied and deep. For thumbnail snapshots: FastFacts 1999, Quick Reference / Research, and My Facts Page. For a more studied approach: My Virtual Newspaper, My Search Engines, Internet Help, and Writing Web Documents. For an in-depth exploration consider My Virtual Encyclopedia with fifty volumes of indexed subjects.
http://www.refdesk.com/

Today's cool web site... (from TipWorld) 

PEEP SURGERY http://www.learnlink.emory.edu/peep/surgery.html 

This thorough documentation of an experimental surgical technique is not for the squeamish-at-heart. In one grueling but groundbreaking series of operations, Dr. Jim and his dedicated team attempt to separate conjoined quintuplets. First, a Karo Syrup intravenous drip is started. After all, the patients are four "Peeps." You may remember Peeps as pastel-colored, sugarcoated marshmallow treats that are popular around Easter. The team encounters complications along the way and is at times forced to use evasive techniques to save the individual peeps. 

Be prepared for graphic photos of exposed fluffathelium being cauterized, sutured, and stapled. Not content with mere medical success, the kind doctor even experiments with cutting-edge plastic surgery to cover his patients horrific scars. Don't try this at home. 

Quotable Quotes

"Yield and overcome;
Bend and be straight;
Empty and be full;
Wear out and be new;
Have little and gain;
Have much and be confused."
Lao Tsu, Tao Te Ching

"Things men have made with weakened hands, and put soft life into are awake through years with transferred touch, and go on glowing for long years. And for this reason, some old things are lovely warm still with the life of forgotten men who made them."
D. H. Lawrence

"The world is my origin, but my soul I have drawn from the stars."
Prophecy of the Great Sybil 

This e-newsletter is available through the generous unrestricted support of 
ACUTE CARE, INC. You can find out more about ACUTE CARE, INC.
by going online to http://www.acutecare.com
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