In this issue:

News Briefs

Proposed Plan for Smallpox Outbreak

Can CT Eliminate the Initial Portable Lateral Cervical Spine X-Ray in the Multiple Trauma Patient?

Bioterrorism Update

The Joint Commissions Bioterrorism Preparedness Recommendations

Committee Passes Teaching Children to Save Lives Act

Martial Art Aids Arthritis Sufferers

History, as Reported by Our Youth (Humor)

Cool Web Sites

Quotable Quotes

ERDOCS listserv

How to get in touch with us; questions; sponsorship

News Briefs

Eggs Are Now In
Are eggs good for you? We knew they had protein, vitamins A and E, and vitamins B-6, B-12, and folate, but what about all the cholesterol? Recently, Kansas State University researchers reported identifying an ingredient in eggs called phosphatidylcholine, or PC, that reduces dramatically the amount of cholesterol from eggs that actually enters your bloodstream. They have applied for a patent for this ingredient, as reported in the September issue of Journal of Nutrition

Cardiac Legacy for Pre-Eclampsia?
The British Medical Journal shows that the 3-5% of women that experience pre-eclampsia (high blood pressure, protein intheir urine) may also be genetically tagged for increased cardiac risks. Scientists from Norway looked at parents in over 625,000 births. They found that women who suffered from pre-eclampsia were more than eight times as likely to die from heart disease. They did not see a coorelation between fathers of the pre-eclampsia pregnancies and heart disease.

New Drug Halts Dramatically Halts Insulin-Dependent Diabetes
A new experimental drug, DiaPep277, can block the progression of insulin- dependent diabetes and may be able to prevent the disease,which affects up to 20 million people worldwide, researchers said this month. In early trials, it completely stopped the body's immune system from attacking insulin-producing beta cells in the pancreas of people newly diagnosed with Type 1 diabetes.Ten months later, their capacity to secrete insulin was the same as it was in the beginning (of the trial) and perhaps better. The drug, which follows research by scientists at the Weizmann Institute in Israel, is produced by Peptor, a private Israeli pharmaceutical company.

Hydroxycobalamin as Antidote for Cyanide Overdoses
Cyanide is widely used in industry and routinely transported through and near major metropolitan areas by train and truck. Hazardous material accidents have released large amounts of the toxin. In addition, victims of fire exposure and smoke inhalation may often be suffering from cyanide intoxication. At this time, the only antidote to cyanide approved for use in the United States is the rather expensive Cyanide Antidote Kit, which contains amyl nitrite, sodium nitrite, and sodium thiosulfate. This kit has significant side effects that must be avoided and is not currently available in mass quantities for potential terrorist-related exposures. The cyanide antidote hydroxycobalamin has been used for decades in other countries with excellent results. Though not currently approved by the FDA for clinical use in theU. S., evidence indicates that it is safe and effective, and less expensive to treat suspected cyanide exposures. (Sauer SW, Keim ME. Ann Emerg Med June 2001;37:635-641. Includes 53 references)

Evaluation of Adenosine-Induced Proarrhythmia in the ED
An Italian study looked at the arrhythmogenicity of adenosine treatment in an emergency room (ER) has not been clearly established. One hundred and sixty consecutive patients treated with adenosine for regular wide or narrow complex tachyarrhythmias were included in the study. An initial bolus of 3 mg of adenosine was used, followed by 6mg boluses up to a maximum dose of 18 mg. Proarrhythmia was defined as the new appearance of any brady- or tachyarrhythmia within 1 minute from the bolus administration of adenosine. 84% of the patients treated presented initially with narrow complex tachycardia and16% had wide complex tachycardia. Adenosine was effective in the diagnosis/treatment of the underlying arrhythmia in 92%. The overall prevalence of adenosine- induced proarrhythmia was 13%. Events included prolonged AV block inducing asystole lasting greater than 4 seconds (7%), paroxysmal atrial fibrillation (1%) and non-sustained ventricular tachycardia (5%). All adenosine-induced arrhythmias were transient and subsided spontaneously. Camaiti A, et al., Emergency Department, Careggi Hospital,Florence, Italy.

Study Surveys Emergency Preparedness in Public Schools in Rural State
In this review, questionnaires were mailed to school nurses registered with the State Department of Education in New Mexico. Data collected included school nurse and staff training, school location, emergency equipment available, and Emergency Medical Service (EMS) access. Seventy-two percent of the surveys were returned after one or two mailings. They report little emergency training for both school nurses and school staff. Also, emergency equipment availablility varied widely: oxygen 20%, artificial airways 30%, cervical collars 22%, splints 69%. Equipment was more likely to be available in communities with populations of less than 200,000. Sixty- seven percent of schools activate EMS for a student and 37% for an adult annually. Eighty-four percent of schools have a less than 10-minute EMS response time. Pediatr Emerg Care 2001 October;17(5):329-333

Proposed Plan for Smallpox Outbreak

The Centers for Disease Control and Prevention (CDC) on November 26, 2001 released its plans to cope with smallpox if it is used as an agent of bioterrorism. The plan does not call for mass vaccination in advance of an outbreak, because the risks associated with vaccination are deemed to outweigh the risks of exposure to the smallpox virus. Smallpox was officially eradicated 21 years ago, but research stores of the virus still exist in the U.S. and former Soviet Union. Health officials released the interim plan to stimulate local and state officials to begin to think about state and community-wide responses in the event of an terrorist-based outbreak. The heart of this plan is ring vaccination, or search and containment; to identify individuals infected with smallpox and identify those who have been in contact with the patient and vaccinate those in outward rings of contact.This strategy will produce a buffer of immune individuals. The guidelines note that current supplies of smallpox vaccine are limited, but vaccine would be available within hours of a case being detected anywhere in the country. There have been recent studies regarding methods to stretch or extend coverage using supplies of the current vaccines. Some have reported success in these dilution studies, including from one site where they have vaccinated 77 individuals with diluted vaccine. Each person had a titer-level. It looks encouraging for a 1-to-5, perhaps even a 1-to-10 dilution of the vaccine to still be effective. Rapid dissemination of the disease has been fear because of the mobile nature of our society. Many fear that someone who is infected could spread the infection widely by traveling on an airplane or crowded subway. Researchers report that such a scenario is unlikely because there is an incubation period of 10 to 12 days, followed by 2 to 3 days of high fever and debilitating severe headaches and backaches. The disease is contagious to others only at that high fever point (also this is when the rash begins). At this stage in the progression of the disease, people are likely to feel quite poorly and to be staying in bed. The CDC notes that the overall mortality rate associated with smallpox is usuallu quoted at about 30%. However, two rare forms have a nearly 100% mortality rate;flat-type smallpox, which is characterized by severe toxemia and confluent lesions, and hemorrhagic-type smallpox.

U.S. Decides to Retain Smallpox Virus Stocks
The Bush administration, reversing a course set 2 decades ago, has decided that the world's remaining stocks of smallpox virus should not be destroyed, at least not until scientists develop new vaccines and treatments for the disease, a process that could take years if not decades. Administration officials said the stock should not be destroyed until the nation develops at least 2 licensed antiviral drugs, a vaccine that can be taken by the entire population, and other defensive measures. A succession of administrations have endorsed the goal of destroying the virus, which was eradicated as a disease in the1970's. But some American scientists and Pentagon officials have argued for retaining smallpox stocks. The United States stopped routine vaccinations for smallpox in 1972; remaining American smallpox stock are stored a laboratory at the Centers for Disease Control and Prevention in Atlanta. How long vaccines continue to protect against the disease is not known, but the immunity is believed to fade over time. Americans under 30 are completely vulnerable to the disease. Lev S.Sandakhchiev, director of Russia's State Research Center of Virology and Biotechnology, the Siberian research laboratory where smallpox strains are stored, has privately warned that North Korea, among other countries, is secretly keeping smallpox virus stocks.

Can CT Eliminate the Initial Portable Lateral Cervical Spine X-Ray in the Multiple Trauma Patient?

The data from this 200-patient review of suspected cervical spine injury (CSI),suggest that an initial lateral portable cervical spine radiograph is unnecessary if the patient is also having a screening CSCT. The review questioned whether there is a continued role for the initial screening lateral portable radiograph in such patients. In cases included for review, all patients had a screening lateral portable cervical spine radiograph (LPCSR) followed by cervical spine CT (CSCT). All scans were helical and included coronal and sagittal reformations.Reports of both examinations were compared for all patients. For those patients with signs of acute CSI, the two reports were compared to determine whether the LPCSR contained any information affecting patient outcome that was not detected by CSCT. The results were as follows: the CSCT showed no signs of acute CSI injury in 190 patients. Ten CSCT scans showed signs of fracture. In these 10 patients, the screening LPSCR showed signs of fracture in 1 patient, question of fracture in 2 patients, and no fracture in 7 patients. No LPCSR demonstrated significant information not seen on the accompanying CSCT. No LPSCR showed a finding that altered patient management prior to CSCT. http://link.springer.de/link/service/journals/10140/bibs/1008005/10080272.htm

Bioterrorism Update E-Learning Enters Battle Against Bioterrorism

The promise of E-learning will be on full display starting Dec. 4 when emergency room physicians around the country meet online for a course on bioterrorism intervention. In order to combat the lack of current information on anthrax, smallpox, and other diseases that are believed to be potential terrorist tools, the University of Tennessee and the Detroit Medical Center are working together to provide a free, real-time course taught by 20 emergency medical practitioners with expertise in bioterrorism agents. They expect 10% of the nation's 30,000 =emergency room physicians to take the course, which will consist of three one-hour sessions. The course, called BT101 (registration information at http://update.informationweek.com/cgi-bin4/flo?y=eE2u0BcTly0V20ZuW0AV is made possible by the University of Tennessee's familiarity with E- learning software from Centra Software Inc., which it has been using for the past four years to offer an online executive MBA course for physicians. Michael Stahl, director of the online MBA program, says it's because of the experience gajned in those four years that the bioterrorism course could be offered so quickly after the events of Sept. 11. Stahl says the experts teaching the course will be doing so from their offices, homes, or hotel rooms, and that the 100 physicians who will be logged in during any of the 90 course sessions will be able to do so via a dial-up connection. Thanks to Centra software's voice-over-IP capability, participants with properly equipped computers will be able to not only hear what the instructors are saying in real time, they'll also be able to ask questions and have other participants hear them, as if they were in a classroom together.

AMA Stockpiles Bioterrorism Information Resources
Since the first anthrax case was discovered in late September, the AMA has been updating its disaster preparedness Web site almost daily to help educate physicians and the medical community on the constantly changing issue of bioterrorism. Now, to make the resources even more user-friendly, the AMA has created a bioterrorism index to help users find the information they're looking for quickly and easily. The index at http://www.ama-assn.org/ama/pub/category/6671.html features information on numerous topics ranging from the basics of anthrax and other biological agents such as smallpox to federal and state resources and educational broadcasts from the CDC.

Another Reminder---ACUTE CARE, INC. has put together an impressive list of resources, links, etc. re: medical responses to nuclear, biological and chemical terrorism; just visit http://www.acutecare.com/whatnew.htm to see the latest or to research an area of concern. Links to the CDC and military medical resources are included, also. The site is frequently updated.

The Joint Commissions Bioterrorism Preparedness Recommendations

The Joint Commission on Accreditation of Health Care Organizations (JCAHO) recently released a special 24-page issue of its own official newsletter entitled Perspectives to provide direction to health care organizations in preparing for terrorists attacks that may involve nuclear, biological, and/or chemical incidents. It includes recommendations made after 9-11-01 by hospitals located near the World Trade Center and the Pentagon. The JCAHO is paying particular attention to emergency management planning during its ongoing, onsite evaluations of hospitals and other health care organizations. To view Perspectives on the Internet go to: http://www.jcrinc.com/subscribers/perspectives.asp?durki=187

Committee PassesTeaching Children to Save Lives Act

The U.S. Senate Health, Education, Labor and Pensions committee approved legislation in October that will help teach children how to respond in life-threatening emergencies. The Teaching Children to Save Lives Act was introduced earlier this year by Senators Susan Collins, R-Maine, and Russ Feingold, D- Wisconsin. It allows local school districts to apply for federal grants to implement cardiopulmonary resuscitation (CPR) training programs. The schools would work in conjunction with community organizations -- such as the American Heart Association, fire and police departments, hospitals, and parent-teacher associations -- to conduct CPR training in grades six through 12. The bill authorizes $30 million over three years to purchase CPR materials, such as mannequins, and to train teachers as CPR instructors. Schools that already have CPR training programs would be able to apply for grants to implement training for automated external defibrillators (AEDs), life-saving devices that provide an electric shock that can stop an abnormal heart rhythm, allowing the normal heartbeat to take over. The legislation awaits action by the full Senate and then the U.S. House of Representatives.

Martial Art Aids Arthritis Sufferers

Sufferers of osteoarthritis may benefit from the practice of the 1,200-year-old ancient martial art, tai chi. Previous studies showed that tai chi may lower blood pressure and reduce the number of falls by the elderly; a new study suggests, that it also leads to stronger abdominal muscles and better balance. Researchers reportedt he findings and recommendation at the American College of Rheumatology annual meeting in San Francisco recently, after studying two groups of arthritis sufferers, half of whom took a 12-week tai chi course.

History, as Reported by Our Youth

A recent internet search found this collection of excerpts from papers written by American youth and warehoused at a site calledstrangeplaces.net. Spelling remains unaltered, in the interest of preserving some of theunintended humor.

Without the Greeks, we wouldn't have history. The Greeks invented three kinds of columns -Corinthian, Doric and Ironic. They also had myths. A myth is a female moth. One myth says that the mother of Achilles dipped him in the River Stynx untilhe became intolerable. Achilles appears in The Illiad by Homer. Homer also wrote the Oddity in which Penelope was the last hardship that Ulysses endured on his journey. Actually, Homer was not written by Homer but by another man of that name.

In the Olympic Games,Greeks ran races, jumped, hurled the biscuits, and threw the java. The reward to the victor was a coral wreath. The government of Athen was democratic because the people took the law into their own hands. There were no wars in Greece, as the mountains were so high that they couldn't climb over to see what their neighbors were doing. When they fought the Parisians, the Greek swere outnumbered because the Persians had more men.

During the Renaissance America began. Christopher Columbus was a great navigator who discovered America while cursing about the Atlantic. His ships were called the Nina, the Pinta, and the Santa Fe. Later the Pilgrims crossed the Ocean, and the was called the Pilgrim's Progress. When they landed at Plymouth Rock, they were greeted by Indians, who came down the hill rolling their was hoops before them. The Indian squabs carried porposies on their back. Many of the Indian heroes were killed, along with their cabooses, which proved very fatal to them. The winter of 1620 was a hard one for the settlers. Many people died and many babies were born. Captain John Smith was responsible for all this.

One of the causes of the Revolutionary Wars was the English put tacks in their tea. Also, the colonists would send their pacels through the post without stamps. During the War, Red Coats and Paul Revere was throwing balls over stone walls. The dogs were barking and the peacocks crowing. Finally, the colonists won the War andno longer had to pay for taxis. Delegates from the original thirteen states formed the Contented Congress. Thomas Jefferson, a Virgin, and Benjamin Franklin were two singers of the Declaration of Independence. Franklin had gone to Boston carrying all his clothes in his pocket and a loaf of bread under each arm. He invented electricity by rubbing cats backwards and declared a horse divided against itself cannot stand. Franklin died in 1790 and is still dead.

George Washington married Matha Curtis and in due time became the Father of Our Country. Them the Constitution of the United States was adopted to secure domestic hostility.Under the Constitution the people enjoyed the right to keep bare arms.

Bach was the most famous composer in the world, and so was Handel. Handel was half German, halfItalian and half English. He was very large. Bach died from 1750 to the present. Beethoven wrote music even though he was deaf. He was so deaf hewrote loud music. He took long walks in the forest even when everyone wascalling for him. Beethoven expired in 1827 and later died for this.

The nineteenth century was a time of many great inventions and thoughts. The invention of thesteamboat caused a network of rivers to spring up. Cyrus McCormick invented the McCormick Raper, which did the work of a hundred men. Samuel Morse invented a code for telepathy. Louis Pastuer discovered a cure for rabbis.Charles Darwin was a naturailst who wrote the Organ of the Species Madman Curie discovered radium. And Karl Marx became one ofthe Marx Brothers.

The First World War, cause by the assignation of the Arch-Duck by a surf, ushered in a new error in the anals of human history.

Cool Web Sites

Top 20Gifts .
gifts.connectonline.com

If you need some help searching for the perfect gift, check this one. You can simplyclick on a gift box that designates the price you want to spend and the age oftherecipient. You'll be presented with a page full of ideas at that price range,including the links to go get the item. Even if you dont plan on buying online, it can give you some great ideas!

Iowa Poison Center
www.iowapoison.com

A new web site by a hospital consortium that includes Central Iowa Poison Control Center Iowa Methodist Medical Center and the University of Iowa Hospitals and Clinics offering online non- emergent info on poisonings. Their telephone number is (800) 222-1222.

News Search Engine
www.alltheweb.com

ResearchBuzznewsletter thinks AllTheWeb.com is a seriously under-rated contender on the search engine scene. A press release saysthat AllTheWeb is indexing news stories from over three thousandonline sources. It also claims that AlltheWeb is twice as fresh as Google, with six times more news

Pixar Animation Short Films Available Online
http://www.pixar.com/shorts/index.html

If youve seen or heard about Disney's Toy Story, Toy Story 2, A Bug's Life, and the new Monsters, Inc., then you know something about Pixar Animation Studios. They also have created short films like Tin Toy, and Luxo Jr. Pixar recently redesigned their Web site, with seven of Pixar's short films now available online, free of charge. You'll need two things to easily access and view these: 1. A fairly fast Internet connection (or a slow connectionand a lot of patience); and 2. Apple's QuickTime plug-in, which is availableat no charge for both PCs and Macs at the following site: http://www.apple.com/quicktime/download/ Unfortunately, Pixar's site doesn't let you download and save the any of the seven short films to your computer to watch later, but you can always go back to Pixar's site to watch the films again and again.

More on Urban Myth Busting
www.purportal.com

We have listed individual sites before, but Purportal.com is an entry site that gives access to five of the Web's leading debunking sites: Snopes; About.com's Urban Legends; CIAC; CERT; and Symantec's (Real) Virus Encyclopedia. There are also special reports and links to most of the better known schemes, scams and frauds.

Quotable Quotes

Abigail Adams (1744-1818)
US first lady

Learning is not attained by chance. It must be sought for with ardor and attended to with diligence.

We have too many high sounding words,and too few actions that correspond with them.

Charles DeGaulle (1890-1970)
French president, politician, military leader

How can anyone govern a nation that has two hundred and forty-six different kinds of cheese?

Deliberation is the work of many men. Action, of one alone.

A man of character finds a special attractiveness in difficulty, since it is only by coming to grips with difficulty that he can realize his potentialities.

Billy Sunday (1862-1935)
Revivalist, baseball player

More men fail through lack of purpose than lack of talent.

Going to church doesn't make you a Christian any more than going to a garage makes you an automobile.

ERDOCS e-mail group (listserv)

As a Clinician providing acute and emergency medical care, you are invited to visit and participate in our new ERDOCS group at eGroups, a free, easy-to-use email group service! You have plenty of experiences to share, questions to ask, concerns and opinions to voice, suggestions, news to post, tips to offer, etc. and can do so within this framework. This is a versatile system for posting things to be sent to a group to peruse, respond to, or simply be aware of. It eliminates conventional mail delays and allows you to review and post at your leisure. (We still have the more open-ended [any visitor can observe/post] discussion group at the ACUTE CARE, INC. web site). Our goal is to give you a variety of feedback and communication tools.

The manager/moderator for this ERDOCS egroup is the webmaster for the ACUTE CARE, INC. website (http://www.acutecare.com/), Paul Hudson. You can subscribe by sending an e-mail indicating your wish to be included to Paul at mailto:paulh@acutecare.com

As this site grows, it will feature news, calendars, links to references, resources, and other useful features. We hope you will support this effort to foster ongoing communication amongst EM providers.