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Cada día en una gran ciudad se producen más de 300 emergencias. Para salvar vidas, hacen falta héroes y estos héroes deben estar bien preparados

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New Seizure treatment for EMS

Seizure treatment study: Implications for EMS

Being able to use an auto-injector can simplify the procedure and speed up the delivery time

By Art Hsieh

Seizures are a common call for EMS systems. Often the physical manifestations of the seizure activity is over by the time we arrive; rarely do we have to manage the more serious condition of status epilepticus.

Related Article: Study: Injection offers faster help for seizure patients

Because of its commonality, we might not consider the impact that seizures can have upon the patient, long after we managed their acute condition.
An advance like this has the potential to dramatically improve the overall health of the individual, and possibly reduce the need for emergency services.
There are also implications for EMS providers as well. It can be a challenge to administer an intravenous benzodiazepine when the patient is actively seizing.
Being able to use an auto injector can simplify the procedure and speed up the delivery time. It might also mean that terminating an active seizure might become a basic life support procedure. This can improve a system's overall ability to respond to these common calls.
That time might be some ways off. However, it's another interesting development in our business that benefits both patients and providers alike

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. In the profession since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. A Past President of the National Association of EMS Educators, former Chief Executive Officer of the San Francisco Paramedic Association, and a scholarship recipient of the American Society of Association Executives, Art is a published textbook author, has presented at conferences nationwide, and continues to provide patient care at a rural hospital-based ALS system. Contact Art at Art.Hsieh@ems1.com.

 

 

 

Study: Injection offers faster help for seizure patients Results probably will change how seizures are treated by paramedics

Link to original information
 
By Erin Allday
The San Francisco Chronicle

Expert Analysis Seizure treatment study: Implications for EMS By Art Hsieh Seizures are a common call for EMS systems. Often the physical manifestations of the seizure activity is over by the time we arrive; rarely do we have to manage the more serious condition of status epilepticus. Because of its commonality, we might not consider the impact that seizures can have upon the patient, long after we managed their acute condition. An advance like this has the potential to dramatically improve the overall health of the individual, and possibly reduce the need for emergency services. Continue reading Seizure treatment study: Implications for EMS

SAN FRANCISCO —  Injecting patients in the thigh with a drug-loaded syringe is a safe and effective way to stop a seizure in an emergency, according to results of a national study released Wednesday, a finding that could pave the way toward making such syringes as widely available as EpiPens used to treat severe allergic reactions.
The two-year study, published in the New England Journal of Medicine, concluded that a single stab from an auto-injector was more effective in stopping a prolonged seizure than the traditional method of inserting an intravenous line and delivering the drug directly into the bloodstream.
The results probably will change how such seizures, which can be life-threatening if they're not stopped right away, are treated by paramedics. But they could have more long-term repercussions if doctors start giving the auto-injectors to epileptic patients, some of whom have several severe seizures a year, to use at home, much as people with severe allergies carry epinephrine syringes with them.
"I don't think we're ready to hand these out at epilepsy clinics for people to take home right now," said Dr. J. Claude Hemphill, chief of neurology at San Francisco General Hospital, who led the San Francisco arm of the study. "But that may be a follow-up some folks want to do."
The U.S. Department of Defense also has taken special interest in the study, because auto-injectors would be much more convenient than IV drug treatment in a large-scale bioterrorism attack involving seizure-inducing nerve gas.
"The advantage is you can give it the auto-injection faster," said Dr. Walter Koroshetz, deputy director of the National Institute of Neurological Disorders and Stroke. "If you have 100 people simultaneously seizing, no way can you do all those IVs. But you could just run around and inject everybody for their seizures."
Seizures are caused by a disruption in the brain's electrical system, and in most cases they resolve themselves after a minute or so. Roughly 2 percent of Americans have epilepsy, a condition marked by chronic seizures.
Some seizures, known as status epilepticus or prolonged seizures, can last several minutes or longer, and they may require drugs to stop them. More than 50,000 people in the United States die from prolonged seizures every year, either from brain damage due to the seizure itself or from accidents related to passing out mid-attack.
The study, which was funded primarily by the National Institutes of Health, involved 79 hospitals nationwide, including several in the Bay Area. More than 4,000 paramedics were trained to participate in the study and 893 patients were treated.
A drug and a placebo
Every patient was given both the auto-injector shot, usually to the thigh, and an intravenous injection. But in half the cases the auto-injector was filled with a placebo, and in the other half the IV drug was a placebo. Neither patients nor paramedics knew which treatment was the placebo in any given case.
Researchers found that 73 percent of patients who were given the auto-injector drug had stopped seizing by the time they reached the emergency room; 63 percent of patients who got the IV drug were seizure-free.
Patients who were given the auto-injector drug were less likely than the IV group to be admitted to the hospital after their seizure.
"This auto-injection should be the new standard of care," said Dr. James Quinn, a professor of surgery and emergency medicine at Stanford who led the study there. "It's great when you can do a study and it's probably going to change how we do things."
Although two different drugs were used in the trial - midazolam for the auto-injector and lorazepam for the intravenous injection - researchers don't believe that the drugs made a difference in how effective the treatments were. Rather, they said, the auto-injectors are simply easier to use.
It's much simpler to give a single shot than to try to start an intravenous line on a patient who is actively convulsing, doctors and paramedics said. In the study, 42 patients did not receive the intravenous treatment because the paramedic couldn't start the IV, whereas only five patients didn't receive the auto-injector shot because the syringe malfunctioned.
"It takes time to set up an IV. You have to find a vein that's going to be good, you have to isolate the arm and hold it still, you have to clean the arm, you have to insert the needle," said Judy Klofstad, a paramedic with the San Francisco Fire Department who participated in the study. "If you're really good, it can take 2 1/2 minutes."
Paramedics took on average just 20 seconds to use the auto-injector, according to the study. "You just hold their thigh down, target it, and it can go right through their clothing, through jeans even," Klofstad said.
Doctors said that because the auto-injection drug causes heavy sedation and can lead to respiratory problems and low blood pressure, more research is needed before the syringes are handed out to patients.
But Tiffany Manning, who has epilepsy and suffers a prolonged seizure every two or three months, said she's excited about someday being able to carry around an auto-injector. Her doctor at the UCSF epilepsy clinic has prescribed an oral drug that her parents can give her when she has a seizure, but it can be time-consuming and difficult to measure out the proper dosage and make sure she swallows it, she said.
"And when I wake up I have a funny taste in my mouth," said Manning, 30. "My doctor doesn't prescribe it very often. You can overdose someone on it. ... I'd rather just have a shot in the leg."

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Health Information for Travelers to Dominican Republic

Preparing for Your Trip to the Dominican Republic

Before visiting the Dominican Republic, you may need to get the following vaccinations and medications for vaccine-preventable diseases and other diseases you might be at risk for at your destination: (Note: Your doctor or health-care provider will determine what you will need, depending on factors such as your health and immunization history, areas of the country you will be visiting, and planned activities.)
To have the most benefit, see a health-care provider at least 4–6 weeks before your trip to allow time for your vaccines to take effect and to start taking medicine to prevent malaria, if you need it.
Even if you have less than 4 weeks before you leave, you should still see a health-care provider for needed vaccines, anti-malaria drugs and other medications and information about how to protect yourself from illness and injury while traveling.
CDC recommends that you see a health-care provider who specializes in Travel Medicine.  Find a travel medicine clinic near you. If you have a medical condition, you should also share your travel plans with any doctors you are currently seeing for other medical reasons.
If your travel plans will take you to more than one country during a single trip, be sure to let your health-care provider know so that you can receive the appropriate vaccinations and information for all of your destinations. Long-term travelers, such as those who plan to work or study abroad, may also need additional vaccinations as required by their employer or school.
Be sure your routine vaccinations are up-to-date. Check the links below to see which vaccinations adults and children should get.
Routine vaccines, as they are often called, such as for influenza, chickenpox (or varicella), polio, measles/mumps/rubella (MMR), and diphtheria/pertussis/tetanus (DPT) are given at all stages of life; see the childhood and adolescent immunization schedule and routine adult immunization schedule.
Routine vaccines are recommended even if you do not travel. Although childhood diseases, such as measles, rarely occur in the United States, they are still common in many parts of the world. A traveler who is not vaccinated would be at risk for infection.

Vaccine-Preventable Diseases

Vaccine recommendations are based on the best available risk information. Please note that the level of risk for vaccine-preventable diseases can change at any time.

Vaccination or Disease	Recommendations or Requirements for Vaccine-Preventable Diseases
Routine	Recommended if you are not up-to-date with routine shots, such as measles/mumps/rubella (MMR) vaccine, diphtheria/pertussis/tetanus (DPT) vaccine, poliovirus vaccine, etc.
Hepatitis A or immune globulin (IG)	Recommended for all unvaccinated people traveling to or working in countries with an intermediate or high level of hepatitis A virus infection (see map) where exposure might occur through food or water. Cases of travel-related hepatitis A can also occur in travelers to developing countries with "standard" tourist itineraries, accommodations, and food consumption behaviors.
Hepatitis B	Recommended for all unvaccinated persons traveling to or working in countries with intermediate to high levels of endemic HBV transmission (see map), especially those who might be exposed to blood or body fluids, have sexual contact with the local population, or be exposed through medical treatment (e.g., for an accident).
Typhoid	Recommended for all unvaccinated people traveling to or working in the Caribbean, especially if staying with friends or relatives or visiting smaller cities, villages, or rural areas where exposure might occur through food or water.
Rabies	Recommended for travelers spending a lot of time outdoors, especially in rural areas, involved in activities such as bicycling, camping, or hiking. Also recommended for travelers with significant occupational risks (such as veterinarians), for long-term travelers and expatriates living in areas with a significant risk of exposure, and for travelers involved in any activities that might bring them into direct contact with bats, carnivores, and other mammals. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites.

Malaria

Areas of the Dominican Republic with Malaria: All areas (including resort areas), except none in the cities of Santiago and Santo Domingo.
If you will be visiting an area of the Dominican Republic with malaria, you will need to discuss with your doctor the best ways for you to avoid getting sick with malaria. Ways to prevent malaria include the following:

• Taking a prescription antimalarial drug
• Using insect repellent and wearing long pants and sleeves to prevent mosquito bites
• Sleeping in air-conditioned or well-screened rooms or using bednets

All of the following antimalarial drugs are equal options for preventing malaria in the Dominican Republic: Atovaquone-proguanil, chloroquine, doxycycline, or mefloquine. For detailed information about each of these drugs, see Table 3-11: Drugs used in the prophylaxis of malaria. For information that can help you and your doctor decide which of these drugs would be best for you, please see Choosing a Drug to Prevent Malaria.
To find out more information on malaria throughout the world, you can use the interactive CDC malaria map. You can search or browse countries, cities, and place names for more specific malaria risk information and the recommended prevention medicines for that area.

Malaria Contact for Health-Care Providers
For assistance with the diagnosis or management of suspected cases of malaria, call the CDC Malaria Hotline: 770-488-7788 (M-F, 9 am-5 pm, Eastern time). For emergency consultation after hours, call 770-488-7100 and ask to speak with a CDC Malaria Branch clinician..

More Information About Malaria

Malaria is always a serious disease and may be a deadly illness. Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health-care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites.
Travelers to malaria risk-areas in the Dominican Republic, including infants, children, and former residents of Dominican Republic, should take one of the antimalarial drugs listed in the box above.

Symptoms

Malaria symptoms may include

• fever
• chills
• sweats
• headache
• body aches
• nausea and vomiting
• fatigue

Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, you should see a doctor right away if you develop a fever during your trip.
Malaria may cause anemia and jaundice. Malaria infections with Plasmodium falciparum, if not promptly treated, may cause kidney failure, coma, and death. Despite using the protective measures outlined above, travelers may still develop malaria up to a year after returning from a malarious area. You should see a doctor immediately if you develop a fever anytime during the year following your return and tell the physician of your travel.
A Special Note about Antimalarial Drugs
You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use.
Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available.
For detailed information about these antimalarial drugs, see Choosing a Drug to Prevent Malaria.

Items to Bring With You

Medicines you may need:

• The prescription medicines you take every day. Make sure you have enough to last during your trip. Keep them in their original prescription bottles and always in your carry-on luggage. Be sure to follow security guidelines, if the medicines are liquids.
• Antimalarial drugs, if traveling to a malaria-risk area in Dominican Republic and prescribed by your doctor.
• Medicine for diarrhea, usually over-the-counter.

Note: Some drugs available by prescription in the US are illegal in other countries. Check the US Department of State Consular Information Sheets for the country(s) you intend to visit or the embassy or consulate for that country(s). If your medication is not allowed in the country you will be visiting, ask your health-care provider to write a letter on office stationery stating the medication has been prescribed for you.

Other items you may need:

• Iodine tablets and portable water filters to purify water if bottled water is not available. See A Guide to Water Filters, A Guide to Commercially-Bottled Water and Other Beverages, and Safe Food and Water for more detailed information.
• Sunblock and sunglasses for protection from harmful effects of UV sun rays. See Basic Information about Skin Cancer for more information.
• Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol.
• To prevent insect/mosquito bites, bring:
  • Lightweight long-sleeved shirts, long pants, and a hat to wear outside, whenever possible.
  • Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
  • Bed nets treated with permethrin, if you will not be sleeping in an air-conditioned or well-screened room and will be in malaria-risk areas. For use and purchasing information, see Insecticide Treated Bed Nets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.

See other suggested over-the-counter medications and first aid items for a travelers' health kit.
Note: Check the Air Travel section of the Transportation Security Administration website for the latest information about airport screening procedures and prohibited items.

Other Diseases Found in the Caribbean
Risk can vary between countries within this region and also within a country; the quality of in-country surveillance also varies.

The following are disease risks that might affect travelers; this is not a complete list of diseases that can be present. Environmental conditions may also change, and up to date information about risk by regions within a country may also not always be available.
Dengue epidemics have occurred on many of the Caribbean islands.  Most islands are infested with Aedes aegypti, so these places are at risk for introduction of dengue.  Protecting yourself against insect bites (see below) will help to prevent this disease.
In 2006, malaria (falciparum) was confirmed in travelers to Great Exuma, Bahamas, and Kingston, Jamaica, areas where malaria transmission typically does not occur.  An outbreak of eosinophilic meningitis caused by Angiostrongylus cantonensis occurred in travelers to Jamaica.
Cutaneous larval migrans is a risk for travelers with exposures on beaches and leptospirosis is common in many areas and poses a risk to travelers engaged in recreational freshwater activities.  Such activities may include whitewater rafting, kayaking, adventure racing, or hiking. Endemic leptospirosis is reported in Jamaica. Travelers to regions in Jamaica can reduce their risk to leptospirosis by avoiding activities which expose them to contaminated fresh surface water. Outbreaks of ciguatera poisoning, which results from eating toxin-containing reef fish, have occurred on many islands.
Endemic foci of histoplasmosis are found on many Caribbean islands, and outbreaks have occurred in travelers.
Anthrax is hyperendemic in Haiti but has not been reported on most of the other islands.  Haiti also has a high incidence rate of tuberculosis and high HIV prevalence rates.

Staying Healthy During Your Trip

Prevent Insect Bites

Many diseases, like malaria and dengue, are spread through insect bites. One of the best protections is to prevent insect bites by:

• Using insect repellent (bug spray) with 30%-50% DEET. Picaridin, available in 7% and 15% concentrations, needs more frequent application. There is less information available on how effective picaridin is at protecting against all of the types of mosquitoes that transmit malaria.
• Wearing long-sleeved shirts, long pants, and a hat outdoors.
• Remaining indoors in a screened or air-conditioned area during the peak biting period for malaria (dusk and dawn).
• Sleeping in beds covered by nets treated with permethrin, if not sleeping in an air-conditioned or well-screened room.
• Spraying rooms with products effective against flying insects, such as those containing pyrethroid.

For detailed information about insect repellent use, see Insect and Arthropod Protection.

Prevent Animal Bites and Scratches

Direct contact with animals can spread diseases like rabies or cause serious injury or illness. It is important to prevent animal bites and scratches.

• Be sure you are up to date with tetanus vaccination.
• Do not touch or feed any animals, including dogs and cats. Even animals that look like healthy pets can have rabies or other diseases.
• Help children stay safe by supervising them carefully around all animals.
• If you are bitten or scratched, wash the wound well with soap and water and go to a doctor right away. 
• After your trip, be sure to tell your doctor or state health department if you were bitten or scratched during travel.

For more information about rabies and travel, see the Rabies chapter of the Yellow Book or CDC's Rabies homepage. For more information about how to protect yourself from other risks related to animals, see Animal-Associated Hazards.

Be Careful about Food and Water

Diseases from food and water are the leading cause of illness in travelers. Follow these tips for safe eating and drinking:

• Wash your hands often with soap and water, especially before eating.  If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol).
• Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles.  Avoid tap water, fountain drinks, and ice cubes.  If this is not possible, learn how to make water safer to drink.
• Do not eat food purchased from street vendors.
• Make sure food is fully cooked.
• Avoid dairy products, unless you know they have been pasteurized.

Diseases from food and water often cause vomiting and diarrhea. Make sure to bring diarrhea medicine with you so that you can treat mild cases yourself.

Avoid Injuries

Car crashes are a leading cause of injury among travelers. Protect yourself from these injuries by:

• Not drinking and driving.
• Wearing your seat belt and using car seats or booster seats in the backseat for children.
• Following local traffic laws.
• Wearing helmets when you ride bikes, motorcycles, and motor bikes.
• Not getting on an overloaded bus or mini-bus.
• Hiring a local driver, when possible.
• Avoiding night driving.

Other Health Tips

• To avoid infections such as HIV and viral hepatitis do not share needles for tattoos, body piercing, or injections.
• To reduce the risk of HIV and other sexually transmitted diseases always use latex condoms.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, especially on beaches where animals may have defecated.

After You Return Home

If you are not feeling well, you should see your doctor and mention that you have recently traveled. Also tell your doctor if you were bitten or scratched by an animal while traveling.
If you have visited a malaria-risk area, continue taking your chloroquine for 4 weeks after leaving the risk area.
Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.

Important Note: This document is not a complete medical guide for travelers to this region. Consult with your doctor for specific information related to your needs and your medical history; recommendations may differ for pregnant women, young children, and persons who have chronic medical conditions.

#MSPInfectología | Para la organización Mundial de la Salud (OMS) la incidencia del virus del dengue va aumentando a pasos agigantados a nivel mundial. Según las estimaciones, cada año se reportan alrededor de 390 millones de casos.

La prevención de este virus se puede hacer mediante el manejo adecuado de los desechos sólidos, limpiar y vaciar cada semana los recipientes donde se almacena agua para el uso doméstico y fumigar las zonas estancables y los productos susceptibles de traer el mosquito.

Aprende más sobre este virus con esta infografía o en https://lnkd.in/dSunwEi

#MSP: Lo más relevante para médicos, pacientes y profesionales de la salud. #Pioneros

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#NoAlPlagio

LIBROS GRATIS #PDF solo dirígete al enlace de las fotos y allí tienes el enlace en donde puedes descargar de forma legal y sin trucos tu libro. Dr. Ramon Reyes, MD @DrRamonReyesMD https://lnkd.in/eVpFyzZ #DrRamonReyesMD

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2010 AMERICAN HEART ASSOCIATION and AMERICAN RED CROSS FOR FIRST AID

Please Follow the link to download in pdf

COAST GUARD AVIATION MEDICINE MANUAL

COAST GUARD AVIATION  
MEDICINE MANUAL 

U.S. Department of
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Enlace para bajar manual en pdf

Vinculo mayor Riesgo de Muerte con Pildoras para Dormir

SALUD

Las píldoras para dormir vinculadas a un mayor riesgo de muerte

AFP

Londres

Las pastillas para dormir comúnmente recetadas están ligadas a un riesgo cuatro veces mayor de una muerte prematura, según un estudio estadounidense publicado en la revista British Medical Journal.

Esta medicación a grandes dosis está asociada con un 35% más de riesgo de padecer cáncer en comparación con personas que no las usan, pero las razones de este vínculo todavía no son claras, señala el estudio publicado el lunes.

Los doctores dirigidos por Daniel Kripke del Centro del Sueño de la Clínica de la Familia Scripps Viterbi en La Jolla, California, estudiaron el historial médico de 10.500 adultos que viven en Pensilvania y a los que se les había recetado medicación para dormir.

Los datos fueron cotejados con los de más de 23.600 personas, comparadas por edad, salud, y origen, que no tomaba esa medicación.

El estudio se alargó durante dos años y medio y estudió las píldoras comúnmente recetadas a amplios sectores de la población para dormir, lo que incluye benzodiazepinas, no benzodiazepinas, barbitúricos y sedativos.

El número total de muertes que ocurrió durante este período fue pequeño en ambos grupos, totalizando menos de 1000 muertes.

Pero hubo una sorprendente diferencia en la mortalidad, encontraron los investigadores.

Aquellos que tomaron entre 18 y 132 dosis anuales de medicación para dormir tenían 4,6 más posibilidades de morir que el grupo de control.

Incluso aquellos que tomaron menos de 18 dosis anuales tenían 3,5 más posibilidades de morir.

"Los cálculos a grandes rasgos sugieren que en 2010 los hipnóticos (pastillas para dormir) podrían estar asociados con entre 320.000 y 507.000 excesos de muertes en Estados Unidos únicamente", afirma el estudio.

Los detalles de cómo murieron los individuos no fueron desvelados, y los autores recalcan que encontraron una relación estadística pero no una causa.

Pero hicieron sonar la alarma debido al gran número de gente que toma esta medicación.

"Estimamos que, aproximadamente, del seis al 10% de los adultos en Estados Unidos tomaron estos fármacos en 2010 y los porcentajes podrían ser mayores en algunas partes de Europa", escriben.

La media de edad de las personas del estudio fue 54 años. Los investigadores afirmaron que tomaron en cuenta factores que pudieran hacer posible la comparación entre los dos grupos, como si el individuo fumaba o tenía una problema de salud pre existente.

Sin embargo, no fueron capaces de tener en cuenta factores como depresión, ansiedad u otras cuestiones emocionales, ya que los diagnósticos se mantienen en secreto bajo la ley de Pensilvania.

Las investigaciones previas en píldoras para dormir encontraron una relación entre accidentes de coche y caídas graves, síndromes relacionados con comer por la noche, darse atracones de comida, regurgitación en el esófago y úlcera péptica.