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The use of opioid agents has increased dramatically in the United States. Prescription drug overdoses now account for more deaths than traumatic injuries in the 1-44 age group. There is a need for more high level evidence to target optimal pain management strategies in the acute (ED) and non-acute settings (office practice) especially for chronic disorders such as low back pain, headaches, fibromyalgia, acupuncture etc. ...more »
Vascular access is a challenge in the setting of out-of-hospital cardiac arrest (OHCA). The failure of medications to impact outcomes may be in part related to the delay in drug delivery from the IV route. EMS systems have adopted intraosseous (IO) access but it is not clear if these are affecting outcome and there has been no large RCT. The current IO access devices are expensive and use different routes (sternal, tibia, ...more »
The majority of patients who are resuscitated from OHCA have a presumed cardiac etiology. One of the key interventions post cardiac arrest is to study the coronary circulation for underlying thrombosis. Some centers do this routinely but at other centers interventional cardiologists are hesitant to do this since the mortality rates are high and so affect their individual and institutional performance measures related ...more »
Epinephrine is the primary drug that is used in resuscitation but observational studies and a few small RCT suggest that it improves short term but not long term outcomes. Factors such as timing, dose, quality fo CPR and post-resuscitation care all confound the issue. Large RCTs conducted at multiple centers are desperately needed to address this question.
Traditionally the Health Care model has meant that patients come to HCF for their care. Hospitals are increasingly overcrowded and also not always the best place to be due to the risk for nosocomial infections. Utilizing existing community resources to enhance the health both acute and chronic deserves exploration at the national level. Training paramedics to do chronic disease monitoring as well as as remotely work with ...more »
Out of hospital cardiac arrest remains a major cause of mortality in the United States and there is a large variability in survival within communities. We need to better understand the reasons for this variability which include patient, event, EMS system and care processes and work as a nation to reduce the variability but adopting best practices and actively addressing the barriers to change which can be social, cultural, ...more »
As the volume of information in EHR has continued to increase, one of the current challenges is how to find key pieces of information within the EHR. For example if a patient presents to the ED with Chest Pain as chief complaint, key information for that patient related to this chief complaint should be retrieved by the IT system and presented to the clinician for review such as prior ECG's, prior work-ups including any ...more »
The major barrier to further reducing mortality from ACS in particular STEMI remains patient delay. Symptoms are either ignored or misinterpreted and this behavior has not changed despite community education efforts. The advance of social media as well as smartphones and other internet based tools suggests that there is a new opportunity to potentially help change human behavior.