Healthcare Update Satellite — 06-15-2013


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What’s the highest sodium level you’ve seen? These docs saved a patient with a corrected sodium level of 196 which is the highest I’ve ever heard of. Lower 170s is the highest I can remember. The patient drank a quart of soy sauce on a dare, then started having seizures a couple of hours later. Some quick thinking docs gave him 6 liters of free water over 30 minutes and the patient survived and was neurologically intact! Amazing. The docs from University of Virginia in Charlottesville deserve a lot of credit for saving this fellow.
Another story about the case is here.

$5 heroin killing many New Jersians. Ocean County, NJ has lost 53 people to drug overdoses this year alone.

California man enters hospital, walks into emergency department restroom, pulls out gun and shoots himself dead.

Are CT scans useful for evaluating dizziness in the emergency department?
This study showed that there was a 1 in 50 chance of a significant finding. Some people had bleeding in their cerebellum, some had hydrocephalus, some had cancers. When patients received a follow up MRI, 13% of patients had significant findings – most of which were strokes that had gone undiagnosed on the initial CT scan. I’m betting that if the testing was negative, certain groups of people [cough cough Consumer Reports hack cough]would label the tests “unnecessary” and state that the testing shouldn’t have been performed.
What would you want if it was your family in the emergency department?

An unfortunate case of “crying wolf”? UK patient takes overdose of pain medications then is taken to the emergency department (A&E department). There, she denies taking any medications to cause her lethargy. She was assigned to be watched by “unqualified” Healthcare Assistants, and was believed to be faking a coma because she was a “frequent flyer.” She stopped breathing and died from a narcotic overdose 12 hours later.
Now the Secretary of State for Health is being petitioned to prevent Healthcare Assistants from observing seriously ill patients and requiring that only nurses do so.
With more patients, fewer facilities, and lower reimbursement for care, we’re moving toward the system already present in the UK. Can we learn anything?

Another interesting article from the UK. When one hospital closes its emergency department, the domino effect on nearby hospitals is significant. Waiting times to be seen skyrocket: There is a five-fold increase in numbers of patients waiting more than 4 hours to be seen. The number of cancelled elective surgeries doubles. Patients die in ambulances waiting in the hospital parking lots just to get into the emergency departments.
Take note of these types of problems as the United States heads closer to a socialized system.
But at least their care is free.


  1. Managing potential organ donors, I have seen a serum sodium level as high as 205. Obviously not a survivor, but the hypernatremia was a consequence of the poor critical care management of a brain injured patient rather than the proximate cause of death.

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