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Dr. Justina Truong named the ACOEP/RSO resident of the year!

By | Uncategorized

It is a great honor to announce that Dr. Justina Truong was named the ACOEP/RSO resident of the year. This award recognizes an emergency medicine resident who has gone above and beyond their duties as a resident, leader, mentor, and academician. This award is the highest national award bestowed to an osteopathic emergency medicine resident each year. Way to go Dr. Truong!

Sepsis in the Emergency Department

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How Sepsis has Changed ED Protocols

How Sepsis Has Changed Emergency Department Protocols

By Laura Edgerley-Gibb, MD, FACEP, Medical Director, SLV Health Emergency Department, and Chief Medical Officer, Innova Emergency Medical Associates.

Sepsis affects nearly 1.7 million Americans per year and results in 270,000 deaths. It can affect patients at any age, from our tiniest neonates to our elderly patients. There is rarely a shift in the Emergency Department where we do not treat a patient with sepsis. In the past, “sepsis care” was ill-defined and there was inadequate data to show how we should best treat sepsis. Sepsis was not even formally defined in the medical community until 2001.

Through the years, there have been many iterations of sepsis treatments, but today we know that there are three main tenants of sepsis care:
1. Identifying Sepsis – with advances in lab testing (lactate levels, procalcitonin levels, and rapid panels for common bacteria/viruses) we are much better at identifying sepsis.
2. Providing broad-spectrum antibiotics – antibiotic recommendations from the IDSA and other sources are better studied and more robust.
3. Treating poor perfusion – a hallmark of sepsis is poor perfusion to the organs. Prompt treatment with IV fluids and blood pressure support is needed.

We now know that early identification of sepsis and appropriate treatment can save lives.

gibbs and deraet

Pictured in the SLV Health Regional Medical Center are Hospitalist Director Olivier de Raet, MD (L), and Innova CMO Laura Edgerley-Gibb, MD (R).

 

https://www.sanluisvalleyhealth.org/news/2020/september/how-sepsis-has-changed-ed-protocols/?fbclid=IwAR1fGMofF831Lc1RGdfaqOxSTQgte1HSmAAWFavkNBNx7Bbbu6EhhSWs_cA

 

Innova included on prestigious Inc. 5000 list

By | Uncategorized
Inc. magazine announced yesterday that Innova Emergency Medical Associates was included on its annual Inc. 5000 list, a prestigious ranking of the nation’s fastest-growing private companies. This list represents a unique look at the most successful companies within the American economy’s most dynamic segment – it’s independent small businesses. Intuit, Zappos, Under Armor, Microsoft, and many other well-known names gained their first national exposure as honorees on the Inc. 5000. We are proud to be among their ranks and are filled with immense gratitude, as we could not have done this without our incredible crew. So thank you to each and every team member for making Innova the best it can be day in and day out.

A Reflection On Distance by Dr. John Tveten

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Our computer stations are only six feet apart but I can’t recall if we’ve ever touched. Was there an accidental bump while negotiating the ER labyrinth? Now my hand rests on your shoulder. Through double gloves, part of a body covered in synthetic armor, it is meant to be a touch of reassurance. My voice muffled by two masks, tries to project the accompanying words. “We’ll get you through this”. Words I mean. Words I believe. But I can’t help my thoughts from drifting towards Nieci.

Just an hour ago I was told she had died. Just a week ago it was she in this very bed. Like you, she was an integral part of our hospital. Performing a task that I came to see while I was a resident as the heart of the department: the quartermaster who plots the course and steers the ship.

Neici was a powerful woman of color. I’ve heard her called “big mamma”, in the most respectful light. Played out in real time she was bigger than big. Grand is more like it, singular. Brazen in her determination to provide, with arms that could hug two city blocks. It was impossible to get in her way.

While you have the same effect, your way is different. In your tradition you are the silent pillar. A cornerstone in a foundation that has absorbed the weight of generations of massacre from disease in all its forms. Providing the strength needed to nurture community and sustain culture. From six feet away I have seen you calmly handle the next crisis that your cell phone delivers even as you steer me through the next crisis that comes through the ambulance bay doors. Now it is you who is in need of support. When I tell you that we need to admit you, are you anxious? With you it is hard to tell.

I walk the roughly sixty meters to the medical floor reflecting on distance. Six feet, the distance from middle fingertip to middle fingertip of the average English sailor’s outstretched arms, aka a fathom. Six feet, the distance declared to bury victims during the plague of 1665 to prevent further spread, hence the euphemism ‘six feet under’. Six feet, the standard unit of social distance… based on what? A sneeze can propel droplets to speeds of 100 miles per hour. According to an MIT study, these droplets can travel eight meters and remain suspended in the air for ten minutes. A cough is not far behind traveling up to six meters. Why six feet? The answer is no different in 2020 then it was 355 years previously, it seems about right.

Whether I measure by seven sneezes, ten coughs, or thirty-three social distance units I arrive at the Covid ward. I walk past the void left where Nieci. used to sit. It is fathoms deep. I can’t see where it ends. Three days have passed since I last saw you and a quick glance tells me your oxygen requirement has gone up. Your anxiety is now plain to see. Can you see mine?

This disease is like nothing I’ve encountered in my twenty-five years of practice. For most it is goes unnoticed or is a quickly passing storm. But some get walked to the canyon rim, are allowed a moment to take in the view and then without warning are cast into free-fall. I wish I could tell you that someone couldn’t be you.

Double masked and gloved, armor in place, I sit on your bed and hold your hand. It is the best medicine I can offer. There is no distance. I remain hopeful. You remain strong. We make a pact to hug.

John Tveten is an ER doctor at Little Colorado Medical Center in Winslow, AZ., which provides emergency care for northeast Arizona including the southern Navajo Reservation. The Navajo reservation has been particularly affected by Covid-19 and has suffered the third highest per capita cases in the country.

https://medium.com/@johntveten/a-reflection-on-distance-41f62a066b7f

Aspirus in Iron River named Top 100 Critical Access Hospital

By | Emergency Medicine, Health News, Innova News, Rural Communities

So proud of our partner hospital in Iron River, Michigan!

IRON RIVER — Aspirus Iron River Hospital recently was named one of the Top 100 Critical Access Hospitals in the U.S. by iVantage Health Analytics and The Chartis Center for Rural Health.

As a top-performing CAH, Aspirus Iron River is recognized as being one of the best of the 1,332 rural safety-net hospitals in the nation, officials said.

“This achievement is very gratifying and validates our daily commitment to providing the best health care possible to our community while maintaining an efficient and effective facility,”Aspirus Iron River CEO Connie Koutouzos said. “It’s a testament to the high-quality, patient-centered care we provide. This recognition also salutes the skill and dedication that is displayed daily by our medical staff and employees. We are dedicated to leading the transformation of health care for the communities we serve.”

A CAH is a hospital certified to receive cost-based reimbursement from Medicare. This program is intended to reduce hospital closures in rural areas, promote a process for improving rural health care and focus on community needs.

CAHs are in rural areas, can have a maximum of 25 acute care in-patient beds, and provide 24-hour emergency services.

Aspirus Iron River Hospital scored in the top 100 of Critical Access Hospitals on iVantage Health Analytics’ Hospital Strength INDEX. The INDEX is a comprehensive rating of rural providers. It provides the data foundation for the annual Rural Relevance Study and its results are the basis for many of rural health care’s most prominent awards, advocacy efforts and legislative initiatives.

The list of the Top 100 Critical Access Hospitals and more information about the study can be found at www.iVantageINDEX.com.

Aspirus Iron River was among only five to make the list in Michigan, another being Aspirus Ironwood Hospital. Aspirus partner hospitals in Wisconsin, Aspirus Medford Hospital and Aspirus Langlade were the only CAHs to receive the designation from Wisconsin.

The Top 100 Critical Access Hospitals play a key role in providing a safety net to communities across America — and the INDEX measures them across eight pillars of hospital strength: Inpatient Share Ranking, Outpatient Share Ranking, Cost, Charge, Quality, Outcomes, Patient Perspectives, and Financial Stability.

Aspirus is a non-profit, community-directed health system based in Wausau, Wis.

Aspirus serves communities throughout northern and central Wisconsin, as well as the western Upper Peninsula.

The integrated system includes four hospitals in Michigan and four hospitals in Wisconsin, 50 clinics, home health and hospice care, pharmacies, critical care and helicopter transport, medical goods, nursing homes and affiliated physicians.

http://www.ironmountaindailynews.com/news/local-news/2017/03/aspirus-in-iron-river-named-top-100-critical-access-hospital/

New Car Seat Safety Recommendations for 2018

By | Health News

The American Academy of Pediatrics (AAP) has published new car seat safety guidelines as of August 30, 2018.  They have updated their recommendations to state that children should remain rear-facing until they reach the highest weight or height (whichever they reach first) for their seat.  Previously the AAP recommended rear-facing until at least age 2, but with these new guidelines, many children can and should remain rear facing much longer.

You may be wondering – why is rear-facing important?  Infants and toddlers have heads of disproportionate weight to the rest of their body.  Rear-facing seats help to better cradle the head during a crash, therefore protecting the neck and spine from injury.  Neck and spine injuries are some of the most devastating and heart-breaking injuries we care for in the emergency department.

As Emergency Physicians, we are thrilled with these new recommendations.  Car accidents remain a major cause of death and disability for children under age 15 and this evidence-based policy recommendation guides parents in proper restraint use to protect their child. Please check your specific seat for the height and weight limits for rear-facing installation.

The National Highway Traffic Safety Association has published guidelines, recommendations and can even help set up an installation inspection.   See their website for further information.

EpiPen Shortages & Anaphylaxis Risks

By | Emergency Medicine, Health News

EpiPen Shortages & Anaphylaxis Risks

Drug shortages are affecting our patients and providers on a daily basis.  One of the most concerning recent shortages is the limited availability of the Epi-Pen, a home device used to deliver epinephrine to patients with life-threatening allergic reactions (anaphylaxis). 1-2% of the population will develop anaphylaxis in their lifetime.  Anaphylaxis is a complicated reaction leading to mast cell release, airway swelling, and can cause cardiopulmonary arrest.  Epinephrine is the treatment of choice.

The development of epinephrine auto-injectors has allowed patients with a history of anaphylaxis to initiate immediate life-saving treatment in cases of repeat events.  Patients are provided with prescriptions for epinephrine auto-injectors to carry with them at all times.  Patients benefit from having multiple auto-injectors to keep at home, school, work, and daycare.

In order to manage this dangerous shortage, the FDA has extended the expiration date of some of the pens (regular Epi-pens, not the Jrs) by up to 4 months.  Patients can check the FDA website to verify the lot number on their pen.  Patients should not throw away their pens until they check the website to see if the expiration date has changed and also verify that the pharmacy can refill them.  Some schools and daycares are still refusing to use expired pens even with this FDA announcement due to liability concerns.

Verify your EpiPens here

There are now additional auto-injectors available – Adrenaclick or Auvi-Q – both are FDA approved epinephrine devices but they have a different delivery system so patients will need to read the instructions carefully and train themselves before they need to use them. Patients should check with their pharmacy to determine what they have in stock and what their insurance will cover.