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February 23rd, 2012 posted by Paul Rega, MD, FACEP February 23, 2012 @ 8:35 pm

Emergency Care & Lower Death Rate

http://www.medscape.com/viewarticle/759006

Top Hospitals for Emergency Care Have 40% Lower Death Rate

Mark Crane

February 22, 2012 — “Medicare patients admitted to the nation’s best-performing hospitals for emergency medicine have a 40% lower death rate compared with all other hospitals, according to a new survey by HealthGrades, a Denver, Colorado–based provider of information about physicians and hospitals….”



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February 23rd, 2012 posted by Paul Rega, MD, FACEP @ 5:32 pm

Musayyib, Iraq: A car bomb parked near an elementary school kills three and wounds 73. Most of the injured in the town, located about 40 miles (60 kilometers) south of Baghdad, were schoolchildren.

Uncategorized

http://abcnews.go.com/International/wireStory/rapid-fire-attacks-iraq-kill-55-people-15774315

Widespread Shootings, Bombings Kill 55 Across Iraq

By LARA JAKES Associated Press

BAGHDAD February 23, 2012 (AP
 
“Bombs and deadly shootings relentlessly pounded Iraqis on Thursday, killing at least 55 people and wounding more than 225 in a widespread wave of violence the government called a “frantic attempt” by insurgents to prove the country will never be stable.Cars burned, school desks were bloodied, bandaged victims lay in hospitals and pools of blood were left with the wounded on floors of bombed businesses after the daylong series of attacks in 12 cities across Iraq….”


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February 23rd, 2012 posted by Paul Rega, MD, FACEP @ 5:20 pm

National Situation Update: Thursday, February 23, 2012

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http://www.fema.gov/emergency/reports/2012/nat022312.shtm

Significant National Weather:

West
Look for snow & lower elevation rain to develop over parts of the Northern Intermountain West, Northern Rockies and Central Great Basin this morning. Elsewhere will be sunny and dry, with highs in the mid to upper 70s across California and the Desert Southwest. Late tomorrow, a new Pacific system will begin to move onshore over the Pacific Northwest, producing more coastal rain & high elevation snow.
Midwest
A system moving from the Northern & Central Rockies will produce light snow over much of the Northern & Central Plains across to the Great Lakes this afternoon into tonight. Heavy snow is possible between the Upper & Middle Mississippi Valleys and Lower Peninsula of Michigan. Elsewhere, light to moderate rain will develop over the Middle Mississippi and Ohio Valleys today.
South
Rain and thunderstorms are expected over parts of the Tennessee Valley, and Southeastern U.S. throughout today, with a slight risk of severe thunderstorms threatening the lower Ohio & Tennessee Valleys into the Gulf States later this afternoon into tonight. Elsewhere, the Carolinas down through Florida should be mostly warm and dry, with temperatures 15-20 degrees above average across to southern/eastern Texas.
Northeast
A system moving from the Great Lakes will produce light to moderate rain over the coastal region of New England and snow over parts of the interior Northeast, mainly this morning. Temperatures will continue to be 15 to 20 degrees above average across the Mid-Atlantic today, with sunny to partly cloudy skies. By tomorrow, light rain and some thunderstorms will develop along and ahead of the associated cold front stretching from the Central Appalachians to the Mid-Atlantic.

Western Washington State Flood Event:

The heavy rains over western Washington are ending and rain amounts were less than anticipated. As a result, the upper reaches of the western Washington rivers crested early yesterday, and the lower reaches are cresting this morning as crests continue to move downstream. The Snoqualmie River at Carnation in King County (Seattle) crested yesterday at moderate flood stage and is receding, while the Snohomish River at Snohomish in Snohomish County (Everett) crested yesterday evening and has now receded below flood stage. Both the Green and White Rivers are anticipated to remain above the trigger points through this morning, February 23, 2012.

Planned dam releases from the Howard Hansen Dam will keep the Green River at Auburn in King County, WA at minor flood stage through Friday afternoon; and the White River is forecast to remain below flood stage for the period. Scouring of the Union Slough Levee along the Snohomish River near Everett, WA weakened two portions of the levee causing a loss of embankment material. The U.S. Army Corps of Engineers (USACE) Seattle District EOC is now activated at Level IV (Full Activation – 24/7 operations) and has deployed flood teams to the Snohomish (8 people), Green (5 people), and White (4 people) River basins. The Snohomish Flood Team is working 24 hours a day to reduce the risk of a levee breach by strengthening the levee with armor material. The levee repair is approximately 40% complete; and work is anticipated to be completed this afternoon. No residences have been threatened. Meanwhile, the Green and White River teams are assessing levee and river conditions and providing feedback for regulation of the Howard Hansen and Mud Mountain Dams. There has been no request for FEMA assistance and none is anticipated.

The U.S. Army Corps of Engineers (USACE), Mississippi Valley Division, is identifying and developing communication strategies for the elevated threat in the Mississippi River’s flood risk reduction system brought about by 2011 flood damages. A USACE regional flood preparedness team is currently building on Mississippi River damage assessment information (which includes levees, reservoirs, channel stabilization and floodways). The massive 2011 flood damaged many structures, navigation channels and levees along the Mississippi River, leaving many in a state of vulnerability that raise concerns for increased risk of diminished performance, possible failure and potential for adverse consequence to their dependent communities, citizens and industry. The risks are being carefully assessed along with consideration for potential risk reduction measures that may be needed prior to the enactment of full repairs. In addition to the risk information above, select high-risk areas within the Mississippi River Valley will be modeled with a hypothetical major flood using historical data and the National Weather Service spring forecast, and then mapped to show potential inundation (e.g., inundation timing and depth). This regionally standardized inundation information will be extremely helpful for future interagency collaboration designed to enhance or improve preparation, mitigation and response to flooding emergencies.

Space Weather:

No space weather storms were observed for the past 24 hours and no space weather storms are predicted for the next 24 hours.

Tropical Weather Outlook

No new activity (FEMA HQ)

Earthquake Activity

No new activity (FEMA HQ)

Disaster Declaration Activity

No new activity (FEMA HQ)

Last Modified: Thursday, 23-Feb-2012 09:04:46 EST



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February 23rd, 2012 posted by Paul Rega, MD, FACEP @ 12:17 am

What caused the train to crash?

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http://www.cbsnews.com/8301-202_162-57383278/cause-of-argentine-train-crash-still-unknown/

February 22, 2012 9:58 PM
Cause of Argentine train crash still unknown
 
(AP)BUENOS AIRES, Argentina – “……The train didn’t come to a halt until it had slammed into a metal barrier at Buenos Aires’ Once station. With eight cars carrying a mass of steel and humanity — more than 1,200 people on board — the momentum was devastating. Forty-nine people were killed and 600 were injured….”

 



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February 23rd, 2012 posted by Paul Rega, MD, FACEP @ 12:09 am

GAO reports on national emergency communications

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Read


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February 23rd, 2012 posted by Paul Rega, MD, FACEP @ 12:08 am

ER:Antibiotic and Bronchodilator Prescribing for Acute Bronchitis

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Antibiotic and Bronchodilator Prescribing for Acute Bronchitis in the Emergency
Department
Published online: 20 February 2012
Jason C. Kroening-Roche, Arash Soroudi, Edward M. Castillo, Gary M. Vilke
DOI: 10.1016/j.jemermed.2011.06.143
Journal of Emergency Medicine

http://www.jem-journal.com/article/S0736-4679%2811%2901400-4/abstract

Antibiotics are over-prescribed in the ED for acute bronchitis, with broad-spectrum antibiotics making up the majority of the antibiotics prescribed. Age50 years and smoking are associated with higher antibiotic prescribing rates.



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February 23rd, 2012 posted by Paul Rega, MD, FACEP @ 12:06 am

Needlestick injury during pandemics: Increased almost 5 times due to inexperience

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http://www.ncbi.nlm.nih.gov/pubmed/22305115

Am J Infect Control. 2012 Feb 2. [Epub ahead of print]
Needlestick injury surveillance during mass vaccination clinics: Lessons learned and why more is needed-Tri-County (Denver Metropolitan) region, Colorado, 2009.
Williams NJ, Ghosh TS, Vogt RL.

Tri-County Health Department studied needlestick injury (NSI) risks in pandemic influenza A (H1N1) mass vaccination clinics through incident reports and an Internet-based vaccinator survey. The mass vaccination clinic NSI rate was 4.9 times the mean rate observed during Tri-County Health Department’s 2003 to 2009 routine vaccination clinics. There was also a trend of increased risk for NSI with vaccination inexperience. These findings can be used to improve future mass vaccination clinic safety.



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February 23rd, 2012 posted by Paul Rega, MD, FACEP @ 12:05 am

Nature Editorial: Flu papers warrant full publication

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http://www.nature.com/nature/journal/v482/n7386/full/482439a.html

NatureVolume:482,Page:439Date published:(23 February 2012)DOI:doi:10.1038/482439a

Published online

“Although more debate is needed, the benefits of publishing sensitive data outweigh the risks that have so far been made public.”

 

 



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February 23rd, 2012 posted by Paul Rega, MD, FACEP @ 12:05 am

Women with MIs and no chest pain

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Journal of the American Medical Association
Source reference:
Canto JG, et al “Association of age with sex with myocardial infarction symptom presentation and in-hospital mortality” JAMA 2012; 07: 813-822.

http://jama.ama-assn.org/content/307/8/813.short

Conclusion In this registry of patients hospitalized with MI, women were more likely than men to present without chest pain and had higher mortality than men within the same age group, but sex differences in clinical presentation without chest pain and in mortality were attenuated with increasing age.



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February 23rd, 2012 posted by Paul Rega, MD, FACEP @ 12:04 am

What two countries in Europe remained measles-free in 2011: Iceland and Cyprus.

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http://ecdc.europa.eu/en/press/news/Lists/News/ECDC_DispForm.aspx?List=32e43ee8-e230-4424-a783-85742124029a&ID=568&RootFolder=%2Fen%2Fpress%2Fnews%2FLists%2FNews

Latest European monthly measles monitoring report reviews 2011 surveillance data
21 Feb 2012

The latest European Monthly Measles Monitoring (EMMO) provides analyses of last year’s measles surveillance data. In 2011, 30,567 cases of measles were reported by 29 European countries, roughly same number of cases last year but a four-fold increase compared to 2009 (7 175). Only two countries in Europe remained measles-free in 2011, Iceland and Cyprus.

France reported the most cases as well as the highest notification rate per 100 000 population, and accounted for more than half of the cases. Other countries with a high number of cases were Italy, Romania, Spain and Germany. Together, these five countries accounted for more than 90 percent of all measles cases in the EU. Bulgaria, which experienced a large outbreak with more than 22 000 cases in 2010, reported only 157 cases in 2011.

The enhanced measles surveillance data in this report was retrieved from The European Surveillance System (TESSy) on 26 January 2012 and the analysis covers the period from 1 January to 31 December 2011.

The report also pointed out that there is an ongoing measles outbreak in Ukraine with more than 3,000 cases reported in 2012. The country will be hosting the European Football Championship in June this year and large numbers of visitors are expected. Unvaccinated tournament visitors will be at risk of measles infection.

ECDC is monitoring measles transmission in EU Members States, Iceland, Liechtenstein and Norway. The EMMO aims to provide public updates on the measles situation in Europe for effective disease control measures, and in support of the common 2015 measles elimination target.

European monthly measles monitoring, February 2012

Read more:

EUVAC surveillance page

Measles health topic page

 



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