I-gel shows a higher success rate in cardiac arrest patients compared to the ET tube. Staff who chose to use methods other than i-gel indicated this was a confidence issue when using new equipment. The re-audit indicated an upward trend in the popularity of i-gel; insertion is faster with a higher success rate, which allows the crew to progress with the other resuscitation measures more promptly. Airway soiling and aspiration beforehand have been reasons staff resort to ET intubation. It is anticipated by the authors that i-gel will emerge as the first choice of airway management device in prehospital cardiac arrests.

Although the epidural administration of clonidine and fentanyl provides pain relief after surgery, the interaction between the two drugs has not been examined formally. This study used an isobolographic method to determine whether epidurally administered fentanyl and clonidine interact in an additive or synergistic manner. Ninety women with moderate to severe pain after elective cesarean section under epidural anesthesia were studied. Using a randomized, double-blind protocol, we assigned each patient to receive a single epidural injection of one of three doses of fentanyl, clonidine, or a fixed ratio combination. Pain relief, blood pressure (BP), heart rate (HR), and sedation were measured 15 min after injection. Each drug alone and in combination produced analgesia, as measured by pain relief scores, and reduced need for intravenous morphine. Although the effective dose producing analgesia in 50% of patients (ED50) for the mixture was only 52% of that predicted by an additive interaction, this did not differ significantly from additivity, likely due to large variability. Clonidine, alone or in combination with fentanyl, produced a minor reduction in BP, but did not affect HR or cause more sedation than fentanyl. Unlike studies in rodents, this clinical study did not demonstrate synergy between fentanyl and clonidine. This could reflect a true species difference or differences in methodologies used. Nonetheless, a reduced dose of fentanyl and clonidine can be combined for excellent analgesia.

The purpose of this survey and record review was to characterize emergency department management of unprovoked seizures and status epilepticus in children in Illinois. The survey was sent to 119 participating emergency departments in the Emergency Medical Services for Children program; responses were received from 103 (88% response rate). Only 44% of the emergency departments had a documented protocol for seizure management. Only 12% of emergency departments had child neurology consultation available at all times. Record review showed that 58% of patients were discharged home, 26% were transferred to another institution, and 10% were admitted to a non-intensive care unit setting. Ninety percent of patients were treated with anticonvulsants. Seizure education was provided by the primary emergency department nurse (97%) and the treating physician (79%). This project demonstrated strengths and weaknesses in the current management of pediatric seizure patients in Illinois emergency departments.

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Electronic medical records (EMR) have become the standard of care for documentation in today’s health care settings. The EMR system allows for standardization of care and widespread access to information with ability to subsequently evaluate that care. Additionally, trends are more easily documented and monitored. Development of a stroke specific EMR system for a comprehensive stroke center (CSC) was the goal from the initiation of our multidisciplinary steering committee. Our center enlisted the stroke nursing and physician teams, administration, health services researcher, quality and clinical informatics teams to develop an EMR navigator tool based on guidelines from the American Heart/Stroke Association (AHA/ASA) in anticipation of being an early CSC. It was designed to be used for all patients with a diagnosis of stroke during hospitalization. The informatics team developed a method to capture proposed CSC metrics and quality indicators. Progress notes were developed to auto populate necessary data using a specific template. Order sets were standardized according to AHA/ASA guidelines. Discrete fields were built into the EMR to ensure data could be automatically aggregated to evaluate quality-of-care for all stroke patients without requiring chart review. Efforts were made to ensure ease of use and efficiency while preventing errors. The navigators were designed to allow for reports required by Joint Commission to be more readily run on a regular and ongoing basis. Clinical informatics worked with representatives from EPIC to develop custom code for unique situations such as “door to needle time,” as required by Joint Commission. Smart phrases were identified when able, but minimized to prevent duplicity and erroneous assessment and documentation. Stroke patients often require complex interdisciplinary team care. Having a stroke navigator EMR in place enables all health care providers to have consistent access to information at hand to improve our ability to provide comprehensive care. Cues for care can be provided, improving safety and preventing errors. It also enables standardization of data extraction with ability to track progress between notes and trend data in spread sheet format.