Emergency medicine:

For people aged between five and 45
years, injury is second only to
HIV/AIDS as a cause of death. Each
year about 600,000 injured patients
bleed to death worldwide.  Injuries may
be accidental, for example traffic
crashes, or intentional, such as
shootings, stabbings or land mine
injuries and the majority of deaths
occur soon after injury. Although most
deaths from injuries are in developing
countries, injury is a leading cause of
death in young adults throughout the
world.

It's important to remember that deaths
from injuries are increasing around the
world and that they usually involve
young adults, often the main
breadwinner in the family. The impact
on the family is devastating.

CHANGING TREATMENT TO FIGHT E
COLI
Doctors in Germany are trying a
treatment that might be risky to fight
severe Escherichia coli infections.
They are treating some patients with
antibiotics as soon as they enter the
hospital.

Antibiotics are commonly used to kill
bacteria that cause illness. But E. coli
infections are different. The illness is
caused by toxins rather than the
bacteria. Many doctors fear that killing
the bacteria quickly could release
more toxins. This could kill the patient.

Most hospital cases are treated with
intravenous fluids.

But doctors treating people in the
latest outbreak said they tried
antibiotics because the cases have
been so severe. At least 27 people
have died. Hundreds have developed
a syndrome that can cause kidney
failure.

The antibiotic treatment has shown
some signs of success. Some patients
have recovered well. Therefore, more
German hospitals are trying it.

More than 700 of the patients in
Germany are suffering not only from
diarrhea and cramps but have also
developed a life-threatening
complication that can cause kidney
failure, and require round-the-clock
medical care.

Some pateints are undergoing blood
plasma exchange to try and remove
the toxins from their system. In the
procedure, doctors remove  four liters
of blood plasma and replace it with
fresh plasma for three days in a row --
or longer if needed.

Some 77 percent of patients in
Germany are women and the majority
of them are between 20 and 50 years
old, most fit and with healthy lifestyles.



EMERGENCY  COOLING OF THE
BRAIN THRU THE NOSE
Therapeutic hypothermia, or cooling,
lowers a patient's body temperature to
help reduce the risk of injury to the
brain following a period of insufficient
blood flow due to an ischemic event,
such as a stroke or cardiac arrest.

Results from a recent study showed
that the RhinoChill  Intra-Nasal Cooling
System enabled brain temperature to
reach target several hours earlier than
patients cooled in the emergency
room. It is widely recognized that the
sooner brain temperature can be
reduced, the better the chances of
minimizing long-term damage.

In a study in this month's Circulation, a
new nasopharyngeal device was used
to initiate cooling
during cardiac arrest.
The RhinoChill Intra-Nasal Cooling
System from BeneChill (San Diego,
CA) uses a non-invasive nasal
catheter that sprays a rapidly
evaporating coolant liquid into the
nasal cavity, adjacent to the major
vascular structures of the brain. The
system is compact, battery operated
and easy and fast to insert, making it
more practical in emergency situations
than surface or intravascular cooling
devices.
Patients were randomized to either
intra-nasal cooling with RhinoChill
along with standard advanced cardiac
life support (ACLS) care or ACLS
alone until they were either
resuscitated or reached hospital, at
which stage patients in both groups
were cooled.
Results showed that the target
tympanic temperature of 34°C, used
as an approximation of brain
temperature, was reached three hours
earlier in the group receiving pre-
hospital cooling with RhinoChill. Target
core body temperature was also
reached two hours earlier. Among
patients surviving as far as hospital
admission, 47% of patients who were
cooled survived to discharge,
compared with only 31% of those who
had not been cooled. Survival rates in
the 75% of patients who received CPR
within ten minutes of collapse were
59% and 29% respectively.

The RhinoChill System received CE
Mark Approval for marketing in
European Union countries in
December 2007. It is currently planned
to commence launches in selected
European markets from October 2010.
The RhinoChill System is not for sale
in the USA.


INEXPENSIVE  MEDICINE TO STOP
BLEEDING
If recently injured patients with serious
bleeding were to receive a cheap,
widely available and easily
administered drug to help their blood
to clot, tens of thousands of lives could
be saved every year, according to a
paper published on-line by The Lancet.

TXA (tranexamic acid)  is an off-patent
drug, manufactured by a number of
different companies. The cost per
gram is about $4.50.

A  trial, named CRASH-2, was a large,
randomised trial involving over 20,000
adult patients in 274 hospitals across
40 countries, and was funded by
England's National Institute for Health
Research (NIHR) Health Technology
Assessment program. This is the first
trial of TXA in injured patients,
although smaller trials have shown that
it reduces bleeding in patients
undergoing major surgery.  

The drug helps by reducing clot
breakdown. Although this would be
advantageous in patients with severe
bleeding, doctors were worried that
TXA might increase the risk of
complications, such as heart attacks,
strokes and clots in the lungs. The
results of this large trial show that TXA
reduces death from bleeding without
any increase in these complications.

Severely injured adults were enrolled
in the trial if they had significant
bleeding, or were at risk of significant
bleeding and were within a few hours
of injury. They were randomly
allocated to receive either one gram of
TXA by injection, followed by another
one gram in a drip over the following
eight hours, or a matching placebo.
The researchers studied the numbers
of deaths in hospital within four weeks
of injury in the two groups and found
that TXA reduced the chances of
death due to massive blood loss by
about one sixth.

The researchers estimate that
administering TXA soon after injury
could prevent up to 100,000 deaths
per year across the world.



PROGESTERONE TESTED WITHIN 4
HOURS OF INJURY
The ProTECT study will determine if
intravenous (IV) progesterone (started
within 4 hours of injury and given for a
total of 96 hours), is more effective
than placebo for treating victims of
moderate to severe acute traumatic
brain injury.
Trial no: NCT00822900
The new three-to-six-year trial, which is
known as proTECT III (for
progesterone for traumatic brain injury,
experimental clinical treatment), will be
led by David Wright, MD, associate
professor of emergency medicine at
Emory University School of Medicine.
Atlanta’s Grady Memorial Hospital has
been designated the lead center.

The possible introduction of
progesterone as treatment for brain
injured patients will be most welcome
by the medical community, as there
have been no effective treatments for
such injuries.

Progesterone, a hormone that has a
role in female fertility, it also seem to
protect brain cells  in  brain injured
patients.

This large-scale trial, which will involve
hospitals in 15 states, was prompted
by findings from several previous
studies, including a recent small study
in which investigators found that
administering progesterone soon after
a brain injury reduced the death rate
by 50 percent and improved the
patients’ ability to recover.

Another earlier study conducted at
Zhejiang University in China two years
ago found that patients with serious
brain injuries who were given
progesterone were more likely to
survive than those who received a
placebo. Among the patients who
survived, those who had received
progesterone had made a good
recovery at six months after treatment
(58% of patients) compared with those
who had received placebo (42% of
patients).

In the new trial, hospitals will randomly
assign 1,140 patients who arrive for
emergency care within 11 hours of
their brain injury to receive either three
days of infusion treatments with
progesterone or placebo. Because it
appears the infusions are most
effective if given within 11 hours of a
patient’s injury, it may not always be
possible to obtain consent from next of
kin for a patient to take part in the trial.
The Food and Drug Administration has
drawn up special rules to allow trials
that involve emergency medical
treatments to proceed without consent.

Another trial called  SyNAPSe  Phase
3  will study if giving intravenous (i.v.)
progesterone within 8 hours of the
injury for a total of 120 hours to severe
traumatic brain injury patients
improves their recovery.
Trial no: NCT01143064 and it is
conducted by  BHR Pharma, LLC.
"This drug has the potential to help a
gravely ill population that includes car
crash and battlefield injuries and we
could not be more pleased to initiate
this important trial," said Tom
MacAllister, J.D., Ph.D., BHR president
and CEO. "The annual incidence of
TBI is higher than breast cancer and
HIV/AIDS combined, yet it is largely
ignored. We are proud to lead the
efforts to make a difference for these
patients and their families."

BHR Pharma is a wholly owned
subsidiary of Besins Healthcare SA,
which markets healthcare products in
93 countries.



OTHER DEVELOPMENTS
pumping ice slurry into bloodstream
cools in 5 minutes by Argonne
equipment;

Cooling hood for brain by KCI;

Spray thru nose to cool brain
Rhinochill by Benechill;

Cooling helmet;

The liquid perfluorocarbon;

Angiojet by Possis Medical vacuums
out clots from veins;

Quick Angioplasty Best After Heart
Attacks;

Lucas 2 chest compressor by Jolife AB;

Victims of sudden cardiac arrest  who
are treated with automated external
defibrillators  by bystanders have a
much greater chance of survival than
their counterparts, as per study