Re: Preparing for Office Emergencies

[Guest guest]

I have NOTHING, and yes I think I should. This is a great question. Here are some things I think I should have: epi benedry IV setup Rocephin what else is absolutely essential? an AED would be nice, but I'm not going to get one, at least not for quite a while ... not till I'm making a decent income. Lonnadrmarge@... wrote: I was at my dentist's office the other day and saw an AED hanging on the wall. It got me thinking that I am not really set up

well to handle any unplanned emergencies. I am curious what types of things some of you guys have on hand, besides maybe epinephrine/benadryl. For instance, I don't have O2. I do not think I even have an ambu-bag. I recently took over a solo practitioner's office so there may be some things still hidden in the cabinets that I am not aware of yet. Curious minds want to know...... Thanks.Margaret Coughlan Millbrook, NY

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.

[Guest guest]

I have an AED and oral airways. Ambulance is about 5 minutes away, so my job would

be to call for it, open airway, possibly re-charge the heart and do chest

compressions.Interestingly, new research suggests the breaths are not as

important if chest compressions are done well. I guess the air moves in-out and the

blood moves round-n-round well enough with the chest pressure changes.I

should have an Epipen, but I keep forgetting to order.TimOn Thu, February 7, 2008 11:59 am EST,

drmarge@... wrote:

I was at my dentist's office the other day and saw an AED hanging on the wall.

Itgot me thinking that I am not really set up well to handle any unplannedemergencies. I am curious what types of things some of you guys have on hand,besides maybe epinephrine/benadryl. For instance, I don't have O2. I do not think

Ieven have an ambu-bag. I recently took over a solo practitioner's office so

theremay be some things still hidden in the cabinets that I am not aware of

yet. Curiousminds want to know...... Thanks.Margaret Coughlan Millbrook, NY

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

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[Guest guest]

I decided on an AED when I realized that a patient who needs defibrillation asap has

a better chance of survival in a local supermarket than in my office if I didn't

have one! I couldn't accept that. Considering that the

priorities are airway (I have 3 oral airways to keep tongue back) and possible

defibrillation asap, I figure that's all I need. Epipen is next on my list, but even

with an airway, someone should be fine until ambulance gets here (few minutes).Now, for the rural folks, the discussion is much more important I think.TimOn Thu, February 7, 2008

12:07 pm EST, Lonna Larsh wrote:

I have NOTHING, and yes I think I should. This is a great question.

Here are some things I think I should have:

epi

benedry

IV setup

Rocephin

what else is absolutely essential? an AED would be nice, but I'm not going to

get one, at least not for quite a while ... not till I'm making a decent

income.

Lonnadrmarge@... wrote:

I was at my dentist's office the other day and saw an AED hanging on the wall.

It got me thinking that I am not really set up well to handle any unplanned

emergencies. I am curious what types of things some of you guys have on hand,

besides maybe epinephrine/benadryl. For instance, I don't have O2. I do

not think I even have an ambu-bag. I recently took over a solo

practitioner's office so there may be some things still hidden in the

cabinets that I am not aware of yet. Curious minds want to know...... Thanks.Margaret Coughlan Millbrook, NY

Be a better friend, newshound, and know-it-all with Yahoo!

Mobile. Try it now.

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------

[Guest guest]

Aspirin

Nitroglycerin

I don't have an IV set-up, but maybe I should?

Sharon

At 09:07 AM 2/7/2008, you wrote:

I have NOTHING, and yes I think

I should. This is a great question.

Here are some things I think I should have:

epi

benedry

IV setup

Rocephin

what else is absolutely essential? an AED would be nice, but I'm not

going to get one, at least not for quite a while ... not till I'm making

a decent income.

Lonna

drmarge@... wrote:

I was at my dentist's office the other day and saw an AED hanging on

the wall. It got me thinking that I am not really set up well to handle

any unplanned emergencies. I am curious what types of things some of you

guys have on hand, besides maybe epinephrine/benadryl. For instance, I

don't have O2. I do not think I even have an ambu-bag. I recently took

over a solo practitioner's office so there may be some things still

hidden in the cabinets that I am not aware of yet. Curious minds want to

know...... Thanks.

Margaret Coughlan

Millbrook, NY

Be a better friend, newshound, and know-it-all with Yahoo! Mobile.

Try it now.

[Guest guest]

I have an epi pen ,benadryl ,aspirin and 911 one touch on the phone I do

not care about an AED as much as it might be nice to have oxygen but ain't

gonna happen

My officemate of 20 yrs has some emergency kit but she does not have

oxygen or a defib. either.

Re: Preparing for Office Emergencies

I have NOTHING, and yes I think I should. This is a great question.

Here are some things I think I should have:

epi

benedry

IV setup

Rocephin

what else is absolutely essential? an AED would be nice, but I'm not

going to get one, at least not for quite a while ... not till I'm making

a decent income.

Lonna

drmarge@... wrote:

I was at my dentist's office the other day and saw an AED hanging on the

wall. It got me thinking that I am not really set up well to handle any

unplanned emergencies. I am curious what types of things some of you

guys have on hand, besides maybe epinephrine/benadryl. For instance, I

don't have O2. I do not think I even have an ambu-bag. I recently took

over a solo practitioner's office so there may be some things still

hidden in the cabinets that I am not aware of yet. Curious minds want to

know...... Thanks.

Margaret Coughlan

Millbrook, NY

_____

Be a better friend, newshound, and know-it-all with Yahoo! Mobile.

<http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6

2sR8HDtDypao8Wcj9tAcJ> Try it now.

[Guest guest]

I would aspirin, and oxygen. The oxygen company lets me borrow small tanks,

since I send them patients. I sent them homw ith patients also, and then they

pick them up when they set u poxygen. We are at 9000 ft, but its good for chest

pain. I've had 3 MI's and several high altitude pulmonary edema patients.

I do not have an AED and my emergency plan is O2, ASA, an IV and 911.

________________________________

From: on behalf of

Sent: Thu 2/7/2008 10:54 AM

To: 'Lonna Larsh '; ' '

Subject: RE: Preparing for Office Emergencies

I have an epi pen ,benadryl ,aspirin and 911 one touch on the phone I do

not care about an AED as much as it might be nice to have oxygen but ain't

gonna happen

My officemate of 20 yrs has some emergency kit but she does not have

oxygen or a defib. either.

Re: Preparing for Office Emergencies

I have NOTHING, and yes I think I should. This is a great question.

Here are some things I think I should have:

epi

benedry

IV setup

Rocephin

what else is absolutely essential? an AED would be nice, but I'm not

going to get one, at least not for quite a while ... not till I'm making

a decent income.

Lonna

drmarge@... <mailto:drmarge%40pol.net> wrote:

I was at my dentist's office the other day and saw an AED hanging on the

wall. It got me thinking that I am not really set up well to handle any

unplanned emergencies. I am curious what types of things some of you

guys have on hand, besides maybe epinephrine/benadryl. For instance, I

don't have O2. I do not think I even have an ambu-bag. I recently took

over a solo practitioner's office so there may be some things still

hidden in the cabinets that I am not aware of yet. Curious minds want to

know...... Thanks.

Margaret Coughlan

Millbrook, NY

_____

Be a better friend, newshound, and know-it-all with Yahoo! Mobile.

<http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6

<http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6>

2sR8HDtDypao8Wcj9tAcJ> Try it now.

[Guest guest]

There are two implicit questions here:

1: What must I do from a medico-legal standpoint?

The answer is typically along the lines of " have an adequate means

of dealing with office emergencies. " This might be nothing

more elaborate than " speed dial 911 " in an urban/suburban

setting and maybe having a trauma bay in a rural setting.

2: What should I do to best help my patients?

This is a much more involved question and begins to get at how we can

organize our work to best serve the population in our practices.

With unlimited resources we can purchase, maintain, and store any device

for which there exists demonstrable advantage for our patients and our

practices. Unfortunately for us all, we work with limited

resources.

If there is a limitation on resources, we should keep in mind some level

of cost/benefit analysis. Should I spend $850 on an AED or on a

subscription to Instant Medical History, or lab tracking software, or on

.......? Which intervention is most likely to help my

patients?

The good news is that there is some research to guide our choices.

There are some studies that would put AEDs pretty far down the list of

cost effective strategies (see below).

Strategies that cost less and have a much greater impact

are:

Open access (patients who experience access delays are less likely to

come in for needed care)

High continuity (patients who see multiple providers and lose track

of who is in charge are hospitalized more often)

Not wasting patient time in the office (patient who experience wasted

time are less likely to follow up for needed care)

Assessing your patient for major determinants of health and wellness

(feelings, pain, finances)

Assessing your patient's level of understanding of diagnosis and

treatment plans

Assessing your patient's level of self-efficacy

Testing and implementing these key practice attributes costs less

than an AED. The impact on your patient population is

immense.

If you are wondering how well you perform on these key indicators, rest

assured that you no longer have to wonder. These can be measured

easily. The IMPs are using HowsYourHealth.org. See

www.IdealMedicalPractices.org and

www.IdealMedicalHome.org.

Of course you may be doing all these things and still have resources left

over for an AED.

Then go for it.

Gordon

Unique

Identifier

17579940

Status MEDLINE

Authors

Sharieff

W.

Kaulback K.

Authors Full

Name Sharieff,

Waseem. Kaulback, Kellee.

Institution

Department of

Health Policy, Management and Evaluation, University of Toronto, Ontario,

Canada. doc.sharieff@...

Title

Assessing

automated external defibrillators in preventing deaths from sudden

cardiac arrest: an economic evaluation.

Source

International

Journal of Technology Assessment in Health Care. 23(3):362-7,

2007.

At 11:59 AM 2/7/2008, you wrote:

I was at my dentist's office the

other day and saw an AED hanging on the wall. It got me thinking that I

am not really set up well to handle any unplanned emergencies. I am

curious what types of things some of you guys have on hand, besides maybe

epinephrine/benadryl. For instance, I don't have O2. I do not think I

even have an ambu-bag. I recently took over a solo practitioner's office

so there may be some things still hidden in the cabinets that I am not

aware of yet. Curious minds want to know...... Thanks.

Margaret Coughlan

Millbrook, NY

[Guest guest]

They probably have a greater need as they administer anaesthetics etc.

>

>

> I was at my dentist's office the other day and saw an AED hanging on the

> wall. It got me thinking that I am not really set up well to handle any

--

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records system

[Guest guest]

From Rural Drain: Besides the phone, I have aspirin, oxygen with mask and nasal Asprin ; an AED, a nebulizer with medications to use in it; IV set up with appropriately dated fluids, epinephrine and inject-able antihistamines and soluable corticosteroids; Rocephin. Dressing materials for traumatic wounds and for burns including ointments, Second Skin and bulk rolls of cotton; and splint making materials and some metal adjustable splints; Lots of adhesive tape to adapt or make other devices. Also I have a written plan and extra gloves, extra masks and gowns as part of the infectious disease emergency protocol I have evolved in response to a request from the state medical association. Don't forget to tape that epinephrine inside the drawer in your exam room if you personally

give inoculations: Twice in 30 years as a veterinarian I had a reaction to the innoculation that would have given me a dead dog if I had not been able to give epinephrin within a minute. Joanne, the MD from Drain Oregon Jim.Kennedy@... wrote: I would aspirin, and oxygen. The oxygen company lets me borrow small tanks, since I send them patients. I sent them homw ith patients also, and then they pick them up when they set u poxygen. We are at 9000 ft, but its good for chest pain. I've had 3 MI's and several high altitude pulmonary edema patients. I do not have an AED and my emergency plan is O2, ASA, an IV and 911.________________________________From: on behalf of Sent: Thu 2/7/2008 10:54 AMTo: 'Lonna Larsh '; ' 'Subject: RE: Preparing for Office

EmergenciesI have an epi pen ,benadryl ,aspirin and 911 one touch on the phone I donot care about an AED as much as it might be nice to have oxygen but ain'tgonna happen My officemate of 20 yrs has some emergency kit but she does not haveoxygen or a defib. either. Re: Preparing for Office EmergenciesI have NOTHING, and yes I think I should. This is a great question. Here are some things I think I should have:epibenedryIV setupRocephinwhat else is absolutely essential? an AED would be nice, but I'm notgoing to get one, at least not for quite a while ... not till I'm makinga decent income.Lonnadrmargepol (DOT) net <mailto:drmarge%40pol.net> wrote:I was at my dentist's office the other day and saw an AED hanging on thewall. It got me thinking that I am not really set up well to handle anyunplanned emergencies. I am curious what types of things some of youguys have on hand, besides maybe epinephrine/benadryl. For instance, Idon't have O2. I do not think I even have an ambu-bag. I recently tookover a solo practitioner's office so there may be some things stillhidden in the cabinets that I am not aware of yet. Curious minds want toknow...... Thanks.Margaret Coughlan Millbrook, NY_____ Be a better friend, newshound, and know-it-all with Yahoo! Mobile.<http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6 <http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6> 2sR8HDtDypao8Wcj9tAcJ> Try it now.

Never miss a thing. Make Yahoo your homepage.

[Guest guest]

Gordon --I think you are comparing apples and oranges.I

fully agree with the issues about improving access, etc, etc.But I do not

agree that you should compare the one-time cost of an AED (just being used as an

example for " emergency supplies " ) as the costs of the other resources and

tools you describe.That would be like saying one should not buy health

insurance for catastrophic care because spending money for fitness equipment and

healthy foods is better at maintaining wellness.I don't consider my AED

as a cost for " running the office. " It is more like an

" insurance policy " that I hope to never use. But, geez, if one time I have

a patient drop, pulseless, and I'm able to call 911 but then defibrillate in the

first minute or two while the ambulance is on its way, that would make it worth

every penny. Tim

There are two implicit questions here:1: What must I do from a medico-legal standpoint? The answer is

typically along the lines of " have an adequate meansof dealing with

office emergencies. " This might be nothingmore elaborate than

" speed dial 911 " in an urban/suburbansetting and maybe having a

trauma bay in a rural setting.2: What should I do to best help my

patients?This is a much more involved question and begins to get at how we

canorganize our work to best serve the population in our practices.With unlimited resources we can purchase, maintain, and store any devicefor

which there exists demonstrable advantage for our patients and ourpractices. Unfortunately for us all, we work with limitedresources.If there

is a limitation on resources, we should keep in mind some levelof cost/benefit

analysis. Should I spend $850 on an AED or on asubscription to Instant

Medical History, or lab tracking software, or on.......? Which intervention

is most likely to help mypatients?The good news is that there is

some research to guide our choices. There are some studies that would put AEDs

pretty far down the list ofcost effective strategies (see below). Strategies that cost less and have a much greater

impactare:

Open access (patients who experience access delays are less likely tocome in for needed care)

High continuity (patients who see multiple providers and lose trackof

who is in charge are hospitalized more often)

Not wasting patient time in the office (patient who experience wastedtime are less likely to follow up for needed care)

Assessing your patient for major determinants of health and wellness(feelings, pain, finances)

Assessing your patient's level of understanding of diagnosis andtreatment plans

Assessing your patient's level of self-efficacy

Testing and implementing these key practice attributes costs lessthan an AED. The impact on your patient population isimmense.If you are

wondering how well you perform on these key indicators, restassured that you

no longer have to wonder. These can be measuredeasily. The IMPs are using

HowsYourHealth.org. Seewww.IdealMedicalPractices.org

andwww.IdealMedicalHome.org. Of course you may be doing all these

things and still have resources leftover for an AED. Then go for it.GordonUniqueIdentifier17579940StatusMEDLINEAuthorsSharieff W.Kaulback K.Authors FullNameSharieff,Waseem. Kaulback,

Kellee.InstitutionDepartment ofHealth Policy, Management and Evaluation,

University of Toronto, Ontario,Canada. doc.sharieff@...TitleAssessingautomated external defibrillators in preventing deaths from

suddencardiac arrest: an economic evaluation.SourceInternationalJournal of Technology Assessment in Health Care. 23(3):362-7,2007.At 11:59 AM 2/7/2008, you wrote:I was at my dentist's office theother day and saw an

AED hanging on the wall. It got me thinking that Iam not really set up well to

handle any unplanned emergencies. I amcurious what types of things some of you

guys have on hand, besides maybeepinephrine/benadryl. For instance, I don't

have O2. I do not think Ieven have an ambu-bag. I recently took over a solo

practitioner's officeso there may be some things still hidden in the cabinets

that I am notaware of yet. Curious minds want to know...... Thanks.Margaret Coughlan Millbrook, NY

---------------------------------------- Malia, MDMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450 (phone /

fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------

[Guest guest]

Add to that a vial of amonia inhalant, and perhaps a plastic mouthpiece that prevents one from swallowing the tongue (such as in seizure), panic button in the bath room?Jim.Kennedy@... wrote: I would aspirin, and oxygen. The oxygen company lets me borrow small tanks, since I send them patients. I sent them homw ith patients also, and then they pick them up when they set u poxygen. We are at 9000 ft, but its good for chest pain. I've had 3 MI's and several high altitude pulmonary edema patients. I do not have an AED and my emergency plan is O2,

ASA, an IV and 911.________________________________From: on behalf of Sent: Thu 2/7/2008 10:54 AMTo: 'Lonna Larsh '; ' 'Subject: RE: Preparing for Office EmergenciesI have an epi pen ,benadryl ,aspirin and 911 one touch on the phone I donot care about an AED as much as it might be nice to have oxygen but ain'tgonna happen My officemate of 20 yrs has some emergency kit but she does not haveoxygen or a defib. either. Re: Preparing for Office EmergenciesI have NOTHING, and yes I think I should. This is a great question. Here are some things I think I should have:epibenedryIV setupRocephinwhat else is absolutely essential? an AED would be nice, but I'm notgoing to get one, at least not for quite a while ... not till I'm makinga decent income.Lonnadrmargepol (DOT) net <mailto:drmarge%40pol.net> wrote:I was at my dentist's office the other day and saw an AED hanging on thewall. It got me thinking that I am not really set up well to handle anyunplanned emergencies. I am curious what types of things some of youguys have on hand, besides maybe epinephrine/benadryl. For instance, Idon't have O2. I do not think I even have an ambu-bag. I recently tookover a solo practitioner's office so there may be

some things stillhidden in the cabinets that I am not aware of yet. Curious minds want toknow...... Thanks.Margaret Coughlan Millbrook, NY_____ Be a better friend, newshound, and know-it-all with Yahoo! Mobile.<http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6 <http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6> 2sR8HDtDypao8Wcj9tAcJ> Try it now.

Never miss a thing. Make Yahoo your homepage.

[Guest guest]

I work in urgent care, decidedly different from most IMPs, except maybe Joanne. My thoughts tend to align with Tim's. I feel that the requirements are dependent on your local EMS response time to your office. There's no point in having an intervention that takes longer to initiate than the time to the EMS, first responders, etc. reach your office once you dial 911. I'm required to recertify in ACLS every 2 years and this past year the mantra was shock, shock, shock as evidence shows that survival in a witnessed arrest is directly related to early defibrillation, early CPR is helpful but eventually VF deteriorates into an unshockable rhythm and the patient will expire. So I respectfully disagree with Gordon, an AED is an essential part of any doctor's office. We have traditonal defibs/pacers/etc at each UC center but I believe this is overkill. As Tim points out, airways are essential in a small office as you may have no help in controlling the airway. Benadryl, EPI, ASA, are cheap and probably essential, I use all of them a lot in urgent cases. Nebulizers are great, but i don't know the cost. EPI would buy you time in an asthmatic if you're waiting for EMS and don't have nebs. O2 is almost always an appropriate in an emergency situation, may cost, though you can bill for it's use (and the rest of these interventions, though I don't know about AED use). Injectable steroids are nice if you are comfortable sending patients home shortly after a moderate allergic reaction. Rocephin isn't an emergent med to me but may enable you to send a healthy pyelo, pneumonia, hand cellulitis, etc. home rather than to the ER. I have 2 nurses, a lab tech, and 2 doctors, if necessary, to start IVs. In situations where we dial 911, the paramedics arrive most times before we are able to start an IV. Knock on wood, but I've never had a patient in the UC whose most important emergent treatment was an IV. I think staffing is also a consideration. How much can a solo/solo doc do in an emergency situation? Call for help - 911, airway, one person CPR, and defib's about it. Even with the staff I have, running a code is my worse nightmare. No respiratory therapist, so that puts me at airway. Who to do CPR? The MA just out of school I guess as the nurse has to do meds, lab tech on IV access. I guess I need to shock as well as I don't want to see any of the staff hurt accidentally on my watch. Not going to be pretty. Straz From Rural Drain: Besides the phone, I have aspirin, oxygen with mask and nasal Asprin ; an AED, a nebulizer with medications to use in it; IV set up with appropriately dated fluids, epinephrine and inject-able antihistamines and soluable corticosteroids; Rocephin. Dressing materials for traumatic wounds and for burns including ointments, Second Skin and bulk rolls of cotton; and splint making materials and some metal adjustable splints; Lots of adhesive tape to adapt or make other devices. Also I have a written plan and extra gloves, extra masks and gowns as part of the infectious disease emergency protocol I have evolved in response to a request from the state medical association. Don't forget to tape that epinephrine inside the drawer in your exam room if you personally give inoculations: Twice in 30 years as a veterinarian I had a reaction to the innoculation that would have given me a dead dog if I had not been able to give epinephrin within a minute. Joanne, the MD from Drain Oregon Jim.KennedyUCHSC (DOT) edu wrote:I would aspirin, and oxygen. The oxygen company lets me borrow small tanks, since I send them patients. I sent them homw ith patients also, and then they pick them up when they set u poxygen. We are at 9000 ft, but its good for chest pain. I've had 3 MI's and several high altitude pulmonary edema patients. I do not have an AED and my emergency plan is O2, ASA, an IV and 911.________________________________From: on behalf of Sent: Thu 2/7/2008 10:54 AMTo: 'Lonna Larsh '; ' 'Subject: RE: Preparing for Office EmergenciesI have an epi pen ,benadryl ,aspirin and 911 one touch on the phone I donot care about an AED as much as it might be nice to have oxygen but ain'tgonna happen My officemate of 20 yrs has some emergency kit but she does not haveoxygen or a defib. either. Re: Preparing for Office EmergenciesI have NOTHING, and yes I think I should. This is a great question. Here are some things I think I should have:epibenedryIV setupRocephinwhat else is absolutely essential? an AED would be nice, but I'm notgoing to get one, at least not for quite a while ... not till I'm makinga decent income.Lonnadrmargepol (DOT) net <mailto:drmarge%40pol.net> wrote:I was at my dentist's office the other day and saw an AED hanging on thewall. It got me thinking that I am not really set up well to handle anyunplanned emergencies. I am curious what types of things some of youguys have on hand, besides maybe epinephrine/benadryl. For instance, Idon't have O2. I do not think I even have an ambu-bag. I recently tookover a solo practitioner's office so there may be some things stillhidden in the cabinets that I am not aware of yet. Curious minds want toknow...... Thanks.Margaret Coughlan Millbrook, NY_____ Be a better friend, newshound, and know-it-all with Yahoo! Mobile.<http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6<http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6> 2sR8HDtDypao8Wcj9tAcJ> Try it now.Never miss a thing. Make Yahoo your homepage.

[Guest guest]

Straz --Good points.If you have the equipment and people, I suggest you

and your team put together a formal protocol for who does what in a code; then do

some practice run throughs. You don't want to be in that situation and

suddenly need to consider who's doing each role.TimOn Fri, February 8, 2008 2:13 am EST, Strazzullo

wrote:

I work in urgent care, decidedly different from most

IMPs, except maybe Joanne. My thoughts tend to align with Tim's.

I feel that the

requirements are dependent on your local EMS response time to your office. There's

no point in having an intervention that takes longer to initiate than the time to

the EMS, first responders, etc. reach your office once you dial 911.

I'm required to

recertify in ACLS every 2 years and this past year the mantra was shock, shock,

shock as evidence shows that survival in a witnessed arrest is directly related to

early defibrillation, early CPR is helpful but eventually VF deteriorates into an

unshockable rhythm and the patient will expi re. So I respectfully disagree

with Gordon, an AED is an essential part of any doctor's office. We have traditonal

defibs/pacers/etc at each UC center but I believe this is overkill. As Tim points

out, airways are essential in a small office as you may have no help in controlling

the airway.

Benadryl, EPI,

ASA, are cheap and probably essential, I use all of them a lot in urgent cases.

Nebulizers are great, but i don't know the cost. EPI would buy you time in an

asthmatic if you're waiting for EMS and don't have nebs. O2 is almost always an

appropriate in an emergency situation, may cost, though you can bill for it's use

(and the rest of these interventions, though I don't know about AED use). Injectable steroids are nice if you are comfortable sending patients home shortly

after a moderate allergic reaction. Ro cephin isn't an emergent med to me but

may enable you to send a healthy pyelo, pneumonia, hand cellulitis, etc. home rather

than to the ER.

I have 2 nurses,

a lab tech, and 2 doctors, if necessary, to start IVs. In situations where we dial

911, the paramedics arrive most times before we are able to start an IV. Knock on

wood, but I've never had a patient in the UC whose most important emergent treatment

was an IV.

I think staffing

is also a consideration. How much can a solo/solo doc do in an emergency situation?

Call for help - 911, airway, one person CPR, and defib's about it. Even with the

staff I have, running a code is my worse nightmare. No respirator y

therapist, so that puts me at airway. Who to do CPR? The MA just out of school I

guess as the nurse has to do meds, lab tech on IV access. I guess I need to shock

as well as I don't want to see any of the staff hurt accidentally on my watch. Not

going to be pretty.

Straz

From Rural Drain:

Besides the phone, I have aspirin, oxygen

with mask and nasal Asprin ; an AED, a nebulizer with medications to use in it; IV

set up with appropriately dated fluids, epinephrine and inject-able antihistamines

and soluable corticosteroids; Rocephin. Dressing materials for traumatic wounds

and for burns including ointments, Second Skin and bulk rolls of cotton; and

splint making materials and some metal adjustable splints; Lots of adhesive tape to

adapt or make other devices.

Also I have a written plan and extra gloves,

ex tra masks and gowns as part of the infectious disease emergency protocol I

have evolved in response to a request from the state medical association.

Don't forget to tape that epinephrine inside

the drawer in your exam room if you personally give inoculations: Twice in 30 years

as a veterinarian I had a reaction to the innoculation that would have given me a

dead dog if I had not been able to give epinephrin within a minute.

Joanne, the MD

from Drain Oregon

Jim.KennedyUCHSC (DOT) edu wrote:

I would aspirin, and oxygen. The oxygen company

lets me borrow small tanks, since I send them patients. I sent them homw ith

patients also, and then they pick them up when they set u poxygen. We are at 9000

ft, but its good for chest pain. I've had 3 MI's and several high altitude pulmonary

edema patients. I do not have an AED and my emergency plan is O2,

ASA, an IV and 911.________________________________From: on behalf of Jean

AntonucciSent: Thu 2/7/2008 10:54 AMTo: 'Lonna Larsh '; ' 'Subject: RE: Preparing for Office EmergenciesI have an epi pen

,benadryl ,aspirin and 911 one touch on the phone I donot care about an AED as much as it might be nice to have oxygen but

ain'tgonna happen My

officemate of 20 yrs has some emergency kit but she does not haveoxygen or a defib. either. Re: Preparing for Office EmergenciesI have NOTHING, and yes I think I should. This

is a great question. Here are some things I think I should have:epibenedryIV setupRocephinwhat else is absolutely essential? an

AED would be nice, but I'm notgoing to get one,

at least not for quite a while ... not till I'm makinga decent income.Lonnadrmargepol (DOT) net

mailto:drmarge%40pol.net>

wrote:I was at

my dentist's office the other day and saw an AED hanging on thewall.

It got me thinking that I am not really set up well to handle anyunplanned emergencies. I am curious what types of

things some of youguys have on hand, besides

maybe epinephrine/benadryl. For instance,

Idon't have O2. I do not think I even have an

ambu-bag. I recently tookover a solo

practitioner's office so there may be some

things stillhidden in the cabinets that I am not

aware of yet. Curious minds want toknow......

Thanks.Margaret Coughlan Millbrook,

NY_____ Be a better friend, newshound, and know-it-all with

Yahoo! Mobile.http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6> 2sR8HDtDypao8Wcj9tAcJ> Try it now.

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homepage.

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

Confidentiality Notice --This email message, including all the attachments, is

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[Guest guest]

I agree with almost everything but the AED. I think the

need for AEDs have been created by the maker of the machine. And with all

the recalls I get notice of every month, I wonder how many actually work.

Correct me if I am wrong (I know you will) but I thought AEDs only shock

identifiable V-tach, that’s the “A” (Automatic) in AED.

I don’t believe that happens all that often, even in hospital witnessed

arrests. I wonder how many AED prevented deaths there really are out

there/year.

I don’t keep IV solution for several reasons: 1) I

have not found a source to buy just one and they expire frequently, same with

the needles, 2) I almost never start IVs now that I am not a resident and am

terribly out of practice, 3) we have pretty quick EMS response time and for the

chest pain and the SVT I have had to call in EMS they were there in minutes.

I do encourage potential emergencies to just go to the ER and

skip my office.

I have a receptionist and a biller in the office with me, so it

would be difficult to do more than support someone while waiting for EMS.

The receptionist is good at calling 911 so I don’t need to be on the

phone.

I do keep aspirin, NTG, epinephrine (not the pens as very expensive

and expire in a year, the vial is dirt cheap and I write the dose on the box so

I don’t need to read when panicking, I mean excited. This is for

911 emergencies.

I have always had a nebulizer and use it a lot. Not only

for asthma and bronchitis but to do spirometry. I keep O2. I have

gauze, tape and dressing supplies should a bleeder ever walk in. I have

steroid because epi wears off quickly so if ever a severe allergic reaction I

feel starting the next phase of treatment is beneficial. I also

keep Tylenol because parent will bring their kids in with high fevers so “you

can see it”.

And don’t forget the chicken soup, or juice or cookies for

that vasovagal person who tries to or does pass out on you.

I used to get Rocephin samples but they have always expired on

my shelf so I won’t buy it.

My thoughts.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of

Strazzullo

Sent: Friday, February 08, 2008 2:13 AM

To:

Subject: Re: Preparing for Office Emergencies

I

work in urgent care, decidedly different from most IMPs, except maybe Joanne.

My thoughts tend to align with Tim's.

I

feel that the requirements are dependent on your local EMS response time

to your office. There's no point in having an intervention that

takes longer to initiate than the time to the EMS, first responders, etc. reach

your office once you dial 911.

I'm

required to recertify in ACLS every 2 years and this past year the mantra was

shock, shock, shock as evidence shows that survival in a witnessed arrest is

directly related to early defibrillation, early CPR is helpful but eventually

VF deteriorates into an unshockable rhythm and the patient will expire.

So I respectfully disagree with Gordon, an AED is an essential part of

any doctor's office. We have traditonal defibs/pacers/etc at each UC

center but I believe this is overkill. As Tim points out, airways are

essential in a small office as you may have no help in controlling the airway.

Benadryl,

EPI, ASA, are cheap and probably essential, I use all of them a lot in

urgent cases. Nebulizers are great, but i don't know the cost. EPI would

buy you time in an asthmatic if you're waiting for EMS and don't have nebs.

O2 is almost always an appropriate in an emergency situation, may cost,

though you can bill for it's use (and the rest of these interventions, though I

don't know about AED use). Injectable steroids are nice if you are

comfortable sending patients home shortly after a moderate allergic reaction.

& nbsp;Rocephin isn't an emergent med to me but may enable you to send a

healthy pyelo, pneumonia, hand cellulitis, etc. home rather than to the ER.

I

have 2 nurses, a lab tech, and 2 doctors, if necessary, to start IVs. In

situations where we dial 911, the paramedics arrive most times before we are

able to start an IV. Knock on wood, but I've never had a patient in the

UC whose most important emergent treatment was an IV.

I

think staffing is also a consideration. How much can a solo/solo doc do

in an emergency situation? Call for help - 911, airway, one person CPR,

and defib's about it. Even with the staff I have, running a code is my

worse nightmare. No respirator y therapist, so that puts me at airway. Who

to do CPR? The MA just out of school I guess as the nurse has to do meds, lab

tech on IV access. I guess I need to shock as well as I don't want to see

any of the staff hurt accidentally on my watch. Not going to be pretty.

Str_

[Guest guest]

We have a "gently used" Banyan STAT kit (donated) from chiropractors office that went out of business.(http://www.statkit.com/index.cfm?fuseaction=stat)The suitcase-like kit provides us a place to store the airways, iv bags, iv sets, needles and syringes in one organized place. We have an oxygen bottle and setups from a local O2 vendor. They are happy to replace anything we give out to patients. They also keep a store of nebulizers at our office to dispense at no cost to us. We replace the Benadryl, epinephrine, nitroglycerine in the STAT kit to stay current. We are across the street from the Emergency Room, so we pitched all the amiodarone and lidocaine. Total cost is just a few dollars. An AED would be great, but the cost is very significant.Bob Forester drmarge@... wrote: I was at my dentist's office the other day and saw an AED hanging on the wall. It got me thinking that I am not really set up well to handle any unplanned emergencies. I am curious what types of things some of you guys have on hand, besides maybe epinephrine/benadryl. For instance, I don't have O2. I do not think I even have an ambu-bag. I recently took over a solo practitioner's office so there may be some things still hidden in the cabinets that I am not aware of yet. Curious minds want to know...... Thanks.Margaret Coughlan Millbrook, NY

Looking for last minute shopping deals? Find them fast with Yahoo! Search.

[Guest guest]

I keep chewable benadryl, aspirin and a vial of epinephrine. Agree that epi pens are too expensive. A vial of epinephrine is <$5. I have an albuterol inhaler with a mask. Probably because I do so much Peds, I do have generic Rocephin. Can buy a box of 10 vials of powder, lasts for >1 year before expiration and costs (I think) about $100 for 1g vials. A box of 10 vials of 500mg is about $80. Don't really think of that as an emergency drug, just alot cheaper for my patients for me to give it than to send them to the hospital for an outpatient shot! I also have injectable steroids as I do alot of joint injections and trigger point injections. Used to keep Solumedrol around, but a full 125mg dose is 2 cc. Now I just keep dexamethasone in addition to my joint steroids. Having called the ambulance to my clinic twice now, the only other thing I've thought about is an AED. I have a younger practice and so wasn't jumping up and down to get one. My new partner (my husband is joining me mid-April) has an older practice and so, we'll probably end up getting one. I have thought about approaching several of the business people around here to go in with me on one.

Lynette I Iles MD 214 South Iowa Ste 3 Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

Joanne,

Nasal aspirin?

Do tell. I couldn't find much on google.

From: [mailto: ] On Behalf Of joanne hollandSent: Thursday, February 07, 2008 2:06 PMTo: Subject: RE: Preparing for Office Emergencies

From Rural Drain:

Besides the phone, I have aspirin, oxygen with mask and nasal Asprin ; an AED, a nebulizer with medications to use in it; IV set up with appropriately dated fluids, epinephrine and inject-able antihistamines and soluable corticosteroids; Rocephin. Dressing materials for traumatic wounds and for burns including ointments, Second Skin and bulk rolls of cotton; and splint making materials and some metal adjustable splints; Lots of adhesive tape to adapt or make other devices.

Also I have a written plan and extra gloves, extra masks and gowns as part of the infectious disease emergency protocol I have evolved in response to a request from the state medical association.

Don't forget to tape that epinephrine inside the drawer in your exam room if you personally give inoculations: Twice in 30 years as a veterinarian I had a reaction to the innoculation that would have given me a dead dog if I had not been able to give epinephrin within a minute.

Joanne, the MD from Drain Oregon

Jim.Kennedy@... wrote:

I would aspirin, and oxygen. The oxygen company lets me borrow small tanks, since I send them patients. I sent them homw ith patients also, and then they pick them up when they set u poxygen. We are at 9000 ft, but its good for chest pain. I've had 3 MI's and several high altitude pulmonary edema patients. I do not have an AED and my emergency plan is O2, ASA, an IV and 911.________________________________From: on behalf of Sent: Thu 2/7/2008 10:54 AMTo: 'Lonna Larsh '; ' 'Subject: RE: Preparing for Office EmergenciesI have an epi pen ,benadryl ,aspirin and 911 one touch on the phone I donot care about an AED as much as it might be nice to have oxygen but ain'tgonna happen My officemate of 20 yrs has some emergency kit but she does not haveoxygen or a defib. either. Re: Preparing for Office EmergenciesI have NOTHING, and yes I think I should. This is a great question. Here are some things I think I should have:epibenedryIV setupRocephinwhat else is absolutely essential? an AED would be nice, but I'm notgoing to get one, at least not for quite a while ... not till I'm makinga decent income.Lonnadrmargepol (DOT) net <mailto:drmarge%40pol.net> wrote:I was at my dentist's office the other day and saw an AED hanging on thewall. It got me thinking that I am not really set up well to handle anyunplanned emergencies. I am curious what types of things some of youguys have on hand, besides maybe epinephrine/benadryl. For instance, Idon't have O2. I do not think I even have an ambu-bag. I recently tookover a solo practitioner's office so there may be some things stillhidden in the cabinets that I am not aware of yet. Curious minds want toknow...... Thanks.Margaret Coughlan Millbrook, NY_____ Be a better friend, newshound, and know-it-all with Yahoo! Mobile.<http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6 <http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6> 2sR8HDtDypao8Wcj9tAcJ> Try it now.

Never miss a thing. Make Yahoo your homepage.

[Guest guest]

, I think she probably left out a comma and meant oxygen with mask

and nasal cannula. Although, its good to ask, Joann has some neat

tricks.

Sharon

At 10:47 AM 2/8/2008, you wrote:

Joanne,

Nasal aspirin?

Do tell. I couldn't find much on

google.

From:

[

mailto: ] On Behalf Of

joanne holland

Sent: Thursday, February 07, 2008 2:06 PM

To:

Subject: RE: Preparing for Office

Emergencies

From Rural Drain:

Besides the phone, I have aspirin, oxygen with

mask and nasal Asprin ; an AED, a nebulizer with medications to use in

it; IV set up with appropriately dated fluids, epinephrine

and inject-able antihistamines and soluable corticosteroids;

Rocephin. Dressing materials for traumatic wounds and for

burns including ointments, Second Skin and bulk rolls of

cotton; and splint making materials and some metal adjustable

splints; Lots of adhesive tape to adapt or make other

devices.

Also I have a written plan and extra gloves,

extra masks and gowns as part of the infectious disease emergency

protocol I have evolved in response to a request from the state medical

association.

Don't forget to tape that epinephrine

inside the drawer in your exam room if you personally give

inoculations: Twice in 30 years as a veterinarian I had a reaction

to the innoculation that would have given me a dead dog if I had not been

able to give epinephrin within a minute.

Joanne, the MD from Drain Oregon

Jim.Kennedy@... wrote:

I would aspirin, and oxygen. The oxygen company lets me borrow small

tanks, since I send them patients. I sent them homw ith patients also,

and then they pick them up when they set u poxygen. We are at 9000 ft,

but its good for chest pain. I've had 3 MI's and several high altitude

pulmonary edema patients.

I do not have an AED and my emergency plan is O2, ASA, an IV and

911.

________________________________

From:

on behalf of

Sent: Thu 2/7/2008 10:54 AM

To: 'Lonna Larsh ';

' '

Subject: RE: Preparing for Office

Emergencies

I have an epi pen ,benadryl ,aspirin and 911 one touch on the phone I

do

not care about an AED as much as it might be nice to have oxygen but

ain't

gonna happen

My officemate of 20 yrs has some emergency kit but she does not

have

oxygen or a defib. either.

Re: Preparing for Office

Emergencies

I have NOTHING, and yes I think I should. This is a great question.

Here are some things I think I should have:

epi

benedry

IV setup

Rocephin

what else is absolutely essential? an AED would be nice, but I'm

not

going to get one, at least not for quite a while ... not till I'm

making

a decent income.

Lonna

drmarge@...

<

mailto:drmarge%40pol.net> wrote:

I was at my dentist's office the other day and saw an AED hanging on

the

wall. It got me thinking that I am not really set up well to handle

any

unplanned emergencies. I am curious what types of things some of

you

guys have on hand, besides maybe epinephrine/benadryl. For instance,

I

don't have O2. I do not think I even have an ambu-bag. I recently

took

over a solo practitioner's office so there may be some things

still

hidden in the cabinets that I am not aware of yet. Curious minds want

to

know...... Thanks.

Margaret Coughlan

Millbrook, NY

_____

Be a better friend, newshound, and know-it-all with Yahoo!

Mobile.

<

http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6

<http://us.rd.yahoo.com/evt=51733/*http://mobile.yahoo.com/;_ylt=Ahu06i6>

2sR8HDtDypao8Wcj9tAcJ> Try it now.

Never miss a thing.

Make Yahoo your homepage.

[Guest guest]

When AED's were not yet available and a used LifePak was in the many thousands of dollars, I made a decision to postpone the purchase of one for my semi-rural FP clinic. We had a really good and responsive EMS mere minutes from my office.

So, one day the 45 y/o male with crushing chest pain bursts into the office and arrests within a few seconds of getting him to the exam room. We had already called 911, both rigs were en route with minor cases to the nearby town leaving us w/o the normally available response. It took 20 minutes to get help.

So, the intubation, IV, O2 etc were fruitless. I often wonder if this otherwise robust fellow would have survived had I put out the 7K (at the time) for a lifepak.

Now, of course, it seems to be a no brainer, I'll buy the AED at Wall Mart.