AHA CPR Guidelines 2010

In November 2010, the latest guidelines for cardiopulmonary resuscitation were published by the American Heart Association (AHA). There are 16 parts to the guidelines addressing cardiac arrest, post- arrest care, dysrhythmias, acute coronary syndromes, stroke and special situations in which cardiac arrest occurs such as pregnancy. The biggest change is shift in the focus from airway to chest compressions or circulation. Instead of A-B-C (Airway, Breathing, Circulation-Compressions) it is now C-A-B (Circulation-Compressions, Airway, Breathing). Airway management is no not recommended until after the first cycle of chest compressions. Compressions precede the first 2 ventilations. The main reason behind this change is the fact most people suffering cardiac arrest have specific dysrhtymias (ventricular fibrillation or pulseless ventricular tachycardia) which are best treated with early defibrillation and chest compressions, not airway management. A second important reason behind the change was the public's fear of performing mouth-mouth breathing. For a review of the executive summary of the new guidelines click HERE

To download a copy of the November article click HERE

Quality of Care in Dialysis Centers

ProPublica has published previously confidential information the U. S. Government collected on the quality of care provided in dialysis centers nationwide.The comprehensive clinic data was obtained through the FOIA.  The site is easy to use and categorized by state. Once on the state page, scroll to find the center in which you are interested learning more about. The site allows for comparison of up to five sites in close geographic proximity. Each facility is compared to state averages for each measure. Key measures reported include mortality, hospitalization and infection rates. Data shows a wide variability among facilities in the same community. The information is submitted by facilities and collected by contractors of the Centers for Medicaid and Medicare Services, the federal agency that oversees most dialysis care.

Anesthesia Guidelines for People on Blood Thinners

The American Society of Regional Anesthesia and Pain Medicine (ASRA)  published practice guidelines for regional anesthesia in people on blood thinners. As this type of drug is being used more commonly, the risk of bleeding/hematoma formation related to administration of regional anesthesia has increased. The ASRA addressed this issue in their recently published guidelines. Click HERE to download a free copy of the article.

Chronic Pain Practice Guidelines Updated

The American Society of Anesthesiologists recently published an update to their clinical practice guidelines for chronic pain. To download a free copy of this article click HERE.

A Billion Dollar Club to Avoid

Who wouldn't want to be in a billion dollar club? One such club to avoid is companies that have paid out billion dollar settlements to the U.S Government for fraud. Those companies are GlaxoSmithKline, Pfizer, Eli Lilly and Schering-Plough, all drug companies, with a payout of $10.5 billion over the last 20 years. Most of the huge settlements relate to the illegal marketing of their products. Pfizer paid out a $2.3 billion settlement in 2009 over illegal marketing of their drug, Bextra, which has since been withdrawn from the market.Drug companies have eclipsed defense contractors in defrauding the government. Recent Public Citizen Report

Pressure Ulcer Pictures

Pressure ulcer cases are complex in that the entire patient must be taken into account including preexisting conditions, nutrition, clinical status, compliance with prescribed medical treatment and overall physical condition. When pressure ulcers develop some facilities take photos as part of the documentation of the wounds. Pictures of these wounds can be powerful demonstrative evidence. For those cases where no wound pictures exist, the National Pressure Ulcer Advisory Panel, an authoritative source on pressure ulcers in the U.S., offers a large selection of  pressure ulcer photos. Cost is $25.00 for professional use. These pictures can be particularly compelling demonstrative evidence.

CMS delays start of reporting requirment for another year

Enforcement of the Medicare Secondary Payer reporting rules has been delayed to Jan 1, 2012, the Department of Health & Human Services has announced. Those rules require attorneys and  insurers to report any personal injury settlement, judgment or other award to the Centers for Medicare and Medicaid Services. This is in an effort to protect Medicare's interests.

Virginia's Controversial DNA searches

The Associated Press recently reported results from the legislative panel convened at the request of the Forensic Science Board to provide guidance on familial DNA searches. The panel recommended legislative guidelines but not new law. The issue - DNA testing of suspects' relatives to help identify perpetrators.

VA Med Mal Cap Will Go Up

Negotiations between the Virgina Trial Lawyers Association and the Medical Society of Virginia resulted in an agreement to increase the $2 million dollar cap on medical malpractice damages. Beginning in July 2012, the cap will begin to annually increase by $50,000 until it reaches $3 million dollars, a process that will take 20 years.

Plaintiff to Indemnify Insurer for Medicare Lien?

Richmond Circuit Judge Walter W. Stout III denied State Farm Mutual Automobile Insurance Company's request to require plaintiff firm, Marks & Harrison  to indemnify the carrier for any claims or liens, specifically Medicare liens. John Ayers, attorney for Marks & Harrison, agreed to escrow $1500.00, the amount of the lien; however, the carrier was not satisfied and thus asked for indemnification. During settlement negotiations, Medicare did not come up. Mr. Ayers was apparently unaware his client had become Medicare eligible during the course of litigation. Mr. Ayers eventually contacted Medicare but had yet to receive a response from them at the time of the hearing. Jolly Consulting's nurses can provide initial cost projections and verify your client's eligibility for Medicare before settlement negotiations are finalized. If necessary, we can then prepare a MSA to show your consideration of Medicare's interest in any settlement. For more information, please contact us or visit Our Expertise page.

Click HERE for Judge Stout's order.

World Stroke Day - Ocotober 29, 2010

Stroke is the second leading cause of death in people over 60 and the fifth leading cause of death in those aged 15-59. Children, newborns and fetuses also suffer from strokes. Below are links to two recently published articles pertinent to medicolegal analysis of stroke cases.

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Prehospital stroke care: potential, pitfalls, and future

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage Stroke Spontaneous, nontraumatic intracerebral hemorrhage (ICH) is a significant cause of morbidity and mortality throughout the world. Although much has been made of the lack of a specific targeted therapy, much less is written about the success and goals of aggressive medical and surgical care for this disease. The Relationship of Physical Function to Social Integration After Stroke Journal of Neuroscience Nursing Stroke is a leading cause of death and a serious long-term disability in this country. Much of the research on stroke rehabilitation has focused on physical/functional recovery as the predominant measure of outcome. There is a gap in knowledge of social issues and integration into societal, family, and community roles after stroke. Prehospital stroke care: potential, pitfalls, and future Current Opinion in Neurology The shortening of prehospital delays requires education of patients and health professionals and optimization of transport strategies. Future developments may include video conferencing offering telestroke expertise, strategies (i.e. therapeutic interventions) that might help to treat acute stroke patients with tissue-type plasminogen activator, and prehospital selection of candidates for endovascular therapies.