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CRITICAL CRITICAL Document Transcript

  • Situation CRITICAL A Publication for Providers of Trauma and Critical Care Spring 2007 Biting the Hand That Feeds You
  • Situation Critical is published two times a year to inform trauma and critical care providers about news and events at North Memorial and to provide helpful information related to patient care. If you would like to be added to (or removed from) our mailing list, please contact Sharon Stieg, Situation Critical editor, at (763) 520-5063. You can also send an e-mail message to sharon.stieg@northmemorial.com. Your questions, comments and suggestions for upcoming articles are also welcome. © 2007 North Memorial Health Care_07027
  • Letter from Dr. Lilja Dear Friends, The outpatient center itself (aka ambulatory It has been several months since my last Situation care center) will be owned Critical introduction, and I hope this one finds you well. and operated solely by While our publication took something of a sabbatical North Memorial and since our last 2006 issue, we’ve been anything but idle at will include urgent care North Memorial. services. We’re excited to bring a full-range of This past October, we completed the third and final phase health care services closer of our Emergency Department construction project. to the residents of Maple Emergency Services Director Maribeth Woitas and Medical Grove and surrounding Director Craig Matticks led an incredible (some thought communities. impossible) effort to simultaneously renovate and operate a major emergency center without disruption to patient Warming weather is just care. Their staff deserves a great deal of credit for a job around the corner, and well done, and I want to thank all of you for your patience that means busier months and cooperation during the project, as this was critical ahead for those of us in to its success. emergency care. Best wishes for a safe spring and summer! Without skipping a beat (literally weeks after the official grand opening), the ED became the first department at North Memorial to begin using Epic –the name given to our new Information Technology transformation G. Patrick Lilja, MD, FACEP that will be taking place over the next three years. Medical Director, Emergency and Trauma Services The rollout of Epic will use software to automate and connect the hospital’s many different business and clinical care functions into one seamless system. As with any change, this new system will take some getting used to, but is a necessary advance to enhance our level of service to patients and streamline work processes for employees. Thanks in advance for bearing with us as we get up to speed. As you may know, state lawmakers approved a plan for a new Maple Grove hospital that would entail a partnership between North Memorial and Fairview Health Services. Construction on that hospital is slated to begin this summer, and a separate outpatient center on the same campus will open at the end of this year. Table of Contents 2 North Memorial in the News 10 Outstate Partner Profile 4 Feature Story: Biting the Hand 11 Meet Our Staff That Feeds You 12 Calendar of Events 9 Center of Excellence
  • North Memorial in the News Maple Grove Hospital Update North Memorial announced last year that it will build a new hospital in Maple Grove in a joint venture with Fairview Health Services. The new hospital will be located on North Memorial’s 30-acre Maple Grove health campus. Construction on the new hospital will begin in Spring 2007 with the hospital scheduled to open in December 2009. North Memorial will open a medical office building and outpatient center on the Maple Grove campus later this year as part of Phase I of the project. The new hospital, when built, will be connected to the outpatient center. North Memorial Emergency and Trauma He has had many past positions as advisor, board member, Services Physicians Recognized for examiner or instructor. Professional Excellence Dr. Lilja currently is the Medical Director for Emergency and Trauma Services at North Memorial and for North J. Kevin Croston, MD, Memorial Ambulance. He holds appointments North Memorial’s Surgical as a clinical professor for the University of Minnesota Director of Trauma, was and Family Practice and Community Health. Also, recently recognized by Dr. Lilja has had numerous publications and guest the Minnesota Medical speaking engagements. Association (MMA) with a Community Service Award. According to a program description, the Award of Merit is given to a public safety officer or citizen for excellent According to a MMA press and unusual accomplishment as recognized by superiors, release, Dr. Croston received fellow officers or concerned citizens. the award for his work to advance Minnesota’s new Statewide Trauma System, stating that he has, J. Kevin Croston, MD “campaigned vigorously for a statewide trauma network that was recently approved by the Minnesota Legislature. This network will improve trauma care and increase the survival rate of trauma victims in both urban and rural Minnesota.” Dr. Croston was one of three physicians to receive a Community Service Award during the MMA’s 2006 Annual Meeting in Minneapolis. G. Patrick Lilja, MD, North Memorial’s EMS Medical Director, received an Award of Merit at the 2006 Minnesota Public Safety Service Awards program in November. He was recognized for 35 years of work dedicated to health and public safety for the citizens of Minnesota. Dr. Lilja began his career at the University of Minnesota and then at G. Patrick Lilja, MD, receives an Award of Merit at the 2006 Hennepin County Medical Center in Emergency Medicine. Minnesota Public Safety Service Awards program. 2 Situation Critical | Spring 2007
  • North Memorial in the News Emergency Department is Officially Complete North Memorial officially opened the doors to its newly renovated Emergency Department (ED) in October of 2006. The new department features natural lighting and colors that promote healing and comfort. Its 48 private rooms (up from 34) can accommodate any patient care need, regardless of one’s illness or injury. This improvement helps eliminate the time traditionally required for an appropriate treatment room to become available and therefore expedites patient care and comfort. Past patients and ED staff were consulted during the planning process, and the result of that feedback is a facility that fosters enhanced care, customer service and staff satisfaction. Dr. Craig Matticks, Emergency Services Medical Director, describes the department as one that “truly reflects the future of emergency care.” North Memorial Welcomes Longville The ambulance service was previously operated by the to its EMS Family City of Longville and a joint powers board and had been negatively impacted by the undesirable trinity of 24-7 ALS Ambulance low volume, inadequate reimbursement and declining Base Expands North volunteerism. Neighboring communities came together Memorial’s Coverage in with a common goal to provide reliable, high-quality the Brainerd Region ambulance service and formed a subordinate taxing Longville district to fund operations. The district is being By Pat Coyne, administered through Cass County, which is responsible Outstate Director Brainerd for arranging ambulance service for communities North Memorial previously served by the city. Ambulance Twin Cities North Memorial was selected as the provider for the On December 31, 2006 area by demonstrating the capacity to exceed the criteria North Memorial became set forth by the communities. This includes providing the ambulance service advanced life support service using paramedics and provider for Longville, EMTs who respond from a full-time ambulance base. Minnesota and the surrounding area. Located in Cass The Longville service will be part of North Memorial County approximately 55 miles north of Brainerd, it is in Ambulance’s Brainerd Region, which also has bases in the heart of the beautiful North Central Lakes Region and Brainerd, Pine River, Cross Lake and Aitkin. has become a popular destination for many vacationers in both summer and winter. Simply put, Longville is one of Longville joins more than two-dozen ambulance bases the most beautiful places in the state. It is also a medically North Memorial operates in eight regions across Minnesota underserved area, being almost 50 miles from any one of and Western Wisconsin. Nearly sixty thousand patients are three hospitals serving the region. Therefore, rapid access served annually. North Memorial’s vision in Longville and to high-quality EMS is critical for the well-being of people elsewhere is to “Inspire each other to give our patients and who live, work or vacation there. their families compassionate, remarkable care.” Situation Critical | Spring 2007 3
  • Biting the Hand That Feeds You David J. Roberts, MD and Barbara G. Roberts, JD Introduction <1 year and the oldest patient 91 years.) Among children, boys aged 5 to 9 years experience the highest incidence There are 65 million dogs in the United States, according of dogbite.2 to the American Pet Products Manufacturers Association (APPMA). Dogs can be wonderful pets, and dogs can play It has been estimated that almost half of all children have a special role in the lives of their owners. Dogs can add been bitten by a dog at some point in their lives.2 Children to the mental and physical well-being of adults, and they are normally at greatest risk from a dog bite because can enrich the development of children. Most dogs will they play with dogs more often, have less experience in never bite a human. However, the interaction between anticipating a dog’s behavior, are more likely to engage in activity that stimulates or alarms a dog, and are less able people and dogs can result in injuries related to dog bites; to defend themselves when a dog becomes aggressive.3 in very rare cases, it can even result in death. When a Half the children requiring medical care are bitten on dog bite occurs, emergency medical personnel must be the face,1 (see Figure 1) and children seen in emergency knowledgeable about how to treat the bite effectively. departments are more likely than older patients to be bitten on the face, neck and head (73 percent versus Injuries in the U.S. Related to Dog Bites 30 percent) followed by the upper and lower limbs. Americans have a 1-in-50 chance of being bitten by a dog each year, according to the Centers for Disease Control and Prevention (CDC). Almost five million people are bitten Safety Tips For Dog Owners 4 each year in the U.S. by dogs, or almost two percent of the population. Of these five million bites, approximately 800,000 (about one out of every six bites) require medical • Dog owners should try to socialize puppies to people of care. Almost 1,000 bites per day result in visits to hospital all ages and both sexes, especially children. A toddler emergency departments (368,000 patients per year).1 looks, sounds and acts differently than a 6-year-old child, a teenager, a 30-year-old, or an elderly adult. Some studies published in JAMA (Journal of the The critical age for a dog’s socialization is between American Medical Association) indicate that bites are the 3 and 14 weeks of age; continue to socialize your dog second most frequent cause of visits to U.S. emergency at least until it reaches 1 year of age. departments (injuries associated with certain sports and recreational • Supervise all interactions between your dog and equipment were children or strangers, and never leave infants or first).2 Dog children alone with a dog of any size. bite injuries account for • Do not mistreat your dog. Avoid physical or aggressive more emergency games like tug-of-war and wrestling. Instead, department visits encourage retrieving games or games that involve than playground training (e.g., hiding a toy that your dog has to find). injuries, bikes, mopeds, ATVs, • Don’t let your dog roam.6 inline skating and skateboard injuries combined.6 The It is a common misconception that dog bites are generally median age of inflicted by “fighting dogs” or strays.4 Over half the dog patients bitten by bite injuries (58 percent) occurred at a home or in a dogs is 15 years, familiar place.2 The vast majority of biting dogs, more than and children have 75 percent, belong to the victim’s family or a friend.1 the highest rate of injury resulting in Approximately every 40 seconds someone comes to an visits to emergency emergency department in the U.S. for a dog bite-related Figure 1 departments. (The injury.4 Dog bite-related injuries were triaged in the This child was bitten by a neighbor’s dog youngest patient in emergency department as urgent-emergent in about 46 (labrador mix). Her wounds were repaired those studies was percent of the cases. The remainder of cases was triaged in the OR by a plastic surgeon. 4 Situation Critical | Spring 2007
  • Biting the Hand That Feeds You as non-urgent.2 Dog bites result in approximately 44,000 facial injuries (see Figures 2 and 3) requiring medical treatment each year.1 Ninety-six percent of patients making dog bite-related emergency department visits were treated and released, and four percent were admitted to the hospital or admitted to another facility.2 The majority of dog bites are not fatal, but unfortunately there are about 20 dog bites in the U.S. every year which result in death (see Figure 4). For each dog bite fatality in the U.S., there are about 670 hospitalizations, 16,000 emergency department visits, and 21,000 other medical visits (office and clinic). Approximately 187,000 dog bites each year do not receive medical attention in the U.S.2 This young woman from San Francisco was fatally mauled Figure 4 by two large Mastiff breeds. The dogs’ owners were convicted of manslaughter and second degree murder. Although dog bite fatalities are very rare, the majority of fatalities involve children. About 7 out of 10 dog bite fatalities each year will be kids. By contrast, the chances that a victim of a fatal dog attack will be a burglar are 1 in 177. Merritt Clifton, editor of Animal People, has published a detailed study of U.S. and Canadian dog-related injuries and This young man was attacked by a pit bull. Bites to Figure 2 deaths from 1982 to November 13, 2006. The Clifton study the mid face (nose, lips) are especially common. summarizes the number of serious dog-inflicted injuries by breed. It includes fatalities, maimings (permanent disfigurement or loss of limb) and other dog-related injuries requiring extensive hospital treatment. The study is complied from press accounts of dog-related injuries attributable to clearly identified breeds, as designated by animal control officers or others with canine expertise. Attacks by police dogs, guard dogs, and dogs specifically trained to fight are excluded from the Clifton study.3 Not all of the injuries or fatalities in the Clifton study deal with dog bites, however. For example, one elderly patient died as a result of a fall from an overly rowdy greeting by a German shepherd mix; one child was killed by strangulation when a beagle tugged on a leash which was around the child’s neck; one child was strangled by a chain tied around a pit bull’s neck; and one 6-month-old child was apparently suffocated in bed by the family Rottweiler. Yet, the majority of the Clifton study deals specifically with Patient in Figure 2 after repair by a plastic surgeon. Figure 3 dog bites.3 Situation Critical | Spring 2007 5
  • Biting the Hand That Feeds You Most experts agree that the idea of a child-friendly or bite-averse breed of dog is a myth. However, those experts often concede that some breeds may be more suitable than others for certain environments or social conditions. Yet most dog behavior remains a result of inherited traits modified by training and socialization after a puppy is born. Perhaps the most important influence in a dog’s comfort around adults and children is the opportunity to interact positively with them when the dog is a young puppy (i.e., under four months of age).4 According to the Clifton study, a few canine breeds and mixes are responsible for the majority of dog bite-related injuries and deaths in the U.S. and Canada. Pit Bulls, Figure 5 Tips For Non-Owners To Avoid Being Bitten4 Rottweilers, Presa Canaries (Bull Mastiff) and their mixes are responsible for 74 percent of the attacks included in the study; 68 percent of the attacks on children; 82 percent • Never approach a dog you do not know. of the attacks on adults; and 68 percent of maimings. Of • Never run from a dog if it approaches you. these breeds, pit pull terriers are noteworthy for attacking adults almost as frequently as children suggesting they may • If a dog approaches you, stand still and do not look have less inhibition about attacking people who are larger directly at him. Avoid screaming or yelling at the dog than they are. In addition, “domesticated” wolves or wolf because it may scare or threaten it. If the dog’s owner hybrids kept as pets appear to have attack patterns which is close, wait until the owner reaches the dog and are more dangerous than the majority of dog species.3 restrains it before you move any closer or continue on Intact male dogs appear more likely to inflict serious your way. Remain calm and do not act excited. injuries than females or castrated males.1 Of course, numerous animals fitting these profiles will live amicably • Always ask permission from an adult owner before among humans and never bite. petting a dog you do not know, and never enter a According to the Clifton study, Pit Bulls, Rottweilers, Presa fenced area if a dog is in the yard unless an adult Canaries and their mixes were responsible for 65 percent owner accompanies you. of the dog-related fatalities that occurred during a period • Never approach a dog that is tied up. Do not reach of 24 years in the U.S. Other breeds were also responsible, over or through a fence or car window to pet a dog but to a lesser extent: German Shepherds, Huskies, Alaskan Malamutes, Doberman Pinschers, Chows, Great Danes, St. even if you know it well. Bernards and Akitas. Since 1975, fatal attacks have been • Never approach a dog that appears to be sleeping. attributed to dogs from at least 30 breeds. In more than 75 percent of the cases covered by the Clifton study, the life- • Never try to take something from a dog or physically threatening or fatal attack appears to be the first known break up a fight between two or more animals. dangerous behavior by the dog. In some instances, the injuries or fatalities were caused by attacks from multiple • Pay attention to a dog’s body language and behavior. dogs at once (See Figure 5). In another case, it was caused Be particularly cautious if a dog’s ears are laid back; by rabies.3 if it appears fearful (e.g., tail between its legs or cowering); if it appears lethargic, injured or sick; if Sixty-five percent of reported bites take place while a dog it is with puppies; if it is eating; if it is chewing on a is being played with, fed, teased, abused or separated from bone or drinking; or, if a dog appears aggressive (e.g., another dog. Thirty-five percent of dog bite victims are it growls, stiffens its body, stares, or bares its teeth). involved in normal, non-provoking activities before a dog attacks.6 Neonatal deaths resulting from dog bites, for example, usually involve a sleeping baby.5 6 Situation Critical | Spring 2007
  • Biting the Hand That Feeds You Emergency Department Treatment of Dog Bite Injuries Initial wound management of dog bite injuries usually consists of confirming that a patient is medically stable, followed by taking and recording a history. Medical conditions associated with a high risk of infection after a dog bite should be recorded, including: chronic disease, chronic edema of the extremity, diabetes mellitus, immunosuppression, liver dysfunction, previous mastectomy, prosthetic valve or joint, splenectomy and systemic lupus erythematosis. In the absence of risk factors, only about five percent of dog bites become infected, which is less than human or cat bites. Other pertinent information includes the time of the injury This patient was bitten by his own dog on the wrist, Figure 6 and the general health, immunization status, and current resulting in ulnar nerve injury. location of the dog. This information should be noted in the record and, depending on applicable law, reported to a better outcome with delayed primary closure (suturing local authorities. A patient’s tetanus immunization status, several days later in the absence of any signs of infection) current medications and allergies should also be recorded. or healing by secondary intention (natural healing without Tetanus vaccine and tetanus immune globulin should be suturing). Most physicians will close fresh (<8 hours) administered, as appropriate.5 and uncomplicated wounds on the face, where cosmesis During the physical exam, emergency health care is a priority. In contrast, most physicians will not close professionals should measure and describe the wound bite wounds on the hands or feet, because they are much (e.g., laceration, puncture, crush or avulsion). In addition, more likely to become infected. Delayed, primary closure providers should assess the range of motion of the affected of such wounds – if they remain clean – after several and adjacent areas, documenting nerve, vascular and days is another option. Plastic surgery or general surgery motor function (see Figure 6). If feasible, diagrams and consultation is appropriate for complex wounds or those photographs may be useful, particularly if there are irregular requiring significant debridement. For wounds involving wounds, signs of infection or a high risk of infection.5 joints or other bony structures, orthopedic consultation should be considered.5 Dog bite wounds can be contaminated with dirt, feces, soil or saliva. If possible at the scene or before transport to the A patient’s risk of infection with rabies virus should be hospital, washing with plain soap and water is advisable. assessed immediately. Although canine rabies is relatively In the Emergency Department, prompt and thorough rare in the U.S. (the most commonly reported cases of irrigation with sterile saline solution will significantly rabies virus involve wild animals, specifically raccoons, reduce the rate of infection. Infiltration of wound margins skunks and bats), cases of rabies virus associated with dog with plain lidocaine or bupivacaine will reduce the bites still occur. This risk increases when the dog is a stray discomfort of this procedure. Avoid epinephrine in local or feral, and when the bite occurs outside the U.S. (the anesthetic solutions, because it impairs local perfusion risk of rabies virus varies by country). A college student and increases infection rate. Removal of necrotic or traveling through Nepal was bitten by a sleeping dog devitalized tissue is important, but it is equally important when she bent over to pet it. The wound was minor, did not to debride so much tissue that wound closure and not become infected, and she disregarded it. Many weeks appearance are compromised. In the event of puncture or later – long after her return to the United States – she died crush marks near a joint or bone – especially from larger of encephalitis. Examination of her brain revealed the animals – consider x-ray of the affected area, looking for rabies virus. A long incubation period – often weeks to bony injury or signs of joint penetration (pneumarthrosis months – is typical of rabies. The virus slowly travels up – air in the joint).5 the peripheral nerves and spinal cord to the central nervous system (brain). Those bitten by a non-provoked dog, a The role of wound closure is controversial, and varies by stray dog, a feral dog, or a dog outside the U.S., should be location. Puncture wounds, wounds that appear clinically considered at higher risk for rabies infection than patients infected, and wounds more than 24 hours old, may have bitten by a provoked dog, a pet dog or a dog within the U.S.5 Situation Critical | Spring 2007 7
  • Biting the Hand That Feeds You The first consideration in rabies risk assessment is whether wounds are more likely to become infected than the dog is available for rabies testing or confinement and scratches or tears. The majority of dog bite infections observation. Second, a judgment must also be made as to are polymicrobial (i.e., multiple bacterial species). The whether it is prudent to wait for test results or completion most common aerobic organisms (i.e., requiring oxygen of the 10-day quarantine and observation period before to survive) are Pasteurella multocida and Staphylococcus starting rabies post-exposure prophylaxis (PEP). aureus, and they occur in 20 to 30 percent of infected dog bite wounds. Anaerobic organisms (i.e., growing without Several factors determine whether a patient should receive oxygen) have also been implicated in infected dog bites.5 rabies PEP following a dog bite. These include whether there was penetration of the skin by teeth; the location Treatment of a dog bite injury patient with prophylactic of the bite (if the bite occurs to the face or head, rabies antibiotics for 3 to 7 days appears appropriate, unless the PEP is more often started prior to obtaining the results risk of infection is low, i.e., the wound appears superficial of rabies testing or completion of the observation period and the patient is not in a high risk group for infections. – as distinguished from bites to an extremity); the severity If frank cellulitis (infection of the skin recognized by of the bite (the deeper the bite, the more likely that rabies erythema spreading beyond the wound edges) is evident, a PEP will be promptly started); whether the bite was 10 to 14 day course of treatment is indicated. Amoxicillin- provoked (any unprovoked attack, including bites during clavulanate (Augmentin™) is the antibiotic of choice for feeding or handling a dog, is considered more serious than dog bite injuries. Doxycycline appears to be an acceptable a provoked bite); and, vaccination status of the dog (rabies alternative for patients who are allergic to penicillin, is extremely rare in vaccinated dogs).7 provided the patient is ≥ 8 years and not pregnant. A macrolide antibiotic (erythromycin, clarithromycin, or Generally speaking, if a dog’s vaccination against rabies azithromycin) can be used, but the risk of treatment cannot be promptly confirmed, if the dog cannot be failure appears greater because of antimicrobial observed or if the dog’s behavior is suspicious, the dog resistance. More effective antibiotic combinations include bite victim should receive rabies immunization promptly. clindamycin (Cleocin™) and a fluoroquinolone in adults Rabies immunization should begin within 48 hours after a or clindamycin and trimethoprim-sulfamethoxazole bite, and it can be discontinued subsequently if the dog is (Bactrim™, Septra™) in children.8 Daily parenteral proven to be free of rabies virus.5 injections of ceftriaxone (Rocephin™) may be appropriate if compliance is a concern.5 Many states have resources available to answer questions about possible rabies exposure. In Minnesota, an Regrettably, outpatient treatment of infection sometimes epidemiologist from the Minnesota Department of Health fails and a patient needs to be hospitalized. Reasons for (MDH) is available 24 hours a day at (651) 201-5414 to hospitalization from dog bite injuries include: systemic discuss possible rabies exposure to human dog bite victims. signs of infection (fever, sweats or chills); severe or rapidly spreading cellulitis or advancement of cellulitis past one Unlike the relatively rare rabies virus, about five percent joint; and involvement of a bone, joint, tendon or nerve. of dog bite wounds will become infected with various Intravenous ampicillin-sulbactam (Unasyn™) is the bacteria.8 Crush injuries, puncture wounds and hand antibiotic of choice, but surgery may be more important. For patients hospitalized with deeper infection or abscess formation, surgical consultation should be promptly What To Do If A Dog Attacks You 4 obtained because of the risk of worsening infection and tissue damage.5 Surgical exploration, debridement of devitalized tissue, and drainage of abscesses can be life-saving. • Surrender anything you have if a dog attacks you (e.g., bag, purse, jacket) in the hope that the dog will bite Conclusion the item and not you. Thousands of years after dogs were first domesticated • If you fall to the ground, curl into a small ball and wrap and welcomed into human homes, they remain a part of our culture. Most would agree that the benefits of your hands and arms around your head. Be quiet and responsible dog ownership outweigh the risks. However, remain still until the dog has left before you get up. dog bite injuries are all too common, their complications painful and their treatment expensive. Death is fortunately Continued on page 9. 8 Situation Critical | Spring 2007
  • Center of Excellence Stroke Prevention, Care and Rehabilitation Services at North Memorial Acute Stroke Program Clinical Stroke Research with North Memorial continues to be among the best in the Near Infrared Laser Therapy country in providing emergency care to stroke patients By Irfan Altafullah, MD through our comprehensive acute stroke program. Stroke Center Medical Director The Stroke Team provides thrombolytic therapy to Stroke is a devastating condition with significant stroke patients that exceeds the national average. North mortality and morbidity. The only proven effective Memorial also offers state-of-the-art interventional treatment for acute stroke is thrombolytic therapy (“clot neuro-radiology services featuring intra-arterial rt-PA, busters”) which can only be given within three hours clot retrieval devices, angioplasty and carotid stenting. of the onset of stroke symptoms. Nationally, less than The Stroke Center has a registry that captures data on all 10 percent of all patients with acute stroke receive this of our stroke and TIA patients. This registry allows us to treatment, largely because they do not reach a hospital monitor patient outcomes and improve stroke care. within the treatment time window. The Heart and Stroke Center provides care to stroke There are several promising therapies currently being patients and their families. This 80-bed care center offers researched to improve the care of stroke patients. One staff specially trained in stroke management, including such intervention is Near Infrared Laser Therapy which certification in the National Institutes of Health Stroke Scale. has shown positive results in animals and in small preliminary studies in humans. The laser treatment is North Memorial is the only hospital in the Twin Cities non-invasive, painless, and is applied to the skull. The currently participating in the NIH funded multi- entire treatment lasts about 40 minutes. A current FDA- center CREST study comparing carotid stents and approved study is evaluating the effectiveness and safety endarterectomy. We also participate in a variety of of laser therapy in patients up to 24 hours after onset of ongoing studies to work toward better treatment and stroke symptoms. prevention of stroke. The Stroke Center at North Memorial remains at the forefront of clinical stroke research in the search for better ways to treat stroke. Biting the Hand That Feeds You: Continued from page 8 rare, for dogs usually bite once out of fear rather than 4 Mertens, Petra. “Dog Bite Prevention,” University of repeatedly with intent to kill. Prompt and attentive Minnesota, College of Veterinary Medicine, <http:// treatment by emergency care providers will help reduce www.cvm.umn.edu/newsandevents/facts/petsafety/ pain, infection, disfigurement and other complications of dogbiteprevention>, last accessed January 29, 2007. these injuries. 5 Presutti, R. John. “Prevention and Treatment of Dog References Bites,” American Family Physician, April 15, 2001. 1 Phillips, Kenneth M. “Dog Bite Law”. <http://www. 6 “Facts About Dog Bites.” City of Minneapolis, Animal dogbitelaw.com>, Last Updated November 6, 2006. Care and Control, <http://www.ci.minneapolis.mn.us/ Last Accessed January 28, 2007. environment/docs/dogbitebrochure>, last accessed on- line on February 5, 2007. 2 Weiss, Harold B., Friedman, Deborah I, and Coben, Jeffrey H. “Incidence of Dog Bite Injuries Treated in 7 “Management of Possible Rabies Exposure in Humans”, Emergency Departments.” JAMA, Vol. 279, No. 1, Minnesota Department of Health, <http://www.health. January 7, 1998. state.mn.us/divs/idepc/diseases/rabies/human>, last accessed on-line on February 5, 2007. 3 Clifton, Merritt. Editor, Animal People. “Dog Attack Deaths and Maimings, U.S. & Canada, September 1982 8 The Sanford Guide to Antimicrobial Therapy, to November 13, 2006.” 36th ed, 2006. Situation Critical | Spring 2007 9
  • Outstate Partner Profile St. Joseph’s Area Health Services, which include socks, underwear, pants and a top, are labeled according to size and gender.” Park Rapids Located in Park Rapids, Minnesota, St. Joseph’s Area By having these supplies readily available, clinical staff Health Services was established in 1946 by the Sisters of are better able to concentrate on a patient’s health needs St. Joseph in Crookston. Today, it is a JCAHO-accredited without the stress of trying to figure out how to clothe the hospital offering comprehensive inpatient and outpatient patient to get them home. “It’s a very nice added service care to residents of Hubbard County and portions of that we’re happy to offer our patients,” says Rooney. Becker, Cass and Wadena counties. St. Joseph serves a rapidly growing, rural resort area of more than 25,000 people (with a summer population that exceeds 50,000). A particularly unique patient service at St. Joseph’s is St. Joseph’s by the Numbers the hospital’s Patient Compassion Closet. This unique resource provides patients in need with clothing and sometimes funding for needs like transportation or • Licensed beds: 50 medication. Communication and Development Manager Cynthia Rooney explains that hospital staff donate to a • Average inpatient days each year: 6,135 patient compassion fund that provides monies for patients during a time of crisis. • Average emergency room visits each year: 10,600 “Some of these funds are used to purchase clothing for our compassion closet,” she says. “Secondly, an area church • Number of employees: 400 Source: www.sjahs.org provides sets of children’s clothing for us. The outfits, 10 Situation Critical | Spring 2007
  • Meet Our Staff Dan DeSmet Megan Hartigan Title: Manager - North Title: Air Care/ Memorial Ambulance - Criticare Supervisor Marshall Region (Redwood since Fall, 2005 Falls, Marshall, Minneota & assist with AC 3) Education: • AS - Emergency Education: Medical Care • Bachelor’s Degree from St. and Rescue Cloud State University in • AS - Nursing Criminal Justice & Health • Completing BS • Education, Paramedic in Community Certificate from McKennan Health/ Hospital - Sioux Falls, SD Management • Registered Emergency Medical Technician, National DRE (Drug Recognition Expert) Professional Experience: Professional Experience: • Served as an EMT in rural Wisconsin I began my emergency health care career in 1990 by completing • Paramedic at North Memorial Ambulance an EMT program during my senior year at Minneota High (first female hired) School. I worked for Minneota Ambulance and continued that • One of the original Flight Paramedics with Air experience while completing my college education at St. Cloud Care; served five years as Air Care Supervisor State University. • RN at a Level II Trauma Center Following my college education, I began working as a police • Flight Nurse/Supervisor/ Director of Air officer and dispatcher for the city of Marshall. I was trained as a Operations for another air care service paramedic through McKennan Hospital in Sioux Falls and began • Appointed to the Emergency Medical Services working for North Memorial Ambulance in Marshall in 1997. Regulatory Board with term expiring this year I transitioned from the Marshall Police Department to the Lyon Favorite Part About My Career: County Sheriff’s Department as a full-time deputy in 1999 and continued working as a paramedic for North Memorial Each phase of my career has offered many rewards. Ambulance in Marshall. In 2005, I accepted my current position as I enjoy the adventure of the working environment, Manager for the Marshall Region of North Memorial Ambulance. even in adverse conditions. I appreciate the ability, knowledge and dedication of the wide variety of Favorite Part About My Career: people I have the opportunity to come in contact with. The favorite part of my career is the fast-paced and ever- I have confidence that our patients are being served by changing work environment. Some days I can go from a warm knowledgeable, competent, top-notch crews. and cozy office to the middle of a blizzard in a matter of seconds. And the nature of my work is also ever changing. While Personal Interests: in the office, I can be working on a yearly budget and the next I am married with four daughters, a dog, hamster minute be intubating a critically injured patient in a ditch. and fish. We live on a lake in rural Minnesota and I love outdoor silent sports such as swimming, Personal Interests: kayaking, running and biking. Some of my personal interests include hunting, biking and swimming when the weather permits. Additionally, I am also an avid storm chaser and enjoy watching a summer thunderstorm. Situation Critical | Spring 2007 11
  • Calendar of Events North Memorial Medical Center Emergency Medicine and Trauma Conferences April – July, 2007 Date Time Conference Title Presenter Room 4/20/07 Acute Med/Surg Mgmt Conference* Dr. Smith V.DeMong 1210-1300 Identification of Dementia 1300-1400 Documentation & Coding L.Vorhes, C. Pfeifer V.DeMong 4/27/07 Stabilization Room Conference Dr. Kolar V.DeMong 1210-1300 Case Presentations Dr. Soberay 1300-1400 Ortho X-Ray Tutorial #3 Dr. Allegra V.DeMong 5/1/07 Emergency Medicine Noon Conference Dr. Roberts Ridgeview 1210-1300 Seizures 1300-1400 Calculation Lab #3 Dr. Allegra Ridgeview Pinecrest/ 5/18/07 Acute Med-Surg Mgmt Conference* Dr. Taylor Lakeshore 1210-1300 DVT Update 1300-1400 Documentation & Coding L.Vorhes, C. Pfeifer Pinecrest 5/21/07 Trauma Grand Rounds* Dr. Roberts Pinecrest 1210-1300 Toxic Peripheral Vascular Accidents Dr. Knapp 1300-1400 Emergency X-Ray Tutorial #3 Dr. Allegra Pinecrest 6/5/07 Emergency Medicine Noon Conference Dr. Barnhart Ridgeview 1210-1300 Hypertensive Emergencies 1300-1400 Calculation Lab # 3 Dr. Gengerke Ridgeview 6/8/07 Trauma Grand Rounds* Dr. Roberts V.DeMong 1210-1300 Liver Trauma Drs. Steiner, Moser 1300-1400 Emergency X-Ray Tutorial #3 Dr. Travnicek V.DeMong 6/15/07 Acute Med/Surg Management Conference V.DeMong 1210-1300 TBA 1300-1400 Documentation & Coding L.Vorhes, C. Pfeifer V.DeMong 6/22/07 Stabilization Room Conference Dr. Kolar V.DeMong 1210-1300 Case Presentations Drs. Gengerke, Travnicek 1300-1400 Ortho X-Ray Tutorial #3 Dr. Nelson V.DeMong Attendance by medical students and residents required. *North Memorial Health Care is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians. North Memorial Health Care designates this educational activity for a maximum of 1 AMA Physician’s Recognition Award™ category 1 credits. Physicians should claim only those credits commensurate with the extent of their participation in the activity. If you need auxiliary aides or services identified in the Americans with Disabilities Act, please contact North Memorial Continuing Medical Education prior to the program at (763) 520-7274. For directions or more information about any of the conferences, contact Dr. Roberts at david.roberts@northmemorial.com. 12 Situation Critical | Spring 2007
  • Calendar of Events North Memorial Medical Center Emergency Medicine and Trauma Conferences April – July, 2007 Date Time Conference Title Presenter Room 7/13/07 Trauma Grand Rounds* Dr. Roberts Pinecrest 1210-1300 Smoke Inhalation: CO or Cyanide? 1300-1400 Emergency X-Ray Tutorial # 1 Pinecrest 7/20/07 Acute Med/Surg Mgmt Conference* V.DeMong 1210-1300 TBA 1300-1400 Documentation & Coding L.Vorhes, C. Pfeifer V.DeMong 7/27/07 Stabilization Room Conference Dr. Kolar V.DeMong 1210-1300 Case Presentations 1300-1400 Ortho X-Ray Tutorial #3 V.DeMong Attendance by medical students and residents required. *North Memorial Health Care is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians. North Memorial Health Care designates this educational activity for a maximum of 1 AMA Physician’s Recognition Award™ category 1 credits. Physicians should claim only those credits commensurate with the extent of their participation in the activity. If you need auxiliary aides or services identified in the Americans with Disabilities Act, please contact North Memorial Continuing Medical Education prior to the program at (763) 520-7274. For directions or more information about any of the conferences, contact Dr. Roberts at david.roberts@northmemorial.com. Air Care’s Annual Spring Emergency Care Trauma 101 Seminars – FREE Multi-System Care of the Trauma Patient for the Information: (763) 520-3021 or visit northmemorial.com Nurse Working in a Non-critical Care Setting (click News and Events) September 19 from 8 a.m. to 4 p.m. You are invited to join us at one of the upcoming free Information: (763) 520-5999 or visit northmemorial.com seminars for emergency care providers. Following are (click For Health Care Professionals) program dates and locations: This course will give you the tools you need to respond quickly to a wide variety of multi-system trauma involving April 25 Air Care 4 Princeton Base different patient needs, ages, cultures and severity of May 2 Air Care 2 Brainerd Base presenting symptoms. Registration is $99 for professionals or $49 for North Memorial employees ($8/box lunch). May 8 Air Care 1 Lakeville Base Beyond the Secondary Survey Topics may vary from one location to the next, but all will Critical Care Trauma Nursing Course be conducted between 6 and 9 p.m. and will include two Monday & Tuesday, October 22-23 from 8 a.m. to 4 p.m. 60-minute general sessions and three 20-minute breakout Information: (763) 520-5940 or visit northmemorial.com sessions. A complimentary dinner and registration begin (click For Health Care Professionals) at 5:15 p.m. Sessions are designed to meet continuing education requirements for nurses and EMTs. While many courses cover initial trauma evaluation and resuscitation, this 2-day program will use lecture and case studies to give you the skills you need to provide care for these patients after the initial resuscitation period is completed. Registration is $149 ($16/box lunches both days). Intended for nurses who have at least one year of critical care experience. Situation Critical | Spring 2007 13
  • Non-Profit Org. U.S. Postage PAID Minneapolis, MN Permit No. 3784 Emergency and Trauma Services 3300 Oakdale Ave. N. Robbinsdale, MN 55422 Please share this with your staff.