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UROLOGY

• 5 Star Rated for Prostatectomy - 2008

Dr. Carney: “Well what’s unique about Memorial in Johnstown is we have surgical residents so we do surgical training so it actually keeps all the attending surgeons up on their toes and the latest modalities for surgical care and we push them and they push us.  It’s a nice, nice exchange, and that does help our surgical treatment for patients.”

GENERAL SURGERY

• 5 Star Rated for Appendectomy - 2008

Welcome back to the Conemaugh Connection. In the first week of the 2007 NFL season,  Buffalo Bills Tight End Kevin Everett suffered a life-threatening spine injury. Many thought he would never walk again but Everette’s treatment included an experimental procedure that cooled his body to about 92 degrees … a procedure that some doctors believe may have contributed to his miraculous recovery. 

Cooling the body is a technique still being studied for spine injuries but it is now being used routinely at Memorial Medical Center for cardiac arrest patients. Doctors in intensive care believe, in some cases, this induced hypothermia may be the difference between a patient waking up or not.

Every good team knows that the game is won on the practice field, where every movement can be rehearsed and every decision analyzed. It’s true in sports and its true here as well, only this practice field is Memorial’s human patient simulator lab, and this team…it’s special too.

Dr. DePriest: “It has physicians, nurses, respiratory therapists, pharmacists, and all of those people receive some training in basic CPR or advanced cardiac life support, but they never trained together.  And the problem is is that when you have a patient suffering from cardiopulmonary arrest everyone shows up and they have to work as a team right away, and there is really no time for them to learn at that point.  And so what this allows us to do is bring all those people in together in a simulated environment and very realistically recreate a code environment and let them learn how to work as a team.”

“You really can replicate the tension of and just the stress in a real code pretty effectively, and the feedback from the residents has been that it really did help them when they had to go to their first code that the speed of it and how quickly things moved and just the whole pace of trying to resuscitate somebody, they were better prepared.”

But sometimes restarting the patient’s heart is not enough.

Christine Schreyer:  “The brain usually takes somewhat of a hit, it’s a secondary hit but it does take a hit from the lack of circulation and oxygen being delivered to the brain so they can very well recover from their cardiac event to have a negative outcome neurologically.”

DePriest:  “So once we revive them that actually introduces a new risk to them that as blood starts going back to the brain reperfusion, toxic substances can be produced in the brain that can cause further brain injury and brain damage.”  

So for the past five years, Memorial’s critical care team has been using a hypothermia protocol, a cooling of the body for those cardiac arrest patients who  have been successfully resuscitated but are not waking up.

Christine: “Within four hours we want to usually take them from a normal temperature which is 98.6 down to 32 to 34 which translates to 92 to 94 degrees Fahrenheit.  So if we can get them down there within four hours that’s great.”

When the brain is cooled the demand for oxygen decreases, this protects the cells from injury and reduces the production of chemicals which cause further brain damage.

Dr. Gregory: “We know that the brain does better in a cool environment. We’ve all heard of people who fall into the water, cold water drowning and they come out perfectly fine because the cold water preserved the brain.”

In the past cooling blankets or even ice packs were used but now a new product called Arctic Sun provides a more efficient method of cooling the body.

 Christine: “This wraps around the patient.  This goes next to the back and then it wraps around and then there is an additional leg pad.  These wrap around the legs of the patient.  There are left and right legs to provide that surface cooling area and then if you have a larger patient you also have what’s called a universal pad that you can place onto the abdomen to get that about approximately, again, 40 percent body surface area.”

The cooling process can be started in the emergency department and can even be used while the patient is undergoing a heart catheterization to open a blocked artery.

DePriest: “With the old system you sort of had to pick between the heart or the brain and that’s obviously a tough choice and so now we can really direct treatment at both.”

Surveys show not all hospitals – only about 25% have a hypothermia protocol in place for cardiac arrest. At Memorial Medical Center the technology is also being used on trauma patients with traumatic brain injury.

Dr. Bowles: “When you have a traumatic brain injury, you can have a primary injury which occurs at the impact but then there is this generation of secondary injury. You have sort of injured brain cells that have a potential to recover or they have a potential to worsen and they can recruit other cells to become damaged too.”

Dr. Gregory: “Whatever we can do to save brain just like we used to say save muscle for the heart, we’re trying to do for the brain injured patients. It includes an aggressive approach that begins the minute the patient hits the emergency room.”

Dr. Bowles: “I think it is every exciting. You know, the things that we may be, the things that we’re able to do now that we weren’t able to do a few years ago and the things that potentially we’ll be able to do later, it’s really exciting.” 

Innovation, new protocols, a commitment to learn and improve has been a cornerstone of Memorial’s Level One Trauma Center which recently celebrated 20-years and 14-thousand lives saved. One of those lives belongs to Ronald Markosky.

Ronald Markosky: “I was involved in an accident involving a log truck. They extricated me from the vehicle, flew me here, medical helicopter and I don’t remember much after that, coming in here. I mean afterwards I got to meet all the doctors now.They pretty much had me sedated the first two days. What the wife says what they had to do those two days was miraculous to say the least.”

Anna: “You don’t realize it until something like this happens and it’s a life and death situation, and you are thanking God that this is here for that life because without this and so close, he would’ve died.”

Even before trauma patients like Ron arrive, the team is gathered together and ready to go.

Dr. Miller: “Trauma affects the majority of us right at the prime of our life, affects without warning. Your whole life and your family’s life is completely put in disarray and it is imperative that there is an organized system there to help put the pieces together.”

“It’s every, everyone who works in the hospital is part of the team.  Their commitment is instrumental in good outcomes.  You know everything from housekeeping, materials management, environmental facilities, everything.  You know people think that the surgeon and the nurses, that’s just the first layer, and there are just literally hundreds and hundreds of people whose input is vital to make sure the patient has a good outcome at the final, at the end.”

The Regional Resource Trauma Center at Memorial is one of just 15 Level I trauma centers in Pennsylvania – and the only one between Pittsburgh and Harrisburg. What amazing work they do!

Coming Up … Out of approximately 7,500 home health agencies across the country, Conemaugh Home Health ranks in the Top 1%. Why? We’ll show you after the break.

PULMONARY

• 5 Star Rated for Treatment of COPD - 2004, 2005, 2006, 2007, 2008
• 5 Star Rated for Treatment of Community Acquired Pneumonia – 2008

Dr. Begley: “We go upon evidence based medicine for the treatment of patients in the intensive care unit.  So we are aware of the current updated therapies and medications for particular problems.  In addition, we’ve initiated several actually quite a few protocols which are standard protocols which are the best treatment protocols for particular problems and those are initiated immediately when the patient is admitted to the intensive care unit.