CDC's Wants Bloggers to Encourage Getting Flu Shots

Today, the CDC, America's Centers for Disease Control and Prevention, hosted a webinar for bloggers to ask us to get the word out that people should go get their flu shots.

Over the course of 40 minutes, they gave the scientific background supporting influenza vaccine and how it helps, and how it doesn't. They strongly encouraged those affected by the delay in shipping to go get shot even in January, since it only takes 2 weeks to develop immunity, and the flu season continues through March.

A statistic I found interesting was that 40% of patients get the shot in their physician's office. That's really striking since there's a great potential for improvement, if the government and local health agencies would be willing to go to places that it's easier to get your shot. For example my family was at the mall yesterday which was so crowded that there was no parking for what felt like miles. Last year, I was so passionate about getting my friends who are parents of infants and toddlers vaccinated, that I brought flu shots (refrigerated) to holiday parties and immunized friends where they were relaxing. I immunized dozens who would otherwise would have probably gone without, rather than face the waits at flu shot clinics or having to make an appointment.

I asked the only question after the talks, which was surprising since I figured bloggers would be more outspoken. I asked if they could address why California passed legislation preventing children under 3 and pregnant women from receiving Thimerisol containing vaccine. I was pleasantly surprised that the research physician very personally revealed that for her own 2 year old, she didn't even ask what kind of vaccine was given (thimerisol containing or not). She said that not only was the initial research linking thimerisol to autism discredited, more recent research supports no link either. It was an answer tailored perfectly for a blogger, a personal anecdote showing just how much she believes her research, she applies it to her own family.

It thought the tone of the 2 presentations was overall too clinical, with terminology that was physician-oriented rather than lay blogger oriented. Specifically, I'm not only referring to the science slides, but also in slide 34, they point out medicare coverage of flu shots, which was great since they had elderbloggers on the line as well as the mommybloggers who manage their healthcare. The problem is that the terms they used to refer to the 2 different kinds of insurance was "managed care plan" and "fee for service" which means less to bloggers than the more widespread used terms "HMO / POS / EPO" and "PPO," respectively, which have the same meaning.

I also would have appreciated them alerting me to online resources that would keep me up to date on flu activity and spread through the USA. Such as the map that they showed, with Florida being the only state with reported widespread flu activity.

The CDC promised more webinars and communications with bloggers, and I'm hoping for the same. I suggested that bloggers tag their posts with technorati or del.icio.us with the terms "CDC flu webinar blogger" and we'll see if you'll be able to read other reports from the webinar from other bloggers. Hurrah for more openness!

Others commenting on the webinar:
Mary Lu Wehmier
Fitness-web
and others at technorati

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Avoid Intravenous Promethazine (Phenergan) When You're Nauseous or When You're Getting a Pain Shot

For video scroll down:

The FDA has been highlighting the Institute for Safe Medication Practices warnings, who recently warned that administering promethazine intravenously (in a vein) may cause more severe tissue injuries than previously recognized. Promethazine, known by the trade name Phenergan, is most used as an antiemetic (anti nausea & vomiting) in conjunction with a narcotic pain reliever, but also has uses for its antihistamine and sedative effects. You'd most likely encounter it when you go to the Emergency Room or Urgent Care (like where I work) and may require an antiemetic for vomiting and dehydration, or to prevent those side effects from happening while receiving injectable painkillers. That's why I'm bringing it to your attention, so you can ask for it to be given to you intramuscularly or to consider asking for a different medication.

Although promethazine is a known vesicant which is can damage blood vessels and surrounding tissue it is commonly used intravenously. Deep intramuscular injection is the preferred kind of injection, and is least likely to cause damage. Starting in residency, physicians are taught that promethazine can be given by slow IV push, say, over 5 minutes. Unfortunately, this IV route can put you at risk of injecting it into an artery or into your tissue rather than a blood vessel, resulting in possible serious complications, ranging from pain to paralysis, tissue necrosis, and gangrene. Recent cases highlight complications requiring fasciotomy (releasing the capsule around a muscle because of swelling), skin graft (transplanting over removed dead skin) and amputation.

Please click on the video links below to see graphic pictures of one case where a 19-year-old woman who went to the emergency department with flu-like symptoms was given Phenergan IV. The video shows how she complains of pain, but is told by the nurse that her arm was fine. The patient's fingers became dark and then turned black and shriveled. Her thumb, index finger, and top of her middle finger had to be amputated.

For these reasons and others, many Emergency Departments have switched to using other anti-nausea antiemetics rather than take the risk of complications. You could limit your risk by asking for a different drug, or consider the following good recommendationss which were noted by ISMP to minimize the risk of problems:

- Stop if there's any discomfort

- Check that the IV is running into your vein and not extravasating into your tissue, then inject slowly, not faster than 25mg / minute

- Stock promethazine only in the 25 mg/mL concentration (not the 50 mg/ml) since this is the highest concentration of promethazine that can be given IV.

- Consider 6.25 to 12.5 mg of promethazine as the starting IV dose, especially for elderly patients.

- Give the medication only through a large-bore vein and check the patency of the access site before administering.

- Administer IV promethazine through a running IV line at the port furthest from the patient’s vein.

- Consider administering IV promethazine over 10-15 minutes.

- Before administering the drug, tell patients to let you know immediately if burning or pain occurs during or after the injection.

Source quoted by FDA:
ISMP Medication Safety Alert! Serious Action needed to prevent serious tissue injury with IV Promethazine. August 10, 2006

Videos:
Windows Media, closed captioned
Real Player, closed captioned
MPEG Download (e.g. iPod)

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Grand Rounds Volume 3 Number 11 is available

Emily Devoto hosts Grand Rounds, this week's best writing in the medical bloggosphere, those intrepid folks that take time out to share stories about health like the ones you see here at Healthline. Thanks for linking to my child safety post!

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Top Toddler Parenting Myths

This week, I was asked to speak to our preschool co-op about Child Safety. It got me thinking about what I think are the top health myths for parents with toddlers, having to do with child safety:

1) You can adequately install a child car seat yourself

Don't, get someone certified to do so. A certified installer may be available at your local police station, but due to budgetary cutbacks many of these have been cancelled. Your local children's hospital often has a program (Stanford has one). The NHTSA keeps a installation website, that's not very complete, so check with your local parents club or mothers club.

2) Kids accept the tightness of the restraint belt

2 fingers under belt is as loose as it should be, can you believe it!?!? If you've ever tried to put squirelly toddlers into a car seat, you know that the first thing as you try to tighten the belt is their yell: "too tight!" My recommendation is to start 'em young. Try to get them used to a snug belt from the get go, and you won't have the fight I have with my daughter, a mistake I didn't repeat with my younger son.

3) Boosters are safe enough for kids over 40 pounds of weight

This is not as safe as a full 5 point harness, as rollover ejection deaths of kids secured in booster seats. LATCH is really important as well, to secure the car seat to anchors that should be connected to the frame of the car's. Also look for seats with it's belts secured to frame of car seat for greatest security. Car seats are available for kids up to 80 pounds, so you can bet I'll have mine in these with 5 point restraints for a bunch of years more.

4) Infants & toddlers can be taught to swim

The AAP recommends no swimming lessons under 4 because of the false security it gives you that your kid can be independent in the water. Yeah, I know, my daughter swam on her own at 2 years of age, but I was there in the pool next to her every second, since I more than once swooped her out sputtering from swallowing a mouthful.

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