Incidence and characteristics of preventable iatrogenic cardiac arrests

Article Abstract:

Iatrogenic illness is any disorder that results from medical treatment administered by a physician. Implicit in the notion of iatrogenic illness is the preventability of the disorder. A particularly catastrophic form of iatrogenic disorder is cardiac arrest, in which the heart stops supplying blood to body, and (in the absence of immediate reversal of the condition) death ensues. To characterize the conditions and patient population involved in iatrogenic cardiac arrests, a study was carried out in which the records of 203 cases of cardiac arrest were reviewed. All the arrests occurred during 1981 at a teaching hospital. Of the 203, 28 arrests (14 percent) resulted from errors in the use of medication, complications from procedures, and inadequate monitoring of fluid balance, electrocardiograms and other clinical symptoms. Seventeen of the 28 patients (61 percent) died. When the patient characteristics of the 28 cases of iatrogenic arrest were compared with the 175 noniatrogenic cases, no major demographic differences were seen. Patients with iatrogenic arrest were less likely to have suffered a heart attack or to be in cardiac shock at the time of cardiac arrest, but were more likely to survive the episode and to have been taking digoxin than noniatrogenic cases. Iatrogenic cardiac arrest was most often caused either by adverse response to medication (44 percent) or less-than-optimal response to clinical symptoms on the part of physicians (28 percent). An objective review of the circumstances surrounding each incident suggests that 18 of the 28 cases of iatrogenic cardiac arrest (9 percent of the total cases) could have been prevented by improved care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Therapeutics, Cardiac arrest, Iatrogenic diseases

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Patients who drink alcohol: pain, pleasure, and paradox

Article Abstract:

Difficulties in treating alcoholism may be partially ameliorated by current advances in biomedical research and greater public awareness of the disease, but problems remain that are inherent to addiction and the to health care system. The March 1996 issue of the Archives of General Psychiatry deals exclusively with such current issues in alcoholism. Social problems, genetic predisposition and the difficulty in supplanting alcohol with something equally pleasurable have tempered the optimism surrounding drug treatments such as naltrexone. The benefit to cardiovascular health that is currently associated with moderate alcohol use has raised the issue of whether alcoholics can eschew abstinence in favor of controlled drinking. Current cost control and managed care approaches appear to curtail the treatment options available to alcoholics. Physicians may need to consider the wider social context of alcohol and addiction when treating patients suffering from the disease.

Health aspects, Care and treatment, Editorial, Alcoholism, Alcoholism treatment, Temperance

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Clinical crossroads: an invitation

Article Abstract:

A new feature is introduced in JAMA called Clinical Crossroads, which presents a medical dilemma faced by physician and patient, and discusses how the dilemma is resolved. The patients are from Beth Israel Hospital in Boston or an ambulatory facility in Boston. Practitioners invite experts to provide input on the diagnosis and treatment. Patients with chronic illnesses are discussed. The format includes perceptions of the patient, questions answered by physicians, and a comprehensive discussion.

Publishing industry, JAMA, The Journal of the American Medical Association (Periodical)

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