Emergency Medicine

Priapism is indicative of spinal cord injury in trauma

Conditions

December 4, 2010

It had been a high-speed motor-vehicle accident. One car. A twenty-something male driver without passengers. No seat belt. And now, this same driver had no movement from his waist down and no sensations below his mid-abdomen.

According to bystanders, he had been driving his sedan dangerously fast, some estimates of nearly 100 m.p.h., before losing control. The car veered off the roadway to the right, flipping mid-air before smacking head-on into …

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Shifts and making switches in the ER

ER Stories, MD

Physician

November 28, 2010

Everyone one knows ER docs work shifts. Many places though have each doc doing a set schedule. Such as 1 day, 1 evening, 1 overnight or one week with days, one with evenings, and one with nights.

Others, like my hospital, it is a mass jumble. We work all sorts of random shifts at random times, so long as it evens out at the end of the 6 week block that …

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When does the duty to provide emergency medical care end?

Kevin

Physician

November 20, 2010

by Lyle Denniston

Hospitals know that medical care decisions often have legal consequences, which makes it all the more important to know what the law requires. But when judges can’t agree, and there also is some ambiguity in the way government officials see a legal issue affecting care decisions, hospitals may need to go to the ultimate authority – the U.S. Supreme Court – for an …

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Kidney stone pain, as experienced by a man and a woman

StorytellERdoc, MD

Conditions

July 5, 2010

shutterstock_128891225

As a typical guy, there are several painful illnesses that can hit our brotherhood in an instant. No warning was given. No “Get out of jail free” pass, either. Just cruising along, having another fine, healthy day, and bam! — suddenly, you are lying on the floor in severe distress.

The most feared? A testicular torsion. It can happen spontaneously. It can …

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Can chest pain patients be evaluated in the ER waiting room?

Kevin

Physician

June 12, 2010

by John Gever

Emergency department patients with chest pain may safely be evaluated in the waiting room when necessary, researchers said.

Among 303 patients triaged to waiting-room evaluation in a prospective study, no acute coronary syndromes were missed and adverse event rates overall were lower than among 804 patients who were assessed in conventional monitored beds, reported Frank Scheuermeyer, MD, of St. Paul’s Hospital in Vancouver, British Columbia, and colleagues online in …

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Treating a child with fever and leukemia

StorytellERdoc, MD

Conditions

June 10, 2010

I walked into Room 35 to find a three year-old lying on the hospital cot. Her father sat alongside her bed, whispering softly to her. The patient appeared quite tired, wiped-out even, and if it weren’t for her complacent eyes tracking my every move, I would have thought she might be sleeping.

She was visiting our ER because, after a few days of cough and congestion, she had developed a fever. …

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False patient contact information worsens emergency care

Kevin

Physician

May 10, 2010

One of the biggest emergency room problems is contacting patients after they leave.

Patients sometimes leave false contact information — which makes it difficult for the emergency room staff should problems arise after the visit.

The issue was illustrated in a piece from msnbc.com. Many times, results like blood cultures or x-ray findings take time to return. And if there’s something that needs to be acted upon, contacting the …

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Psychiatric patients detained in the ER

Edwin Leap, MD

Physician

April 22, 2010

Our state of South Carolina is a delight. From wonderful people to beautiful landscapes, from a vibrant Southern culture to excellent food like shrimp and grits, it’s a place I’m thrilled to live. But we do lack a few things. And one of the most striking is adequate mental health care.

The state budget, like so many state budgets, has been trimming anything and everything. And of course, mental health coverage …

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Using CT scans to diagnose chest pain in the ER

John Mandrola, MD

Physician

March 6, 2010

During residency, there was always a case of misdiagnosed chest pain to discuss in conference. Incorrectly sending a patient home and missing the diagnosis of cardiac chest pain was an infrequent, but repetitively observed, phenomenon.

So as to tread carefully with words, it is sufficient to say that even now, chest pain triage remains a vexing problem.

Chest pain diagnosis is like appendicitis; there are always small numbers of unusual cases in …

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How teamwork is essential in the emergency department

Edwin Leap, MD

Physician

November 12, 2009

I recently cared for a patient who raised my heart-rate a bit. Of course, any emergency physician will tell you, the potentially difficult and complicated cases often come at the end of the shift, as you’re trying to clean up all of the paperwork and ‘head for the house.’ Nurse Ginger came to me and said, ‘we need a doctor in room 11.’ I snarled, snatched the paper, grumped and …

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Vicodin and Percocet banned and taken off the market, or is a black box warning more likely?

Kevin

Meds

June 30, 2009

The FDA has declared war on acetaminophen, with Vicodin and Percocet being collateral damage. You can bet Dr. Gregory House is sweatin’ pretty hard over this news.

In the last few days, acetaminophen, otherwise known as the brand name Tylenol, has been squarely in the FDA advisory panel’s crosshairs. In general, it’s a very safe medication, but there is …

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Did Demerol cause Michael Jackson’s cardiac arrest and death?

Kevin

Conditions

June 26, 2009

Michael Jackson’s death continues to consume the news cycle.

There is currently no clear explanation. Some have speculated that it may be related to the narcotic pain drug, Demerol. According to this report from the UK’s The Sun, “An Emergency Room source at UCLA hospital said Jackson aides told medics he had collapsed after an injection of potent Demerol …

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Can you really kill a man by gluing his anus shut?

Kevin

Potpourri

May 9, 2009

A recently reported method of torturing gay men in Iraq sounds horrifying.

Andrew Sullivan points to an article that spares no graphic details: “. . . anti-gay Shiite death squads are sealing their anuses with a powerful glue, then inducing diarrhea, which leads to a painful and agonizing death.”

But, can someone really die from this novel form of torture?

Emergency physician Shadowfax has his doubts. …

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Did the Canadian health system fail Natasha Richardson?

Kevin

Physician

March 20, 2009

Would Natasha Richardson be alive today if she had gone skiing in the United States instead?

I don’t think it would have made a difference.

To recap the tragedy, Ms. Richardson died from an epidural bleed, after she fell while skiing. Her presentation was somewhat classic, with the well-described “lucid” period before she deteriorated.

According to Canada’s Globe and Mail, “ambulance workers were not …

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