Emergency Medicine

Before getting a CT scan, ask your doctor if its really needed

Conditions

June 15, 2011

How and when do new medical technologies become the standard of care?

A recent study showed that the use of CT scans in hospital emergency departments rose sixteen percent between 1995 and 2007.

Looks a bit like a medieval torture doughnut.

The only thing that surprises me about this is that it’s not more.

Way more.

I remember the first time I actually ordered a CT scan on a patient all by myself, in …

Pain control in a patient with rib fractures and a spinal cord transsection

Ralph Gordon, MD

Physician

June 1, 2011

When I was called to see the patient after a motorcycle accident I expected the worst. The patient sustained a thoracic spine injury with cord transsection at T5 level as well as significant chest wall injury on the right side.

Multiple ribs were broken; some with a significant displacement. Managing patients with a significant chest wall trauma could be a nightmare. Pain control is only one of the challenges.

What happened inside the hospital during the Joplin, MO tornado

Kevin J. Kikta, DO

Physician

May 31, 2011

joplin hospital tornado

Dr. Kevin Kikta was one of two emergency physicians on duty at St. John’s Regional Medical Center in Joplin, MO on Sunday, May 22, 2011, when an EF-5 tornado struck the hospital.

You never know that it will be the most important day of your life until the day is over. The day started like any other day for me: …

The exhaustion of emergency physicians, and its toll on patients and family

Jessica Freedman, MD

Physician

April 26, 2011

When I advise students about how to choose a specialty, I suggest that they seek out advice from physicians who are at least 10 years out of residency and leading the type of life they hope to have in the future.

It is difficult, and perhaps impossible, to anticipate in your late 20s or early 30s what practicing a certain specialty will be like when you are 40, 50, or 60.

Find …

When in the ER with abdominal pain, adjust your expectations

Kevin Pho, MD

KevinMD

February 14, 2011

Abdominal pain is the bane of many emergency physicians.

Recently, I wrote how CT scans are on the rise in the ER. Much of those scans look for potential causes of abdominal pain.

In an essay from TIME, Zachary Meisel discusses why abdominal pain, in his words, is the doctor’s “booby prize.” And when you consider that there are 7 million visits annually by people who report abdominal pain, that’s a …

Treating a patient in a small town versus a big city

StorytellERdoc, MD

Conditions

February 1, 2011

I usually work two or three shifts a month at a small, rural hospital about two hours from where I live. Why? Mainly, the small hospital is less than ten miles from my childhood home, where my widowed father still resides, and thus provides me an opportunity to catch up with Dad as well as four of my siblings and their families, all who live within five miles of Dad.

I …

7 favorite ER superstitions

911Doc, MD

Physician

December 12, 2010

shutterstock_81843283

Emergency physicians, nurses, and paramedics are a superstitious lot. I thought it might be interesting for those not in the business to read about some of our superstitions. In no particular order, here are my favorites.

1. The “Q” word. “Quiet.” it’s truly the kiss of death. The “S” word, “slow,” carries the same jinx. Usually some newbie nurse or clerk who is …

Read more…

7 favorite ER superstitions

Stercoral perforation as a deadly cause of colon rupture

Sid Schwab, MD

Physician

December 9, 2010

I got the call from the ER because I was the “no-doc” surgeon, meaning I was the guy to call when a patient showed up needing a surgeon, and who had no primary care doc to direct the referral. Usually it meant trouble. A drunk who smashed his car and himself, possibly others. Stab-wound, gun-shot. People who don’t have their own doctors include more than those down on their luck; …

Priapism is indicative of spinal cord injury in trauma

StorytellERdoc, MD

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 …

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 …

Read more…

Shifts and making switches in the ER

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 …

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

StorytellERdoc, MD

Conditions

July 5, 2010

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 …

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 …

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. …

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 …

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 …

Read more…

Psychiatric patients detained in the ER

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 …

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 …

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 …

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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