Emergency medicine

2,327 articles · Since 2004

Articles, page 54

A hematologic emergency in the ER

January 3, 2015Jan 3, 20152

I was on call over a holiday weekend and Friday night at 10 o'clock I was paged by the emergency department about a nosebleed. A man in his 30s had a bloody nose Friday morning and over the course of…

I was on call over a holiday weekend and Friday night at 10 o’clock I was paged by the emergency department about a nosebleed. A man in his 30s had a bloody nose Friday morning and over the course of the day had developed red spots all over his legs. The ED checked his blood and his platelet count was near zero.

Blood looks red because of the oxygen-carrying red blood cells, …

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A hematologic emergency in the ER

Physician voices

Serving for the Navy: The global force for good

Ira Nash, MD

January 2, 2015Jan 2, 20153

A few years ago, the United States Navy launched a new recruiting and marketing campaign using the slogan: “America’s Navy: A global force for good.” The line was apparently a flop, and the Navy threw it overboard for “protecting America the world over,” but I liked it. I thought it captured a deep truth about the Navy, which is that it is undoubtedly a global force and that the force exists for …

Medical education

From medical student to patient, in a matter of minutes

Hamsika Chandrasekar

December 26, 2014Dec 26, 20143

As part of the second-year clinical skills course, each member of my class is required to complete two 8-hour emergency department (ED) shifts. I had my first ED shift last week, and when I walked in, I introduced myself as a second-year medical student who needed to practice IV placements, EKGs, and any other procedures that happened to come my way. Three hours later, when I walked out of the …

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Physician voices

An ER patient that stirs every emotion

StorytellERdoc, MD

December 24, 2014Dec 24, 2014

Despite the furious pace of the emergency department, he sat within his private bubble of calm on a hallway cot situated just outside the entrance of room 31. He sat upright, facing the opposite direction from which I approached, with the thinning brown hair of his broad occiput splayed across the upper edge of his pillow. From this approach, I paused for several seconds to appreciate this serene, surreal view …

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An ER patient that stirs every emotion

Physician voices

Don’t pay specialists for being on call. Here’s why.

Shadowfax, MD

December 21, 2014Dec 21, 201455

Every ER has its call roster, that sacred list of oracles, laying out who we can call when our patients need some service that we cannot provide. If I need a cardiologist, or a neurosurgeon or even a dermatologist for some acute emergency condition, all I need to do is ring up the operator and tell them, “This is the ER …

Physician voices

The American hospital as we know it is in peril

Edwin Leap, MD

December 16, 2014Dec 16, 201416

I appreciate the need for physicians and others to sleep. I’ve spent a great deal of my career awake in the wee hours. In some very real ways, emergency medicine as a specialty exists as a shield between patients and their sleeping (or otherwise engaged) physicians. But I fear we’re all wearing a little thin. Because the emergency room has become …

Physician voices

She died thirsty! Ice chips matter when it comes to patient satisfaction.

David Klein, MD

December 15, 2014Dec 15, 20146

“My wife died uncomfortable and alone. She died thirsty!” The man who spoke those words came in to the emergency room recently where I was working a shift. He was accompanied by his wife, a 70-year-old with high sugar, weakness,…

“My wife died uncomfortable and alone. She died thirsty!”

The man who spoke those words came in to the emergency room recently where I was working a shift. He was accompanied by his wife, a 70-year-old with high sugar, weakness, and nausea. The team worked to get her seen under the presumption that her diabetes needed control. Once she was brought back to …

Patient voices

A costly anomaly on a brain MRI

Kevin Davis

December 14, 2014Dec 14, 2014

It started with a mild case of nausea and got progressively worse. I became dizzy and shaky, but tried to ignore it. There was work to be done that afternoon. We were moving boxes into storage at my in-laws’ house in Michigan, and I needed to be strong. I carried boxes on unsteady feet, catching myself before bumping into walls. By early evening my legs were wobbly, and I felt …

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A costly anomaly on a brain MRI

Physician voices

Married to a physician: Holiday blessings in disguise

Rochelle Bach

December 11, 2014Dec 11, 20145

Each year as the holidays approach, countless medical families prepare for the dreaded release of the holiday schedule. Will the physician spouse be home this year? Will the non-physician spouse be packing up three kids under the age of five and traveling across the country alone to visit family they may only see once a year? It can be stressful. It …

Physician voices

Holidays in the ER: What you’ll see is a lot of humanity

Edwin Leap, MD

December 8, 2014Dec 8, 2014

People ran to the church for refuge in Medieval times. It was considered a place of safety, a sanctuary from civil punishment. In the church, one could claim a right to justice, food, water and shelter. That role was recognized…

shutterstock_229011745 People ran to the church for refuge in Medieval times. It was considered a place of safety, a sanctuary from civil punishment. In the church, one could claim a right to justice, food, water and shelter. That role was recognized by church and government authorities alike; doubtless sometimes grudgingly as the wanted escaped harsh punishments.

These days, America’s emergency rooms have filled …

Physician voices

The time I almost got fired for saving a young woman’s life

Carolyn Messere, MD

December 8, 2014Dec 8, 201430

I was a fourth-year surgery resident, on the transplant team. It was a difficult rotation, because the doctor who ran it was sexist and got along better with you if you flirted with him. He made innumerable sexual wisecracks in the OR while we were working, and preferred to round with his arm around me as he made further innuendoes.

I wasn’t …

Physician voices

Everyone cries when they bury their dead

Edwin Leap, MD

December 1, 2014Dec 1, 20142

When I was in college and decided I wanted to go to medical school, I kept a picture of a medical transport helicopter on my desk. It represented the excitement I wanted to experience one day. When I was in medical school, I loved nothing better than watching in the chaos of the trauma bay, helping as the blood spurted to …

Physician voices

Even if no life was saved, an ER physician makes a difference

BirdStrike, MD

November 26, 2014Nov 26, 20142

I walk out of the patient room. My eyes stare at the computer screen. I’m behind, way behind. I roll my head on my neck. My neck feels tense, and I have a headache. It’s been a long week. I…

I walk out of the patient room. My eyes stare at the computer screen. I’m behind, way behind. I roll my head on my neck. My neck feels tense, and I have a headache. It’s been a long week. I need a vacation. Hurry up, click-click-click this computer, I think to myself. Dammit, is this EMR really freezing up again?

I look …

Physician voices

When the art of medicine gets lost in the business

Hans Duvefelt, MD

November 25, 2014Nov 25, 2014

Andy was new to me. He told me he had seen several doctors over the past few years for various pains in his right arm. Some months ago, he had right shoulder pain that went away on its own, but…

Andy was new to me. He told me he had seen several doctors over the past few years for various pains in his right arm.

Some months ago, he had right shoulder pain that went away on its own, but for the past few weeks, he had pain in the middle of his upper arm. Last year he had tennis elbow and forearm pain for many months.

A slender, middle aged man, …

Physician voices

(Dis)comfort measures

Jay Baruch, MD

November 23, 2014Nov 23, 20143

Close to midnight and Tonya is somnolent, lying on an emergency department (ED) stretcher and not in her own bed at home. The change in location alters the fairy tale quality of the word somnolent from sleepy or drowsy to one that’s more sinister and worrisome. Especially when Tonya is dying of brain cancer, a single mother of thirty-four, a hospice patient now …

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(Dis)comfort measures

Physician voices

We owe it to our patients to put on our game faces

Starla Fitch, MD

November 19, 2014Nov 19, 20142

When you walk into the emergency room to see a trauma patient, do you remind yourself as you enter the doors, “Keep your game face on?” When you finish a difficult surgery and make your way to the waiting area…

When you walk into the emergency room to see a trauma patient, do you remind yourself as you enter the doors, “Keep your game face on?”

When you finish a difficult surgery and make your way to the waiting area to review the prognosis with the family, do you tell yourself, “Take a deep breath. You can do this?”

When you steel yourself …

Physician voices

Run your emergency department like a restaurant

Patsy McNeil, MD

November 17, 2014Nov 17, 20147

Imagine you walk into a restaurant named Luigi’s. From the décor and the smell of pasta sauce coming from the kitchen, you assume that this restaurant serves Italian food. You walk forward, your name is taken and you are then told to sit off to the side and wait until your name is called so that you can get a table. Time goes by, and no one gives you any …

Health policy

5 ways to ease the integration of NPs and PAs

Tracy Cardin, ACNP

November 10, 2014Nov 10, 201419

I talk a lot with different physicians about integrating NP/PA providers into their practice. I am frequently astonished by the level of reluctance, resistance and downright animosity from these physicians. Many times a doctor will have a medical “horror story” with the NP/PA playing the villain. One bad encounter or event seems to justify a complete rejection of the many positive …

Physician voices

The lessons hospitals and physicians can learn from Ebola

David Klein, MD

October 30, 2014Oct 30, 20148

Among reams of coverage on the Ebola outbreak, Politico just published a characteristic story with the headline, “In the world of Ebola, no room for error.” The only problem is that is as soon as you introduce a human element…

That’s the reality that health care leaders across the United States are grappling with now in a simultaneous effort both to tighten the health …

Physician voices

Ebola presents a new paradigm from the ER

Joshua Elder, MD, MPH

October 26, 2014Oct 26, 20143

Ebola is frightening but not for the reason you may imagine. A little over a year ago Asiana Flight 214 crashed while landing at San Francisco International Airport resulting in 181 injuries and 3 deaths. As an emergency medicine resident,…

Ebola is frightening but not for the reason you may imagine.

A little over a year ago Asiana Flight 214 crashed while landing at San Francisco International Airport resulting in 181 injuries and 3 deaths. As an emergency medicine resident, this fast-forwarded my training as I took care of many of the patients arriving in our emergency department. I left that day inspired that I had the education and training to …

Emergency medicine

Articles, page 54

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