Emergency medicine

2,327 articles · Since 2004

Articles, page 55

Helicopter emergency services: A disparity between aviation and medical proficiency

October 25, 2014Oct 25, 20147

As the helicopter emergency services (HEMS) industry enters its fifth decade, there is an 800-pound gorilla in the room and nobody is talking. The average EMT, fireman and emergency physician too often make the flawed assumption that when it comes to HEMS, the industry is a uniform, high quality, strictly regulated entity. They assume that all HEMS programs use state of …

Physician voices

When treating neo-Nazis, should physicians have a choice?

Alberto Hazan, MD

October 21, 2014Oct 21, 201422

What I found most disturbing about the man’s arm was not the deep, stellate laceration on the underside of his biceps. It was the swastika tattoo next to it. “Sir,” I said, “we’ll have you fixed up in no time.…

shutterstock_113334004 What I found most disturbing about the man’s arm was not the deep, stellate laceration on the underside of his biceps.

It was the swastika tattoo next to it.

“Sir,” I said, “we’ll have you fixed up in no time. I’m going to numb up the wound, irrigate it, then repair the laceration with sutures and send you home on antibiotics and pain …

Physician voices

Quantified health and the great digital divide

Kevin R. Stone, MD

October 21, 2014Oct 21, 2014

Go into any hospital today and notice that between every great nurse and patient sits a computer terminal. The quantified health movement has created the great digital divide, between the patient and everyone else. The nurse of old used to…

The nurse of old used to actually touch the patient. No more. Now, they wheel in a computer console, sit down and record the digital output of the wired up patient, every vital sign, every drug order or …

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Working in an ER in Liberia: A physician shares his story

Antonio Webb, MD

October 20, 2014Oct 20, 2014

In June 2014, the first patient with Ebola arrived at Liberia’s county hospital, Redemption. As tensions grew around the city of Monrovia, administrators at JFK Hospital began to devise plans for handling patients with suspected Ebola. Officials from the CDC then came and gave us lectures. They discussed prevention of spreading and what our plans would be in the event of a potential outbreak. Before that moment, there were no …

Physician voices

Running a code is a team sport

Denitza Blagev, MD

October 18, 2014Oct 18, 2014

“They need you in room 13,″ she said when I answered the phone and I ran back to the ICU. The patient was coding and for each minute that felt like an hour, we tried, and failed, to save her.…

“They need you in room 13,″ she said when I answered the phone and I ran back to the ICU. The patient was coding and for each minute that felt like an hour, we tried, and failed, to save her. She wasn’t breathing, her heart wasn’t working, and despite the 30 people gathered in the room, in the end, she died.

Running a code, as we call it, means that someone is …

Read more…

Running a code is a team sport

Health policy

There is no excuse for physicians to take advantage of vulnerable patients

Bob Doherty

October 18, 2014Oct 18, 201447

Patients are being stuck with huge and unexpected medical care bills in circumstances where they have no say in selecting the physician who is billing them, and no way for them to know in advance which services the physicians would…

Mr. Peter Drier received a “surprise $117,000 medical bill from …

Conditions and diseases

How did a Dallas hospital miss Ebola? Maybe we shouldn’t be surprised.

David Mann, MD

October 17, 2014Oct 17, 20149

The first “wild” Ebola case in the United States has occurred in Dallas, Texas. The patient, who is from Liberia and had contact with a pregnant Ebola victim in his native country, was initially sent away from the emergency department (ED) of a Dallas hospital after reporting there with viral symptoms. He told the triage nurse that he had just arrived …

Conditions and diseases

Ebola in Texas: A fascinating story of system errors

Vamsi Aribindi, MD

October 15, 2014Oct 15, 201474

Ebola is in the United States! Everybody (please don't) panic! Quarantine all Texans! Though that might be a good idea anyway (just kidding). More on Ebola in general in another post if I have time. First off though, we've found…

Ebola is in the United States! Everybody (please don’t) panic! Quarantine all Texans! Though that might be a good idea anyway (just kidding). More on Ebola in general in another post if I have time.

First off though, we’ve found out more information about the sequence of events leading to the hospitalization of the patient, Thomas Duncan. Apparently, he came …

Physician voices

An ER missed Ebola. Here’s how it could happen to you.

Edwin Leap, MD

October 14, 2014Oct 14, 201444

How did the emergency department staff of a Texas hospital see, and discharge, a patient infected with Ebola? Despite the fact that blame spreads through hospitals faster than hemorrhagic fever viruses, I’m not interested in pinning down a single person or a single thing, which may have allowed that to happen. I am very interested, however, in offering a few insights …

Conditions and diseases

Ebola in the ER: What you should and shouldn’t worry about

Darria Long Gillespie, MD, MBA

October 13, 2014Oct 13, 20149

As an ER doctor, right now I'm thinking a lot about Ebola -- it's in the news, in my inbox, and in questions from my patients. Whether it's an outbreak, a flu epidemic, or a bombing -- we in the…

As an ER doctor, right now I’m thinking a lot about Ebola — it’s in the news, in my inbox, and in questions from my patients. Whether it’s an outbreak, a flu epidemic, or a bombing — we in the ER see them first, and so I’m always thinking about how we’ll be ready.

So, what concerns me, and what doesn’t?

Ebola patients in the …

Physician voices

The ER demonstrates the inverted priorities of American society

Edwin Leap, MD

October 11, 2014Oct 11, 201425

We fling open the doors of America’s emergency departments to help those who can’t afford health care. We have legislated this protection: No person can be turned away for financial reasons. This is very compassionate and represents the higher angels of our culture. Alas, it also is emblematic of the stupider demons of government. You see, the ER demonstrates the inverted priorities …

Physician voices

Doctors should be challenged to explain what they are charging and why

Ira Nash, MD

October 9, 2014Oct 9, 201418

About a year ago, I shared details of my own out of pocket medical expenses and concluded that we have to have to be more transparent with our patients (and potential patients) about the costs they will face for our services. The urgency of price transparency as a business imperative and a professional responsibility has only increased since then.

Consider that we are now a year in to the implementation of the …

Conditions and diseases

The Ebola outbreak: Don’t blame the nurse

Sarah Beth Cowherd, RN

October 4, 2014Oct 4, 201436

There is a lot of talk about why the man diagnosed with Ebola at Texas Health Presbyterian Hospital was sent home from the emergency room not having been tested for Ebola despite telling the triage nurse he had been in…

Because they let him go, he came in to contact with up to 20 people including a handful of school aged children. …

Physician voices

Physicians don’t take the time to communicate with their colleagues

Steven Reznick, MD

October 4, 2014Oct 4, 201414

I was finishing tying my shoes as I got dressed to take my lovely wife out to dinner for our 41st wedding anniversary. It was 7:30 p.m. after a hectic day at work and we had a wonderful dinner planned…

The telephone rang with the caller ID identifying a call on my office work line.

“Hello this is the emergency department, please hold on for Dr. S.” …

Physician voices

The thinnest of margins: An ER physician ponders, “What if?”

Gregory Bledsoe, MD

September 30, 2014Sep 30, 2014

It had been crazy busy all night in the emergency department and I had been running from room to room patching holes and trying to get patients seen. I felt behind all night. Finally, I had a moment to collect…

It had been crazy busy all night in the emergency department and I had been running from room to room patching holes and trying to get patients seen.

I felt behind all night. Finally, I had a moment to collect my thoughts and turned my attention to a patient who had been waiting for quite a while.

This patient had multiple large and deep lacerations to his forearm, self-inflicted wounds caused during …

Physician voices

Emergency room doctors can safely use bedside ultrasound

Janice Boughton, MD

September 27, 2014Sep 27, 20145

I have been following the progress of bedside ultrasound (using ultrasound as a diagnostic tool during my physical exam of patients) as it gets a foothold in standard medical practice since I first started learning to do it about 3 years ago. Every so often a study comes out which warms my heart as it proves that less (radiation, expense) is more in treating patients.

An article came out in the …

Physician voices

“I want to give up my son”: Is that child abuse?

Alberto Hazan, MD

September 24, 2014Sep 24, 201421

The case A thirty-five-year-old female presents to the emergency department on a weekend afternoon with the following chief complaint: "I want to give up custody of my son." The patient is well dressed -- and so is her four-year-old son,…

The case

A thirty-five-year-old female presents to the emergency department on a weekend afternoon with the following chief complaint: “I want to give up custody of my son.”

The patient is well dressed — and so is her four-year-old son, who is sitting comfortably on the bed playing a video game on his mother’s cell phone.

According to the patient, she is a single mother with no support system. Her son’s father deserted …

Physician voices

The pressure to admit patients from the ER will only grow

Steven Reznick, MD

September 21, 2014Sep 21, 201413

Once again government regulators have put in place well-meaning rules without anticipating the consequences. We all hate sitting around in the emergency department waiting to be seen and to be treated. On October 15, 2014 as part of the new Affordable Health Care Act and the patient satisfaction portion, hospital ERs will have about 180 minutes from the time you arrive and sign in to evaluate you, treat you and …

Physician voices

Cost-benefit analysis: A case where conservative management wins

Noura M. Dabbouseh, MD

September 20, 2014Sep 20, 2014

We speak of everyday decisions in terms of cost-benefit analyses. Many of our patients can’t afford a healthy meal, let alone a hefty hospital bill, thus making cost awareness increasingly relevant. But on the day that I met Mr. R., it wasn’t the financial aspects of his care that concerned me. I was thinking about the patient, his family, and two roads diverged in a hospital ward. I was thinking …

Conditions and diseases

MKSAP: 72-year-old unconscious woman in the ER

mksap

September 20, 2014Sep 20, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old woman is evaluated in the emergency department for loss of consciousness. Her son, who brought her in, says she seemed confused and…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 72-year-old woman is evaluated in the emergency department for loss of consciousness. Her son, who brought her in, says she seemed confused and agitated when he spoke to her on the telephone less than 2 hours ago. The patient has an 8-year history of type 2 diabetes mellitus. She had strict …

Emergency medicine

Articles, page 55

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