A 56-year-old woman is evaluated in the emergency department for sudden onset of a severe generalized headache that began 36 hours ago and has not responded to over-the-counter medications. The patient has a history of hypertension treated with lifestyle modifications. She has a 30-pack-year smoking history.
On physical examination, blood pressure is 148/68 mm Hg, …
There is a persistent narrative about emergency rooms. This narrative says that emergency rooms are overly expensive places to receive healthcare, that they are a cost drain on the hospitals they are attached to, and that they are a key driver of rising healthcare costs.
A RAND study released recently challenges most of that narrative, and lends support to a view that most of us emergency physicians have long held: that …
Injury to the brain continues to be a unique thing in medicine. These injuries are scary and unfamiliar to many health care providers. There is a finality to them. Their consequences are hidden a little bit; the asystole is easy to figure in the emergency room but the suppression and brain death isn’t something so easily recognized.
They’re what you might imagine, along with polytrauma, as poster child conditions for tertiarization …
Most doctors have a story about being called to assist with an in-flight medical emergency. I have yet to earn one for myself, but my favorite story – passed down from resident to resident – goes something like this: An airline attendant called for a veterinarian’s help. When no one answered, they settled for a doctor and an anesthesiology resident stepped up. He learned that a passenger traveling with her …
Sore throats. Heart attacks. Dog bites. Broken bones. Strokes. Major trauma. If you work in an ED, you see it all. And then some.
Is it any wonder then, with the potential for literally thousands of medical and surgical problems to stumble through the doors of an ED, that hospitals and the bodies that accredit them demand strict, regimented, standard, reproducible emergency assessments …
Maligned over the last decade as places to avoid because of the price of the care they delivered, a study by the RAND Corporation goes a long way toward improving the image of hospital emergency rooms (ERs). The ER price tag was too high for the insurance companies that paid the bills, so many of them tried to discourage ER use by designing policies with high coinsurance and copayments …
The stat cardiac-arrest page came through on my beeper at exactly the same moment as the hospital-wide PA system announced, “Code 411, cardiac arrest, MICU.” The operator chanted the mantra over and over with studied deliberativeness, as though there …
Have you ever been to a Genius Bar at an Apple store?
The last time I was there — checking out a pesky problem on my iPhone — I couldn’t help but wonder: why can’t we have something like that to deal with our common health issues?
Genius Bars are located in Apple Stores in easy-to-access shopping areas, like malls. The Genius Bars are …
So you’re in the emergency department, probably in a small, windowless room, dressed in paper (or, if you’re lucky, crazy green cotton cloth) scrubs. You’re lying in a bed with a plastic mattress and scratchy sheets staring across the room at the door that has a small chicken-wire reinforced tempered glass windowlette in it and is ajar just enough to let you see the shiny black shoe of the security …
I attended a medical staff meeting recently. These are required meetings and attendance is taken, as was done when we were in kindergarten. While some folks are interested in these meetings’ content, many are not and simply sign the attendance sheet and then slither out in a stealth fashion. Sly doctors grab their pagers and then leave hurriedly pretending that they were summoned to an urgent medical situation, when they …
I read the New York Times. I read the health section as much as I can to keep track of what the paper is saying about health-related issues. I read Jane Brody. I like Jane Brody. I’m not sure what Ms. Brody is, but I don’t think she’s a clinician.
In her article “Avoiding Emergency Rooms,” she makes some suggestions on how people should get care if they need …
I first picked up an ultrasound transducer 17 months ago, at an emergency medicine ultrasound course at Harvard University. I had just barely heard about using ultrasound as a clinical tool and was vaguely interested. The course was 3 days long and cost a little under $700 and changed my life forever and made me a better doctor.
Off I go to work a few shifts at a desperately understaffed rural hospital in a state far away. The rental car GPS leads me to the ED address and it’s not there. All that is there is what looks like a small supermarket with a funeral home next door. I see a security guard in the parking lot. He has a lump in his cheek and a badge that says “Sam.” …
Right now hospitals around the country are being asked to reckon with some stark realities regarding readmissions. $17 billion a year is spent on readmissions for Medicare patients alone, and 75% of those readmissions are considered to be preventable. Of all Medicare patients who are admitted to a hospital, 18 percent will be readmitted in 30 days and of those, 50 percent will not have seen a primary care physician …
We doctors who specialize in psychiatry have a sacred trust. We are given the opportunity to talk to people who are hurting every day, people who trust that we will listen to them, try to understand them, not laugh at them, and not think that they are stupid, crazy, or horrible. A tall order, granted, given that we hear stories that sometimes border on the unimaginable, bizarre and otherworldly. This …
I almost fell off my chair. It was bad enough that he showed up to the ER. But what happened next really blew my mind. He fell and bruised a rib. The pain in his left chest had obvious enough origins. But triage had put in for an electrocardiogram and the interpretation apparently scared the resident. The attending took a look, and shook his head.
This is a topic that comes up from time to time for often spirited discussion. The most recent example comes in a couple of articles in the New England Journal of Medicine. One was a research paper; the other was a pro and con discussion.
The research paper studied cardiac arrests that happened outside the hospital. The authors tested the premise that allowing families to watch the efforts of …
As I sit on this old wooden pew, I rock side-to-side to ensure that blood flows to each part of my bottom. We’ve been at this rented church for 75 minutes listening to the sounds of my daughter’s violin class recital and now it’s time for the last piece.
A high school student with a large tattoo of a stanza on her left …
A young lady comes to the emergency department and wants to be evaluated for a somewhat non-urgent problem.
Chief complaint: “I’ve lost 50 lbs in the past month.”
She felt a little weak as well, but she had just lost too much weight. No other symptoms.
The patient weighed 132 pounds. Her skin wasn’t sagging. Her jeans didn’t appear to be new and they seemed to fit pretty well. Nothing about her seemed …
