Emergency Medicine

Emergency physicians, nurses, and residents writing on KevinMD from the emergency department: acute care, the realities of the ER, boarding and overcrowding, violence against staff, and medicine practiced under pressure. Most contributors work in emergency departments. For what emergency physicians and nurses have said about being assaulted at work and told it was part of the job, see Violence against health care workers: what physicians and nurses say, in their own words. For what emergency physicians wrote in the first weeks and months of the pandemic, see COVID-19: what physicians wrote as it happened. For what emergency physicians and pain patients have said about opioid prescribing, see Opioids: what physicians and pain patients say, in their own words. For what physicians in the highest-burnout specialty have said about burnout since 2009, see Physician burnout: what physicians say, in their own words.

A trauma surgeon on the pointlessness of gang violence

Bryan Hubbard, MD

Physician

May 3, 2012

Another call night in downtown L.A. It had not been a particularly eventful day: the usual offering of people hit by cars, falling off of things, and victims of man-made violence. Some injuries happen as a result of an accident, some as a result of carelessness, and of course many happen because of an intentional act. At about 1am the trauma pager went off; the text announced a “Level 1 …

When a heart attack is textbook perfect, it can be a beautiful thing

Stewart Segal, MD

Conditions and Diseases

May 1, 2012

Participating in a patient’s first heart attack can be an extremely stressful event. Thirty years ago, I was an ER doc. At the end of a typical shift, I would come home to my wife and, often, would remark about how nervous family docs got when dealing with emergencies like heart attacks.

Thirty years later, I’m the family doc and heart attacks are unnerving. Yes, I know what to do. We …

Every emergency medicine shift teaches something

Marlene Buckler, MD

Physician

April 28, 2012

Tonight a 17 year-old boy came to the emergency room complaining of headache. As I entered his room, in my usual hurry to do an assessment as expeditiously as possible, so as to get on to the next case and attempt to avoid the inevitable backup of patients so common in our ER, I was struck by the vulnerable demeanor of the patient before me. The triage nurse’s report assured …

Death arrives in many different packages

Monica Williams-Murphy, MD

Physician

April 25, 2012

The sage doctor who stood at the bedside as I held my dying grandmother said, “We seem to die one organ at a time.” I, however, have come to believe that we are too focused on the failing of the organs to rightly perceive the dying of the person.

Death comes in many different ways, in many different packages. Sometimes it arrives wrapped thoughtlessly in advanced dementia, other times the package …

5 key trends to look for in the emergency department

Wesley Curry, MD

Health Policy

April 24, 2012

Patients have been arriving at the doors of emergency departments in increasing numbers over the past decade, and this trend will only grow in the future. I believe there are five key factors that suggest every ED should brace itself for a never-ending rush hour.

As the CEO of a physician group that provides medical care to over 4 million patients per year, I have the opportunity to study in great …

The future of medicine for aspiring young doctors

Edwin Leap, MD

Physician

April 11, 2012

March 29, 2012

Calhoun Lecture Series
Strom Thurmond Institute, Clemson University

Thank you for the invitation to speak tonight. I’m very humbled to stand before you. And what a delight to speak to people who are neither bleeding, intoxicated nor asking for Percocet! And in a setting where no one will burst through the back door on a stretcher!

As you know, I’m an emergency physician …

The obviousness of long waiting times in the emergency department

StorytellERdoc, MD

Physician

April 3, 2012

shutterstock_123325801

Emergency, as per the all-knowing Webster, is defined as an unforeseen combination of circumstances or the resulting state that calls for immediate action. Furthermore, an emergency is also defined as an urgent need for assistance or relief.

These definitions sound pretty spot-on, right? When thinking about emergency room settings, even, one can easily correlate the words of Webster to what one would …

Small opportunities to use mobile technology in medicine

Karim Jessa, MD

Health Technology

March 30, 2012

As citizens of the 21st century, we seem to have adapted personal technology for every conceivable use — Siri, the iPhone’s newest darling, can literally remind us to call a proctologist. But as physicians, we may be missing some of the best opportunities to derive “meaningful use” from technology.

I am an emergency physician, and a few nights ago I worked a shift in the ER. It was a typical, …

Doctors and hospitals are cheated during rate negotiations

Myles Riner, MD

Health Policy

March 29, 2012

Have you ever been in a negotiation with a health plan for a network participation contract and had the impression that the plan knew all the rates that you had agreed to in confidential negotiations with other health plans? Allow me to reassure you: you are not being paranoid. It is quite likely that the plan you are negotiating with knows exactly what rates and terms you have agreed to …

MKSAP: 32-year-old man is disoriented, combative, and agitated

mksap

Conditions and Diseases

March 25, 2012

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

A 32-year-old man is brought to the emergency department after becoming disoriented, combative, and agitated earlier that day. He is accompanied by a friend, who states that the patient has a history of alcohol and drug abuse, including inhalants.

On physical examination, the patient is uncooperative and …

How working as a scribe prepared me for medical school

Steven Krager

Medical Education

March 7, 2012

After undergrad, and before starting medical school, I worked for two years as scribe in the emergency department. I followed emergency physicians and completed their charts as they saw patients. I would also remind the physicians of various tasks to complete, alert them of abnormal lab values and pull up x-rays to be interpreted.

One of the reasons I wanted the job was to gain experience in medicine, first as a …

Denying payment for unnecessary emergency room visits

Douglas Perednia, MD

Health Policy

March 5, 2012

Just when American healthcare system seems so dysfunctional that it seems impossible to imagine how it could be screwed up further, a decision is made that restores one’s faith in the creativity of Man. But before you run out of guesses as to which particular decision we’re talking about today, we’ll just blurt it out. We are referring to a recent decision by Washington State Medicaid to deny payment for …

Extubating the overzealously intubated patient

bongi, MD

Physician

March 5, 2012

One of the curses of kalafong (hell) was that there was no neurosurgical service. This meant us mere general surgeons had to handle the many head injuries that came in.

So, for example, when some guy decided to cave in the head of his so-called best friend with a five iron on the golf course because they had started with the nineteenth hole instead of the first, we ended up either …

Why physicians should care about Amanda Trujillo

J. Doe, RN

Patient

February 25, 2012

For the past month, the case of Amanda Trujillo has resonated deeply among nurses, triggering an avalanche of postings on Facebook, Twitter and in the nursing blogosphere. Trujillo is the Arizona nurse who was fired in April 2011 after providing education and making a hospice care consult request for an end-stage liver disease patient. This patient was slotted for pre-transplant evaluation …

Avoid malpractice while treating minor head trauma in children

Maxwell S. Kennerly

Conditions and Diseases

February 10, 2012

In October 2011, the Centers for Disease Control and Prevention reported a 60% increase in “emergency department visits for sports– and recreation–related traumatic brain injuries, including concussions, among children and adolescents” over the past decade. That’s good news: as the CDC’s press release said, they believe the increase was due in part to “growing awareness among parents and coaches, and the public as a whole, about the need for individuals with a suspected …

An American ER doctor in Tasmania

Rick Abbott, MD

Medications

January 23, 2012

Beginning work at Launceston General Hospital in Tasmania, orientation really, I noticed a lot of things missing: places to sign my name.

For any given patient I’d sign: the completed chart note, perhaps a lab (sorry, pathology) and imaging slip, a prescription form (in triplicate – ok, so that was weird), and a GP letter.

I didn’t have to sign (physically or electronically) multiple different “attestations,” I didn’t have to generate multiple …

Read more…

An American ER doctor in Tasmania

Physician, don’t heal thyself

Myles Riner, MD

Physician

January 12, 2012

A couple of months ago, I was dragging a large suitcase that got hung up on a curb, giving my arm and shoulder a good yank. Over the next few days, my shoulder began to ache a bit. Applying the very reasonable ‘tincture of time’ principle, I rested it a bit, hoping that with time the symptoms would resolve. Two months later, I was getting an MRI and anticipating surgery …

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Physician, don’t heal thyself

Physicians must advocate for their patients

Maria Yang, MD

Physician

January 7, 2012

Editor’s note: Please read Dr. Yang’s entire Red Herring series for background prior to reading this post.

***

The patient really is fine.

She returned to the gastroenterology clinic several times for treatments to widen her esophagus. (It’s a neat procedure: The GI doctors insert a small balloon into the esophagus. They gently inflate the balloon to stretch the stricture a few millimeters. With repeated stretching, the esophagus will remain open.) The patient ate more. …

It’s time to look critically at the concept of board certification

Edwin Leap, MD

Physician

January 4, 2012

In 1994 I was thrilled to become certified by the American Board of Emergency Medicine. I had worked very hard. I studied and read, I practiced oral board scenarios and even took an oral board preparatory course. It was, I believed, the pinnacle of my medical education. Indeed, if you counted the ACT, the MCAT, the three part board exams along the way and the in-service exams, it was my …

Emergency Medicine

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