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.

Experiencing the professionalism of nurses and medical residents

Ryan Madanick, MD

Physician

August 4, 2011

Today I became a patient. If you follow me on Twitter, then by now you know what happened. Yes, I am embarrassed by what happened, but I’ll relinquish my HIPAA right to privacy for this moment.

This afternoon I swam nose-first into the sidewall in the pool. (I haven’t been swimming in awhile and I forgot to bring goggles, so I wasn’t really looking. Laugh all you want …) It …

How telemedicine helped a stroke patient

Matthew Gibson, MD

Conditions and Diseases

July 28, 2011

My attending doctor (a neurologist) and I were sitting at the nurses’ station discussing a patient who had presented with a seizure when his pager beeped.

“Hold on, I have to call this in”, he said. I listened to snippets of the conversation. “How long has he been like that?” “How far away is the helicopter?” “Alright, let me run to my office and set up my equipment.”

He hung up …

The inevitability of AIDS and the presence of addiction

The American Doctor, MD

Patient

July 25, 2011

Jackson’s blood pressure was low, and this had the emergency room physician scrambling, barking orders. A nurse was busy at each arm, attempting to place large-bore IV’s so that fluids could be given rapidly and thus improve the low blood pressure. Other nurses were preparing strong antibiotics for immediate administration. An automated blood pressure cuff was attached to the left arm, inflating every 3-4 minutes with a characteristic grinding …

Cost containment strategies for emergency care

Myles Riner, MD

Health Policy

July 6, 2011

It strikes me that in developing payment reform related, compensation driven cost-containment strategies aimed at constraining the cost of emergency care, policy makers, emergency physicians, and health insurers should adhere to certain principles.

The American College of Emergency Physicians should be at the forefront when it comes to establishing these principles, which I hope will be focused on protecting our patients first, and our specialty second.

The concept and practice of …

When you close an abdomen after a failed rescue, the OR is silent

Sid Schwab, MD

Physician

June 30, 2011

I didn’t know her name until it was over, much too late.

What I knew was she was thirteen and that on this winter day someone in her family had been pulling her behind their car, on a sled. No doubt laughing and looking in the rear-view mirror, the person driving had whipsawed around a corner, and the young girl — probably screaming (fear? delight?) — held onto the sled as …

How a day in the emergency department is a microcosm of real life

StorytellERdoc, MD

Physician

June 25, 2011

I imagine the world as a vast, boundless frontier weathered by our swirling human emotions and complicated energies–hurricanes of intense heartbreak and tornadoes of joyous, unbridled celebrations, with every weather pattern in between. Sunshine and rain included.

If I could gather this world, foolishly believing that I could sweep my arms and hands through the unsuspecting air to collect a smaller, more-contained version of reality, I know with absolute sureness that …

What to say if you suspect child abuse in the ER

ER Stories, MD

Physician

June 19, 2011

I don’t know anyone that works in health care that does not dread suspected child abuse.

On all levels it is horrible. Horrible that someone would do such a thing to a child, horrible for the logistical nightmares it can cause in treating the patient, horrible going though the whole mandated reporting process. It just sucks. Now, if it is obvious and you are totally sure it’s going on, you …

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

John Schumann, MD

Conditions and Diseases

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 …

Medication reconciliation brings the ER back to 1960

Chris Rangel, MD

Medications

June 14, 2011

What a blessing and a curse it must have been to practice medicine fifty years ago.

Most internists had only about twenty or so medications that they used regularly. It was a curse not to have effective medications to treat many common ailments but somewhat of a blessing not to have the modern medical nightmare of having patients on 15-20 chronic medications with all the logistical problems of keeping track of …

Helping acute care patients find the right care in the correct setting

Donald Tex Bryant

Health Policy

June 5, 2011

The number of patients with acute care problems visiting the emergency rooms is steadily climbing.

According to the article Hospitals Work to Reduce ER Wait Times posted on the ASQ website the rate is increasing at a 3% annual rate. This leads to several problems, including longer waiting time. An analysis of the growth reveals several trends in the demographics …

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

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 transection 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: …

In medicine, the greatest save is not having to make a save at all

Shantanu Nundy, MD

Physician

May 31, 2011

In the real world of medicine, “great saves” are rare. Most patients that you expect to die will die, and those who experience a cardiac arrest or code rarely survive. Mr. GR is the closest I’ve seen to an exception to both of these rules, and his story illustrates the best but also the worst of what our health care system achieves.

I first met Mr. GR in the emergency room. As …

How PAs and NPs impact emergency room care

a medical resident, MD

Physician

May 28, 2011

A recent survey in the American Journal of Bioethics, indicates that 80 percent of patients expect to see a physician when they come to the emergency department.

Parents were more insistent about their child see a physician or resident for even a minor condition such as a sprained ankle.

Patients indicated a preference for seeing a resident alone for non-urgent conditions (60%) and compared to a physician …

Emergency medicine, we can do better

angienadia, MD

Physician

May 18, 2011

When someone gets sick, what are their options?

They can try to make an urgent appointment that day, but how many of your doctors actually offer that? Most people will have to wait for weeks, if not months, for a regular appointment. Even if you go to a walk-in clinic, the wait will likely be hours, and you’re not sure if clinics can take care of everything, so you head to …

Read more…

Emergency medicine, we can do better

Mental health and the shortage of psychiatric help in the ER

Edwin Leap, MD

Physician

May 12, 2011

Every day, mental health clinics, emergency departments, psychiatric hospitals, physicians’ offices, counselors’ offices, school counselors and police officers are faced with an almost impossible responsibility. It is a responsibility, a burden, often highlighted retrospectively, after a tragedy. Their job is this: identify every dangerous person, treat them properly and avoid horrific events like the recent murders in Tuscon.

I sympathize greatly, since I work in the emergency department of a hospital …

Excited about the future of healthcare in the emergency department

Kevin

Health Policy

May 10, 2011

by William Schumacher, MD

Am I the only one excited about the future of healthcare?

With all the prevailing pessimism about America’s “dysfunctional” health” system, optimists (and I am one) sometimes feel stranded on our own lonely islands.

It’s not that we don’t know what the challenges are. I have been practicing emergency medicine for over 30 years, and there …

Our personal commitment and social engagement as physicians

Kevin

Physician

May 9, 2011

by Synphen H. Wu, PhD

Mr. C is a 46-year-old Chinese immigrant restaurant worker who came to Bellevue Hospital after two weeks of fatigue, malaise, right upper quadrant (RUQ) abdominal pain, and progressive jaundice.

He was referred from a Chinatown clinic, where his blood tests showed hepatitis B surface antigen, a hepatitis B viral load of 133 million copies, and elevated liver transaminases and bilirubin levels, …

Why patient satisfaction scores won’t decrease health care costs

Edwin Leap, MD

Physician

May 4, 2011

So now, in addition to the many other bits of medical meddling we have from CMS (Centers for Medicare and Medicaid Services), there’s this.

Reimbursements to hospitals, from Medicare, will be partly tied to patient satisfaction scores. We’ve seen payments already being tied to ‘quality indicators,’ as dictated by the federal government; rewards for doing a better job on care for heart attacks, pneumonia, etc. At least that’s quantifiable, whether scientifically …

How the ACO model can be successful

Kevin

Health Policy

May 1, 2011

by Justin Chang, MD

I think we can all agree — physician, payer, provider, patient, etc. — that the ultimate goal of regulations and reform should be to improve the delivery of healthcare, lowering costs and ultimately, making patients healthier and more satisfied.

Coupled with driving toward the results defined by CMS, this requires some fairly significant changes …

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How the ACO model can be successful