Emergency medicine

2,327 articles · Since 2004

Articles, page 74

How our resuscitation efforts would be interpreted by fate

September 17, 2011Sep 17, 20112

I walked up to the closed door and paused, exhaling a deep breath weighted with disappointment, trying to clear my thoughts for the conversation about to come. My clenched fist was briefly suspended, mid-air, ready to knock. Beyond the door,…

A calm, pretty woman stood beside me. An emergency department case manager. She held a notebook and pen, ready to jot down any useful …

Patient voices

Using the emergency room for routine physicals

Stewart Segal, MD

September 15, 2011Sep 15, 20115

One of my patients thanked me for saving his life. Apparently, many years ago I had told him that most men’s first complete physical is in the emergency room in the midst of their heart attack or stroke. I have been in practice long enough to have forgotten many of the things I have told patients. I try to capture the pearls I have learned over the last 30 …

Patient voices

Talk to your patients before sending them home from the ED

Charles A. Pilcher, MD

August 26, 2011Aug 26, 2011

So you’re not having a heart attack like your wife thought. That’s the good news. But what is wrong, what did cause that pain, and what should you do from here on out? That’s the purpose of discharge instructions, and…

So you’re not having a heart attack like your wife thought. That’s the good news. But what is wrong, what did cause that pain, and what should you do from here on out?

That’s the purpose of discharge instructions, and it’s not enough for the ED staff to just print out some forms, say “sign here,” and send you on your way.

What constitutes good discharge instructions, and why are they critical …

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Patient voices

An ER specifically built for older patients

Brian Goldman, MD

August 24, 2011Aug 24, 20112

Seniors spend a lot of time at hospital ER's. Now, a small but growing number of hospitals in the US have built ER's especially for the aging patient - with wider hallways, motion detectors, hearing and visual aids. To me,…

Seniors spend a lot of time at hospital ER’s. Now, a small but growing number of hospitals in the US have built ER’s especially for the aging patient – with wider hallways, motion detectors, hearing and visual aids. To me, this is long overdue.

Older patients are avid consumers of emergency medical services. Older people make up a significant percentage of the total population of ER patients. A 2008 …

Physician voices

Experiencing the professionalism of nurses and medical residents

Ryan Madanick, MD

August 4, 2011Aug 4, 20112

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…

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 …

Conditions and diseases

How telemedicine helped a stroke patient

Matthew Gibson, MD

July 28, 2011Jul 28, 20112

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…

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 …

Patient voices

The inevitability of AIDS and the presence of addiction

The American Doctor, MD

July 25, 2011Jul 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 …

Health policy

Cost containment strategies for emergency care

Myles Riner, MD

July 6, 2011Jul 6, 20114

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…

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 …

Physician voices

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

Sid Schwab, MD

June 30, 2011Jun 30, 201115

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…

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 …

Physician voices

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

StorytellERdoc, MD

June 25, 2011Jun 25, 20115

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…

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 …

Physician voices

What to say if you suspect child abuse in the ER

ER Stories, MD

June 19, 2011Jun 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…

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 …

Conditions and diseases

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

John Schumann, MD

June 15, 2011Jun 15, 20112

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…

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 …

Drugs and prescribing

Medication reconciliation brings the ER back to 1960

Chris Rangel, MD

June 14, 2011Jun 14, 201110

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…

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 …

Health policy

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

Donald Tex Bryant

June 5, 2011Jun 5, 20112

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.…

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

…

Physician voices

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

Ralph Gordon, MD

June 1, 2011Jun 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. …

Physician voices

What happened inside the hospital during the Joplin, MO tornado

Kevin J. Kikta, DO

May 31, 2011May 31, 201128

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: waking up, eating, going to the gym, showering, and going to my…

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: …

Physician voices

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

Shantanu Nundy, MD

May 31, 2011May 31, 20114

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…

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 …

Physician voices

How PAs and NPs impact emergency room care

a medical resident, MD

May 28, 2011May 28, 201119

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…

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 …

Physician voices

Emergency medicine, we can do better

angienadia, MD

May 18, 2011May 18, 201115

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…

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

Physician voices

Mental health and the shortage of psychiatric help in the ER

Edwin Leap, MD

May 12, 2011May 12, 20114

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…

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

Emergency medicine

Articles, page 74

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