The trend of voluminous, exhaustive discharge instructions puts
the pressure on patients to understand and identify complex risk
factors, like infection. According to the research, this is probably a
bad idea.
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One of the trickiest diagnoses in emergency medicine is pulmonary
embolism. The problem is not a lack of information; the amount of
literature on this topic is truly staggering. The problem with making
the PE diagnosis is that ordering the definitive test, a CT pulmonary
angiogram, is a big deal.
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It gets a little tiring, and certainly frustrating, to be on the receiving end of recurring mandates from “the experts” regarding the care provide by physicians and nurses. It seems that CMS and its watch dog, the Joint Commission (JC), relish adding more and more requirements onto healthcare staff because, obviously, we just don’t seem to understand the importance of initiating these behaviors on our own.
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WARNING: If you are a radiologist, married to a radiologist, related to a radiologist, or even remotely like radiologists, you will be offended by this article. Be forewarned.
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I think that I have made my view of electronic health records very clear
to anyone who’s cared to listen. I think they are great for monitoring
the movement of patients in larger EDs (electronic tracking boards). I
have concerns that CPOE (computerized provider order entry) through the
use of order sets has the potential to result in over-ordering (and will
result in higher bills, unnecessary tests and less thought by
providers).
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In a follow-up to January’s analysis of COCPR, Rick Bukata, MD, reviews a new round of
abstracts and answers the question: Is compression-only CPR data too good to be true?
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With every indicator pointing towards a looming physician shortage and
increased medical demand, there’s really only one thing for emergency
physicians to do . . .
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By this time in the year, everyone has likely seen quite a bit of bronchiolitis. We’ve have tried suctioning, nebulizers, maybe even steroids, and the baby is still grunting and working hard to breathe. What next besides routine humidified oxygen or intubation? Is there any bridge therapy to prevent the intubation? Non-invasive ventilatory strategies like continuous positive airway pressure (CPAP) have been employed in the treatment of bronchiolitis, and they have been shown to be useful at preventing intubations and improving ventilation. However, CPAP may be technically difficult to use and is sometimes poorly tolerated by small children and infants. What about high flow nasal cannulae oxygen therapy (HFNC)? There is little data with its use in bronchiolitis, but one recently published study addresses this very question.
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Is the radiology department changing its mind after your patient is discharged?
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Until we start educating patients about what really affects their health and what a doctor is capable of fixing, we will continue to waste a large portion of our healthcare dollar on treatments which just don’t make any difference.
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