In a recent issue of EM:RAP, Dr Michael Weinstock and colleagues review missed diagnoses, referencing a study by Kachalia et. al. They reviewed 122 closed malpractice claims from 4 liability insurers in which patients had an alleged missed or delayed diagnosis in the ED. A total of 79 claims (65%) involved ED diagnoses that harmed patients; 48% of these were associated with serious harm and 39% resulted in death.
When evaluating children with CSF pleocytosis, bacterial meningitis is the greatest concern, although most children end up having aseptic meningitis. Therefore, these children are routinely admitted and treated with broad spectrum antibiotics while awaiting final culture results.
Dr. Al Sacchetti weighs in on the issue of etomidate in sepsis and reviews his recent debate with Dr. Ron Walls in the July issue of annals of emergency medicine. Here’s a highlight. A single dose of etomidate will eliminate the adrenal gland’s response to ACTH by inhibition of 11-ß-hydroxylase leading to a depressed cortisol response.
You hear the report from the medics at a scene of a male child, “between the ages of 8 and 14, involved in a rollover MVC, child was unrestrained, initially A&O x 3 but now becoming progressively more lethargic, not intubated, coming in 5 minutes”. Now after you change your shorts, you remember your trusty Broselow tape. But as you shake the dust off of the tape, you also remember something one of your pediatric colleagues said about the Broselow tape not being accurate anymore. 
Aortic dissection is a difficult diagnosis to make and has been dubbed the “Great Masquerader” due to the myriad of possible presentations including stroke, MI, abdominal pain, and lower extremity problems. D-dimer may be useful as a screening test for dissection because of reported sensitivities of >99% and negative predictive values >99% across multiple studies.
A digest of Mel Herbert’s monthly audio CME series
edited by Chris Feier, MD
A digest of Mel Herbert's monthly audio CME series
edited by Chris Feier, MD
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A digest of Dr. Herbert’s monthly audio CME series
edited by Chris Feier, MD
A digest of Dr. Herbert’s monthly audio CME series
edited by Chris Feier, MD
A digest of Dr. Herbert’s monthly audio CME series
edited by Chris Feier, MD

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