altA walk down memory lane reminds us that we have yet to see a stroke study of sufficient size to end the tPA debate. And even when we had such data, it was largely ignored. Let’s study our history to avoid repeating mistakes.

altLincoln County Hospital 1982. A mother bursts into the ED waiting room where I happen to be, sees my white coat and hands me a non-breathing infant. The look on her face stuns me and in less than an instant her panic, fears and raw emotions become my own. All the preparation, planning, memorization and practice in the world cannot fully prepare you for that moment.

altAlthough the technology is fascinating, caution must be exercised when applying coronary computed tomography angiography (CCTA) to emergency department chest pain patients. The only way this diagnostic modality will help us, and our patients, is if it guides us with risk stratification, showing a clear path to discharge for patients we currently don’t know what to do with.

altShould antibiotics be used in conjunction with incision and drainage of a simple abscess? Recent studies suggest not, yet they leave room for physician discretion at the bedside.

altThe College’s new policy lacks a comprehensive perspective and too readily discourages the use of opioids. The dearth of valid evidence should lead EPs to a balanced approach on pain, rather than a restrictive one.

altLast month, Dr. Kevin Klauer suggested that emergency physicians “unbundle the sepsis bundle.”
This month, Dr. Emanuel Rivers offers his rebuttal, explaining why EGDT greatly improves sepsis outcomes.

Two years ago I called into question the use of the sepsis bundle of therapies defined by the “Surviving Sepsis” campaign (EPM, March 2010) Although aggressively managing sepsis is a good thing, and the mere focus on the rapid identification and application of appropriate management strategies for sepsis is essential to good patient outcomes, it appears that EGDT and the research it was based on may have promised more than it could deliver.

altDespite popular belief and common practice, due process for EPs is a right, not merely a privilege. Dr. Larry Weiss offers a counterpoint to “Due Process in Due Time,” from EPM’s February issue.

altYou rarely hear of problems with the old standby, TMP-SMZ, but there is a growing body of literature suggesting that physicians need to be wary of the drug’s potentially serious side effects.

A study published in last month’s Archives of Internal Medicine has reignited the patient sat survey debate, correlating high patient satisfaction with several negative indicators, including higher patient death rates.

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