A 76-year-old man was diagnosed with appendicitis and placed on levofloxacin, 300 mg/day for two weeks, post-operatively. At seven days, he developed bilateral Achilles’ tendon pain. At day 14, the tendons began to swell, and four days later they both spontaneously ruptured while putting his pants on.

Mid-level providers, such as physician assistants and nurse practitioners, are gaining popularity – and authority – in the emergency department. To explore the issue of using mid-level providers to extend the reach of emergency physicians, we brought together four experts to take part in a dialogue, moderated by EPM executive editor Mark Plaster. Read the full transcript of the roundtable here.

Aging ED patients can be likened to the life cycle of a banana. When you buy a bunch of bananas they are green and hard and if you drop them, nothing happens. As time goes on, they become more yellow and if you drop one of these, you might get some bruising on the skin, but once you open the peal the inside of the banana is intact. As time goes on the banana starts to accumulate brown spots very similar to aging spots. When one of these gets dropped on the floor, the amount of damage is impressive.

Everyone seems to be talking about this new idea called Accountable Care Organizations. However, the best way to look at these may be as a recycled product.

Several years ago, during the last Joint Commission survey of our hospital lab, we got dinged because we failed to routinely do a strep culture whenever a “quickie” strep screening test was negative. And we weren’t alone; I’ve heard from a colleague whose hospital got their wrist slapped for the same thing.

The Society for Academic Emergency Medicine’s Annual Meeting was held June 1-5, 2011 in Boston, Massachusetts. The Research Forum featured 655 Abstracts, and 24 Innovations in Emergency Medicine education presentations. We selected the 10 we thought had the most potential to impact the practice of emergency physicians.

I recently consulted at a Virginia hospital that is planning on opening an Emergency Department Observation Unit (EDOU) in 2012. While on site, I was asked an interesting question by the hospital CEO. “What do you think will be the role of Observation Units within the structure of an Accountable Care Organization (ACO) and how can we design our future unit to meet that challenge?”

The successes and failures of physician in triage regarding waiting room hours, length of stay and consults. 

When contemplating the potential complications of a sore throat, it’s time to consider more than the usual suspects. Lemierrie’s syndrome might not be the zebra you thought it was.

Kevin Kikta, an EP on duty during the Joplin tornado, recalls the first harrowing moments, and Michael Lohmeier, an EP from St. Louis, recounts the first hours of Missouri DMAT’s recovery effort.