In a recent issue of SMART EM we went under the evidence sea and into the depths of pediatric orthopedics, where there is a question trainees (and parents) with overdeveloped common sense have been asking for a half century: why do we immobilize bones that are clinically and radiographically normal?

Lack of medical staff in public emergency departments is in many ways a global phenomenon, so why should Hong Kong’s public emergency departments be singled out for special attention? Anyone who circuits the globe from country to conference and back will hear many similar stories of a critical shortage of emergency trainees and physicians.

It’s a familiar story: after getting selected and working through thousands of hours of lectures, training, and evaluations, I was told I was ready. Yet after all that, when I heard the first code of my career, my mind went blank, my heart took off, anxiety took over and I was left scared and overwhelmed.

A 56 year old Russian speaking male (limited English capability) presents to the emergency department via EMS with the chief complaint of generalized abdominal pain. In triage he is noted to be rubbing his stomach and touching his lower back. He indicates that this has been bothering him for the past two hours. He is noted to be verbal in triage but appears confused and is moaning in discomfort.

No one can deny the aging of our population in general, and of the emergency department patient load in particular. But there is some disagreement about how EDs should respond – specifically whether it is appropriate to design geriatric emergency departments.

According to the Rand Report, the ED routinely makes the most important decision for hospital survival – whether or not to admit. The next question is what the healthcare system will do with that information.

The numbers don’t lie. The emergency department (ED) is the front door to the hospital for the sickest patients, and those that need inpatient service. The 2012 survey results of the Emergency Department Benchmarking Alliance (EDBA) – which compiled data from about 1,000 EDs comprising over 38 million patients – indicate that over 68% of hospital admissions are processed through the ED.

A 25-year-old woman presents to the emergency department having syncopized in the waiting room, where she was triaged with the chief complaint of abdominal pain. Ectopic pregnancy immediately bubbles to the top of your differential diagnosis.

It is a busy Friday evening in the emergency department when you get called to the resuscitation bay for a 14-year-old female who was the restrained back seat passenger in a rollover motor vehicle crash. After a thorough initial inspection you find that the patient has a large laceration to the lateral side of her left ankle, and swelling that suggests either a fracture or a severe sprain or dislocation.

I believe that every physician, nurse, PA, NP, tech and clerk who works in an ED should periodically have an organ removed. We have lots of organs that will only get us into trouble, so let’s remove them before that happens. Hey, we don’t need that appendix or gall bladder, and the ladies can get rid of that bothersome uterus once they hit the menopause.

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