There are few things more satisfying in emergency medicine than
employing your technical skill to quickly alleviate a patient’s pain. And
there are few things more annoying in modern practice than reading a
lit review that relies on animal studies and histology slides to warn
you about potential downsides to your skillful, pain-relieving ways. Yet here we are.
New York City’s Mayor Michael Bloomberg stepped into emergency
department operations in January with an administrative order
restricting the use of pain killers in the city’s emergency departments.
While various hospitals are reported to be voluntarily complying (the
order lacks legal authority over the 50 hospitals in the city) Bloomberg
is on a collision course with a recent ruling from CMS that suggests
that those hospitals are in violation of EMTALA.
With the baseball and softball seasons well underway, you are likely to
encounter children with arm pain in the emergency department. Injuries
to the elbow and shoulder in the pediatric throwing athlete are
relatively prevalent and result from a variety of factors, including
skeletal immaturity, poor mechanics, and overuse.
The April 2013 Boston Marathon bombings brought the sobering reality of
domestic terrorism back to the United States. Yet amidst the carnage and
chaos that followed the explosions emerged a superb response by the
Boston EMS system and the emergency medicine community.
The routine use of contrast (both oral and IV, and certainly rectal) is
unnecessary for the majority of abdominal CT scans performed in the ED.
At least that is what the literature says over and over.
Merely utter the term “patient satisfaction” among most emergency
physicians and you’ll quickly see us retreat into a world of skepticism
and exasperation. The term has become symbolic of a never-ending battle
over flawed data and an inaccurate evaluation of our performance.
In room six sat a typical 78-year-old nursing home patient with the
history of a cough and low grade fever. She was pleasantly confused but
followed instructions; grey and wrinkled but otherwise she looked better
than most. Her vitals were normal. We found no fever at the time of
triage and she had received no antipyretics.
I occasionally enjoy intellectual jousting, especially with other airway
enthusiasts, and its fun to prognosticate about the future of our
practice. So let me give you my controversial take on the future of
airway management. As I see it, the future of oxygenation in emergency
airways is through the nose, not the mouth.
Are Tasers a safe alternative to lethal force, or are they dangerous weapons associated with dysrhythmia and sudden cardiac death? Everything you need to know to treat the taser victim in the ED.
Burning belly pain awakens Marcus at 2 AM. Having it multiple times
before, he’s tired of waking up and having to walk until it goes away.
‘No more,’ he declares, ‘I’m going to the ER to get some relief.’