Mr. B presented to the ED acutely septic, likely secondary to an
underlying pneumonia. He had advanced dementia and was functionally and
cognitively declining at home. His recent life had been punctuated by
trips back and forth to the hospital
In the name of high quality, cost-conscious care, ACEP has revised its
stance on the Choosing Wisely campaign, voting to join the initiative in
the fight against low value care.
Emergency medicine education is an evolving art. As educators and
learners, emergency physicians are quick to integrate new technologies
into our educational armamentarium. It’s now the norm to glean pearls
from podcasters while running on the treadmill, keep up with EM
conference lectures via tweets, and use a variety of handheld apps to
improve bedside care.
Drug shortages are an all-too-common problem in the United States.
Emergency physicians are more aware of the severity of the issue than
most, as we use such a wide variety of medications. While the causes of
drug shortages are multi-faceted, there is one contributing factor
that’s been flying under the radar: “pay for delay.”
A recent Time Magazine cover article is the latest in a series of eye-opening reports about runaway hospital charges. Here we break down some of the critical numbers to know.
Last month marked the end of India’s Kumbh Mela, a Hindu festival billed
as the world’s largest human gathering. Over the course of the 55-day
festival, as many as 100 million ascetics and pilgrims traveled by
train, car and foot to perform a bathing ritual in the Ganges river in
the city of Allahabad. Some came for a single dip while others settled
for weeks, inhabiting a temporary tent camp that is arguably the largest
pop-up mega city ever erected.
In writing about medical errors, health policy researcher Robert Wears,
MD, breaks down a common problem in how we view mistakes in general. We
often choose to view the error or mistake a person makes as a linear
process and assign blame to that individual, but it’s rarely that
simple. A medical error (or any mistake for that matter) is usually the
result of a confluence of many different occurrences. The error or
mistake is not the cause, but the result.
The elegantly (and deliciously) simple Mediterranean diet is among the
most life-saving post-MI interventions. Look beyond statins and bring on
the olive oil!
The debate surrounding the use of etomidate in sepsis has been going on
since the 1980s and continues to plague contemporary literature. Those
muddy waters were recently stirred when a meta-analysis in Critical Care
Medicine concluded higher rates of adrenal insufficiency and increased
mortality associated with its use1. This is not the first meta-analysis
to have made such a claim2. We could spend our time debating the
statistical merits of a meta-analysis, but we’d be missing the forest
for the trees.
Those concerned about the use of etomidate in septic patients seem to
focus on two primary issues. First, that etomidate results in
adrenocortical suppression. Second, that suppression is associated with