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
A 49-year-old clinically intoxicated male patient presented to the
emergency department (ED) after suffering an assault. Upon initial
presentation, he was noted to have a complex upper lip laceration and
significant jaw pain suspicious for mandible fracture. During the
course of his evaluation, the patient suddenly leapt from the bed and
assaulted a medic.
Emergency physicians (EPs) often presume that critically ill patients
presenting to the emergency department (ED) are in need of
life-sustaining interventions. At the end of life (EOL), many patients
are caught between the need for our expertise and assistance and the
desire to avoid invasive procedures.
If your EHR system is a lemon, you’re not alone. Get involved in the process of developing the data and literature necessary to push this industry in the right direction.
In the second of two installments, emergency medicine elder statesmen Ricardo Martinez and Lynn Massingale continue their discussion on the changing role of hospitals and the future of Accountable Care Organizations.
If that coughing and wheezing febrile premee is a boy he is at greater risk for a bad outcome due to his prenatal testosterone causing a delay in his lung maturity. If the patient with afib is a woman, she is at higher risk to stroke out and her stroke is more likely to be hemorrhagic. In addition, she is at a greater risk for developing both a prolonged Qtc from certain anti-arrhythmics, and for digoxin toxicity plus she will require smaller amounts of warfarin to become therapeutic.
EP Monthly has highlighted the issue of practice heterogeneity over the
last four years, but the universe of emergency medicine has largerly
resisted efforts to admit and address this problem. Why? Do we not
believe it to be true? Do we assume that it is unavoidable?
As the director of a single-coverage community ED with about 22,000
visits a year and about 20% admissions, I’ve been fortunate to be left
alone by the administration. The nursing director and I – along with a
team of scribes, advance practice clinicians and staff, have largely
been free to do whatever we could to improve throughput in the ED.
Emergency Physicians Monthly has teamed up with the board prep pros at Rosh Review to bring you a mini board review, so that you can test yourself on a regular basis and track your progress. The following is the test – and answers – from the March edition of Emergency Physicians Monthly. Questions about the test? Talk back on Twitter @epmonthly.