HINTS-90A 65-year-old gentleman with hypertension and hyperlipidemia presents to your emergency department one evening complaining of continuous vertigo that began suddenly two hours prior to arrival. He notes significant head motion intolerance, is nauseated, and has vomited several times. On exam, he has horizontal nystagmus in lateral gaze, is very unsteady on his feet, but otherwise has a normal neurologic exam.

pig-tail-90It’s a typical busy Saturday night in your ED. The next chart you pick up is a 15-year-old male with cough shortness of breath and chest pain for one day. He is tall, with normal vitals and in no distress, and you note decreased breath sounds on his right side. Chest X-ray confirms it: pneumothorax.

The results are in. According to the Fast-Mag study, IV magnesium given for stroke patients in the field doesn’t do anything therapeutically. That’s what was reported at the recently completed meeting of the American Stroke Association.

sunset-90An elderly woman arrives from a nursing home with acute respiratory distress and altered mental status. She is febrile, hypoxic and hypotensive. She has moderate retractions, increased secretions and significantly diminished lung sounds. She has a signed current DNR/DNI.

cardiac-90Each year, approximately 300,000 people suffer out-of-hospital cardiac arrest (OHCA) in the United States.1 About one-third of these will have return of spontaneous circulation (ROSC), either en route to the hospital or in the emergency department (ED). Unfortunately, more than two-thirds of those with ROSC will not leave the hospital alive.

Droperidol has been used successfully in the emergency department (ED) and operating room (OR) for over 40 years. It has been employed with success for the treatment of headache, nausea, agitation, pain in opiate-tolerance and even the dreaded multidrug-resistant abdominal pain (MDRAP).1,2 Unfortunately, in 2001 the FDA issued a black box warning indicating there was a significant risk of cardiac arrhythmias with droperidol.

In an attempt to mitigate the high costs of medical malpractice insurance, decrease the number of multimillion dollar jury verdicts, and encourage physicians to provide medical care, some states have enacted laws to limit the liability of medical providers in medical malpractice cases. Capping noneconomic damages in medical malpractice cases is but one of the better-known methods that many states have utilized, but there are many others.

david-newmanIn November the American Heart Association released its shiny new guidelines for the management of cholesterol, and in the process set off a firestorm. Talk shows talked, pundits opined, and cardiologists postured. But in the center of it all there is an evidence base that offers a clear-eyed view. Do statins for healthy people save lives?

poll-90In February of 2013, the American College of Emergency Physicians published a Clinical Policy statement regarding the use of tissue plasminogen activator (tPA, Alteplase®, Genentech) for the treatment of acute ischemic stroke. 

psych-90Emergency physicians in our group ask that question daily with a combination of hope and fear. We’re not referring to one of our on-call psychiatric colleagues, rather to which one of us has the responsibility to spend roughly two hours or more during and after our shifts caring for the 10 to 20 behavioral health holding patients in one of our EDs. It’s not uncommon for the “Psych Doc” to average 10 interruptions per hour regarding Psych ED patients.

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