From movies to music to clothing lines, the widespread promotion of the glorified “pimp and Ho” culture has unwittingly created an unacceptable tolerance and ignorance to the reality of the sex slave industry in the United States. Unfortunately, the misperceptions about prostitution are pervasive even among healthcare workers, who are missing valuable opportunities to recognize and offer aid to victims of sex trafficking.

With payment reform at the gate, emergency medicine needs to find ways to promote the more judicious use of advanced imaging tests like CT scans, or other groups will make the rules for us.

In April of this year, the American Board of Internal Medicine Foundation took a baby step in the cause of lowering the high cost of medical care by initiating the Choosing Wisely campaign. The campaign asked physician specialty boards, including ACEP, to identify “five tests or procedures commonly used in their field, whose necessity should be questioned and discussed.”

A campaign called Choosing Wisely has gotten some attention of late because of its stated goal of reducing health care costs by eliminating tests and procedures that are not “necessary.” Since ‘Choosing Wisely’ launched, nine medical specialty organizations have offered up their top five items for the chopping block.

altThirty years ago a surgical airway was considered the ultimate means of rescue ventilation and rescue intubation. Today, it is neither. The LMA, similar devices, and the King LT (or Combitube) have become the default means of rescue ventilation when mask ventilation fails.

altIn the coming years, there will be major changes in the way doctors and hospitals are paid. Namely, several government programs – along with contractual changes between health systems and private insurers – will focus on rewarding value over volume.

altWhen a 3-year-old girl is brought into your remote emergency department after being struck by a car, she has gurgling respirations and is unconscious with a pediatric GCS of 4 (no eye opening, no verbal response, and decerebrate posturing). You need to intubate her, but the smallest endotracheal tube (ETT) you have is size 7.0 mm; she needs a 5.0 mm (ID) or smaller tube. How do you rapidly make an ETT for her?

altIn recognition of the dire need to fix the failed Medicare physician payment formula, the House Ways & Means Committee asked the AMA to provide feedback about alternative payment models.

It has been well demonstrated that administration of tPA is most effective in the treatment of acute ischemic stroke if given within 3 hours of stroke symptom onset. Furthermore, some experts have even reported this as the standard of care for ischemic stroke since the late 1990s [1].

altThe department was packed and I was counting down the seconds until I would board a plane for the Ivory Coast. I snapped back out of my haze to realize that I had 18 patients on the board. It was a pretty good day, all in all, yet somehow after admitting and discharging scores of patients, the board was still overflowing.

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