When 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?
In 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
The 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.
The Detroit News and the Free Press reported that an emergency physician
was stabbed in the neck by a patient at Lansing, MI, Sparrow Hospital
near midnight May 4, 2012. Assaults on healthcare workers are becoming
all too common.
You’re having a rough shift: The ED is out of metoclopramide and
prochlorperazine, so you worry that you’ve been turning migraineurs into
drug-seekers by treating them with promethazine and hydromorphone. You
know that sodium bicarbonate is running low, so you hope that you don’t
see a bad tricyclic overdose any time soon.
The Society for Academic Emergency Medicine’s Annual Meeting was held
May 9-12, 2012 in Chicago, Illinois. The Research Forum featured 746
Abstracts, and 37 Innovations in Emergency Medicine education
presentations. We selected the 10 we thought had the most potential to
impact the practice of emergency physicians.
Part 1 in a series about the cold, hard numbers behind some of our most common ED practices
This is the third in a series of columns dealing with non-allergic,
potentially serious reactions caused by antibiotics. In the column
dealing with macrolides, the increased risk of sudden death was noted.
Clearly, the absolute numbers of deaths associated with macrolides has
to be small, but it makes sense to take this fact into consideration
when prescribing these antibiotics to those prone to arrhythmias (such
as patients with congestive heart failure).
If you are an emergency physician and you Google yourself, you’ll find a
host of companies offering the world a chance to “rate” you as a
doctor. On a scale of 1 to 5 stars, “How would you rate your overall
experience?” asks eHealthScores. “Does the provider listen to you and
answer your questions?” asks HealthGrades. The internet is replete with
these sites, and now even mega-review sites like Yelp have gotten in the
mix, stacking physician reviews right next to write-ups on bars and