"The bottom line is the person came for care. The degree that you put judgement into that is the degree to which you are not keeping up with the intent of what medicine really is." -Greg Henry, MD
A 43-year-old male presents after a mechanical fall down five stairs
with a fall on outstretched hand injury to his left wrist. There is an
obvious deformity. No other injuries were identified on
complete physical exam and the patient’s neurovascular exam is intact.
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.
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
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.
Thirty 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.
In 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.
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.