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.
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.