For the third time this week Ms. A, a 49 year old with a history of
alcohol dependence and untreated bipolar disorder presents to your
emergency department (ED) for suicidal ideations. Of course it is Friday
night, or rather, Saturday morning, your department is over capacity
and Ms. A is being uncooperative with both the triage nurse and the
security staff attempting to maintain order.
Decompression Sickness (DCS) is a condition caused by the change in
absorbed gas volume upon depressurization that releases gas bubbles into
tissue and vasculature (1). This process can occur in divers who
quickly arise from depth or who perform repetitive dives. The most
common presentation of DCS in shallow dives is referred to as DCS Type 1
and is characterized by localized deep joint pain.
An entitlement culture is one which says, “you owe me” because of who I
am or what status group I belong to. While some have argued that such a
mentality has been on display in the Occupy Wall Street movement – young
people believing that they are “owed” a job because a small percentage
of the population earns a lot of money – they are certainly not alone.
Why should we care about benchmarks? They are a way to be proactive in
evaluating and improving your practice before you get criticized, fired,
or have your compensation reduced.
Rolling in like a Trojan horse, CMS is proclaiming that its new ramped
up benchmarking efforts are primarily motivated by efforts to improve
quality. In reality, they are really focused on cost-reduction.
As part of EPM’s commitment to encouraging emergency physicians to
become more effective advocates for our patients and our specialty,
we’ll be running a series of interviews with the emergency physicians
who will be candidates for congressional office in 2012.
Senator John Barrasso was “Doctor” Barrasso, an orthopedic surgeon from
Casper, Wyoming, long before he came to Washington. So, after the
passage of broadsweeping healthcare reform, it came very naturally for
him to offer a physician’s perspective on the floor of the Senate. Since
then, he’s given these “second opinions” about the unintended
consequences of healthcare reform nearly every week.
MedGadget.com presents the top 10 smartphone applications that can save a
patient’s life … before they get to the emergency department.
A physician recently emailed me with a question (paraphrasing): “Our lab
recently switched over to using the new highly sensitive troponins’ and
we’re confused. What do we do with a positive troponin?”
Next November, when Americans enter the polling booths, there
will be five emergency physicians who are either seeking re-election or
running for a seat in the US House of Representatives.