altThe debate surrounding the use of etomidate in sepsis has been going on since the 1980s and continues to plague contemporary literature. Those muddy waters were recently stirred when a meta-analysis in Critical Care Medicine concluded higher rates of adrenal insufficiency and increased mortality associated with its use1. This is not the first meta-analysis to have made such a claim2. We could spend our time debating the statistical merits of a meta-analysis, but we’d be missing the forest for the trees.

altThose concerned about the use of etomidate in septic patients seem to focus on two primary issues. First, that etomidate results in adrenocortical suppression. Second, that suppression is associated with increased mortality.

altA 49-year-old clinically intoxicated male patient presented to the emergency department (ED) after suffering an assault. Upon initial presentation, he was noted to have a complex upper lip laceration and significant jaw pain suspicious for mandible fracture.  During the course of his evaluation, the patient suddenly leapt from the bed and assaulted a medic.

Emergency physicians (EPs) often presume that critically ill patients presenting to the emergency department (ED) are in need of life-sustaining interventions. At the end of life (EOL), many patients are caught between the need for our expertise and assistance and the desire to avoid invasive procedures.

If your EHR system is a lemon, you’re not alone. Get involved in the process of developing the data and literature necessary to push this industry in the right direction.

altIn the second of two installments, emergency medicine elder statesmen Ricardo Martinez and Lynn Massingale continue their discussion on the changing role of hospitals and the future of Accountable Care Organizations.

If that coughing and wheezing febrile premee is a boy he is at greater risk for a bad outcome due to his prenatal testosterone causing a delay in his lung maturity. If the patient with afib is a woman, she is at higher risk to stroke out and her stroke is more likely to be hemorrhagic. In addition, she is at a greater risk for developing both a prolonged Qtc from certain anti-arrhythmics, and for digoxin toxicity plus she will require smaller amounts of warfarin to become therapeutic.

altEP Monthly has highlighted the issue of practice heterogeneity over the last four years, but the universe of emergency medicine has largerly resisted efforts to admit and address this problem. Why? Do we not believe it to be true? Do we assume that it is unavoidable?

altAs the director of a single-coverage community ED with about 22,000 visits a year and about 20% admissions, I’ve been fortunate to be left alone by the administration. The nursing director and I – along with a team of scribes, advance practice clinicians and staff, have largely been free to do whatever we could to improve throughput in the ED.

Emergency Physicians Monthly has teamed up with the board prep pros at Rosh Review to bring you a mini board review, so that you can test yourself on a regular basis and track your progress. The following is the test – and answers – from the March edition of Emergency Physicians Monthly. Questions about the test? Talk back on Twitter @epmonthly.

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