Abdominal pain is one of the most frequent complaints that present to
the emergency department. With every physical examination of the abdomen
we note if there is pain in the right lower quadrant (RLQ) over that
most famous of landmarks, McBurney’s point.
At the ACEP Scientific Assembly this year, I spoke to a group of
physician assistants and advanced practice nurses. I gained many
insights into the uniqueness of their role and their place in Emergency
Medicine. The first thing I learned was that terminology is evolving as
their training and scope of practice is evolving.
In 2010, Rep. Joe Heck became the first emergency physician (and first
osteopathic physician) elected to the US Congress. In addition to his
emergency physician skills, Rep. Heck brought to Washington a unique
skill set developed through years of military and specialized medical
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.