I’m a believer that if an adult patient presents to the ED with chest pain, unless you are very, very positive the diagnosis is not cardiac, you owe it to the patient to pursue a cardiac work-up. Sounds pretty straight forward to me – but many would disagree.
Are you ready for an acute inflammatory mediator for sepsis that is consistent and works just as we’d expect it to? Well, it’s here: procalcitonin. Or is it? It can certainly claim that it works just as well as former acute phase reactants and inflammatory mediators. But these predecessors all suffer from a similar, critical problem - they are somewhat sensitive but not very specific.
The first 24 hours for a patient with early signs of sepsis are critical. The first hour after this patient arrives in the emergency department is equivalent to the “golden” hour of trauma. The initial evaluation, with particular emphasis on the laboratory findings are vital in the effective management of a septic patient.
“Set phasers to full body scan!” Radar gun technology similar to that used by police to catch speeding cars may someday be used to monitor vital signs in your emergency department.
A Swedish EP on an observership in New York City reflects on the differences in care between the two developed nations.
More than just intubation, a short fiberoptic scope can check for edema, infection, burns, or foreign bodies. And single use and sheathed scopes are bringing the usefulness of this technology back into the ED.
On January 28, 2011, 28-year-old single mom Courtney Capps brought her 5-year-old child to the emergency department at Huguley Medical Center in Burleson, TX for evaluation of paronychia. According to Ms. Capps, the emergency physician asked about the child’s race, and, when told that the child was bi-racial, grunted, then asked, “What does your family think about that?”
Long after the elected legislators have cast their votes, the agency administrators write the rules and regulations that interpret the law and give it meaning. The Accountable Care Act is poised to fundamentally change how we practice emergency medicine, but the scope and impact of those changes will be determined by the rule writers.
Healthcare reform threatens to usher in an era of complexity that could put small contract management groups at a distinct managerial disadvantage.
When a tubed patient is delivered by EMS with good oximetry and
capnographic readings (clear repeating wave forms), plus bilateral
breath sounds over the axillae and easy ventilation through the tube,
thank your EMS personnel for a job well done.