Part 1 in a series about the cold, hard numbers behind some of our most common ED practices
This is the third in a series of columns dealing with non-allergic,
potentially serious reactions caused by antibiotics. In the column
dealing with macrolides, the increased risk of sudden death was noted.
Clearly, the absolute numbers of deaths associated with macrolides has
to be small, but it makes sense to take this fact into consideration
when prescribing these antibiotics to those prone to arrhythmias (such
as patients with congestive heart failure).
If you are an emergency physician and you Google yourself, you’ll find a
host of companies offering the world a chance to “rate” you as a
doctor. On a scale of 1 to 5 stars, “How would you rate your overall
experience?” asks eHealthScores. “Does the provider listen to you and
answer your questions?” asks HealthGrades. The internet is replete with
these sites, and now even mega-review sites like Yelp have gotten in the
mix, stacking physician reviews right next to write-ups on bars and
While travelling along the interstate between who-knows-where and
woebegone—a long way from any EMS services—you come across a rollover
accident that has just occurred. For some reason you’re not carrying any
medical equipment. (Why not?) One of the van’s former occupants is in
respiratory distress from a chest injury and needs a chest tube. When
you ask, a trucker who has also stopped says that he has some tubing in
his truck. So, now you need a scalpel.
CASE STUDY: Clearing Athletes for Return to Play
New legislation in Pennsylvania has mandated greater scrutiny of student
athletes who suffer on-field concussions. An interview with Dr. Michael
24 year old male presents with laceration to the right elbow after
rollover MVC. He has stable vital signs and no other injuries. Plain
films reveal no fracture or dislocation and no foreign bodies. He has
full ROM and is neurovascularly intact. Your intern suggests local
infiltration of Lidocaine for analgesia, copious irrigation and primary
Did you know that the macrolide group of antibiotics (erythromycin and
all its cousins) could kill you? Drop dead – sudden death. Well there is
a growing body of literature saying just that.
“I am not sure that any research should be performed in emergency
department settings, and I suspect that many grant review study sections
feel the same way. Patients come to the ED with an acute problem and
they need clinical care, not research protocols and consent forms.”
On March 22, the U.S. House of Representatives passed HR-5 – the
Protecting Access to Healthcare Act – by a vote of 234-173. The Act,
which went strongly down the party line (only 11 democrats voted for the
bill) had broad support from ACEP as well as the AMA and a range of
other medical organizations.
As an emergency medicine (EM) practice management consultant I”m
frequently asked “How can we determine what’s fair to pay for physician
administrative duties?” It’s an emotional subject in every group
because it involves the discussion of each member’s relative value to
the business enterprise side of the practice.