dollahz-prevIt’s been nearly three decades since Congress enacted the landmark Emergency Medical Treatment and Active Labor Act (EMTALA), changing the field of emergency medicine forever. One the byproducts of EMTALA was the “Prudent Layperson Standard (PLP),” which was codified in 1998 in response to a critical payer issue of the day — payment denials for the lack of prior authorization. Under the PLP standard, if the patient reasonably thinks he or she has an emergency medical condition, then the service is covered, even if it turns out to not be an emergency. This system worked for years, but now, thanks to the Affordable Care Act, the idea of what a “prudent” person is likely to do is fundamentally shifting, which brings the PLP standard into question.

lqt-prevA nine-year-old healthy girl at summer camp, running up a hill to chase her friend, collapses and fractures her left arm. She is seen in the local emergency department where she is diagnosed with a supracondylar fracture and dehydration. Three months later her brother is found dead in his bed in the morning.

monurol-previewYou may want to consider this old stand-by now to cover drug-resistant bacteria.

rsz lobster cutout clawComputed Tomography (CT) scan using radiocontrast is one of the most common imaging modalities used in emergency departments today. Several studies and my own anecdotal experiences indicate that both physicians and patients believe that iodine allergies are linked to seafood allergies, and that both are related to a disproportionate increased risk of “allergic” reactions to radiocontrast agents. But is iodine allergy fact or fiction?

rsz 1ep2-preview picEPM reviews the second episode of "The Night Shift," NBC's new drama about emergency medicine and the hospital night crew. Full of preposterous medical situations and soap opera romance, The Night Shift might be a step backwards from "ER," but it'll provide hours of entertainment.


EPM reviews the premiere of "The Night Shift," NBC's new drama about emergency medicine and the hospital night crew. Full of preposterous medical situations and soap opera romance, The Night Shift might be a step back from "ER," but it'll provide hours of entertainment.


rickThe great debate over allowing non-boarded EM physicians into ACEP is a battle that doesn’t make sense anymore. Here’s why ACEP needs to open its doors a little wider.

headache-90Studies have shown that opioid use is increasing across the country. Abuse is rampant, but so is the misapplication and over-prescribing of opioids by well-meaning physicians. We’ve reviewed four recent papers which can help create a strategy for ED management of this ever-increasing – and often demanding – patient population.

intubation-90A 70-year-old male comes to the emergency department via EMS febrile, with worsening respiratory distress and altered mental status. You quickly diagnose him as having severe sepsis stemming from pneumonia, and initiate treatment. After setting up and preoxygenating him, you have first-pass success on your intubation, pat yourself on the back, and admit him to the ICU.

Emergency physicians frequently need to manage severe bleeding associated with vitamin-K antagonists (VKAs, eg. warfarin). Most of us are comfortable with the appropriate dosing of fresh frozen plasma (FFP) and vitamin K, as well as the general bleeding control measures that are needed for the intracerebral hemorrhages (ICHs), gastrointestinal bleeds (GIBs) and other major bleeding events in these anticoagulated patients.

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