In April of this year, the American Board of Internal Medicine Foundation took a baby step in the cause of lowering the high cost of medical care by initiating the Choosing Wisely campaign. The campaign asked physician specialty boards, including ACEP, to identify “five tests or procedures commonly used in their field, whose necessity should be questioned and discussed.”

A campaign called Choosing Wisely has gotten some attention of late because of its stated goal of reducing health care costs by eliminating tests and procedures that are not “necessary.” Since ‘Choosing Wisely’ launched, nine medical specialty organizations have offered up their top five items for the chopping block.

altThirty years ago a surgical airway was considered the ultimate means of rescue ventilation and rescue intubation. Today, it is neither. The LMA, similar devices, and the King LT (or Combitube) have become the default means of rescue ventilation when mask ventilation fails.

altIn the coming years, there will be major changes in the way doctors and hospitals are paid. Namely, several government programs – along with contractual changes between health systems and private insurers – will focus on rewarding value over volume.

altWhen a 3-year-old girl is brought into your remote emergency department after being struck by a car, she has gurgling respirations and is unconscious with a pediatric GCS of 4 (no eye opening, no verbal response, and decerebrate posturing). You need to intubate her, but the smallest endotracheal tube (ETT) you have is size 7.0 mm; she needs a 5.0 mm (ID) or smaller tube. How do you rapidly make an ETT for her?

altIn recognition of the dire need to fix the failed Medicare physician payment formula, the House Ways & Means Committee asked the AMA to provide feedback about alternative payment models.

It has been well demonstrated that administration of tPA is most effective in the treatment of acute ischemic stroke if given within 3 hours of stroke symptom onset. Furthermore, some experts have even reported this as the standard of care for ischemic stroke since the late 1990s [1].

altThe department was packed and I was counting down the seconds until I would board a plane for the Ivory Coast. I snapped back out of my haze to realize that I had 18 patients on the board. It was a pretty good day, all in all, yet somehow after admitting and discharging scores of patients, the board was still overflowing.

The Detroit News and the Free Press reported that an emergency physician was stabbed in the neck by a patient at Lansing, MI, Sparrow Hospital near midnight May 4, 2012. Assaults on healthcare workers are becoming all too common.

You’re having a rough shift: The ED is out of metoclopramide and prochlorperazine, so you worry that you’ve been turning migraineurs into drug-seekers by treating them with promethazine and hydromorphone. You know that sodium bicarbonate is running low, so you hope that you don’t see a bad tricyclic overdose any time soon.

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