No one can deny the aging of our population in general, and of the emergency department patient load in particular. But there is some disagreement about how EDs should respond – specifically whether it is appropriate to design geriatric emergency departments.

According to the Rand Report, the ED routinely makes the most important decision for hospital survival – whether or not to admit. The next question is what the healthcare system will do with that information.

The numbers don’t lie. The emergency department (ED) is the front door to the hospital for the sickest patients, and those that need inpatient service. The 2012 survey results of the Emergency Department Benchmarking Alliance (EDBA) – which compiled data from about 1,000 EDs comprising over 38 million patients – indicate that over 68% of hospital admissions are processed through the ED.

A 25-year-old woman presents to the emergency department having syncopized in the waiting room, where she was triaged with the chief complaint of abdominal pain. Ectopic pregnancy immediately bubbles to the top of your differential diagnosis.

It is a busy Friday evening in the emergency department when you get called to the resuscitation bay for a 14-year-old female who was the restrained back seat passenger in a rollover motor vehicle crash. After a thorough initial inspection you find that the patient has a large laceration to the lateral side of her left ankle, and swelling that suggests either a fracture or a severe sprain or dislocation.

I believe that every physician, nurse, PA, NP, tech and clerk who works in an ED should periodically have an organ removed. We have lots of organs that will only get us into trouble, so let’s remove them before that happens. Hey, we don’t need that appendix or gall bladder, and the ladies can get rid of that bothersome uterus once they hit the menopause.

When the Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010, the year 2014 seemed a long way off. Now that we are on the down side of 2013, the “big” changes of the ACA are fast approaching. Some are good, some are bad, and some are just plain ugly.

altThis month EPM asked 17,003 emergency physicians how they felt about tPA and stroke.
1,333 physicians (7.8%) responded. Here’s what you told us:

altThe jury is still out among EPs as to whether tPA helps more than it hurts, yet ACEP has forged ahead with clinical guidelines which seem to ignore controversial findings. 

Emergency Physicians Monthly has teamed up with the board prep pros at Rosh Review to bring you a mini board review, so that you can test yourself on a regular basis and track your progress. The following is the test – and answers – from the June edition of Emergency Physicians Monthly. Questions about the test? Talk back on Twitter @epmonthly.

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