A 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.
This landmark trial suggests that complex, invasive sepsis care brings no statistical mortality benefit while consuming healthcare resources. Here is a quick run-down of the study that is shifting the sepsis conversation.
Traditionally, there is often a large gap in the time between when a therapeutic intervention is proven effective and when it becomes routine clinical practice.
An excellent example: The use of thrombolytic therapy in myocardial infarctions.
The evidence continues to pile up confirming that boarding patients in the ED while they wait for an inpatient bed is bad for patient care and bad for hospital business. So why is boarding still so prevalent, and why are hospitals so reluctant to take action to alleviate this practice?
What’s not to like about FOAM? You certainly can’t beat the price. It’s as ubiquitous and portable as your laptop or phone. And many of the contributors are leaders in our field – not simply knowledgable, but also exceptional communicators.
The editor of this publication asked me to address the question, “Is FOAM an essential tool for medical education?” My first response was, “Are you kidding me? Of COURSE it’s an essential tool, and especially for emergency and critical care practitioners.” We of notoriously short attention spans who endure the blessings and curses of shift work are exactly the people for whom FOAM is essential.
Today, you are the sole EP on duty in a semi-rural, critical access hospital ED. As a matter of fact, you are always the only EP on shift. You were trained in a solid tertiary care EM residency with a level I trauma center, stroke center, and 24/7 cardiac cath lab facilities. You know all the clinical guidelines (all of which have been developed in tertiary care centers by academic faculty physicians) and all the tertiary care tricks of our trade.
A 65-year-old gentleman with hypertension and hyperlipidemia presents to your emergency department one evening complaining of continuous vertigo that began suddenly two hours prior to arrival. He notes significant head motion intolerance, is nauseated, and has vomited several times. On exam, he has horizontal nystagmus in lateral gaze, is very unsteady on his feet, but otherwise has a normal neurologic exam.
It’s a typical busy Saturday night in your ED. The next chart you pick up is a 15-year-old male with cough shortness of breath and chest pain for one day. He is tall, with normal vitals and in no distress, and you note decreased breath sounds on his right side. Chest X-ray confirms it: pneumothorax.