An 84-year old woman presents to your ED with a traumatic, left-sided posterior hip dislocation. You need to reduce the hip, but how should you sedate her? Procedural sedation is an important component of ED care. It allows us to more comfortably perform otherwise painful procedures such as fracture or dislocation reductions, endoscopies, large laceration repairs, and I&Ds. But how safe is procedural sedation in older adults?
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 December edition of Emergency Physicians Monthly. Questions about the test? Talk back on Twitter @epmonthly.
A few months before the Chilean Society of Emergency Medicine (SOCHIMU) sponsored the nation’s first course on emergency department management, emergency medicine – known as Urgencia – was recognized as Chile’s 38th medical specialty by the nation’s Comptroller General.
It’s a sunny Saturday afternoon and you are settling into your second cup of coffee when a young mother comes running into the emergency department clutching her 3-year-old son. She reports “I just took my eyes off of him for a second to answer the door. When I returned, he had a broken necklace on the floor, several small beads lying around him, and was crying.
You are working one evening when EMS brings in a 52-year-old gentleman who achieved return of spontaneous circulation (ROSC) in the field following cardiac arrest. He was walking on his treadmill when he clutched his left shoulder suddenly.
Calcium is a basic element necessary for normal human body functions and is found in all tissues. Calcium gluconate and calcium chloride salt solutions are perhaps most familiar to EPs for the treatment of life-threatening emergencies involving hyperkalemia1.
The size of the bills people receive for emergency care can seem somewhat remote to most of us. It’s easy to resign ourselves to saying, “the patient’s insurance will pay for it,” or “the government will pay for it.” But it is truly hard to witness some of the more egregious cases of price gouging in emergency care and remain detached.
It’s been another busy shift in the ED. You finish discharging one
patient as you are pulling up the x-rays of a 24 year old who rolled his
ankle while playing basketball. You don’t see a fracture and so you go
into the room to tell him the good news that it is only a sprain. As you
finish demonstrating some exercises that he can do to rehabilitate his
ankle, he says, “Hey doc, what you gonna give me for this?”
Studies show that EMS delivers a significant percentage of patients who
will go on to be admitted. Armed with these numbers, we must rethink
diversion, considering its true cost to the hospital.
Q: Does early antibiotic use reduce wound infections in open fractures? read more
Q: Do glucocorticoids prevent return visits, admissions, or need for additional treatment? read more