Is there a definitive standard? 

 

Renal transplant patients can be very complicated to manage because of hte underlying pathology necessitating the transplant, unique post-operative problems, and because of the vast array of immunosuppressants that they must take.  Because of this, and in order to effectively communicate with their transplant surgeon, the EP must have an understanding of likely post-operative complications, such as infections that the patient is likely at risk of acquiring.  He needs awareness of how common complaints such as abdominal pain and headache may warrant a more significant evaluation in these patients.  Also, the EP will need to be aware of the complex drug interactions between the many immunosuppressants that are prescribed.

From hypothermia to dermatology, a preview of some of ACEP’s finest offerings during the ‘07 Scientific Assembly.

 

 

The emergency physician is faced with the challenging task of making many clinical decisions very rapidly during a shift.  In order to do this properly and without endangering patients, the emergency physician (EP) must not only have a solid base of medical knowledge but also a repertoire of decision-making skills in order to make good decisions while preventing mental fatigue.  These decisions can include aspects of patient care pertaining to triage, diagnostic testing, disposition, cost effectiveness, and patient satisfaction.  By better understanding how decisions are made, the EP can become more efficient and more effectively teach others how to make better decisions.

 

by Jose Vega

 

You’re leaving the room of a patient with uncomplicated cellulitis.  You’re just about to order blood cultures when you realize all the nurses are busy.

 

At that moment an email from your department chair concerning cutting costs and improved efficiency begins to resonate in your head.  If you order the cultures, it’s going to tie up a room for half an hour until someone can draw them.  So do you really need them?  Will they change your management?

 

by Evan Schwarz

 

It’s a normal night in the department and you’ve just left the room of a patient that appears to have cellulitis.  You are about to write your normal prescription for keflex and your mind wanders back to the three abscesses that you drained earlier in the shift.  You were sure that those abscesses were caused by MRSA and wonder if this cellulitis could also be the result of MRSA.  However as you don’t know the prevalence of MRSA in soft tissue infections, you do not know if you should consider changing your practice concerning antibiotic usage in soft tissue infections.

 

It’s been a long night and you grab the last chart in the rack. You walk in the room and find a 20 your old laying on the gurney. On exam he is tender in the right lower quadrant so you give him a small amount of pain medicine and order your labs. An hour later you come back to re-examine him and he's not as tender as before and wants to leave. His white count is normal and he's never had a fever. You wonder, Do I really need to get the CT to rule out appendicitis or can I just let him go, finish my paper work, and sign out to replacement?

 

Here we are, day one of Emergency Physicians Monthly's web log project. It was only a matter of time, really; this is the perfect medium for the kind of free dialogue that has always been our mission. EPM is published by a small, single-title publishing house and our editorial is built around your feedback. We are the little guy, the independent mom-and-pop corner store, but we've got big ideas. And with your help, we believe that we can bring more accountability, and eventually some positive change, to emergency medicine.

Citation:
Ultrasonography-Guided Peripheral Intravenous Access Versus Traditional Approaches in Patients With Difficult Intravenous Access.  Costantino, TG, Parikh, AK, Satz, WA, Fojtik, JP.  Annals of Emergency Medicine 2005; 46:
456-461

 

Review by Chet Schrader, MD

Edited by Evan Schwarz, MD