How many times have you evaluated acute, non-traumatic, monoarticular
arthritis while contemplating the risks and benefits of arthrocentesis
to rule-out septic arthritis? What about ruling-in a crystalloid
arthritis like gout?
EP Monthly has highlighted the issue of practice heterogeneity over the
last four years, but the universe of emergency medicine has largerly
resisted efforts to admit and address this problem. Why? Do we not
believe it to be true? Do we assume that it is unavoidable?
“I am not sure that any research should be performed in emergency
department settings, and I suspect that many grant review study sections
feel the same way. Patients come to the ED with an acute problem and
they need clinical care, not research protocols and consent forms.”
In My Opinion
With a wave of new articles published every day, how is an emergency
physician to know how to keep up to date? One EP’s fight against biased
literature reviews, followed by an admittedly-biased endorsement
A helpful application of the Canadian C-Spine Decision Rule, or an onerous malpractice risk?
You recently read a debate on the new American Heart Association
guidelines for CPR on the blog WhiteCoat’s Call Room. Not long after,
your local EMS director asks for your opinion about the evidence
supporting compression-only CPR (COCPR) for witnessed cardiac arrest
victims outside the hospital.
As you polish off the documentation on your last five patients, the
nurse for the closed femur fracture patient asks if you are ready for
the pending reduction. Orthopedic surgery is patiently waiting, and the
nurse has the Propofol that you requested at the bedside.
Extending the window for t-PA (alteplase) thrombolysis in acute ischemic stroke within 4.5 hours of symptom onset is not associated with an increased risk of symptomatic intracranial hemorrhage or death and does improve good outcomes at 90-days.
A 75-year-old female with a history of hypertension and a left-sided stroke 10-years ago presents 2.5 hours after the onset of left arm and leg weakness while playing bridge. After obtaining her head CT, labs, and history you note no contraindications to thrombolytic therapy (Table). Unfortunately, 3.5 hours have now passed since her symptoms began. Her husband, a retired Pediatrician, astutely notes recent professional organizations and newswire reports advocating thrombolysis for acute ischemic stroke at up to 4.5 hours.
A 75-year old male with no reported past medical history is found in his apartment by his grandson with confusion and generalized weakness...
Peer Review with Christopher Carpenter, MD
“When a doctor says, ‘I don’t know,’ it is rarely a sign of weakness or ignorance. More often it’s a sign of a physician who knows and appreciates the limits of our science and is willing to be a partner. It’s an olive branch of commiseration about what is not, and a hopeful readiness for what is.”
-Excerpt from Hippocrates’ Shadow (Scribner, $26)