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 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.

 

You’ve just seen a patient who attempted to overdose on Tylenol. His exam is normal and you think he’ll be alright. However, you would like to admit for the suicide attempt. Of course you just filled the last bed in the psych unit two hours earlier and will now have to find an accepting facility to transfer the patient. You wonder: What are the chances that this patient will actually go on to commit suicide? Are there any ways to risk stratify these patients?

 

 

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?

 

 

Review by Brian Weisenberg, MD

Edited by Evan Schwarz, MD

Citation:
Director TD, Linden JA. Domestic violence: an approach to identification and intervention. Emerg Med Clin N AM 2004; 22: 1117-1132.

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

Citation:
Fricchione G.  Generalized Anxiety Disorder.  New England Journal of Medicine 2004; 351 (7):  675-682.

 

Review by Evan Schwarz, MD