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New: Push Me(ds), Pull Me: Emergency Medicine News

Figure: sedation, best practices, single blanket Figure I’m unabashedly proud of how good EPs are at multitasking and task switching (we fight a lot about how we can get out of a code and into the next room without a break), but I never feel this more intensely than when doing a sedation procedure on […]

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Post-It Pearls: Phenobarbital for alcohol withdrawal symptoms… : Emergency Medicine News

Post-it beads Phenobarbital for alcohol withdrawal symptoms Lin, Michelle MD doi: 10.1097/01.EEM.0000824164.73418.8a Metric Figure: alcohol withdrawal, phenobarbital, best practices Figure Does your patient have more than a mild case of alcohol withdrawal symptoms? Consider giving IV phenobarbital as a first-line agent instead of a benzodiazepine. The initial dose is usually 130 to 260 […]

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Goddess of emergencies: bailing out the COVID-19 tidal wave : Emergency Medicine News

Figure: COVID-19, pandemic outbreak Figure It’s Christmas Day. I sent my fiancé Matt to work with Bojangles fried chicken and chocolate cake, but our brief afternoon phone conversation made it clear that none of his ER workers will have time to eat it. “Sandy, people are coming in carloads. I just had a family of […]

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Diversity matters: How to address health disparities… : Emergency medicine news

Figure: COVID-19, equity in emerging markets, health disparities Figure We have seen an unprecedented increase in demand for emergency services throughout the pandemic. Many emergency departments receive patients who otherwise (pre-pandemic) would never have entered the medical system. This interaction between constants (staff, space, resources) and variables (volume of patients, patient acuity, seasonality) changes daily. […]

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Quick Reference: Symptoms: Syncope and Chest Pressure : Emergency Medicine News

Figure: syncope, chest tightness, Takotsubo cardiomyopathy Figure Figure A 70-year-old woman with a history of hypertension, hyperlipidemia and gastric adenocarcinoma in remission presented to the emergency room with near-syncope and chest pain immediately after learning of the death of a family member due to COVID-19. Chest pain was described as nonradiating retrosternal, pressure-like, nonpositional, […]

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Clinical controversies: Hydralazine is broken (no need to f… : Emergency medicine news

Figure: hydralazine, hypertension, best practices Figure So much variability exists when it comes to managing hypertension in the hospital. (J Clin Hypertens. 2010;12[9]:698; https://bit.ly/3o3B64N.) Hydralazine, a potent vasodilator, is used throughout the United States as an intravenous drug to lower blood pressure, and it is often used off-label for hypertensive emergencies, although it has little […]

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News: Program brings vaccine to where patients are : Emergency Medicine News

Figure: COVID-19 vaccine, social ME Figure We treat a large number of people with issues related to homelessness, chronic non-communicable diseases, psychological crisis and substance abuse at St. Vincent’s Hospital Melbourne, a large tertiary public teaching hospital in central -city of Melbourne, Australia. Our most frequent emergency patients are disproportionately affected by these primarily social […]

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News : Starting a Ketamine Clinic: Another Option for PEs : Emergency Medicine News

ketamine infusion, EM activity: Dr. Ko opens his ketamine clinic. I’ve worked as an ER doctor for a decade, but I jumped into the side gig world four years ago by starting a ketamine infusion clinic in Palm Springs, California. The seed was planted years ago when I first came across an article about […]

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The Speed ​​of Sound: PTA: Ultrasound for Victory : Emergency Medicine News

intra-oral ultrasound, peritonsillar abscess, diagnosis: Peritonsillar abscess as visualized by intraoral ultrasound. Figure A 25-year-old man presented with worsening sore throat and fever. His voice sounded like he had just taken a bite of a hot potato. His posterior pharynx reveals erythema and swelling on the left, with deviation of the uvula to the right. […]

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ER Goddess: My Stupid Heart Belongs to Medicine : Emergency Medicine News

Figure: EP life, first person, narrative medicine Figure I’ve been writing this column since 2015. I’ve poured out my frustrations and revelations related to our crazy specialty in an article every month for over six years. This month, as I sit down to write my 75th article for REM, I’m having a little trouble finding […]

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POV: Overworked nurses need relief : Emergency Medicine News

Figure: nursing, EM workforce, nurse-patient ratio Nurses are the primary patient-facing members of most healthcare organizations and often the first point of contact for many people seeking medical care. They initiate screening exams, draw blood, administer medications, provide education and counseling, and are often the customer service side of any facility. My hospital once ran […]

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What’s Below: An Ode To Droperidol: Emergency Medicine News

Figure: droperidol, sedation Figure Few drugs blackmail me like droperidol. It is a superb and unmatched tool in our pharmaceutical hangar. It’s a sophisticated instrument, a targeted dart, a brilliant medicine to take control of a patient with agitated delirium. The sedation of very excited and dangerous patients is always heavy. As a procedure, it […]

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News: EP blocked when insurer goes bankrupt: Emergency Medicine News

Figure: malpractice insurance, bankruptcy Connecticut emergency physician Eric Salk, MD, MPH, received a distressing notification in March 2021. The Emergency Physicians Insurance Exchange Risk Retention Group (EPIX RRG) had been placed in rehab in Vermont where he was domiciled. (https://epixrrg.com.) The 60-year-old emergency physician, who served as medical director and president of his emergency department […]

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Stand up AFFIRM: Cardiff model translates injury into prevention: Emergency Medicine News

Figure: injury, violence prevention, cardiff model Figure We have all had cases. A 19-year-old alcoholic man presents with a severe laceration to his face and scalp following an assault involving broken glass. The triage nurse asks the usual questions: When did this happen? What was the weapon used? How old are you? Tetanic status? Etc. […]

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Quick consultation: Symptoms: Confusion and urinary retention: Emergency medicine news

Figure: urinary retention, diagnosis, AUS Figure Figure Figure A 53-year-old man presented to the emergency department with major complaints of progressive weakness and confusion. He had a medical history of prostate cancer and a radiation prostatectomy complicated by post-prostatectomy incontinence that resulted in the insertion of an artificial urethral sphincter (AUUS). The patient had to […]

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Brandt’s Rants: Doctor: Be careful what you document …: Emergency Medicine News

Figure: communication, dictation, humor in EM Figure Communication is essential in the emergency department, not only when speaking to our colleagues and patients, but also in writing. Our documentation should clearly show what we have done and what our thought process has been. The notes must convey our reasoning and our reason for being. We’ve […]

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Life in Emergistan: 24-hour shifts: an unexpected joy: Emergency Medicine News

Figure: 24-hour EM positions, alternates Figure I worked for 20 years with eight and 12 hour shifts, day, evening and night. It was a normal life in our specialty. But I started as a locum about eight years ago and discovered the unique wonders of the 24-hour shift in the Critical Access Hospital along the […]

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News: Is emergency medicine ready to unionize? : Emergency medicine news

Figure: unionization, EM workforce, EM law Steeped in corporate profits, liable to be fired without due process, lacking transparency in billing, and beset by rising working hours and falling wages, emergency physicians are increasingly wondering whether unions and collective bargaining could be promising for them. They would like to, at the very least, wrest control […]

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First person: Debrief and breathe, cry and feel : Emergency Medicine News

Figure: well-being, gratitude Figure 1842. This number is etched forever in my memory. It was the announced time of death for the 6-month-old baby who died of cardiorespiratory arrest for no apparent reason. He was lying there with my perfectly placed tube still hanging from his mouth. Her father’s head pressed against hers, screams […]

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Quick Reference: Symptoms: Fever and Sore Throat: Emergency Medicine News

Figure: fever, sore throat, drug-induced agranulocytosis, pharyngitis, Lemierre syndrome, thyroid storm Figure Figure A 29-year-old woman with hyperthyroidism presented with a fever and sore throat she had had for three days. She had developed difficulty in swallowing and breathing, bilateral ear pain, palpitations and pain on deep inspiration but no abdominal pain, nausea, vomiting, diarrhea, […]

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Toxicology Rounds: Ivermectin is not the crisis it claims… : Emergency Medicine News

Figure: ivermectin, COVID-19 Figure Yesou are not a horse. You are not a cow. Seriously, y’all. Stop that. —Tweet from @US_FDA, August 21, 2021 I can’t remember a time when the US Food and Drug Administration had to resort to the faux-folksy mode of expression to try to get their point across. We live in […]

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What Lies Beneath: The Complex Web of Emergency Department Overcrowding : Emergency Medicine News

Figure: Emergency room overcrowding, health care A poster (pictured) perches on my living room wall, showing its staggering complexity to anyone passing by. I don’t know why it takes pride of place on my wall when a stylish print would surely do better, but I like to remember the almost hallucinatory sophistication and connectedness of […]

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Viewpoint: The Rise and Fall of Emergency Medicine : Emergency Medicine News

Figure: EM history, ED management, EM jobs Doctors had few useful treatments centuries ago. They could do a few things, but most importantly they understood the path of illness, predicted the outcome of a problem, and summoned friendly spirits, such as leeches, and sometimes a herbal remedy to help those in pain. A doctor couldn’t […]

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News : CONS: HINTS exam not ready for prime time : Emergency Medicine News

Figure: TIPS, vertigo Figure The HINTS exam, first reported in 2009, has been touted as a tool that can help us identify patients with central vertigo without the need for advanced imaging. (Stroke. 2009;40[11]:3504; https://bit.ly/3jGxQc2.) The results of this study seemed promising at first glance, but closer examination revealed concerns about the applicability of this […]

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Emergentology: Depersonalization, Emotional Exhaustion, Burning…: Emergency medicine news

Figure: EP life, mental health, well-being Figure About 20 minutes into my shift, I struggled to find a place to sit and place orders. Or even stand up and place orders. The emergency room was crowded. The hospital upstairs was completely full. PE colleagues stayed after their shifts ended, recording and summarizing, disconnecting and arranging […]

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Life in Emergistan: They just need help : Emergency Medicine News

Figure: mental health, life EP, EMTALA Figure Angry, loud and profane, the young woman was brought in by the police in handcuffs and chains. She had been out of control (as she so often was) and was causing destruction at home. She had made a passing reference to self-harm in the throes of her […]

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POV: Give me regular procedure, not bottled water : Emergency Medicine News

Figure: contract management, ACEP I first heard of the American College of Emergency Physicians as an emergency medicine resident nearly 30 years ago. The organization has been and still is extremely helpful in establishing emergency medicine as a specialty, providing policies and guidelines to improve and standardize the way it is practiced. I also enjoyed […]

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Viewpoint: CAPE must approve resolutions to break CMG strategy… : Emergency Medicine News

ACEP 2021, contract management: A slide from a presentation by Aisha T. Terry MD, MPH, at the ACEP Reimbursement & Coding 2021 Conference, January 2021. Figure Figure The Board of the American College of Emergency Physicians must act quickly and decisively at the 2021 Scientific Assembly by adopting, in their entirety, resolutions 29 and 44. […]

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Emergentology: Goodbye for now : Emergency Medicine News

Figure: EP life, COVID-19, burnout Figure I’m eight days late writing this column. I don’t have much to say at the moment. (Strike that out. I have a lot to say, ask my colleagues.) But none of this is more productive. I’ve been writing this column for 10 years, if you can believe it. […]

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News: Hip-hop inspires kids to spot strokes : Emergency Medicine News

stroke, health literacy, social justice: The cover of a Hip Hop Public Health comic teaching children how to recognize and respond to strokes in their elders. Hip Hop Stroke seems like an incongruous name for an organization teaching young people about a serious subject like stroke. But that’s only until you realize he’s using music […]