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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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Clinical Pearl: Withdrawal of buprenorphine-precipitated opioids… : Emergency Medicine News

Figure: buprenorphine, opioid withdrawal, substance use disorder BY EMEDHOME.COM Buprenorphine-precipitated opioid withdrawal is seen in physically opioid-dependent patients who have recently taken full agonist opioids and are subsequently receiving buprenorphine. (J Addict Med. 2021 Nov 16. doi:10.1097/ADM.0000000000000929.) Withdrawal intensity can range from mild to life-threatening. (J Addict Med. 2021 Nov 16. doi:10.1097/ADM.0000000000000929; Cardiovascular toxicol. […]

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News: AAEM sues Envision for practice of medicine in business : Emergency Medicine News

Figure: AAEM, Envision, company medicine When Placentia-Linda Hospital, a Tenet-owned facility in Placentia, California, awarded a contract to manage and staff its emergency department to Glass Beach Medical Services, a company controlled by Envision Physician Services , Placentia Linda Emergency Physicians (PLEP) and the American Academy of Emergency Medicine Physicians Group, Inc., (AAEM-PG), which provided […]

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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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POV: Titanic sinks without nurses : Emergency Medicine News

Figure: nursing, understaffed, EM workforce The shortage of nurses in the emergency department has been a beleaguered issue for years in which the staffing grid has never quite matched the help in the field due to calls, mentorship, management or of a handful of other shell game explanations that makes an ED feel fully staffed […]

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Viewpoint: Government can do better with COVID-19 : Emergency Medicine News

Figure: public health policy, COVID-19, government I often ruminate on the first patient I lost to COVID-19. What was different about her, besides being young and pregnant, was that she was my first. We knew so little in the spring of 2020 and we had so few tools to fight the virus. These losses sometimes […]

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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 Pearl: Diagnosing pediatric appendicitis at the first… : Emergency Medicine News

Figure: pediatrics, appendicitis, diagnosis BY EMEDHOME.COM A recent study identified characteristics of pediatric patients with acute appendicitis missed in the emergency department. (JAMA Netw Open. 2021;4[8]:e2122248; https://bit.ly/3s5SNDH.) The case-control study analyzed nine years of data from five centers to identify 748 children who had two ER visits in a seven-day period with the diagnosis […]

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Diversity matters: Exposing the blind spots of equity with ethnic identity… : Emergency Medicine News

Figure: Social MI, health equity, ethnic identifiers, DEI, diversity Figure A concrete step towards health equity is the active and accurate collection of ethnic identifiers. This has been a controversial subject for years. One school of thought believes ethnicity information has no place in medical records, while another suggests added value. A health equity stance […]

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How about this? : EM overdoses on aspirin : Emergency Medicine News

Figure: aspirin, chest pain, best practices Figure Aspirin for chest pain is here forever, but should it be? The Centers for Medicare & Medicaid Services withdrew its aspirin rule on arrival last year. The federal government no longer sees the point of monitoring compliance or financially rewarding good compliance. A CMS spokesperson confirmed this to […]

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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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Scientific conferences on toxicology: Toxicology articles to read for 20… : Emergency medicine news

Figure: toxicology, Digibind, digoxin, Cannabis Figure These three articles are not necessarily the best medical toxicology articles of 2021, but they are particularly interesting. Clinical experience with anti-digoxin antibody dose titration in acute digoxin poisoning (ATOM-6) Chan BS, et al. Clin Toxicol (Phila) 2021; August 23: 1 I argued in […]

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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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The essential articles on acute care medicine of 2021

As 2021 began, there seemed to be light at the end of the long, dark COVID-19 pandemic. A vaccine was introduced, the “curve” had been flattened, and by spring businesses were slowly starting to open. While the medical literature of 2020 seemed to be almost entirely focused on COVID-19, medical writers, researchers, and educators seemed […]

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Diversity Matters: Simulation Cases Exploring Racial Equity… : Emergency Medicine News

Figure: simulation, racial equity, social MI Figure Simulation has become an educational reference in emergency medicine. The beauty of this is that EPs benefit from the full Danger Room experience, an unbridled opportunity to practice critical skill sets in a low-impact environment. EPs can gain confidence through repetition and bouts of constructive feedback for everything […]

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Post-It Pearls: Observing Patients With Biphasic Anaphylaxis: Emergency Medicine News

Figure: biphasic anaphylaxis, epinephrine Figure How long do you observe emergency department patients with anaphylaxis for a recurrent episode (biphasic anaphylaxis)? This phenomenon occurs in about five percent of patients and can occur at any time during the first 72 hours. The answer is not clear, but experts generally agree on the higher risk predictors […]

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Diversity Matters: A Simulation Case Exploring Racial Equity …: Emergency Medicine News

Figure: simulation, racial equity, social EM Figure Simulation has become an educational gold standard in emergency medicine. The beauty of it is that EPs get the full Danger Room experience, an unbridled opportunity to rehearse critical skill sets in a low impact environment. PEs can gain confidence through repetition and episodes of constructive commentary for […]

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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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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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News: Emergency physicians, not just social workers, can …: Emergency medicine news

Figure: homelessness, health equity Figure The disproportionate use of emergency services by homeless people is no secret. (BMC Health Service. 2021; 21[1]: 428; https://bit.ly/3EXx4k8.) Overuse not only strains the healthcare system, it is also a major source of burnout for PE. (Ann Emerg Med. 2019; 74[5S]: S19; https://bit.ly/3bYrxgB.) Homelessness sometimes manifests itself as treatable medical […]

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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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Letter to the editor: The slippery slope of buprenorphine : Emergency Medicine News

Editor: I am board certified in emergency medicine and addiction medicine and medical director of the Recovery Centers of America in South Amboy, NJ, a hospital facility where we perform detox reductions with buprenorphine. (REM. 2021;43[10]:6; https://bit.ly/3ipxkjb.) Giving patients buprenorphine in the emergency room is much more complex than comparing opioid addiction to asthma. It’s […]

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News: Food as Medicine: Nutrition Prescriptions in the ED : Emergency Medicine News

Figure: lifestyle medicine, nutrition, diet Figure Adding the principles of lifestyle medicine to a busy emergency department is daunting. I always find it difficult to decide when to talk about it and who will be interested in listening. I finally learned to use the same approach that I take with my patients with substance use […]

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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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Diversity matters: Social determinants of health are in EPs… : Emergency Medicine News

Figure: social determinants of health, social justice, equality in SE Figure The role of an emergency physician has evolved significantly over the past 30 years, partly due to patient demand, but also to changing patient needs. Our day-to-day responsibilities as outward-looking suppliers have also become more sophisticated. We interact with diverse patients and family members […]

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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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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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ER Goddess: The Trauma Emperor Has No Clothes : Emergency Medicine News

Figure: trauma centers, for-profit hospitals, reimbursement Figure It’s 6:45 a.m. You click frantically to complete a patient’s discharge paperwork while you wait for the hospitalist to call you back so you can admit another. You’ve been too busy to check if your other four patients’ scans and labs are back. There’s no way you’ll be […]

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Stand up AFFIRM: Enough already! Ending Workplace Violence: Emergency Medicine News

EP safety, workplace violence, emergency management: Chris Coyne, MD, who consented to the publication of this photo, was assaulted by a patient. Figure Every act of violence against an emergency health care provider is a sentinel event, and it deserves the same robust response that hospitals apply to other negative health outcomes, such as patient […]

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Brandt’s Rants: Why I moved to New Zealand : Emergency Medicine News

EP life, global EM, health care: Nugget Point on the Catlins Coast in New Zealand. Figure The year was 2020 and I was working in my busy Michigan emergency department with great staff. I felt some frustration, however; health care was after me. I have had patients with constricting chest pain leave the AMA […]