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After the game: no excuses not to recruit MRUs : Emergency Medicine News

Figure: URM, GME, equity in emerging markets Figure Health care facilities create or expand diversity programs to address gender, ethnicity, and sexual orientation gaps. Higher medical education has a particular interest in recruiting underrepresented minorities (URMs). This effort is more complex than I can cover in this space. Centuries of racial oppression are hard to […]

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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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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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Letter to the Editor: Getting the Truth: Emergency Medicine News

Editor: What about the sensational stories on the front page of the January issue? While I agree with the spirit that EPs that spread misinformation should lose board certification, who gets to decide? This year’s misinformation could be next year’s standard of care. Should doctors who were against solumedrol for spinal cord injury (heresy […]

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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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The speed of sound: Symptoms : Right eye pain : Emergency Medicine News

Figure: ultrasound, right eye pain, laceration, asteroid hyalosis Figure A 55-year-old man complained of pain in his right eye. He reported that the pain started after he hit his head against a door. He noted floaters in that eye, but said they had been there for several years. He had a history of […]

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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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Letter to the editor: ABEM could face future lawsuits : Emergency Medicine News

Letters to the Editor Emergency Medicine News welcomes letters to the editor on any topic related to emergency medicine. Please limit your letter to 250 words and include your full name, references, city and state of residence or practice. Letters can be edited for content, length and grammar. Submission of a letter constitutes […]

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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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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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NUMBERS: Opportunity cost as a proxy for empowerment : Protec… : Emergency Medicine News

Figure: opportunity cost, employee power, BATNA Figure I used a computerized survey of nearly 500 emergency physicians in my last two articles (http://bit.ly/EMN-numbERs) to examine general opportunity costs – the cost of pursuing one option versus your next best alternative – and related them to pursuing an education in the stock market. But what about […]

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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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Quick Reference: Symptom: Facial Swelling : Emergency Medicine News

Figure: facial swelling, rash, diagnosis Figure A 23-year-old woman with no medical history presented with facial swelling. She was brought in by ambulance and said on arrival that the swelling had started a few days earlier. She noted that she started taking an antibiotic for a cyst 10 days prior and then developed pain […]

Medicine articles

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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Letter to the Editor: Undifferentiated Agitation is Different …: Emergency Medicine News

Editor: It appears that a psychiatrist and an anesthesiologist are looking into the suitability of drugs administered by EMS to control undifferentiated agitation in a patient at the scene. (“Death of Black Man Prompts Reanalysis of ExDS”, REM. 2021; 43[10]: 1; https://bit.ly/3D5VQ0m.) I am amazed that the psychiatrist said, “As psychiatrists, dealing with those who […]

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Clinical Pearl: ‘Positive’ Symptoms May Be Acute Stroke: Emergency Medicine News

Figure: positive symptoms, acute stroke BY EMEDHOME.COM It is commonly accepted that TIAs and strokes generally exhibit “negative” symptoms while imitators (eg, migraine, seizures) generally exhibit “positive” symptoms. Doctors should be aware, however, that “positive” symptoms such as certain abnormal movements can be an acute stroke. Sudden hyperkinetic movements are a presentation of acute ischemic […]

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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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Clinical controversies: Stop playing games with anaphylaxis: Emergency medicine news

Figure: anaphylaxis, epinephrine, biphasic reaction Figure We all know anaphylaxis as the sudden and dramatic onset of mast cell degeneration resulting in life-threatening distributive shock. Prompt diagnosis is essential because death can occur within minutes. Unfortunately, it remains underreported and contracted out, and we still get it wrong despite the straightforward processing. Steroids are an […]

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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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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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NUMBERS: Are the scholarships worth it? Not really: the news of emergency medicine

Figure: EM grants, opportunity costs, jobs Figure Opportunity costs and incentives affect our decisions and their outcomes for a career in emergency medicine. As I wrote in October, there are many great entities shaping the fate of emergency medicine, all of which have vast repositories of valuable data. Making the right data public to all […]

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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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Toxicology Rounds: The Truth About High-Dose Insulin : Emergency Medicine News

Figure: high dose insulin, calcium channel blocker poisoning, amlodipine Figure The causative agent when our poison control center is consulted for cases of calcium channel blocker poisoning (CHB) is almost always amlodipine. Quite often the clinical team will be looking for high dose insulin (HDI) as they call us. After all, HDI is often considered […]

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Clinical controversies: An attack on epinephrine Skin Nec… : Emergency Medicine News

Figure: medical myths, epinephrine, skin necrosis My aversion to medical myths started long before residency. I distinctly remember, as a third-year medical student on my EM rotation, when an assistant showed me how to perform digital blocking, but instructed me to avoid using lidocaine with epinephrine because of the “theoretical” risk of digital necrosis. When […]

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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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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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Clinical pearl: An unusual presentation of HSV : Emergency Medicine News

Figure: herpes simplex virus, hepatitis, pregnancy BY EMEDHOME.COM Hepatitis is a manifestation of disseminated herpes simplex virus (HSV) infection, often reported in pregnant women who acquire HSV during pregnancy. Pregnant women in any trimester may have fever and hepatitis (markedly elevated transaminases), but may not have genital or skin lesions. HSV hepatitis is associated with […]

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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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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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Standing AFFIRM: Compassion Matters, Now More Than Ever : Emergency Medicine News

Figure: gunshot wound, compassion, violence prevention Figure Figure AFFIRM’s firearm injury reduction mission at the Aspen Institute is rooted in compassion for others, not only for victims of firearm injuries, but also for those at risk of becoming its victims. authors. One of AFFIRM’s explicit goals is to employ evidence-based practices, and we think this […]

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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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Letters to the editor: Logic, Evidence Support Supplements f… : Emergency Medicine News

Letters to the Editor Emergency Medicine News welcomes letters to the editor on any topic related to emergency medicine. Please limit your letter to 250 words and include your full name, references, city and state of residence or practice. Letters can be edited for content, length and grammar. Submission of a letter constitutes the author’s […]

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Viewpoint: Tackling the mental health pandemic requires society… : Emergency Medicine News

Figure: mental health, COVID-19, quarantine Many publications, including Psychiatric time and American scientist, have published articles over the past year about the mental health pandemic accompanying the COVID-19 pandemic. This terminology got me thinking. I wondered if there really was a mental health pandemic or if people rightly felt more overwhelmed by an international public […]

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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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Life in Emergistan: A Letter to Dear John : Emergency Medicine News

Figure: EP life, friendship, academic EM Figure Dear John, I see you’ve asked our residency list server for advice on returning to college practice. I haven’t been in the world of academic emergency medicine for long, but I have a few suggestions based on my memories and contact with academics that might help you […]

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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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Clinical Pearl: No thrombolytics for non-disabling strokes : Emergency Medicine News

BY EMEDHOME.COM Emergency physicians know only too well the pressure of administering thrombolysis as quickly as possible to a patient with a recent acute ischemic stroke. What about a patient with a non-disabling AIS? Expert opinion now recommends not treating these patients with thrombolysis. The 2021 European Stroke Organization guidelines stated that no […]

Medicine student

IU School of Medicine student shares his COVID-19 experience to warn young people they are not invincible

This is an archived article and the information in the article may be out of date. Please look at the history’s timestamp to see when it was last updated. INDIANAPOLIS, Ind. – A future doctor, 27, warns all young adults: you are not invincible to COVID-19. He shares his story in the hope that people […]