Geriatric Emergency Departments: Coming to a Hospital Near You?

We are all familiar with the concept of pediatric EDs. We see them as medical students, we train in them as residents, and we work alongside pediatric EM fellows. It is generally clear what pediatric EDs have to offer: smaller sized beds and equipment, nurses trained in pediatric triage and assessment who know how to put IVs in babies and calm crying kids, and physicians with training in pediatric Emergency Medicine. But what about the other end of the age spectrum? Over the last 10 years geriatric EDs, also called Senior EDs, have been popping up around the country. You may have been wondering why that is, and what they have to offer. Here are a few thoughts.

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By Christina Shenvi, MD, PhD, MBA|2016-11-11T19:20:40-08:00Apr 29, 2014|Expert Peer Reviewed (Clinical), Geriatrics|

Trick of the Trade: Making your own homemade ultrasound gel

You are spending a month in rural Kenya, doing an ultrasound teaching course. Your enthusiastic participants have been ultrasounding every chance they get. Unfortunately, this has caused your ultrasound gel supplies to dwindle. It will be a month before a new shipment of gel arrives from Nairobi. This gel will cost about $5 per bottle, which is a considerable expense for the local hospital’s budget.

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By Christine Riguzzi, MD|2018-10-28T21:23:04-07:00Apr 17, 2014|Expert Peer Reviewed (Clinical), Tricks of the Trade, Ultrasound|

PEITHO Trial: Fibrinolysis for Intermediate-Risk Pulmonary Embolism

Most of us would agree that massive PE is treated with fibrinolysis and non-massive PE is treated with anticoagulation. The area of great debate has been the optimal treatment for sub-massive PE. The MOPETT Trial was published in January 2013 and although the patient population was small, it did show a huge benefit in pulmonary pressures at 28 months with fibrinolysis. The next study we have all been waiting for is the Pulmonary Embolism Thrombolysis (PEITHO) trial, which was just published yesterday in the NEJM, evaluating fibrinolysis for patients with intermediate-risk PE.

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By Salim Rezaie, MD|2019-09-10T13:34:00-07:00Apr 11, 2014|Cardiovascular, Expert Peer Reviewed (Clinical), Pulmonary|

Top 10 reasons NOT to order a CT scan for suspected renal colic

CT_Scanner_01.jpg2d5efea2-a1b7-4c15-848e-4d6c5567eecfLarger It appears that the excitement and utilization of computed tomography (CT) imaging in the emergency department (ED) has far outpaced our concern for the short- and long-term consequences of increased reliance on this technology. CT has greatly supplemented, or even replaced, our clinical decision making for many chief complaints. Many articles document the dramatic increased CT use in contemporary practice, including a 330% increase in the rate of CT imaging from 1996 to 2007. The likelihood of a CT order being part of any ED encounter now approaches 15%, with no signs of decline.¹

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By Daniel Firestone, MD RDMS|2016-11-11T19:20:03-08:00Apr 10, 2014|Expert Peer Reviewed (Clinical), Genitourinary, Radiology|

High Sensitivity Troponin T and Acute Myocardial Infarction: One and Done?

There has been a lot of publicity about evaluation of chest pain patients in the emergency department (ED) with high sensitivity troponin testing. In the past with older troponin assays, clinicians would evaluate patients, get an ECG, and an initial set of cardiac biomarkers. The subsequent set of biomarkers would be performed at 6-8 hours later before determination of disposition. In the past few years, several studies have been published evaluating point of care troponins, sensitive troponins, and high sensitivity troponins which have changed our practice and evaluation of these patients. An early version of a study was recently released in the Journal of the American College of Cardiology (JACC) stating that for ED chest pain patients, we may be able to discharge patients from the ED with an initial normal ECG and single high sensitivity troponin T (hs-cTnT). So is it true… one and done?

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By Salim Rezaie, MD|2019-09-10T13:34:11-07:00Apr 3, 2014|Cardiovascular, Expert Peer Reviewed (Clinical)|

Cellulitis: Do Not Get Blood Cultures

You are treating a patient with left lower leg cellulitis. The nurse is going to establish IV access, draw blood work, and give analgesia and antibiotics. Before walking into the room, the nurse asks, “Do you need me to grab a set of blood cultures?” Additionally the hospitalist had asked you to order a “set of cultures” on your most recent cellulitis admission. Should you proceed?

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By Jeff Siegler, MD|2016-11-11T19:19:44-08:00Apr 1, 2014|Dermatology, Expert Peer Reviewed (Clinical), Infectious Disease|

When the PERC Rule Fails

Kline et al developed a clinical decision tool based on parameters that could be obtained from a brief initial assessment to reasonably exclude the diagnosis of pulmonary embolism (PE) without the use of D-dimer in order to prevent unnecessary cost and the use of medical resources. ¹ Many of us have used the Pulmonary Embolism Rule-out Criteria (PERC) rule by now, but we should be clear on what it includes. Are we using it appropriately?

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By Jason West, MD|2016-11-11T19:19:14-08:00Feb 11, 2014|Cardiovascular, Expert Peer Reviewed (Clinical), Pulmonary|

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