AMA: 2 high risk myths and misconceptions
Patients who leave the emergency department against medical advice (AMA) are at an increased risk of having a bad medical outcome, and can be a source of significant medicolegal risk to providers. Earlier we reviewed eight elements to address when signing a patient out AMA. There are two common myths regarding patients who leave AMA that can complicate an already difficult situation. [+]
BISAP, EHMRG, ORT: 3 New Medical Scores You’ve Never Heard Of
Let’s face it. You’ve heard about the A-a gradient. And free water deficit. And even the APACHE-II score. But how useful are these in your daily practice? You don’t care that much if a patient has shunt physiology in the first case, nor exactly how much free water they’re lacking in the second. And in the third case, your clinical acumen is probably pretty good at predicting a sick patient’s mortality already. But what about the new medical scores of BISAP, EHMRG, and ORT? [+]
Blood Pressure Management in Adults (JNC 8 and ACEP Policy)
Hypertension is one of the most common conditions seen in primary care clinics and emergency departments (EDs). Frequently, patients are found to have asymptomatic hypertension and referred to EDs for management, despite the fact that rapidly lowering blood pressure is not necessary and may be harmful. Yet many clinics still refer these patients for emergent management. In December 2013, the Eighth Joint National Committee (JNC 8) published a new, open-access, evidence-based hypertension guideline in JAMA. They only cited randomized clinical control trials to answer three questions: Does initiating antihypertensive pharmacologic therapy at specific BP thresholds improve health outcomes? Does treatment with antihypertensive pharmacologic [+]
Buprenorphine and Acute Pain Management: The ED Perspective
Acute pain management in the ED is challenging. For patients on buprenorphine, it can be even more difficult. What if a patient on buprenorphine presents to the ED with a painful condition that requires a short course of opioid therapy? [+]
Serotonin Syndrome: Consider in the Older Patient with Altered Mental Status
What’s the first thing that pops into your head when you see an older woman presenting to the ED from a nursing facility with atraumatic altered mental status? If you’re like me, ‘UTI’ comes quickly to mind. I then banish the thought of a UTI and force myself to go through a worst-first differential diagnosis to exclude, either through the history and clinical assessment or through testing, more dangerous causes. This is a case of a 67-year-old woman with an unusual cause of altered mental status… and a UTI. [+]
Is Pelvic Exam in the Emergency Department Useful?
Women with undifferentiated abdominal pain and/or vaginal bleeding commonly present to the emergency department. Many textbooks advocate for the pelvic exam as an essential part of the history and physical exam. Performance of the pelvic exam is time consuming to the physician and uncomfortable for the patient. It is with great regularity that emergency physicians make clinical decisions, based on information derived from the pelvic examination, but is this information reliable and does it effect the clinical plan of patients? [+]
Highland Emergency Ultrasound website: Check it out
Need a quick refresher course on how to do an ultrasound-guided ear block or ankle arthrocentesis? I recently found out about Drs. Andrew Herring and Arun Nagdev’s Highland Emergency Ultrasound website and thought it was a great resource to share with others in the EM world. The website has easy-to-follow pictorial instructions of anatomic landmarks, probe placement, and ultrasound images of the most common blocks and other procedures. [+]
“Is there a doctor on-board?” 5 tips for dealing with in-flight emergencies
On average, in-flight medical emergencies occur about 15 times per day. When asked by flight crews to help in a medical emergency, providers have fairly extensive legal protection, and in some cases have a legal obligation to help [1]. In the U.S., all 50 states have some form of a “good Samaritan” law, which provides legal protection to medical providers who perform their services in response to medical emergencies outside the hospital. While these laws typically apply broadly to most out of hospital emergencies, in 1998 Congress specifically passed the Aviation Medical Assistance Act (AMAA) which offers legal protection to providers, [+]
Head injury in pediatric patients: To CT or not to CT?
Intracranial injury is the leading cause of death and disability in children. It can arise after severe, moderate, or minor head injury. Children with minor head injury present the greatest diagnostic dilemma for emergency physicians, as they appear well but a small number will develop intracranial injuries. The question that often arises in the ED is: To CT or not to CT? [+]
ALiEM-Annals of EM Journal Club: Clinical Decision Rule for Subarachnoid Hemorrhage
We are very excited this month to bring you our second Global Journal Club, co-hosted by the team here at ALiEM and the editorial board at the Annals of Emergency Medicine. This month, we are changing things up! We will be providing you, our readers, with a clinical vignette and related journal club questions today at the beginning of the week.The discussion will be held asynchronously starting today through Thursday (for 4 days). Respond by blog comment below or tweet (#ALiEMJC). On Wednesday, January 22, 2014 at 11 am PST (2 pm EST), we will be hosting a 30-minute live Google Hangout [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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