Elder Abuse and Neglect: What to do in the Emergency Department

By |Categories: Geriatrics|

Have you ever identified elder abuse in a patient in your ED? The signs can often be subtle, can look like one of many other medical or traumatic problems, and can be mistaken for aging-related changes. This is an unpleasant topic, but rather than bury our heads in the sand and pretend it doesn’t happen, let’s face it and see what we can do to intervene and help. How can you miss it less often? And what are your legal obligations if you suspect elder abuse? […]

Subsegmental Pulmonary Embolisms (SSPE) are Important

By |Categories: Cardiovascular, Critical Care/ Resus, Pulmonary|

Multi-detector computed tomographic pulmonary angiography (CTPA) allows for better visualization of peripheral pulmonary arteries allowing for diagnosis of small peripheral emboli limited to the subsegmental pulmonary arteries. Interestingly as these SSPE’s get diagnosed more and more, two questions come to mind: What is the prognostic utility of diagnosing SSPEs? What is the morbidity and mortality of SSPEs compared to more proximal PEs? A recent study in 2013 Blood looked at these questions. 1 […]

The Not-So-Sick Health-Care Associated Pneumonia Patient: New Treatment Strategy

By |Categories: Infectious Disease, Pulmonary|

Health-care associated pneumonia (HCAP) is the term used to describe patients presenting with pneumonia who may be at higher risk of multi-drug resistant (MDR) pathogens than other patients presenting from the community due to recent contact with the health care system. What are the criteria for HCAP? […]

Shock Index: A Predictor of Morbidity and Mortality?

By |Categories: Critical Care/ Resus, Expert Peer Reviewed (Clinical)|

Emergent airway management and severe sepsis are both high-risk situations that are commonly encountered by emergency physicians. It is well known that complications can be high in both situations, which in turn can lead to increased morbidity and mortality. For instance, about 1/4 of patients who are hemodynamically stable prior to intubation get post-intubation hypotension (PIH) after rapid sequence intubation. Also septic patients may not be reliably identified by systemic inflammatory response syndrome (SIRS) markers early in their disease course. The Shock Index (SI) may be an adjunct that is easy to calculate and could predict both PIH and severe sepsis. [...]

ALiEM Journal Club Question 4: Reimbursement Tied to Diagnosis

By |Categories: Journal Club|

For the ALiEM – Annals of EM global journal club on the article “Emergency Department Computed Tomography Utilization in the United States and Canada”, discuss question number 4 on the topic of reimbursements tied to diagnosis:  The Centers for Medicare & Medicaid Services (CMS) proposed instituting a new process metric OP 15 “Use of Brain CT in the Emergency Department of Atraumatic Headache.” OP 15 measures the percentage of ED visits for atraumatic headache (ie, ED billing codes for tension, cluster, migraine, and nonspecific headaches) among Medicare beneficiaries who have a brain CT performed on the same day. ED patients [...]

ALiEM Journal Club Question 3: Malpractice and CT Use

By |Categories: Journal Club|

For the ALiEM – Annals of EM global journal club on the article “Emergency Department Computed Tomography Utilization in the United States and Canada”, discuss question number 3 on the topic of malpractice and CT use:  Discuss some of the important differences between the current health care systems and medical malpractice environments in Canada and the United States. How might these differences affect CT use in the emergency department (ED)? How might the implementation of the Patient Protection and Affordable Care Act in the US affect these differences? […]

ALiEM Journal Club Question 2: Estimation of CT Counts

By |Categories: Journal Club|

For the ALiEM – Annals of EM global journal club on the article “Emergency Department Computed Tomography Utilization in the United States and Canada”, discuss question number 2 on the topic of estimation on CT counts: Do you think the National Hospital Ambulatory Medical Care Survey (NHAMCS) method is likely to overcount or undercount CTs? What about the method used for calculating use in Ontario? Would these biases likely make the authors’ estimate of the overall difference between these countries too large or too small? Defend your answer.   […]

ALiEM Journal Club Question 1: Bias

By |Categories: Expert Peer Reviewed (Clinical), Journal Club|

For the ALiEM – Annals of EM global journal club on the article “Emergency Department Computed Tomography Utilization in the United States and Canada”, discuss question number 1 on the topic of bias: The authors use distinct methods for tallying computed tomography (CT) use in the 2 countries. List the biases that could occur in counting CTs by each method. […]

Inaugural Global EM Journal Club – hosted by ALiEM and Annals of EM

By |Categories: Journal Club|

CT imaging is a powerful tool in diagnosing pathological medical conditions. Despite this, there is appropriate concern about the “magnitude of imaging-related financial costs and radiation induced malignancies.” In this month’s Annals of Emergency Medicine journal publication, Berdachl et al published about “Emergency Department Computed Tomography Utilization in the United States and Canada.” This article was selected by the journal as the featured piece for a Journal Club discussion. In this inaugural global EM journal club, ALiEM and Annals are collaborating to provide a more dynamic discussion of some of the posed questions. The focus is on teaching concepts around HOW to [...]

NEWS FLASH: ALiEM and Annals EM are hosting a Global Journal Club

By |Categories: Journal Club|

In an unprecedented collaborative effort to accelerate knowledge translation and education, ALiEM is officially partnering with Annals of Emergency Medicine. Together we will be hosting a global Journal Club discussion on ALiEM using the journal club questions posed in the journal’s journal club questions. Here’s how YOU and your colleagues can participate… […]