Crash Cart: Pokémon Go, the Dallas shooting, and hypertension patients

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This week: Pokémon Go trainers are coming to your EDs… either for pokémon or from falling off a cliff trying to catch ’em all. Plus, hypertension patients are also flooding EDs due to technology. Join in as our editors discuss the week’s headlines.

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Dallas EPs take care of “extended family” the night of Dallas ambush.

The ED staff triaged officers while caring for their existing patients as if it was a normal shift. Original Article by Dallas News.

E. Paul DeKoning, MD, MS: This is what we do and when the rubber hits the road, we trust our training. Love the quote that the first indication critically ill patients were coming is that they arrived. As simple as that. The additional emotional burden associated with caring for those who protect us shouldn’t be overlooked. We call on the police not infrequently and we owe them our gratitude. So thanks. And thanks to all of our colleagues in the EM and Trauma world who likewise rise to the occasion when the need arises. Organized chaos. It’s what we do.

Nicholas Genes, MD, PhD: Well said, Paul.

William Sullivan, DO, JD: This article is just a small glimpse behind the curtain to show the public what emergency physicians do every day. Thanks to Dr. Burgher and every person on staff at Baylor and Parkland for making us all proud as you saved many lives during this horrible event.

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Two gamers fall off a cliff while playing Pokemon Go

In San Diego the two players tumbled over a seaside cliff while trying to “catch’em all”. Original Article by USA Today.

E. Paul DeKoning, MD, MS: This seems to be all the rage these days. People are finding all kinds of things, like hidden monuments, dead bodies, and apparently nearly plummeting to their death. “One of the men told sheriffs’ deputies that he and his friend were playing the smartphone augmented-reality game Pokemon Go when they fell over the cliff’s edge” The stupid things people are doing with their ‘smartphones’ seems to know no bounds. Oh, for the days when people read books…Clearly, I’m getting old.

THIS JUST IN: “Bosnia’s PokemonGO players urged to avoid wartime mine fields.” News article I saw today. Probably good advice in general.

Nicholas Genes, MD, PhD: I think anytime you have millions of people trying something new outside, you’re going to have a few injuries – and now, I guess, a rash of articles so readers can cluck about those crazy millennials. I’m sure there were a few hula-hoop injuries during the 1950s craze. I’ve been amused by GomerBlog tracking this phenomenon, in healthcare – for instance a radiologist missed a Pokemon on a chest film recently. I have yet to see a patient come to the ED specifically looking for Pokemon, but wouldn’t be surprised if it happened. We’re very close to Central Park, after all.

William Sullivan, DO, JD: We live near a park and I’ve seen several kids ride off the bike paths playing this idiotic game. Random people show up in our backyard as well. I’ve already told my kids that if they even download the game, I’ll confiscate their phones. Wouldn’t it be innovative to use the game as a way to get patients to keep their doctors’ appointments? “Rare Pokemon appears at the clinic at 1PM. Need medication list to help capture him.” Also, I see Paul’s “no minefields while playing Pokemon Go” article and raise him with the following: “Police invite wanted criminals to come catch a rare Pokemon.” Hopefully this whole fad quickly goes the way of pet rocks and mullets.

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Why are ED visits for hypertension increasing?

According to Annals of EM its due to patients’ increased monitoring of their BP. Original Article by Helio.

E. Paul DeKoning, MD, MS: The problem here, which the article starts to address in the last sentence, is that patients are checking their blood pressure. Finding an incidental elevated BP begets checking another BP which begets elevation in BP which begets checking another BP which begets…Dirty little secret: I tell patients NOT to check their BPs at home, unless they are symptomatic. The article mentions home BP monitoring as a self-management tool. Problem is, that usually just leads to more ED visits–when they call their PCP, they are likely to just be turfed to the ED. Can anyone say job security?

Nicholas Genes, MD, PhD: Nothing worries me more about the future of digital health, remote monitoring, and “virtual” care, than the current epidemic of ED visits for asymptomatic hypertension. If people can work themselves into an ED visit because they saw a BP number they didn’t like, how will they respond to the metrics generated by wearables and apps, coming their way? By the way, the alternative explanation – that primary care doctors are telling patients to go to the ED for asymptomatic hypertension – is just something I can’t accept.

William Sullivan, DO, JD: I printed out this article just yesterday and handed it to a patient who repeatedly argued with me about how her blood pressure needed to be better controlled. I highlighted the last sentence in the abstract stating “With current practice patterns, the feared complications of hypertension are extremely infrequent.” She was sent to the ED because her pressure was 200 systolic and she had “a little headache.” Nick is exactly on point with the whole digital home monitoring revolution. This problem is only going to get worse. Paul’s point is also well-taken, but the problem is that if patients are instructed only to take their blood pressure when “symptomatic,” then every time they develop “symptoms,” they run to the blood pressure machine. Then, when the number is too high for their comfort, they become an ED patient for “symptomatic hypertension.” While good for business, this process is bad for satisfaction. Most of the hypertension patients I’ve treated are either upset because their family doctors sent them to the ED when nothing was going to be done or are upset because we aren’t doing more testing or treatment to immediately address their symptoms and their abnormal blood pressure. Difficult situation.

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