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# Emergency Physicians Monthly

Independent news and analysis in emergency medicine

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## Posts

- [Keep an eye out](https://epmonthly.com/keep-an-eye-out/) - “Less than Lethal” impacts can still lead to significant morbidity. The Case A 26-year-old male with a past medical history of type 1 diabetes mellitus presented to the emergency department after being struck in the left eye by a beanbag shotgun round during a protest. He presented as a trauma activation at our Level 1
- [Time for less is more for the EM Workforce](https://epmonthly.com/time-for-less-is-more-for-the-em-workforce/) - Increasing standards could enhance education, training to avoid physician surplus. Based on recent EM workforce studies, a reduction of ~ 40% for new emergency medicine (EM) residents will be needed to prevent a significant oversupply of emergency physicians (EPs). An oversupply of EPs would have a very negative impact on EM and may lead to
- [Night Shift: Mavericks](https://epmonthly.com/night-shift-mavericks/) - I just celebrated my 70th birthday recently. It was a wonderful time with my family. But all the well wishes from my colleagues, all of whom are much smarter than I, reminded me of all the lies told about people at their funerals. It made me wonder if they knew something about my health that
- [EP Talk Ep. 51 - with Laleh Gharahbaghian](https://epmonthly.com/ep-talk-ep-51-with-laleh-gharahbaghian/) - Don’t miss this discussion of non-convulsive status epileptics with Laleh Gharahbaghian, MD. It will open your eyes to a problem I suspect many, if not most EPs, are currently missing. It is a point of care test that needs to be in every, yes EVERY emergency department.
- ["If I evacuate to the west to some safe place, people will die"](https://epmonthly.com/if-i-evacuate-to-the-west-to-some-safe-place-people-will-die/) - Bracing for missile attacks, EM staff in Kyiv is ready to provide care. The following report is based on a conversation held with Dr. Vitaliy Krylyuk, an emergency physician at Kyiv Hospital of Emergency Medicine in Ukraine on Wednesday, March 16, 2022. This article was originally published in Emergency Physicians International. On Feb. 23, Dr.
- [Much adieu about ’22?](https://epmonthly.com/much-adieu-about-22/) - From pandemic strife to burnout, the EPM board predicts what awaits this year. https://youtu.be/_pJ_BvbCWjI COVID-19 continued to roar through 2021 with vaccinations providing yet another divisive arena. Social media remained a battleground on COVID treatments and deterrents as ERs saw fluxes with the Delta and Omnicron variants. Staffing was reduced then increased to deal with
- [EM Coach: Positively chilling](https://epmonthly.com/em-coach-positively-chilling/) - What caused this teen girl’s breakout of hives? https://youtu.be/P5GwNAdsdxo Question Stem A 14-year-old girl is brought to the emergency department to be evaluated for diffuse hives (pictured below). They developed while the family was swimming in a cold lake where they were picnicking. No one else in the family developed any symptoms. It took her
- [“There’s something down there…”](https://epmonthly.com/theres-something-down-there/) - Accessory breast tissue presenting as a vulvar mass in an adolescent. https://youtu.be/hDM59pgA-uA Case: A 16-year-old, previously healthy, immunized female presented to a Pediatric Emergency Department (ED) with a complaint of a mass in her genital region. The patient reported she had noticed a “small bump” in the area approximately three years before but that over
- [Emergency Management of Angioedema](https://epmonthly.com/emergency-management-of-angioedema/) - What you need to know about this potentially life-threatening condition. https://youtu.be/ibt-vX-Kgm4 Introduction Angioedema is a potentially life-threatening condition that is often managed by the emergency physician. It is estimated to account for as many as 80,000-120,000 emergency department (ED) visits annually.[1,2] Information about the epidemiology of angioedema is limited as prior studies have been reliant
- [Hip Check](https://epmonthly.com/hip-check/) - Be aware of the potential for hemorrhages associated with pelvic ring disruptions. https://youtu.be/Ocb-9HIOgik The Case A 61-year-old male, with a history of morbid obesity and dyslipidemia, complained of pain in his right pelvic and right gluteal region after a fall. Patient stated he was standing on the first step of a ladder. When he stepped
- [7 Dangerous Physician Employment Contract Terms](https://epmonthly.com/7-dangerous-physician-employment-contract-terms/) - Avoid these potentially significant litigious clauses that could cost millions. https://youtu.be/NjrTsOhHIys A physician employment contract is legally binding regardless if the physician understands the terms. Unfortunately, some physician contract terms create significant dangers. Below are seven contract terms that should raise both red flags and a physician’s eyebrows. Indemnification Clauses Indemnification is a legal term
- [The Process of Weeding Out](https://epmonthly.com/the-process-of-weeding-out/) - Deregulation is causing rapid rise in emergency poisoning and overdose cases related to THC consumption. https://youtu.be/X0fpjpRA-Nk There is a new phenomenon in emergency medicine leaving some of us baffled. Our patient was an 82-year-old female complaining of dizziness and nausea. She reported her symptoms began suddenly after finishing dinner with family in Manhattan and
- [Train Yourself: Ultrasound-Guided IV Cannulation Trainer](https://epmonthly.com/train-yourself-ultrasound-guided-iv-cannulation-trainer/) - Practice your technique with this simple strategy. At one time or another every Emergency Medicine provider can attest to failing placing either a peripheral or a central line. While the use of ultrasound has helped with figuring out a patient’s anatomy, it can still be challenging to some learners. Despite being frustrating, this skill has
- [Night Shift: Suicidal Ideations](https://epmonthly.com/night-shift-suicidal-ideations/) - https://youtu.be/6u31ddYnUqE “Not another suicidal patient,” the charge nurse moaned as the chief complaint of a 14-year-old registering for the ER popped up on the screen. We have no psychiatric services at our hospital and we consider ourselves lucky to be able to disposition a suicidal patient within 12 hours. Doing so usually involves 20-30 telephone calls by
- [Are you under treating pain in your ED?](https://epmonthly.com/are-you-under-treating-pain-in-your-ed/) - For analgesics, the sky's the limit. A pet peeve of mine when placing orders in my hospital’s EMR is the default dosing of some of our analgesic medications. The system automatically orders 600 mg, 650 mg and 4 mg for ibuprofen, acetaminophen and morphine, respectively. I’ve always been taught the maximum single doses of these
- [The sky isn’t the limit for NSAIDs analgesia](https://epmonthly.com/the-sky-isnt-the-limit-for-nsaids-analgesia/) - Using the one-dose/one-size approach is detrimental to patient health. As an ED clinician, I take enormous pride in taking care of patients presenting to my ED in pain. I take even bigger pride in the progress that Emergency Medicine has made over the past 15 years to perfect pain management. Armed with a solid knowledge
- [Curriculum vitae Creating How to Write a Masterpiece of any Curriculum vitae.Who definitely are we being letting you know creating your cv?](https://epmonthly.com/curriculum-vitae-creating-how-to-write-a/) - Curriculum vitae Creating How to Write a Masterpiece of any Curriculum vitae.Who definitely are we being letting you know creating your cv? This award-succeeding guide to resume producing will instruct you on to publish a continue comparable to one performed by a top-notch professional article writer. It includes good examples, structure selections, support creating the
- [Get Qualified Bookkeeping Research Help from Specialist Authors!Get Algebra Homework Assistance From Skilled Professionals!](https://epmonthly.com/get-qualified-bookkeeping-research-help-from/) - Get Qualified Bookkeeping Research Help from Specialist Authors!Get Algebra Homework Assistance From Skilled Professionals! Having problems with your data processing due diligence? Have you got some accounting evaluations that are generally time-consuming or perhaps overwhelming to suit your needs? Why have this difficulty? Homeworkcrest.com is the perfect lover to provide you the accounting due diligence
- [Distant Cellular Phone Software](https://epmonthly.com/distant-cellular-phone-software/) - Garmin Forerunner GPS Managing View GPS Running View with Arm-based Heart-Rate Trails rate mileage, time, heartrate and much more much more Attached features: automatic submissions to social media expressing, live tracking, audio requests, clever signals and Garmin Connect Task tracking matters length, daily measures, calories Obtain information areas, widgets, view faces and purposes from Connect
- [The globe cell-phone monitoring site online - Combining the telephone tracking technology that is newest with quick free online telephone checking spot benefits!](https://epmonthly.com/the-globe-cell-phone-monitoring-site-online/) - Mobile Phone Tracking & amp; Monitoring Software Cellular Phone Tracking Best Features Ighster Mobile is extremely potent and beneficial cell phone monitoring application. Ideally suited to observe your young ones or workers Mobile is one of the most advanced cellular phone monitoring and checking software used to confidentially record text messages or course contact info
- [Ten Fundamental Qualities of a High-Grade Virtual Data Storage](https://epmonthly.com/ten-fundamental-qualities-of-a-high-grade-virtual/) - VDRs are becoming more and more demanded in the business realm all over the planet. Lawyers, investment bankers and top managers of organizations are interested in the comfortable and safe environment to keep their information and to accomplish plenty of transactions. Thus, nowadays, VDR vendors offer highly helpful services as high-quality rooms are able to
- [Here are Some Hints for Coming Customers about How to Choose the Best Virtual Storage for their Business](https://epmonthly.com/here-are-some-hints-for-coming-customers-about-how-2/) - Keeping and sharing of the secret files in a virtual space seem to be an inevitable need of the contemporary deal-making environment. Multiple software developers provide deal-makers with highly protected digital environments which are supposed to bring the ease to the entire course of the transaction execution - so-called virtual repositories. Their core function is
- [Flight Shift](https://epmonthly.com/flight-shift/) - Emergency medicine lessons learned in the cockpit of an F-15c It’s a familiar story: after getting selected and working through thousands of hours of lectures, training, and evaluations, I was told I was ready. Yet after all that, when I heard the first code of my career, my mind went blank, my heart took off,
- [Second Chance on Bladder US](https://epmonthly.com/second-chance-bladder-us-3/) - “If you are given a second chance in life, don’t blow it,” you advise your eager resident. It has been an overwhelmingly busy day in the department. Interspersed between the motor vehicle collisions, hypoxic and hypotensive CHF exacerbations, and patients with florid sepsis, your team is trying to see and help all of the ankle
- [A Win for Patient Safety in the Electronic Era](https://epmonthly.com/win-patient-safety-electronic-era-3/) - Emergency medicine takes strides in developing a comprehensive reporting tool for EMR problems We’ve written – in these pages and elsewhere – about the great potential of electronic health records to improve emergency care. That potential includes better access to past histories and medications, easier coordination among the care team, improved guideline adherence and
- [Sepsis Gets an Upgrade](https://epmonthly.com/sepsis-gets-upgrade/) - Defining sepsis has been problematic – especially in the ED. After two decades, we’re ready for Sepsis 3.0 Systemic Inflammatory Response Syndrome (SIRS) is something that has been beat into the heads of medical students, residents, fellows, and all physicians in general. However, the derivation of SIRS occurred in 1991, where the focus was on
- [Second Chance on Bladder US](https://epmonthly.com/second-chance-bladder-us/) - “If you are given a second chance in life, don’t blow it,” you advise your eager resident. It has been an overwhelmingly busy day in the department. Interspersed between the motor vehicle collisions, hypoxic and hypotensive CHF exacerbations, and patients with florid sepsis, your team is trying to see and help all of the ankle
- [Assessing Fever in Returning Travelers: Part II](https://epmonthly.com/assessing-fever-returning-travelers-part-ii/) - Zika continues to be the virus of the day for returning travelers, but there are several other diseases that we need to consider in these patients when they present to us in the emergency department. Chikungunya is epidemic in many of the same countries as Zika and can be even more devastating. And Avian
- [Off Script- You might not want to be so hasty in writing off-hand prescriptions for your friends and family.](https://epmonthly.com/off-script-might-not-want-hasty-writing-off-hand-prescriptions-friends-family/) - One of the great benefits of being a physician is that we can write prescriptions. Calling in a script allows us to easily help our friends save money and time and feel better. But with this right comes responsibility and that’s where many people trip up when writing prescriptions “off the record.” I suspect every
- [All about Oxy](https://epmonthly.com/all-about-oxy/) - RX PAD With the death of the entertainer Prince attributed to a fentanyl overdose, and new FDA warnings, opioids have been making headlines. Since the most common reason patients visit the emergency department is for pain, it is not surprising that emergency physicians prescribe and administer medications such as oxycodone on a daily basis.
- [Emergency Physicians Emerge as Healthcare’s Management Specialists](https://epmonthly.com/emergency-physicians-emerge-healthcares-management-specialists-2/) - We have always been clinicians, but modern emergency physicians have also become the most skilled managers in the healthcare system. It’s time we capitalize on those talents and proactively learn from the management industry. History’s great achievers—Napoleon, da Vinci, Mozart—have always managed themselves. That, in large measure, is what made them great, according to Peter
- [Stroke Care: A Balanced Approach to the tPA Debate](https://epmonthly.com/stroke-care-balanced-approach-tpa-debate/) - Emergency medicine professor and neurology fellow Dr. Rhonda Cadena explores the controversy behind the administration of tPA for acute ischemic strokes. The question of the safety and efficacy of alteplase (tPA) for the treatment of acute ischemic stroke (AIS) has been debated by emergency physicians (EPs) for many years. Differences of opinion have been expressed
- [A Win for Patient Safety in the Electronic Era](https://epmonthly.com/win-patient-safety-electronic-era-4/) - Emergency medicine takes strides in developing a comprehensive reporting tool for EMR problems We’ve written – in these pages and elsewhere – about the great potential of electronic health records to improve emergency care. That potential includes better access to past histories and medications, easier coordination among the care team, improved guideline adherence and evidence-based
- [Emergency Physicians Emerge as Healthcare’s Management Specialists](https://epmonthly.com/emergency-physicians-emerge-healthcares-management-specialists/) - We have always been clinicians, but modern emergency physicians have also become the most skilled managers in the healthcare system. It’s time we capitalize on those talents and proactively learn from the management industry. History’s great achievers—Napoleon, da Vinci, Mozart—have always managed themselves. That, in large measure, is what made them great, according to Peter
- [My Macgyver Moment](https://epmonthly.com/my-macgyver-moment-2/) - Since emergency physicians are the MacGyvers of medicine – mullet not included – we asked our readers to send in their best stories of improvising on the fly. What did you do when you were fighting against the clock and couldn’t find the supplies you needed? Here are our four winning entries, with comments
- [4 Metrics That Can Change Medicine](https://epmonthly.com/4-metrics-can-change-medicine/) - 1 The Changing Landscape: ED visits have increased by about 3% per year over 12 years from 369 visits to 451 per 1000 population. The ED population is aging in line with the demographics of the country, and EDs need to prepare to meet the needs of seniors. 2 Less Trauma, More Sickness: Over the
- [Flight Shift](https://epmonthly.com/flight-shift-3/) - Emergency medicine lessons learned in the cockpit of an F-15c It’s a familiar story: after getting selected and working through thousands of hours of lectures, training, and evaluations, I was told I was ready. Yet after all that, when I heard the first code of my career, my mind went blank, my heart took off,
- [4 Metrics That Can Change Medicine](https://epmonthly.com/4-metrics-can-change-medicine-3/) - 1 The Changing Landscape: ED visits have increased by about 3% per year over 12 years from 369 visits to 451 per 1000 population. The ED population is aging in line with the demographics of the country, and EDs need to prepare to meet the needs of seniors. 2 Less Trauma, More Sickness: Over the
- [Two Midnights, One New Challenge](https://epmonthly.com/two-midnights-one-new-challenge/) - A detailed break-down of CMS’s ‘Two-Midnight Rule’ and how it will impact emergency medicine Perhaps the surest way to drive someone crazy is to expect them to understand the rules and regulations related to coverage and payment by Medicare for hospital inpatient services (Part A), outpatient / observation services (Part B), and skilled nursing facility
- [Dx: Ruptured Vessel](https://epmonthly.com/dx-ruptured-vessel/) - The ultrasound image shows a view of the globe with the retina at the bottom of the image. The vitreous humor appears anechoic (black) and the retina echoic (gray). Just in front of the retina is a small echoic area that was not present in the unaffected eye. It does not appear to be connected
- [Women, Take the Stage!](https://epmonthly.com/women-take-stage/) - Increasing the amount of women speaking at educational conferences is low lying fruit for addressing some of the gender gap in emergency medicine. Here are some concrete tips to get us started. Close your eyes and channel your mind to the last big CME event that you attended. You’ve braved the crowded coffee lines and
- [Rethink the Salter-Harris I Fracture](https://epmonthly.com/rethink-salter-harris-fracture-3/) - The last 50 years of pediatric fracture management may have included a substantial misunderstanding of Salter and Harris’s original findings. In a recent issue of SMART EM we went under the evidence sea and into the depths of pediatric orthopedics, where there is a question trainees (and parents) with overdeveloped common sense have been asking
- [What’s the Deal with Osteopathic Medicine?](https://epmonthly.com/whats-deal-osteopathic-medicine/) - There has long been an air of mystery surrounding the practice of osteopathic medicine. What do these physicians study? What is manipulative medicine? John C. Prestosh, DO, president of the American College of Osteopathic Emergency Physicians (ACOEP) sheds some light on what DOs do. JOHN C. PRESTOSH DO President, American College of Osteopathic Emergency Physicians
- [When a "Fall" Isn't a Fall: Screening for Elder Mistreatment](https://epmonthly.com/fall-isnt-fall-screening-elder-mistreatment/) - Up to 1 in 10 elders experience abuse, but most cases are missed during visits to the ED. by Chloe Sidley, MD and Lauren T. Southerland, MD Emergency departments are exceptional at detecting child abuse and they’ve trained SANE forensic nurses to assist with sexual abuse cases. So why aren’t we better at detecting elder abuse? During a shift on a bitterly
- [How to Confirm Ankle Joint Penetration](https://epmonthly.com/confirm-ankle-joint-penetration-2/) - Suspicious lacerations should be investigated, even if the X-ray is normal. A step-by-step pictorial guide. It is a busy Friday evening in the emergency department when you get called to the resuscitation bay for a 14-year-old female who was the restrained back seat passenger in a rollover motor vehicle crash. After a quick call to
- [Opening the Book on ED Metrics](https://epmonthly.com/opening-book-ed-metrics/) - Dear Director, We’ve never shared metric data among the providers at my site but I’m thinking about doing it as a way to improve our metrics. How transparent should I be with the group? Often, I think docs are unaware of their own metrics, let alone how they compare to their colleagues. Emergency physicians
- [Very Wide and Very Fast](https://epmonthly.com/very-wide-and-very-fast/) - How would you treat this elderly male with one day of chest pain and shortness of breath? An elderly male who missed dialysis presented to the emergency department complaining of one day of chest pain and shortness of breath at rest. Upon arrival to the ED, he was awake, well perfused and neurologically intact,
- [The Six Trigger Patients who can Hijack your Shift](https://epmonthly.com/six-trigger-patients-can-hijack-shift/) - There are certain patients who push your buttons and cause you to lose your cool. It’s up to you to anticipate these triggers and come up with a plan to manage their care with compassion and poise. GREG HENRY, MD Founder and CEO of Medical Practice Risk Assessment, Inc.; past president of ACEP. All my
- [Put Up or Shut Up: What EM Can Learn from the Teamsters](https://epmonthly.com/put-shut-em-can-learn-teamsters-3/) - If emergency physicians are going to have a chance at influencing healthcare policy in Washington, they’re going to need to get serious about organizing and fundraising. The power of unions is legendary. The Teamsters, formed in 1903, now boast more than 1.3 million members and are the 11th largest campaign contributor in the United
- [Cerebral Venous Thrombosis](https://epmonthly.com/cerebral-venous-thrombosis/) - A dangerous, easy-to-miss, neurologic emergency Case: A 32 year-old female presents to the ED with 36 hours of right-sided headache, associated with nausea and vomiting. This is her second visit within the prior 36 hours. Her pain improved with intravenous medications during her first ED visit, and no testing was completed at that time.
- [Do It Yourselfer](https://epmonthly.com/do-it-yourselfer-3/) - I’m proud of the fact that I’m self sufficient in the emergency department. And it irritates the fire out of me to see prima donnas (read surgeons) come into the department and require the entire staff to follow them around to do little things they could do for themselves. I guess you could say that
- [Training advisor says white-paper may cause bigotry in young kids](https://epmonthly.com/training-advisor-says-white-paper-may-cause/) - Website Design Businesses Assessment The very first impression is usually alone you have to find prospective customers. Once on your website, website readers will take only some moments if it is worth their time to click-through, to decide. Bad layout, a confusing interface and slow weight situations affect people to click the option that is
- [Uncompensated Tasks: How Much Is Too Much?](https://epmonthly.com/uncompensated-tasks-much-much-5/) - Dear Director, My hospital is making me undergo mandatory EMR training and I think I should get paid for my time. I also think I should get paid for attending our monthly staff meeting and a committee meeting. Don’t nurses get paid for these kinds of things? —Frustrated Hourly Worker Many physicians choose emergency medicine
- [Uncompensated Tasks: How Much Is Too Much?](https://epmonthly.com/uncompensated-tasks-much-much/) - Dear Director, My hospital is making me undergo mandatory EMR training and I think I should get paid for my time. I also think I should get paid for attending our monthly staff meeting and a committee meeting. Don’t nurses get paid for these kinds of things? —Frustrated Hourly Worker Many physicians choose emergency medicine
- [Less is More: Redefining Balance](https://epmonthly.com/less-redefining-balance/) - Want a better work/life balance? Hint – it’s not about being better at multitasking. I am tired of hearing about balance. We talk about it, we go to lectures on it, we give mandatory presentations on it to our interns. Yet few people would say they have actually achieved this elusive, zen state. In fact,
- [Dx: Ruptured Vessel](https://epmonthly.com/dx-ruptured-vessel-3/) - The ultrasound image shows a view of the globe with the retina at the bottom of the image. The vitreous humor appears anechoic (black) and the retina echoic (gray). Just in front of the retina is a small echoic area that was not present in the unaffected eye. It does not appear to be connected
- [The Right Job at the Wrong Time](https://epmonthly.com/right-job-wrong-time-3/) - Dear Director, I was just asked to take over as medical director of another ED in our hospital’s system. While I want to be a chairman one day, my kids are young and the timing just doesn’t seem good right now. Am I shooting myself in the foot for other jobs down the line if
- [4 Metrics That Can Change Medicine](https://epmonthly.com/4-metrics-can-change-medicine-2/) - 1 The Changing Landscape: ED visits have increased by about 3% per year over 12 years from 369 visits to 451 per 1000 population. The ED population is aging in line with the demographics of the country, and EDs need to prepare to meet the needs of seniors. 2 Less Trauma, More Sickness: Over the
- [Put Up or Shut Up: What EM Can Learn from the Teamsters](https://epmonthly.com/put-shut-em-can-learn-teamsters-4/) - If emergency physicians are going to have a chance at influencing healthcare policy in Washington, they’re going to need to get serious about organizing and fundraising. The power of unions is legendary. The Teamsters, formed in 1903, now boast more than 1.3 million members and are the 11th largest campaign contributor in the United States.
- [Geriatric ED: Cost-Efficient Hub of Care](https://epmonthly.com/geriatric-ed-cost-efficient-hub-care-3/) - Geriatric emergency departments can pay for themselves by meeting healthcare reform incentive goals No one can deny the aging of our population in general, and of the emergency department patient load in particular. But there is some disagreement about how EDs should respond – specifically whether it is appropriate to design geriatric emergency departments. After
- [Visual DX- "My Eye Popped Out"](https://epmonthly.com/visual-dx-eye-popped/) - A 44-year-old male with hypertension presents via EMS with this ocular complaint after having sneezed. What’s your assessment? by Lauren Westafer, DO and Nicholas Daniel, DO A 44-year-old male with hypertension presented via EMS with the complaint “my eye popped out!” The patient reported right eye swelling and pain immediately after sneezing. He denied trauma or
- [Dx: Prostatic Mass](https://epmonthly.com/dx-prostatic-mass/) - Upon seeing the images on the screen, you notice a tinge of red in your resident’s cheeks as she begins her spiel about the need to perform a prostate exam as part of the work up today. She eloquently explains to the patient that the ultrasound results and his symptoms are concerning for a prostatic
- [How to Be a Life-Long Learner](https://epmonthly.com/life-long-learner/) - 1 Don’t look back. I’m proud to say that each generation of EM residents moves to a higher plane of learning than past generations. The depth and breadth of learning in emergency medicine parallels the lightning-fast growth of knowledge that characterizes modern medicine. Keep it up! 2 Residency is just the beginning. Decide how you
- [Uncompensated Tasks: How Much Is Too Much?](https://epmonthly.com/uncompensated-tasks-much-much-3/) - Dear Director, My hospital is making me undergo mandatory EMR training and I think I should get paid for my time. I also think I should get paid for attending our monthly staff meeting and a committee meeting. Don’t nurses get paid for these kinds of things? —Frustrated Hourly Worker Many physicians choose emergency medicine
- [Meditations on the Great American Experiment](https://epmonthly.com/meditations-great-american-experiment/) - GREG HENRY, MD Founder and CEO of Medical Practice Risk Assessment, Inc.; past president of ACEP. To my young friends who find my columns uselessly esoteric, I order you to stop reading right now. Last month we were able to provide you with practical insights from three brilliant and accomplished legends in emergency medicine. You
- [Pam Benson Blazed Trails as EM’s First Female](https://epmonthly.com/pam-benson-blazed-trails-ems-first-female/) - When Pamela Bensen was a young child she liked to play doctor with her cousins and friends, but someone said: “Girls aren’t doctors, girls are nurses.” At age four, Pam looked at that person and said, “You want to bet?” Bensen kept on that path, did well in college, and was married a few
- [Put Up or Shut Up: What EM Can Learn from the Teamsters](https://epmonthly.com/put-shut-em-can-learn-teamsters-2/) - If emergency physicians are going to have a chance at influencing healthcare policy in Washington, they’re going to need to get serious about organizing and fundraising. The power of unions is legendary. The Teamsters, formed in 1903, now boast more than 1.3 million members and are the 11th largest campaign contributor in the United States.
- [The One Area you Shouldn’t Diversify](https://epmonthly.com/one-area-shouldnt-diversify/) - Diversity might be good when investing, but too many financial managers can be a bad thing. Here are five reasons to put your eggs in one basket. One key principle of successful investing is to diversify your portfolio as broadly as possible to minimize the risk that any one specific investment will crush you.
- [Do It Yourselfer](https://epmonthly.com/do-it-yourselfer-2/) - I’m proud of the fact that I’m self sufficient in the emergency department. And it irritates the fire out of me to see prima donnas (read surgeons) come into the department and require the entire staff to follow them around to do little things they could do for themselves. I guess you could say that
- [Rethink the Salter-Harris I Fracture](https://epmonthly.com/rethink-salter-harris-fracture-2/) - The last 50 years of pediatric fracture management may have included a substantial misunderstanding of Salter and Harris’s original findings. In a recent issue of SMART EM we went under the evidence sea and into the depths of pediatric orthopedics, where there is a question trainees (and parents) with overdeveloped common sense have been asking
- [The Elephant Test](https://epmonthly.com/the-elephant-test/) - A 28-year-old female passes out at home after a day of increasing abdominal cramping. What can you learn from this ultrasound? “Hey, I think I see an elephant.” Your trusty resident exclaims as she briskly wheels the ultrasound machine out of the patient’s room. Noting the spring in her step, you walk quickly over to
- [Uncompensated Tasks: How Much Is Too Much?](https://epmonthly.com/uncompensated-tasks-much-much-4/) - Dear Director, My hospital is making me undergo mandatory EMR training and I think I should get paid for my time. I also think I should get paid for attending our monthly staff meeting and a committee meeting. Don’t nurses get paid for these kinds of things? —Frustrated Hourly Worker Many physicians choose emergency medicine
- [Severe Hyponatremic Encephalopathy following Bowel Prep for Colonoscopy](https://epmonthly.com/severe-hyponatremic-encephalopathy-following-bowel-prep-colonoscopy/) - A unique case highlighting the need for physicians to be aware of the potential electrolyte disturbances that can occur during bowel prep for a colonoscopy. A 79-year-old female presented to the emergency department (ED) from home with acute mental status changes over a period of one hour. Family reported this to be in the
- [Geriatric ED: Cost-Efficient Hub of Care](https://epmonthly.com/geriatric-ed-cost-efficient-hub-care-2/) - Geriatric emergency departments can pay for themselves by meeting healthcare reform incentive goals No one can deny the aging of our population in general, and of the emergency department patient load in particular. But there is some disagreement about how EDs should respond – specifically whether it is appropriate to design geriatric emergency departments. After
- [When You Improvise, Use All the Tools in your Toolbox](https://epmonthly.com/improvise-use-tools-toolbox/) - A mark of excellence in emergency medicine is that clinicians can find a way to do what is necessary for their patients. When standard equipment is unavailable or established procedures will not accomplish the job, the emergency clinician must come up with a creative response—either recalling someone else’s solution or, MacGyver-style, thinking of their
- [The CDC Weighs in with Opioid Prescribing Guidelines](https://epmonthly.com/cdc-weighs-opioid-prescribing-guidelines/) - After months of sending mixed messages on the role of emergency medicine in stemming the tide of opioid abuse, the CDC has published guidelines that could prove useful in the emergency department. Opioid abuse is no longer merely a topic for medical discussion. It has become a public health concern of the highest magnitude, even
- [Goodbye SGR, Hello MACRA](https://epmonthly.com/goodbye-sgr-hello-macra/) - How will CMS’s new physician payment policy impact emergency physicians? For nearly twenty years the debate in Washington surrounding physician payment policy revolved around the SGR, or the Sustainable Growth Rate. That all changed last year when Congress passed the Medicare Access and CHIP Reauthorization Act, commonly referred to as “MACRA” in and around the
- [Dx: Ruptured Vessel](https://epmonthly.com/dx-ruptured-vessel-2/) - The ultrasound image shows a view of the globe with the retina at the bottom of the image. The vitreous humor appears anechoic (black) and the retina echoic (gray). Just in front of the retina is a small echoic area that was not present in the unaffected eye. It does not appear to be connected
- [The Right Job at the Wrong Time](https://epmonthly.com/right-job-wrong-time-2/) - Dear Director, I was just asked to take over as medical director of another ED in our hospital’s system. While I want to be a chairman one day, my kids are young and the timing just doesn’t seem good right now. Am I shooting myself in the foot for other jobs down the line if
- [Geriatric ED: Cost-Efficient Hub of Care](https://epmonthly.com/geriatric-ed-cost-efficient-hub-care/) - Geriatric emergency departments can pay for themselves by meeting healthcare reform incentive goals No one can deny the aging of our population in general, and of the emergency department patient load in particular. But there is some disagreement about how EDs should respond – specifically whether it is appropriate to design geriatric emergency departments.
- [Uncompensated Tasks: How Much Is Too Much?](https://epmonthly.com/uncompensated-tasks-much-much-2/) - Dear Director, My hospital is making me undergo mandatory EMR training and I think I should get paid for my time. I also think I should get paid for attending our monthly staff meeting and a committee meeting. Don’t nurses get paid for these kinds of things? —Frustrated Hourly Worker Many physicians choose emergency
- [When HIPAA Doesn’t Apply](https://epmonthly.com/hipaa-doesnt-apply/) - 10 common emergency care situations where the Health Insurance Portability and Accountability Act of 1996 may be improperly invoked Next year marks the 20th anniversary of the passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA’s purpose is to protect the privacy and security of protected health information or “PHI.”
- [Flight Shift](https://epmonthly.com/flight-shift-2/) - Emergency medicine lessons learned in the cockpit of an F-15c It’s a familiar story: after getting selected and working through thousands of hours of lectures, training, and evaluations, I was told I was ready. Yet after all that, when I heard the first code of my career, my mind went blank, my heart took off,
- [A Win for Patient Safety in the Electronic Era](https://epmonthly.com/win-patient-safety-electronic-era-2/) - Emergency medicine takes strides in developing a comprehensive reporting tool for EMR problems We’ve written – in these pages and elsewhere – about the great potential of electronic health records to improve emergency care. That potential includes better access to past histories and medications, easier coordination among the care team, improved guideline adherence and evidence-based
- [Put Up or Shut Up: What EM Can Learn from the Teamsters](https://epmonthly.com/put-shut-em-can-learn-teamsters/) - If emergency physicians are going to have a chance at influencing healthcare policy in Washington, they’re going to need to get serious about organizing and fundraising. The power of unions is legendary. The Teamsters, formed in 1903, now boast more than 1.3 million members and are the 11th largest campaign contributor in the United States.
- [The Right Job at the Wrong Time](https://epmonthly.com/right-job-wrong-time/) - Dear Director, I was just asked to take over as medical director of another ED in our hospital’s system. While I want to be a chairman one day, my kids are young and the timing just doesn’t seem good right now. Am I shooting myself in the foot for other jobs down the line if
- [How to Confirm Ankle Joint Penetration](https://epmonthly.com/confirm-ankle-joint-penetration/) - Suspicious lacerations should be investigated, even if the X-ray is normal. A step-by-step pictorial guide. It is a busy Friday evening in the emergency department when you get called to the resuscitation bay for a 14-year-old female who was the restrained back seat passenger in a rollover motor vehicle crash. After a quick call to
- [Second Chance on Bladder US](https://epmonthly.com/second-chance-bladder-us-2/) - “If you are given a second chance in life, don’t blow it,” you advise your eager resident. It has been an overwhelmingly busy day in the department. Interspersed between the motor vehicle collisions, hypoxic and hypotensive CHF exacerbations, and patients with florid sepsis, your team is trying to see and help all of the ankle
- [Nebulized Naloxone for Acute Opioid Overdose](https://epmonthly.com/nebulized-naloxone-acute-opioid-overdose/) - Paramedics present to an urban emergency department with a middle aged man found unresponsive in a nearby alley The paramedics were unable to obtain IV access due to years of drug abuse and overall poor venous access. Physical Exam General: Middle aged male, unresponsive to painful stimuli Vital signs: P=57/min (sinus bradycardia) RR=5 breaths/min T=97.9
- [The Fault in our (Three) Stars](https://epmonthly.com/fault-three-stars/) - Everything you need to know about the newest hospital rating system. Dear Director, My hospital CEO just told me that we received a three star quality rating from CMS and that the ED needs to improve its performance. What is he talking about? 4604 HOSPITALS WILL BE ASSIGNED A STAR RATING THIS MONTH. The results
- [A Novel Approach to the Shocky Child](https://epmonthly.com/novel-approach-shocky-child/) - Start with three quick bedside ultrasounds and you might avoid an unnecessary IV push An 11-year-old boy is brought to your emergency department following a few hours of persistent vomiting, irritability and decreasing activity. His mother also reports about two days of fever, decreased appetite and nasal stuffness. On initial evaluation, his vital signs
- [Do It Yourselfer](https://epmonthly.com/do-it-yourselfer/) - I’m proud of the fact that I’m self sufficient in the emergency department. And it irritates the fire out of me to see prima donnas (read surgeons) come into the department and require the entire staff to follow them around to do little things they could do for themselves. I guess you could say that
- [Another Krome Sets the Bar](https://epmonthly.com/another-krome-sets-the-bar-11/) - Amy Krome, daughter of EM visionary Ron Krome, embarks on a solo bike ride to benefit military veterans. Let me introduce you to Amy Krome. K-RO-M-E ‘like krome-on-a-car’. Readers who knew Ron Krome will recognize this greeting. For those who didn’t know Ron, he was one of the key founders of emergency medicine, serving as
- [The Inbox](https://epmonthly.com/the-inbox/) - editor@epmonthly.online RE: Throwing stones “We’re ignoring the 300 lb gorilla…” Dear Editor, I enjoyed your article and agree with Hoffman’s conclusions. However, medicine is avoiding the 300 pound gorilla in the room. The main causes of over testing that I see are 1) the administration expects us to increase income, 2) There have been
- [Interviewing 102: Making a Match that Will Last](https://epmonthly.com/interviewing-102-making-match-will-last/) - A successful job interview looks beyond the offer letter There are many ways one might define a successful interview in a typical scenario; usually, job offer = successful interview. But for an EM physician in most markets, the offer is almost a given. A successful interview can and should be so much more than
- [My Macgyver Moment](https://epmonthly.com/my-macgyver-moment/) - Since emergency physicians are the MacGyvers of medicine – mullet not included – we asked our readers to send in their best stories of improvising on the fly. What did you do when you were fighting against the clock and couldn’t find the supplies you needed? Here are our four winning entries, with comments by
- [Rethink the Salter-Harris I Fracture](https://epmonthly.com/rethink-salter-harris-fracture/) - The last 50 years of pediatric fracture management may have included a substantial misunderstanding of Salter and Harris’s original findings. In a recent issue of SMART EM we went under the evidence sea and into the depths of pediatric orthopedics, where there is a question trainees (and parents) with overdeveloped common sense have been asking
- [A Win for Patient Safety in the Electronic Era](https://epmonthly.com/win-patient-safety-electronic-era/) - Emergency medicine takes strides in developing a comprehensive reporting tool for EMR problems We’ve written – in these pages and elsewhere – about the great potential of electronic health records to improve emergency care. That potential includes better access to past histories and medications, easier coordination among the care team, improved guideline adherence and evidence-based
- [Getting Clever with Clindamycin](https://epmonthly.com/getting-clever-clindamycin/) - Another effective antibiotic in your toolbox HOW IT WORKS Clindamycin is an antibiotic in the lincosamide class, active against gram positive bacteria and anaerobes. It binds to the large subunit (50S) of the bacterial ribosome and inhibits new peptide-peptide bond formation. It is bacteriostatic in most cases, though can be bactericidal at high concentrations

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## Articles

- [Director's Corner: AI in the ER, Part 2](https://epmonthly.com/article/directors-corner-ai-in-the-er-part-2/) - Last month we looked at how our clinical encounters may be improved by AI, with AI scribes and EKG interpretation, as well as improvements to our EMR. This month, we’ll look at how other online AI tools can impact our role as physician and/or ED leader. Chat GPT--Large Language Models If you watched the Super
- [Substance Induced Cardiogenic Shock](https://epmonthly.com/article/substance-induced-cardiogenic-shock/) - Case: A 33-year-old male presented to the emergency department for hemoptysis for two days. The patient reported periods of coughing up blood-streaked sputum, generalized fatigue, and orthopnea. He denied chest pain. He had a history of nonischemic cardiomyopathy (NICM) with an ejection fraction of 15% which was diagnosed a month prior to this visit during a hospital admission for cardiogenic shock. An echocardiogram at that time showed multiple
- [New Job, New House: Buying a Home in a Seller’s Market](https://epmonthly.com/article/new-job-new-house-buying-a-home-in-a-sellers-market/) - Sometimes relocating for a new job means buying a new house at precisely the wrong time. Here are a few strategies I learned the hard way for buying a home when the market is against you. Sometimes relocating for a new job means buying a new house at precisely the wrong time. Here are
- [Patient Has a History of Hypertension and GERD... You Decide If the Physician's Care Qualified As 'Reasonable Practice'](https://epmonthly.com/article/patient-history-hypertension-gerd-decide-physicians-care-qualified-reasonable-practice/) - A 55-year-old male with a history of hypertension and GERD was brought by ambulance to the emergency department for a syncopal episode that occurred while he was at his doctor’s office. The day prior he had been to the same physician for evaluation of a two-week history of dry cough, subjective fever and dyspnea on exertion.
- [Director's Corner: AI use in the ER (part 1)](https://epmonthly.com/article/directors-corner-ai-use-in-the-er-part-1/) - Dear Director, How are you using AI at work and when will we see meaningful use of it clinically? You’re two hours into your shift and you step into your next ED room already knowing more about the patient than you used to after ten minutes of chart biopsy. While you were finishing up your
- [The Basics of Documentation in Emergency Medicine](https://epmonthly.com/article/the-basics-of-documentation-in-emergency-medicine/) - In medicine, the story we record is not an unfortunate consequence of our bedside care but a vital aspect of this compassionate work. Documentation is the clinical voice that communicates judgment, complexity, and intent long after the patient encounter has ended. It shapes how care is understood, how decisions are defended, and how outcomes are
- [When Your Gut Says “Admit” — The Leadership Skill Every Young ER Doc Must Master](https://epmonthly.com/article/when-your-gut-says-admit-the-leadership-skill-every-young-er-doc-must-master/) - Dear Director, I called the surgeon for an admission. They thought the patient could go home and follow up in two days. I didn’t think this was a great idea but I’m new at my site and find it hard to push back against the older, more experienced consultants. Unfortunately, the patient had a bad
- [Director's Corner: 10 New Year's Resolutions](https://epmonthly.com/article/directors-corner-10-new-years-resolutions/) - Ten New Year’s Resolutions for the Emergency Physician: Small Shifts, Big Impact Every year around this time, I sit down with a cup of coffee on a weekend morning, typically with ESPN on in the background, thinking about the usual New Year’s resolutions I’ve made. Many of the resolutions, typically shared in this column, I’ve
- [Train Yourself: A Thorn in Your Side](https://epmonthly.com/article/train-yourself-a-thorn-in-your-side/) - Chest tube insertion is a high-risk procedure that occurs with relatively high frequency in the emergency department. Emergency medicine (EM) graduates need to be prepared to place a chest tube. The ACGME requires EM residents to complete at least ten tube thoracostomies as part of their training. Commercial simulation trainers and cadavers have been used
- [Vertigo: An EP's Diagnosis of a National Epidemic](https://epmonthly.com/article/vertigo-an-eps-diagnosis-of-a-national-epidemic/) - It seems like the whole country has a bad case of vertigo. Oh, not acute labyrinthitis. But it does seem to have a lot of similarities. Just like being on a tossing sailboat, it’s hard to tell what’s in motion and what’s not. And it’s making everyone sick as hell. Vomiting up everything they have
- [How Virtual Oral Care Can Divert Dental Emergencies from Emergency Rooms](https://epmonthly.com/article/how-virtual-oral-care-can-divert-dental-emergencies-from-emergency-rooms/) - Introduction Each year, more than 2.1 million Americans turn to hospital emergency departments (EDs) for non-traumatic dental complaints such as toothaches, abscesses, or oral infections.¹ While these individuals often present in severe pain or distress, EDs are rarely equipped with the resources or personnel to resolve these conditions definitively. In fact, more than 80% of
- [How AI is Preventing Violence in America’s Hospitals](https://epmonthly.com/article/how-ai-is-preventing-violence-in-americas-hospitals/) - Healthcare workers are no strangers to stress. Every day, they balance life-and-death decisions with long hours and moments of high emotion. However, one issue often neglected in discussions about the challenges of healthcare is violence. Healthcare professionals routinely endure frightening levels of hostility from both patients and families — the very people they are working
- [Director's Corner: When Should an ER Doctor Consider Retiring?](https://epmonthly.com/article/directors-corner-when-should-an-er-doctor-consider-retiring/) - Last month, I went to a retirement party for an emergency physician colleague. I’ve known docs who have retired, though this was the first retirement party I think I’ve ever been to for a doc who retired while working in the same ED as me. It seems like I’ve seen docs step away from emergency
- [Add Another Year to Physician Residency Training?](https://epmonthly.com/article/add-another-year-to-physician-residency-training/) - Be Careful What We Wish for! One ‘hot button’ topic in EM circles remains an ongoing debate about a perceived need to increase residency training requirements to four full years. A recent article provides insights and clinical arguments on differing sides of this issue. But, at ‘management’ and legislative levels, would the new “real bosses”
- [Director's Corner: Should there be a Mandatory Retirement Age in the ER?](https://epmonthly.com/article/directors-corner-should-there-be-a-mandatory-retirement-age-in-the-er/) - Dear Director, I have a couple of older docs on our team, and it’s got me thinking about whether there should be a mandatory retirement age in our field? It’s a medical director’s job to make sure the emergency department is appropriately and safely staffed. This means that doctors and advanced practice providers are qualified
- [Training for Chaos: How VR and AR Are Preparing First Responders for the Unthinkable](https://epmonthly.com/article/training-for-chaos-how-vr-and-ar-are-preparing-first-responders-for-the-unthinkable/) - In the medical industry, training is one of the most important aspects of a doctor’s career. Since doctors hold their patients’ lives in their hands, they must be well-trained and prepared to handle any number of situations that come their way, so any tool that can be used to improve training for doctors could save
- [Remember the Tide Pod Challenge? A Review of Laundry Pod Ingestion](https://epmonthly.com/article/remember-the-tide-pod-challenge-a-review-of-laundry-pod-ingestion/) - Case A teenage female was brought in by ambulance after intentionally ingesting three liquid Tide pods. She had a prior history of self-harm but no other significant past medical history. Approximately 90 minutes prior to arrival, the patient had cut open three Tide pods and drunk their contents, immediately followed by a glass of apple
- [Ultrasound: Another Case for POCUS](https://epmonthly.com/article/ultrasound-another-case-for-pocus/) - This 34-year-old male presented to the emergency department with concerns for an infection involving his right hand. His past medical history was significant for bipolar disorder, bowel perforation, seizures, COVID-19, hepatitis and substance abuse. He had a hunter rod placed 10 years ago for a staged flexor tendon repair s/p a flexor tendon rupture but
- [Director's Corner: Executive Coaching](https://epmonthly.com/article/directors-corner-executive-coaching/) - Dear Director, I’ve been a medical director for a few years and have done some leadership courses, but I feel like I’ve reached the point where getting one on one coaching may help me reach my potential. What options are out there for me to consider? Although leadership courses and even self-guided learning by reading
- [A Crash Course in Emergency Roadside Toolkits](https://epmonthly.com/article/a-crash-course-in-emergency-roadside-toolkits/) - In the United States, the average ambulance response time to a roadside accident is nine minutes. In 2020, The National Highway Traffic Safety Administration reported a total of 5,250,837 collisions and 38,324 car accident fatalities that occurred in a single year. Early intervention in critical injuries can save lives. We realized that each of us
- [Choosing Greener Pastures: On Leaving the ER for the ICU](https://epmonthly.com/article/choosing-greener-pastures-on-leaving-the-er-for-the-icu/) - Critical care is an integral part of emergency medicine (EM) practice, and critical care fellowship training is becoming an increasingly common training pathway for graduating emergency medicine residents (Gaeta et al, 2024). Many pursue critical care with the hope of maintaining a career in both EM and critical care, only to find that this dream
- [Can you Break the Imposter Cycle?](https://epmonthly.com/article/can-you-break-the-imposter-cycle/) - To start, we begin with our own imposter syndrome confession: we are not experts in imposter syndrome. Our interest in this topic came out of a side project, prompted by a question posed by one of our trainees that became more intriguing as we dove deeper into the available literature. Our resulting discussion comes from
- [Night Shift: Take a Breath](https://epmonthly.com/article/night-shift-take-a-breath/) - Our refrigerator used to be a collection of pictures and magnets. Drawings and papers with “A+” would flop back and forth as the refrigerator doors opened and closed. Over time, the drawings and papers became fewer, and we added a whiteboard with a dry-erase marker. At first, we used the dry-erase board for writing grocery
- [TENSION... Empyema?](https://epmonthly.com/article/tension-empyema-2/) - A 51-year-old male with a past medical history significant for polysubstance abuse presented to the emergency department for altered mental status and peripheral edema. According to EMS, they were originally dispatched for a patient with bilateral leg edema. EMS found the patient altered and obtained a blood glucose in the 50’s. The patient was given
- [Student Mentorship for the Community Doc - Part 2](https://epmonthly.com/article/student-mentorship-for-the-community-doc-part-2/) - In part one of this series, we explored the evolving role of community-based physicians as mentors in emergency medicine, along with an overview of recent changes in the EM residency match process. In this second part, we’ll dive deeper into specific aspects of mentoring, focusing on writing impactful letters of recommendation, providing targeted guidance for
- [Director's Corner: 2025 Resolutions!](https://epmonthly.com/article/directors-corner-2025-resolutions/) - Happy New Year’s. Through the years, I’d like to think that I’ve consciously made professional and personal decisions that created positive growth at work and at home. The new year gives us an opportunity for self-reflection and a chance at a fresh start. Many New Year’s resolutions are about breaking bad habits (complete paperwork, exercise,
- [The ‘Oppositional’ Conundrum Disrupting our Current Healthcare System](https://epmonthly.com/article/the-oppositional-conundrum-disrupting-our-current-healthcare-system/) - Rising ER wait times are just one of a host of warnings of bad things yet to come; unless we can change thy stem to one of collaboration! (Technology innovation alone is not the answer) In a recent publication Aiden Feng MD notes the specter of ongoing rises in ED wait times across the U.S.,
- [Student Mentorship for the Community Doc - Part 1](https://epmonthly.com/article/student-mentorship-for-the-community-doc-part-1/) - For community physicians, mentoring medical students is often a rewarding, one-on-one experience. Without residents or other learners on shift, you get the rare chance to work closely with students, teaching them the ropes of emergency medicine in a more personal setting. This level of access not only helps them gain confidence and skills but also
- [O' Henry - Farewell to an EPM Icon](https://epmonthly.com/article/o-henry-farewell-to-an-epm-icon/) - Yesterday I learned of the passing of Dr. Greg Henry. He meant a lot to a lot of people in his roles as physician, medical society leader, and consummate educator. I feel lucky to have called him a friend, and I will miss him. One of the great experiences of my life was getting to
- [Help! A koala just bit me](https://epmonthly.com/article/help-a-koala-just-bit-me/) - A 38-year-old female with no pertinent past medical history presented to the emergency department after a koala bite to the wrist thirty minutes prior to arrival. She was bit on the left wrist on both the dorsal and volar aspect. Her pain was mild, without numbness or tingling. On initial exam, the patient had two
- [Director's Corner: Going Down the Ladder](https://epmonthly.com/article/directors-corner-going-down-the-ladder/) - Dear Director, I’ve been a chair/medical director for 7 years and am done. It was a good run, but I can’t do it anymore. I’m thinking about going back to being a pit doc. Does anyone ever do that? What do you think the pros and cons of going down the ladder look like? The
- [What Etiology of Clay-colored Stools in a Pediatric Patient?](https://epmonthly.com/article/what-etiology-of-clay-colored-stools-in-a-pediatric-patient/) - A 17-month-old female was brought to the emergency department with concern for white-greyish stool in her diaper that morning (figure 1). The parents noticed a similar stool sample several months ago but has resolved prior to her being seen by her pediatrician. The parents stated that she was a normal full-term delivery and had no
- [Op-Ed: Why Sensitivity Matters More Than Specificity in Identifying Pericardial Tamponade](https://epmonthly.com/article/op-ed-why-sensitivity-matters-more-than-specificity-in-identifying-pericardial-tamponade/) - As I was building an ultrasound lecture for emergency medicine (EM) and reviewing materials in the American College of Emergency Physicians (ACEP) Ultrasound Section, I came across an ACEP newsroom article that raised some concerns. The article discusses the diagnostic criteria for pericardial tamponade, including the variation in mitral and tricuspid valve inflow velocities during
- [PEM Rules for Newborns – Rule No. 12-17](https://epmonthly.com/article/pem-rules-for-newborns-rule-no-12-17/) - Despite being an emergency physician, it is uncommon for me to actually encounter true emergencies. As mentioned in previous issues most of what I do is not emergent or even urgent and many times less is more (see rule number 4). However, every once in a while, I do encounter true emergencies and find myself
- [Ep. 83 - Early IM Epinephrine: A Game Changer in Cardiac Arrest Treatment](https://epmonthly.com/article/ep-83-early-im-epinephrine-a-game-changer-in-cardiac-arrest-treatment/) - In this episode of EP Talk, host Mark Plaster, co-host JD Landon, and guest Marcus Kaplan PharmD discuss a groundbreaking study on the administration of intramuscular epinephrine for out-of-hospital cardiac arrest patients. https://www.youtube.com/watch?v=__jTnLh7XQI&t=128s The conversation covers the study's findings, its potential implications for emergency medical services, and the challenges of implementing this method in
- [Director's Corner: Returning to Medicine](https://epmonthly.com/article/directors-corner-returning-to-medicine/) - Dear Director, I was contacted by a doc I used to work with about a job. We have an opening, and he used to be a great doc, but he’s been out of clinical medicine for about three years and I’m wondering about credentialing, what his skill set will be like, and how much clinical
- [Train Yourself: G-tube Replacement](https://epmonthly.com/article/train-yourself-g-tube-replacement/) - An affordable and easily reproducible G-tube replacement trainer Gastrostomy tubes (G-tubes) are used for nutrition, hydration, and medication administration in patients who have difficulty with oral intake. G-tube dislodgement is a common emergency department presentation, particularly in the pediatric population, since children are prone to pulling on their G-tubes and often do not understand the
- [EPM Talk: Ep. 82 - The Role of Doppler Ultrasound in Cardiac Arrest](https://epmonthly.com/article/epm-talk-ep-82-the-role-of-doppler-ultrasound-in-cardiac-arrest/) - The video, hosted by Mark Plaster and co-host J.D. Landon, features guests Allison Cohen and Dan Ralston discussing their research on the effectiveness of Doppler ultrasound compared to manual pulse checks in cardiac arrest situations. https://youtu.be/hJ5pJZKqbK4 The discussion highlights the inaccuracy of manual palpation, with Doppler ultrasound detecting a pulse 95.4% of the time versus
- [Director's Corner: Rapid Cycle Testing](https://epmonthly.com/article/directors-corner-rapid-cycle-testing/) - Dear Director, Our ED patient flow is not working, and we cannot keep up with our patient arrival and disposition patterns. This has resulted in extended patient wait times and an increase in our LWBS rate. How can we implement sustainable changes to our processes while not overwhelming our staff or compromising quality and/or safety?
- [Closing the Gap: Emergency Physicians’ Vital Role in Treating Patients with AFib](https://epmonthly.com/article/closing-the-gap-emergency-physicians-vital-role-in-treating-patients-with-afib/) - An estimated six million people in the U.S. have been diagnosed with AFib.[1] For many, the emergency room (ER) physician is often the first person diagnosing and treating their condition. AFib is the most common type of cardiac arrhythmia,[2] and the role of the ER physician is critical to ensuring patients are set up on
- [Achieving Top-Box Patient Satisfaction through top-box patient care](https://epmonthly.com/article/achieving-top-box-patient-satisfaction-through-top-box-patient-care/) - Introduction Patient satisfaction is a double-edged sword. While we aim for our patients to be satisfied with the care we provide, leading to better health outcomes, we are often unfairly judged by administration based on patient satisfaction scores. These scores can be influenced by factors outside of our control, causing emergency physicians to perform unnecessary
- [Tension... Empyema?](https://epmonthly.com/article/tension-empyema/) - A 51-year-old male with a past medical history significant for polysubstance abuse presented to the emergency department for altered mental status and peripheral edema. According to EMS, they were originally dispatched for a patient with bilateral leg edema. EMS found the patient altered and obtained a blood glucose in the 50’s. The patient was given
- [Director's Corner: 2024 Reading List](https://epmonthly.com/article/directors-corner-2024-reading-list/) - I feel like I’m always reading though I typically only get to read books when I’m on vacation. I had a couple of great reads during a recent family trip, and I’ve been thinking about my summer vacation for months. As much as I like to read junk novels on the beach, I try to
- [EPM Talk Ep. 81 Micro Skills: Small Actions, Big Impact Part Two](https://epmonthly.com/article/epm-talk-ep-81-micro-skills-small-actions-big-impact-part-two/) - Have you ever felt like things are spinning out of control? Are you looking for ways to optimize your work-life balance? Have you lost all sense of self in the chaos of the ED? https://youtu.be/bRHWM0RAPRQ This week we discuss a HOT OFF THE PRESS book titled, "MICRO SKILLS: Small Actions, Big Impact” by two legends
- [What does FTC ban on Noncompete Clauses mean for Emergency Physicians?](https://epmonthly.com/article/what-does-ftc-ban-on-noncompete-clauses-mean-for-emergency-physicians/) - On April 23, the Federal Trade Commission voted to ban non-compete clauses against workers, deeming them an unfair method of competition and declaring them unenforceable. The ruling was codified in the Code of Federal Regulations as 16 CFR § 910 and is set to take effect in September. How will the FTC ruling will affect
- [EPM Talk Ep. 80 MicroSkills Part 1](https://epmonthly.com/article/epm-talk-ep-80-microskills-part-1/) - Have you ever felt like things are spinning out of control? Are you looking for ways to optimize your work-life balance? Have you lost all sense of self in the chaos of the ED? This week we discuss a hot off the press book titled, "MICRO SKILLS: Small Actions, Big Impact,” by two legends of
- [Hot elbow and 3-point crawl](https://epmonthly.com/article/hot-elbow-and-3-point-crawl/) - An 11-month-old otherwise-healthy male presents with his parents to the emergency department with a chief complaint of right elbow pain. He had experienced three days of fever and two days of tenderness at the right elbow prior to presentation. The patient had been discharged from two different medical centers in the previous two days as
- [EPM Talk Ep. 78 - ResusTEE with Felipe Teran](https://epmonthly.com/article/epm-talk-ep-78-resustee-with-felipe-teran/) - On this week's podcast we interview Felipe Teran (@FTeranMD) who is on the bleeding edge of resuscitative TEE in cardiac arrest and shock. https://youtu.be/QwwICC9nmG4 On this podcast Felipe walks us through several topics.... - Hear about his K23 grant and the resus TEE collaborative he is leveraging to bring us quality data on TEE in
- [Director's Corner: Sign Out Culture](https://epmonthly.com/article/directors-corner-sign-out-culture/) - Dear Director, I work in a high-volume ED and get productivity pay. While the pay is good, I’m tired of staying so long after my shift to dispo patients. I miss the days of residency where I could just sign out at the end of my shift and go home. What do you think sign
- [No False Alarm](https://epmonthly.com/article/no-false-alarm/) - The Case A 65-year-old male presented to the emergency department out of concern for bleeding from a lump at his right groin. The patient reported he had a lump at the location of his right groin for several months but was previously smaller, approximately golf ball- sized compared to how it appears today. The patient’s
- [EPM Talk Ep. 77 - Erector Spinae Plane Block](https://epmonthly.com/article/epm-talk-ep-77-erector-spinae-plane-block/) - This episode on EP Talk we get into the details of the Erector Spinae Plane Block. JD Landon (@emdocjd) walks us through the why and the "how to" of this very safe and relatively easy nerve block. https://youtu.be/GVuzahcrUeo Hit us up in the comments if you are doing this nerve block at your shop. Do
- [EPM Talk Ep.76 - Resuscitative TEE in the ED](https://epmonthly.com/article/epm-talk-ep-76-resuscitative-tee-in-the-ed/) - In this episode Mark Plaster (@epmonthly) and JD Landon (@emdocjd) review a single center series put out by a group from Toronto Canada looking at TEE in the ED for cardiac arrest and severe shock patients. https://youtu.be/LB9S0zewZnQ In their 25 patient case series they noted a significant number of management changes based off the data
- [EPM Talk Ep. 75 - Ultrasound in EM](https://epmonthly.com/article/epm-talk-ep-75-ultrasound-in-em/) - In this episode Mark Plaster (@erdocmark) and JD Landon (@emdocjd) talk about the impact that POCUS (point-of-care-ultrasound) can make in the ED. https://youtu.be/EzGEEFbZfF4 Is a US Fellowship required to feel comfortable doing POCUS? What sorts of scans are most common in the ED? Like and subscribe for more content! Is there something you want us
- [Train Yourself: Putting your best foot forward](https://epmonthly.com/article/train-yourself-putting-your-best-foot-forward/) - Utilizing a life-casted soft tissue foreign body removal trainer Managing soft tissue foreign bodies (FB) in the emergency department (ED) can be unsatisfying. Many emergency physicians (EPs) prefer not to attempt non-emergent removal and instead refer the patient for a more controlled removal, especially when the foreign body is deep or located near sensitive structures.
- [EPM Talk Ep. 74 -- How Are You Treating Blood Clots?](https://epmonthly.com/article/epm-talk-ep-74-how-are-you-treating-blood-clots/) - On this episode of EPM Talk, Mark Plaster chats with Dr. Jeff Johnson, the medical director of the Hillcrest Medical Center Emergency Department. Mark and Jeff discuss the advances in treating blood clots specifically the mechanical removal of clots. https://youtu.be/R4yPrPG9AtQ What are your experiences treating blood clots? Share your tips in the comments.
- [The Economic and Clinical Theft of Emergency Medicine](https://epmonthly.com/article/the-economic-and-clinical-theft-of-emergency-medicine/) - Emergency medicine has experienced a systematic onslaught against its’ finances for decades. This has resulted in revenue loss and practice restructuring, particularly among independent and hospital-employed groups. Today, outside industry factors also threaten the clinical structure of emergency medicine practices. These disruptors must be understood to ensure the future of the specialty, or they will
- [Management of Phantom Limb Pain in a post-traumatic upper extremity amputation](https://epmonthly.com/article/management-of-phantom-limb-pain-in-a-post-traumatic-upper-extremity-amputation/) - Exploring ultrasound guided peripheral nerve block in the emergency setting Introduction: Phantom limb pain (PLP) is a devastating sequalae of major limb amputation affecting 50% to 85% of traumatic amputation patients. Patients describe PLP intractable pain perceived as originating from the missing limb. There is no optimal pharmacologic management of PLP and many medications that
- [Director's Corner: Communicating with Our ED Group](https://epmonthly.com/article/directors-corner-communicating-with-our-ed-group/) - If anyone is still looking for a 2024 New Year’s resolution that does not involve dieting, exercising, saving money, or spending less time on social media, we have a suggestion… commit to improving communication with your team and hospital administration. Leadership requires team building, effecting change, and having others implement your vision. This can be
- [Collar Care](https://epmonthly.com/article/collar-care/) - Few procedures are more prevalent in prehospital trauma care than the application of the cervical collar. The evidence behind the application of the collar is as unstable as the cervical spine injuries hey seek to prevent. The use of the cervical collar is not benign, with known risks of increasing ICPs and complicating airway management.
- [Director's Corner: 2024 Resolutions](https://epmonthly.com/article/directors-corner-2024-resolutions/) - Happy 2024! Let’s talk about some potential resolutions! As a department chair, I find the new year brings an opportunity, or a necessity, for me to wrap up the book of business from last year and focus on goals for the current year. As an emergency physician, husband, and father, I find that it also
- [Transient Resolved Neurologic Symptoms](https://epmonthly.com/article/transient-resolved-neurologic-symptoms/) - A case of pediatric stroke after flipping on a trampoline Strokes are rare in children but require a high index of suspicion given high levels of morbidity and mortality. We present the case of a healthy seven-year-old male who presented with transient neurologic deficit. Four hours later, he was noted to have right sided facial
- [Tranq: A Veterinary Sedative That’s Gaining Traction](https://epmonthly.com/article/tranq-a-veterinary-sedative-thats-gaining-traction/) - “Tranq,” “Philly dope,” “sleep cut,” or “zombie drug;” what did your patient just tell you they took? Xylazine, an animal tranquilizer not approved for humans, is emerging as an adulterant in several drugs of abuse, most notably illicitly obtained opioids. Chemically, xylazine acts as a potent α2-adrenergic agonist, resembling tricyclic antidepressants and clonidine. This stimulation
- [Top Disruptors within Our Healthcare Systems Part 2](https://epmonthly.com/article/top-disruptors-within-our-healthcare-systems-part-2/) - There are those who still say that these ‘disruptors’ were brought on by the COVID pandemic and will now fade away (“just give it time”)? Certainly the pandemic has played a role in the disruption and destabilizing of our healthcare systems – and future pandemic preparedness must now factor in these long-term effects to our
- [Train Yourself: Pediatric Inguinal Hernia Reduction](https://epmonthly.com/article/train-yourself-pediatric-inguinal-hernia-reduction/) - Introduction Hernias are a common occurrence in infants and children, especially those born prematurely.1 Most hernias in pediatric patients are indirect hernias, which develop from a patent processus vaginalis into which the small intestine herniates via the inguinal canal.2,3 In males, this presents as a palpable lump of herniated intestine within the scrotum.3 Although some
- [Lemierre’s-like syndrome in a patient with intravenous drug use](https://epmonthly.com/article/lemierres-like-syndrome-in-a-patient-with-intravenous-drug-use/) - A 28-year-old female presented to the emergency department complaining of right-sided neck pain and swelling for the past 10 days. In addition, she stated she had neck stiffness, trismus, odynophagia, headache, difficulty breathing, right-sided chest pain and fever of 104.0 F measured at home. She had taken five days of a friend’s amoxicillin and trimethoprim-sulfamethoxazole
- [Top Disruptors within Our Healthcare Systems](https://epmonthly.com/article/top-disruptors-within-our-healthcare-systems/) - Why they are bringing the system down A recent article [1] highlights another hospital closure and the burden that this denial-of-access “meltdown” places upon the state, adjacent hospital systems, and patients – noting that “patients are going to die” as a result. Another report notes that over 630 U. S. rural hospitals are at immediate
- [Crash Cart: Bucking the Booster?](https://epmonthly.com/article/crash-cart-bucking-the-booster/) - With experts predicting another COVID surge over the holiday season, the Emergency Physicians Monthly board shared their takes on whether they're getting the latest vaccine booster shot. Mike Silverman: I'm vaccinated and boosted. Getting a booster previously has been shown to reduce mortality and we also know that the benefits of the vaccine wane. Not
- [Director’s Corner: 2023 Summer Reading List](https://epmonthly.com/article/directors-corner-2023-summer-reading-list/) - Some worthwhile reads while relaxing on vacation. The kids are out of school and my vacation is earlier than usual this summer, so I’ve been compiling my reading list for some time. If you’re looking for something to read that is entertaining, professionally interesting (but outside of our usual literature) and can enhance your skill
- [Director's Corner: Beyond the Metrics - How to Measure a Successful Practice](https://epmonthly.com/article/directors-corner-beyond-the-metrics-how-to-measure-a-successful-practice/) - I came across this article recently while searching for info on Ongoing Professional Practice Evaluations (OPPE). Evaluations was the key word that pulled up this article. While I didn't find the info I was looking for regarding OPPE, this column spoke to me about how we often use metrics to define success as an emergency
- [Rising evidence of leprosy in U.S. approaching 'endemic disease' status](https://epmonthly.com/article/rising-evidence-of-leprosy-in-u-s-approaching-endemic-disease-status/) - In Leviticus 13:43-44, the Bible references a man with a reddish-white swollen infection on his bald head, calling him a "leprous man" and "unclean." Thousands of years later, the CDC is warning of "rising evidence" of leprosy in the United States and has suggested that leprosy may now have become an "endemic disease process" in
- [Suicide Attempt by Ethylene Glycol Poisoning](https://epmonthly.com/article/suicide-attempt-by-ethylene-glycol-poisoning/) - Early recognition, treatment is critical for toxic alcohol ingestions. Introduction Toxic alcohol ingestions are potentially fatal and early recognition and treatment are critical. Importantly, a myriad of common household products like automotive antifreeze, cleaning solvents, and cooking fuels contain isopropyl alcohol, ethylene glycol and methanol. These products are inexpensive and easily accessible products and are
- [Director's Corner: Closing the Deal](https://epmonthly.com/article/directors-corner-closing-the-deal/) - Dear Director, I’m recruiting for my group and need to add a doc or two from the current resident seniors. What tips to you have? As medical directors are going on summer vacation, senior residents are finishing CVs and starting the job hunt. It’s definitely recruiting season and all medical directors should be receptive to
- [American Physician Partners is exiting the staffing market](https://epmonthly.com/article/american-physician-partners-is-exiting-the-staffing-market/) - What does this mean for its contracted physicians? American Physician Partners was founded in 2015. Its website boasts more than 2,500 physicians and APCs at 153 practice sites. Less than two years ago, APP was reportedly “gloating” to investors at how an impending glut of emergency physicians would flood the market, drive down wages, and
- [EPM Talk Ep. 73: Too Soon to talk Sudden Death?](https://epmonthly.com/article/epm-talk-ep-73-too-soon-to-talk-sudden-death/) - Is it safe to come out and talk about post-covid vaccination sudden death? Maybe not. Join Bill Sullivan and me as we talk about medical censorship and the damage done to trust in medicine. https://youtu.be/zjs0pAGQG1w
- [PEM Rules for Newborns - Rule No. 10 and 11](https://epmonthly.com/article/pem-rules-for-newborns-rule-no-10-and-11/) - Each month Yaron Ivan, MD shares some of the rules from his popular podcast about Pediatric Emergency Medicine, PEM Rules. To learn more about all of the rules, visit pemrules.com or on your favorite podcast platform. Last time I discussed some helpful rules that help me with the management of my newborn patients. This month
- [The Slippery Slope of Penalizing Medical Misinformation](https://epmonthly.com/article/the-slippery-slope-of-penalizing-medical-misinformation/) - Why licensing boards should proceed with caution In 1847, Dr. Ignatz Semmelweis presented data demonstrating a ten-fold decrease in the incidence of postpartum infections when physicians simply washed their hands. The government didn’t sanction him and his speech wasn’t censored. Instead, “experts” of the time (including Rudolf Virchow) relentlessly mocked him for daring to suggest
- [EPM Talk Ep. 72 - Who's Down with APP Preference?](https://epmonthly.com/article/epm-talk-ep-72-whos-down-with-app-preference/) - Are we committing specialty suicide by giving APP trainees preference over EM residence? Join Andy Little, Andrew Phillips, and myself as we discuss this vital topic. https://youtu.be/Nd69KJIXA_I
- [PEM Rules for Newborns](https://epmonthly.com/article/pem-rules-for-newborns/) - Each month, Yaron Ivan, MD shares some of the rules from his popular podcast about Pediatric Emergency Medicine, PEM Rules. To learn more about all of the rules, visit pemrules.com or on your favorite podcast platform. I see many newborns in the ED, sometimes newborns who are just a few hours old and were born
- [Night Shift: I Could be Wrong](https://epmonthly.com/article/night-shift-i-could-be-wrong/) - https://youtu.be/DZWT7MYEbNY I could see that my wife was troubled by something as I entered the house after coming home from work. I just assumed it was something I’d done or said so I wasn’t anxious to open that can of worms before trying to go to sleep. Finally she blurted it out. “I didn’t know
- [PEM Rules: Less is More!](https://epmonthly.com/article/ped-rules-less-is-more/) - Each month Yaron Ivan, MD shares some of the rules from his popular podcast about Pediatric Emergency Medicine, PEM Rules. To learn more about all of the rules, visit pemrules.com or on your favorite podcast platform. Rule No 4: Less is more This is probably one of the more important rules I practice each and
- [EPM Talk Ep. 71 - SnapNurse Solving Nursing Staffing Shortage](https://epmonthly.com/article/epm-talk-ep-71-snapnurse-solving-nursing-staffing-shortage/) - Have you had the experience of having a full waiting room and a half full ER because of short nursing staffing. It's a huge problem that Jeff Richards of SnapNurse has found a way to solve. https://youtu.be/2iktNVIl4K0
- [Envisioning a future for Envision after bankruptcy filings](https://epmonthly.com/article/envisioning-a-future-for-envision-after-bankruptcy-filings/) - On March 30, Envision Healthcare was awarded $91.2 million in breach of contract action against United Healthcare over allegations that United Healthcare unilaterally reduced reimbursement to Envision clinicians in violation of a network agreement. This arbitration award involved only claims from 2017 and 2018. This award highlights how some insurers may negotiate in bad faith when
- [EPM Talk Ep. 70 - ED ECMO and the future of cardiac arrest: Part 3](https://epmonthly.com/article/epm-talk-ep-70-ed-ecmo-and-the-future-of-cardiac-arrest-part-3/) - Back with Zack Shinar, MD for Part 3 on ED ECMO in cardiac arrest. We dive into the details of the intra-arrest ECMO cannula placement. https://youtu.be/PXrvNcXXdz8 What is a nurse-led code? What does a wire-assistant do? What are some cutting edge tips/tricks for accessing the femoral artery/vein intra-arrest? How do you confirm your wire placement
- [EM Coach: Animal Bites, Envenomation, and Exposure](https://epmonthly.com/article/em-coach-animal-bites-envenomation-and-exposure/) - How would you treat this bite victim? A museum snake handler was bitten on the hand while transferring snakes to a display container. He is unsure which snake bit him. Upon arrival to the emergency department, his vital signs are HR 97, BP 126/87, RR 35, SpO2 97% on room air, T 37.0°C. His exam
- [EPM Talk Ep. 69 - ED ECMO and the future of cardiac arrest: Part 2](https://epmonthly.com/article/epm-talk-ep-69-ed-ecmo-and-the-future-of-cardiac-arrest-part-2/) - In part 2 with Zack Shinar from the ED ECMO Podcast, we cover several topics surrounding ECMO. https://youtu.be/ybjP4ghLnmc What is ECMO and why are we doing it? What is Resuscitative ECMO compared to ECPR? What does the literature say about ECPR efficacy? Who should be placed on ECMO? Zack tells us about some of the
- [EPM Talk Ep. 68 - ED ECMO and the future of cardiac arrest: Part 1](https://epmonthly.com/article/epm-talk-ep-68-cpr-chat-with-zack-shinar/) - Zack Shinar is spearheading an effort to change the way we do CPR. Only this way, it really works. https://youtu.be/DpJuqK51aLc Get to know him in this interview with Mark Plaster and JD Landon of EPM Talk.
- [Director's Corner: Thinking Outside the Box part 2](https://epmonthly.com/article/directors-corner-thinking-outside-the-box-part-2/) - Last time, we looked at individual techniques to reduce medical errors and also some EMR solutions that can help. Today, we’ll look at it from a quality improvement perspective. When you are looking to improve care at your site, many lessons can be learned by reviewing individual cases. Cases come to the attention of a
- [Director's Corner: Thinking Outside the Box Part 1](https://epmonthly.com/article/directors-corner-thinking-outside-the-box/) - In this two-part series, reducing medical errors can be aided by individual efforts, system design, and the use of quality initiatives to evaluate trends and coach towards improvement. Dear Director, As part of our quality assurance program, I’ve seen an uptick in return visits where it looks like our docs could have done better the
- [EPM Talk Ep. 67 - Match Fail Scramble](https://epmonthly.com/article/epm-talk-ep-67-match-fail-scramble/) - Join the EP Talk All Stars, Mike Silverman, Bill Sullivan, Andy Little, and Mark Plaster as we dissect why EM didn't fill in the last Match Day Scramble. https://youtu.be/H6Rqbxs9lX8
- [EPM Talk Ep. 66 - Dr. Haig on the need for antibiotics](https://epmonthly.com/article/epm-talk-ep-66-dr-haig-on-the-need-for-antibiotics/) - Are you still prescribing antibiotics for every CAP? Maybe you don't need to. Join me with Dr. Nicole Haig to discuss the use of procalcitonin. https://youtu.be/AvRT9F3fPgs
- [EPM Talk Ep. 65 - Bryce Pulliam, MD on Unionizing](https://epmonthly.com/article/epm-talk-ep-65-bryce-pulliam-md-on-unionizing/) - Ever thought of unionizing? No, doctors don't strike. But there are a lot of steps to be taken before that. And there are good reasons to organize. Listen to Bryce Pulliam, MD and I discuss those reasons to find out more. https://youtu.be/_EvzK3FeEXg
- [EPM Talk Ep. 58 - Losing Licenses](https://epmonthly.com/article/epm-talk-ep-58-losing-licenses/) - EPM's legal expert and board member, Bill Sullivan, joins Mark Plaster and JD Landon to discuss his latest lawsuit with the Illinois to question its sanctions on Ivermectin and unprofessional conduct charges that in some cases are costing physicians their licenses. https://youtu.be/wp7XftXTLcw
- [Ultrasound: Traumatic horse trample](https://epmonthly.com/article/ultrasound-traumatic-horse-trample/) - Endovascular therapy should be considered in patients with persistent symptoms despite medical therapy A 40-year-old female presented to the emergency department as a category two trauma activation 1.5 hours after she fell off her horse and was stomped over her chest. The patient was evaluated at an outside hospital prior to transfer and was diagnosed
- [Don't order this blood tests in your ED](https://epmonthly.com/article/dont-order-this-blood-tests-in-your-ed/) - Fecal occult blood tests aren't appropriate for gastrointestinal bleeding Fecal occult blood tests (FOBT) are useless tests to order in the emergency department (ED) for the workup of gastrointestinal bleeding (GIB). FOBT has only been approved for the use of screening for colorectal cancer (CRC) and is frequently used “off-label” in the ED for the
- [EPM Talk Ep. 62 - Rich Fabian](https://epmonthly.com/article/epm-talk-ep-62-rich-fabian/) - Put Ultrasound guided peripheral IV placement in the hands of your nurses and techs and make a big win-win-win-win for you, your nurses, your hospital, and the patient. Join us to see how. https://youtu.be/xuX-wRHUglI
- [“Pop” in the leg](https://epmonthly.com/article/pop-in-the-leg/) - Touching up torn tendons PATIENT PRESENTATION: Patient is a 42-year-old male with no significant past medical history presented to the Emergency Department regarding right calf pain since this morning. Patient states that the pain started while he was getting ready to run, notes that he heard a "popping" sound and experienced immediate pain in the
- [2023 Match leads to heated opinions](https://epmonthly.com/article/2023-match-leads-to-heated-opinions/) - Time to step back and consider how over 500 spots did not fill opening day. With the results of the initial 2023 match in hand, we know that over 120 programs and over 500 spots did not fill on the initial day. Since the news hit social media there has been a definite backlash, with
- [Case Report: Springing a Leak](https://epmonthly.com/article/case-report-springing-a-leak/) - Incomplete gastro-cutaneous fistula presenting as focal cellulitis following Billroth II procedure. Background As part of the Billroth II procedure following antrectomy for ulcer disease or tumor, the remnant stomach is anastomosed to the proximal jejunum (figure 1), preserving jejunal but not duodenal continuity. This end-to-side attachment can be performed in an antecolic or retrocolic, isoperistaltic,
- [EPM Talk Ep. 62 - Ultrasound Guided IV Placement with Rich Fabian](https://epmonthly.com/article/epm-talk-ep-62-ultrasound-guided-iv-placement-with-rich-fabian/) - Put Ultrasound guided peripheral IV placement in the hands of your nurses and techs and make a big win-win-win-win for you, your nurses, your hospital, and the patient. Join us to see how. https://youtu.be/xuX-wRHUglI
- [Emergency Medicine – Site Medical Director (MD/DO)](https://epmonthly.com/article/emergency-medicine-site-medical-director-md-do/) - Wake Forest Emergency Providers Wake Forest Emergency Providers is seeking candidates for a site Medical Director position. We are seeking candidates with proven experience in leadership and clinical practice. This is a unique opportunity to lead a dynamic Emergency Medicine team with the support and backing of a large, regional, non-profit, academic health system. In
- [REBOA in Non-Traumatic Cardiac Arrest](https://epmonthly.com/article/reboa-in-non-traumatic-cardiac-arrest/) - Consider this. Over the last 50+ years, the house of emergency medicine and prehospital medicine has yet to significantly improve neurologically intact survival in out of hospital cardiac arrest (OHCA). Despite incredible advances in medicine, our approach to OHCA, in the form of ACLS, has gone through multiple revisions and variations without any significant improvements.
- [Irritability, Apneic Episodes and Decreased Appetite: Part 2](https://epmonthly.com/article/irritability-apneic-episodes-and-decreased-appetite-part-2/) - The true toll of bacterial meningitis. Click to read Part 1. Bacterial meningitis is an infection that results in inflammation of the meninges, subarachnoid space, and vasculature of the brain. It is a severe and truly devasting infection that requires a high index of clinical suspicion, especially in the neonatal population. The most common causes
- [Major pain in the gut](https://epmonthly.com/article/major-pain-in-the-gut/) - What etiology of chronic abdominal distention? A 53-year-old G2P2002 female with a medical history of hypothyroidism presented to her PCP for abdominal distention for three years. The patient endorsed occasional bilateral abdominal pain that she described as dull. She reported that it occurred randomly without specific provocation and was worsened by prolonged immobilization. It was
- [EPM Talk Ep. 64 - Major Kevin Maskell, US Army Medical Corps](https://epmonthly.com/article/epm-talk-ep-64-major-kevin-maskell-us-army-medical-corps/) - Do you have a lot of med school debt? Want to do something interesting, more challenging? Try serving in the US Army Medical Corps. https://youtu.be/GNRYLv4I-Ik Join me in my conversation with Major Kevin Maskell, US Army Medical Corps. You might get some interesting surprises.
- [Responsible Opioid Prescription can be a Valuable Tool in the Compassionate Care of Acute Pain in the ED](https://epmonthly.com/article/responsible-opioid-prescription-can-be-a-valuable-tool-in-the-compassionate-care-of-acute-pain-in-the-ed/) - Emergency situations can happen to anyone, and adequate pain relief is a core tenet of compassionate treatment. Prioritizing multi-modal analgesic care with the help of an opioid that has a lower MME can be an important option for appropriate patients with acute pain when alternative treatments have proved inadequate. Pain is a complex, universal, yet
- [EM Coach: Thoracic Disorders](https://epmonthly.com/article/em-coach-thoracic-disorders/) - A previously healthy 21-year-old male presents with acute right sided chest pain and shortness of breath. He states it started several hours prior to arrival, and denies any trauma, leg swelling, or previous episode. His vitals are HR 133, BP 85/60, RR 32, and SpO2 88% on room air. He is diaphoretic and appears in
- [More Than Medicine: Spidey-Sense](https://epmonthly.com/article/more-than-medicine-spidey-sense/) - Your "Spidey Sense" can be your best friend in the emergency department. Whether you're a doctor, nurse, or patient, your intuition can keep you safe and provide valuable insight into what's going on around you. Here are some tips on how to make the most of your superhero-like superpower: Listen to yourself. When something doesn't
- [Irritability, Apneic Episodes, and Decreased Appetite: Part 1](https://epmonthly.com/article/irritability-apneic-episodes-and-decreased-appetite-part-1/) - Just how common is bacterial meningitis within a neonate’s first month of life? Case Report: A 12-day-old African-American female born at 37-weeks and 3 days via vaginal delivery presented to our community emergency department (ED) for fever, decreased appetite, and fussiness. The patient’s medical history was complicated by no prenatal care and a urine drug
- [Getting a line on Ultrasound-Guided Peripheral Intravenous Placement](https://epmonthly.com/article/getting-a-line-on-ultrasound-guided-peripheral-intravenous-placement/) - Check out the latest trends and best practices in the Emergency Department Establishing peripheral intravenous (PIV) access is essential to emergency care and can often be lifesaving. However, about 35 percent of patients who present to the emergency department (ED) have difficult PIV access, particularly if traditional palpitation or landmark techniques are used, according to
- [Director's Corner: Battling Burnout](https://epmonthly.com/article/directors-corner-battling-burnout/) - Try these strategies to reduce opportunities both inside and outside of the ER that affect your wellbeing. Dear Director, I’m so burned out right now, I’m thinking about leaving emergency medicine. Is there anything I can do to save my career? Besides being on the front lines of a pandemic for nearly three years, we’ve
- [Ready for Reimbursement in 2023?](https://epmonthly.com/article/ready-for-reimbursement-in-2023/) - Here’s the new language clinicians need to learn with updated documentation guidelines A Game-Changing Era Has Arrived: Beginning in January, a paradigm shift of documentation requirements for reimbursement in Emergency Medicine will take effect. New AMA CPT guidelines will dictate what it takes to get paid optimally for the service we provide. The charting criteria
- [How to Treat Pregnant Patients in a post-Roe v. Wade Reality](https://epmonthly.com/article/how-to-treat-pregnant-patients-in-a-post-roe-v-wade-reality/) - Some strategies to avoid potentially sticky legal entanglements in providing care The following article is not legal advice. Only a licensed attorney in the state you practice can give you legal advice. The article is for educational purposes and to help with medical management of patients. Intro: One hour into your shift, with an understaffed
- [EPM Talk Ep. 61 - Point of Care EEG with Dr. Matt Kaplan](https://epmonthly.com/article/epm-talk-ep-61-point-of-care-eeg-with-dr-matt-kaplan/) - This is a game changer! Point of care EEG to rule in/out non-convulsive seizures. https://youtu.be/KvJLvlZHjEI Join Dr. Matt Kaplan and myself as we discuss this VERY important topic.
- [Director's Corner: Time to Cancel Conferences?](https://epmonthly.com/article/directors-corner-time-to-cancel-conferences/) - Are annual meetings still viable in a post-pandemic world? Dear Director, I got back from the ACEP conference and wondered what’s up with the attendance? Do you think these large conferences will ever return to pre-covid attendance? For more than 15 years, I was a regular attendee at ACEP. I loved so much of it—seeing
- [EM Coach: Traumatic Disorders](https://epmonthly.com/article/em-coach-traumatic-disorders/) - A 4-year-old male accidentally tipped over hot butter while making homemade popcorn. The extent of injury is seen in this picture. https://youtu.be/aq1kNrrTzb8 What is the next best step in management? A. Aspirate the blister B. Unroof the blister C. Wash with gentle soap and water D. Wash with gentle soap and water then apply silver
- [EPM Talk Ep. 60 – Navigating the Evolving Political Climate Post-COVID](https://epmonthly.com/article/epm-talk-ep-60-navigating-the-evolving-political-climate-post-covid/) - EPM Executive Editor Mark Plaster chats with Mike Silverman, EPM board member and Director’s Corner author, continue their discussion of navigating ER politics specifically the dangers of physicians losing their licenses over spreading disinformation. https://youtu.be/dGJwnEUk_RM
- [Night Shift: Physician Burnout - It’s Real](https://epmonthly.com/article/night-shift-physician-burnout-its-real/) - The idea that it is taboo to discuss physician mental health must cease Burnout, it seems, is often written about, but the emotions underlying burnout are seldom described. I never appreciated what “burnout” really meant, assuming the term just referred to doctors who were chronically unhappy. Maybe they couldn’t handle stress. Maybe they just needed
- [Could assaults on healthcare workers have avoidable causes?](https://epmonthly.com/article/could-assaults-on-healthcare-workers-have-avoidable-causes/) - How the involuntary hold creates violence. Nearly half of all emergency physicians report being assaulted in the emergency department during their career,[1] with many assaults resulting in significant injury or even death. Given recent studies indicating that emergency physicians lead the nation in career burnout, and the simultaneous critical shortage of nurses, [2] the threat of
- [Sneaky stenosis: start expecting a difficult airway](https://epmonthly.com/article/sneaky-stenosis-start-expecting-a-difficult-airway/) - Could your patient with remote history of COVID, now presenting with shortness of breath, have tracheal stenosis? It is certainly an uncommon but well-described complication of mechanical ventilation. Risk factors include tracheostomy and a prolonged course of mechanical ventilation, which studies report could be as short as seven days. Each of these factors characterize a
- [Pause…Reset…Transformed](https://epmonthly.com/article/pauseresettransformed/) - How a mid-career fellowship in palliative medicine refueled and refined a doctor's love for emergency medicine. I vividly recall my first taste of emergency medicine (EM) as a medical student. My quiet, “take in my surroundings” disposition was swallowed by the hustle and controlled chaos of the emergency department (ED). I started my first shift
- [EPM Talk Ep. 57 - Meet EPM's JD Landon](https://epmonthly.com/article/epm-talk-ep-57-meet-epms-jd-landon/) - Meet our newest EPM contributor, Jondavid Landon, MD., aka JD. Ultrasound trained, JD can help even an old dog like me learn some new tricks. Whatever your age or training, I suspect you can learn something. https://youtu.be/aypa9eUXpgc
- [Managing Monkeypox](https://epmonthly.com/article/managing-monkeypox/) - Avoid getting caught off guard if the latest virus swings through your ED. Medicine changed when the COVID-19 pandemic hit in 2020. Now in 2022, we are yet again facing another virus that has the potential to change the practice of Emergency Medicine (EM) – Monkeypox (MPX). MPX was endemic to Western and Central Africa
- [EPM Talk Ep. 56 - Emergency Responders are Priority with FirstNet](https://epmonthly.com/article/epm-talk-ep-55-emergency-responders-are-priority-with-firstnet/) - What does a telecommunication company have to do with health and wellness? https://youtu.be/bXbxhSutyhA Mark Plaster chats with Dr. Anna Fitch Courie of FirstNet® to discuss how FirstNet deploys mobile communications to ensure connectivity for emergency response personnel in scenarios like earthquakes, hurricanes and tornadoes, as well as how the wireless network has set up a
- [Director's Corner: Don’t Sweat the Joint Commission Survey](https://epmonthly.com/article/directors-corner-dont-sweat-the-joint-commission-survey/) - They can be stressful but are also helpful in prioritizing areas of improvement. Dear Director, It feels like forever since we have had a Joint Commission survey. What are they focusing on now? Let’s start with the basics. The Joint Commission (TJC) is an independent, not for profit organization that accredits health care organizations. You may
- ["We must learn from each disaster"](https://epmonthly.com/article/we-must-learn-from-each-disaster/) - Hurricane Ian is a reminder that preparation and management plans are key in weathering the storm. Having lived in Florida for over 30 years, I’m no stranger to hurricanes. This past week we had historic Hurricane Ian, devastating Fort Myers. It is estimated that the hurricane caused $65 billion in damages. But that’s not the
- [EPM Talk Ep. 55 - Fingering It Out with T-Ring's Bill Green](https://epmonthly.com/article/epm-talk-ep-55-fingering-it-out-with-t-rings-bill-green/) - Coming from Ireland, you can’t miss this great conversation with Bill Green, the inventor of the T-Ring and other helps to make laceration repairs as smooth, quick and painless (for you and the patient) as possible. https://youtu.be/xtqwUFdremc
- [More Than Medicine: Vulnerability](https://epmonthly.com/article/more-than-medicine-vulnerability/) - Don’t try and be a hero — ask for and be willing to receive help. Being vulnerable requires a level of trust. Trusting that the person or people you are being vulnerable with will not take advantage of your weaknesses. When we are vulnerable, we put ourselves in a position to be emotionally and physically
- [EM Coach: Environmental Exposures](https://epmonthly.com/article/em-coach-environmental-exposures/) - A 40-year-old male with an unknown medical history is brought to the emergency department by ambulance after being found unconscious in his yard on a stormy day. The patient is unresponsive and pulseless with cold, mottled extremities. His skin exam is shown below. Which of the following is the most likely inciting event in this
- [“You DO Belong Here”](https://epmonthly.com/article/you-do-belong-here/) - Turning back the doubts of Imposter Syndrome and sense of not belonging in an ED. The first patient I introduced myself to as a “doctor” informed my attending when they went to go evaluate the patient that they had not been seen by a physician all night. In all fairness, I must have looked quite
- [From Surviving the Daily Grind to Thriving](https://epmonthly.com/article/from-surviving-the-daily-grind-to-thriving/) - Five strategies to cultivate a culture of wellness. Although it seems like a lifetime ago, I recall doing medical student clerkships. In my mind, I thought, "They're only 30 days! I can do anything for 30 days!" And I did. With that mentality, I was able to tough it out through many rotations that were
- [No End in Sight?](https://epmonthly.com/article/no-end-in-sight/) - Reflecting on 30+ months of COVID and how to minimize its effects. Rewind to February of 2020, I remember myself and other members of the then EP Monthly editorial board writing an article titled “Covid Myths.” This article was meant to dispel current rumors about the severity of COVID-19 and was based on early data
- [Train Yourself: Knee-dle Aspiration](https://epmonthly.com/article/train-yourself-knee-dle-aspiration/) - A cheaper alternative to commercial knee arthrocentesis models. Picture this: you are a resident working in the emergency department in the middle of a busy shift. You find yourself staring at an angry knee joint that demands to be accessed. It’s swollen, painful and you’re worried about septic arthritis. The orthopedist wants to know cell
- [Septic Shoulder Strategies](https://epmonthly.com/article/septic-shoulder-strategies/) - Unique exam findings in handling progressive pain. A 68-year-old male with a past medical history of poorly controlled type 2 diabetes mellitus (A1c 9.1), coronary artery disease, chronic obstructive pulmonary disease, hypertension and hyperlipidemia, presented to the ED with the chief complaint of left shoulder pain for the last 14 days. The patient had a
- [Why I Canceled My ACEP Membership](https://epmonthly.com/article/why-i-canceled-my-acep-membership/) - Joining a professional medical organization provides many benefits. Members can network with other professionals who share similar interests and organizations provide access to many educational resources and conferences. Participating in a professional medical organization also allows members to work toward common goals improving the practice environment for physicians and improving the access and quality of
- ["We need our heroes to show up now"](https://epmonthly.com/article/we-need-our-heroes-to-show-up-now/) - Even as legislation makes it more challenging, physicians have to provide the best care for their patients. What are the ethical obligations of a physician when laws are in conflict with patient care? Regardless of one’s political opinion, we have reached a place where we must call upon medical ethicists to help lead the way
- [EM Coach: Shock to the System](https://epmonthly.com/article/em-coach-shock-to-the-system/) - A 30-year-old female presents to the emergency department complaining of an electric shock to her hand from a household outlet while doing electrical work on her home. https://youtu.be/GEpwexAgP4s She reports no symptoms and has a normal physical exam. Her electrocardiogram is as shown. Which of the following is the most appropriate next step in management?
- [EPM Talk Ep. 54 - Navigating ER Politics](https://epmonthly.com/article/epm-talk-ep-54-navigating-er-politics/) - EPM Executive Editor Mark Plaster chats with Mike Silverman, EPM board member and Director's Corner author, about the need for exemplary communication as the director and the art of navigating ER politics. https://youtu.be/hQTrdPQc80o
- [‘Burnout’ and the Healthcare Workplace](https://epmonthly.com/article/burnout-and-the-healthcare-workplace/) - Root cause needs to be addressed instead of the symptoms. The US Surgeon General, the AMA, ACEP and multiple other organizations have announced the need for addressing burnout in the healthcare workplace. Physicians, nurses and other healthcare providers experiencing burnout, depression and dissatisfaction were recommended to seek counseling, therapy and work towards re-achieving ‘wellness.’ The
- [Getting a Grip on Penile Fractures](https://epmonthly.com/article/getting-a-grip-on-penile-fractures/) - Surgical intervention is key to prevent sexual dysfunction. Abstract: Penile fracture is a rare urological emergency requiring prompt surgical intervention to preserve sexual function. Complications secondary to penile trauma include urethral injury, permanent erectile dysfunction and a deformed penis. We present a case of a 38-year-old male who presented to the emergency department suffering a
- [Director's Corner: Onboarding new docs](https://epmonthly.com/article/directors-corner-onboarding-new-docs/) - Dear Director, It’s been a while since we’ve added a new doc to our group. What do you recommend for orientation and onboarding procedures? Summer is great for vacations, but every medical director I know is looking forward to their new residency grads starting as much as they are looking forward to vacation. Recruitment and
- [Heat, Rhymes and MCIs](https://epmonthly.com/article/heat-rhymes-and-mcis/) - Physicians face off with triple digit weather incidents, stampede in prehospital event. Famous artists. A hundred-degree weather. False reports of gunfire. And a stampede leading to an Mass Casualty Incident (MCI) declaration by local fire and EMS. All in all, it made for an eventful music festival. Like any MCI event, there were several learning
- [EPM Talk Ep. 53 - Physician vs. Provider](https://epmonthly.com/article/epm-talk-ep-53-physician-vs-provider/) - Mark chats with Mark Langdorf and Andrew Phillips of the Western Journal of Emergency Medicine of the journal's stance on the increasingly controversial discussion on resident physician training. https://youtu.be/n2z71Zeyi9o Langdorf and Phillips explain the key differences of the training EM resident graduates receive compared to others in the medical field while some groups and hospitals
- [EPM Talk Ep. 52 -Staffing Shortages with Mike Silverman](https://epmonthly.com/article/epm-talk-ep-52-staffing-shortages-with-mike-silverman-2/) - It’s almost time for your summertime staffing shortage. Don’t miss my conversation with Mike Silverman of Director’s Corner fame on how to be ready for short staffing situations. https://youtu.be/y5NfyWemmm0
- [EPM Talk Ep.52 - Staffing Shortages with Mike Silverman](https://epmonthly.com/article/epm-talk-ep-52-staffing-shortages-with-mike-silverman/) - It’s almost time for your summertime staffing shortage. Don’t miss my conversation with Mike Silverman of Director’s Corner fame on how to be ready for short staffing situations. https://youtu.be/y5NfyWemmm0
- [Train Yourself: Pop Goes the Shoulder](https://epmonthly.com/article/train-yourself-shoulder-service/) - An inexpensive reduction trainer and demonstration model. https://youtu.be/U1MaHyeYsC0 Shoulders are the most common large joint dislocations seen in the emergency department.[1,2] Multiple effective shoulder reduction techniques have been described.[3] There is no general consensus regarding the preferred approach, and the choice is largely left to clinician preference. Techniques are typically learned by reading or watching
- [Do It Yourselfer](https://epmonthly.com/article/do-it-yourselfer/) - I’m proud of the fact that I’m self-sufficient in the emergency department. And it irritates the fire out of me to see prima donnas (read surgeons) come into the department and require the entire staff to follow them around to do little things they could do for themselves. I guess you could say that I
- [Night Shift: The Mavericks](https://epmonthly.com/article/night-shift-the-mavericks/) - I just celebrated my 70th birthday recently. It was a wonderful time with my family. But all the well wishes from my colleagues, all of whom are much smarter than I, reminded me of all the lies told about people at their funerals. It made me wonder if they knew something about my health that
- [Train Yourself: Ingrown Toenail Removal Trainer](https://epmonthly.com/article/train-yourself-ingrown-toenail-removal-trainer/) - Use this homemade trainer to improve your skills for patients with a painful toe. Most emergency physicians occasionally see patients with ingrown toenails. Conservative management of mild cases includes soaking the foot in warm water, use of topical antibiotics, proper nail-trimming technique and elevation of the corner of the nail.[1] For more severe cases, partial
- [Preventing an avoidable catastrophe](https://epmonthly.com/article/preventing-an-avoidable-catastrophe/) - ERs need focused approach for mass casualty incident management. In 2002, terrorists took 900 people hostage in theater in Moscow. The terrorists were armed with AK-47s and wore suicide vests. Explosives were placed around the entire theater, waiting for the assault by Russian special forces. Just prior to assaulting the building, the military pumped an
- [Major Changes for Emergency Physicians Monthly](https://epmonthly.com/article/major-changes-for-emergency-physicians-monthly/) - Big changes are now underway for EPM. Executive Editor Mark Plaster breaks them down and what readers can expect for 2022 and beyond. https://youtu.be/H0m7xOv2rfw
- [EM Coach: Clearing the throat](https://epmonthly.com/article/em-coach-clearing-the-throat/) - Patient presents with soreness, but which approach is best? https://youtu.be/YK37iL1HCqg Question: A 16-year-old male presents to the emergency department complaining of two days of sore throat without fever. He denies cough. Exam reveals tender submandibular and anterior cervical lymph nodes. Oral exam is as shown. Which of the following is the next best step in
- [8 Books to add to your Summer Reading List](https://epmonthly.com/article/8-books-to-add-to-your-summer-reading-list/) - I probably read more in the summer than the rest of the year combined. Summer is my time for fiction and to catch up on CME, and I also use summer to enhance my professional administrative growth. This summer’s recommended reading list is a mix that I hope will challenge you to grow personally and
- [Director's Corner: How to be a Successful Assistant Medical Director](https://epmonthly.com/article/directors-corner-how-to-be-a-successful-assistant-medical-director/) - Tips to being a department asset instead of a liability. Dear Director, I recently started as a new assistant medical director and am still figuring out how to be effective. What advice do you have for me to be a successful assistant medical director? Congratulations on the new job. Starting an administrative career is exciting
- [Should You Stay or Should You Go?](https://epmonthly.com/article/should-you-stay-or-should-you-go/) - Strategies for stabilizing your current job or migrating to a new career if it's time to leave. The healthcare sector is now overwhelmed with workers reporting burnout, dissatisfaction, noting depression and feelings of helplessness, loss of control, etc. The 2020 COVID pandemic poured more gasoline on this fire, but the problems were certainly there before
- [I don't think your child just had another accident...](https://epmonthly.com/article/i-dont-think-your-child-just-had-another-accident/) - Non-Accidental trauma is a medical and social emergency In the United States over 675,000 children suffer from abuse or neglect annually.[1] Pediatric physical abuse makes up approximately 10% of child maltreatment, with up to 2,500 annual deaths due to inflicted injuries.[2] The World Health Organization estimates abuse and/or neglect account for 13% of the 1.2
- [Train Yourself: The Inside Scoop on Removing Foreign Bodies](https://epmonthly.com/article/train-yourself-the-inside-scoop-on-removing-foreign-bodies/) - Use this technique to clear away troublesome obstacles. https://youtu.be/3qas0MyBgzM Ear canal foreign bodies commonly present to the emergency department. The first attempt at removal is the most likely to be successful, as repeated tries cause further swelling, bleeding and decreased patient cooperation.[1] Additionally, the ear canal is extremely sensitive, as the skin provides little cushion
- [Places We Go: Medical Students During COVID](https://epmonthly.com/article/places-we-go-medical-students-during-covid/) - Curriculum needs updating to unlock potential in case of unprecedented challenges like the pandemic. Introduction The role of medical students in clinical settings has changed significantly over the past two decades. An erosion of once-robust participation in clinical care has occurred, in part, due to institutional concerns regarding liability, risk, billing and safety. [1] While
- [Pulse Check: time to call the code](https://epmonthly.com/article/pulse-check-time-to-call-the-code/) - Considerations for POCUS use in cardiac arrest. You just arrived for your 6 a.m. shift and EMS calls your emergency department for a pre-arrival report – “13-month-old girl found down and last seen awake at 2 a.m.” You’ve been in this dance many times and know exactly what to do. You swiftly gather your residents,
- [Director's Corner: What’s the merit in ACLS certification?](https://epmonthly.com/article/directors-corner-whats-the-merit-in-acls-certification/) - There’s a workaround, but the risk posed to your ED might not be worth the initial convenience. Dear Director, I’m tired of the merit badges we have to produce for jobs. As a board-certified emergency physician, why do I need to take ACLS? As emergency physicians, we have a broad skill set that ranges from
- [EPM Talk Ep. 50 - Civil Discourse with Mike Silverman](https://epmonthly.com/article/epm-talk-ep-50-civil-discourse-with-mike-silverman/) - Can two doctors from different sides of the political spectrum have a civil discussion? Join Mike Silverman and Mark Plaster as they discuss, laugh, and cajole their way through an interesting exchange on a variety of topics important to emergency physicians. *Note: This podcast was recorded Dec. 14 just as the Omicron variant of the
- [More Than Medicine: Bringing Work Home](https://epmonthly.com/article/more-than-medicine-bringing-work-home/) - You just finished working a long shift that you weren’t originally scheduled for, and the shift was full of multiple complex cases and patient encounters. You come home, and your significant other is upset [1] that you had to work on your original day off. Because of your schedule being disrupted and having a tough
- [More Than Medicine: Productivity Pro-Tips](https://epmonthly.com/article/more-than-medicine-productivity-pro-tips-2/) - Maximize your time without getting burnt out. Time is one of the most precious commodities in life. What if I told you that you could get back at least an hour of your day? We all wish we had more hours in the day to accomplish the tasks we set out to complete and often
- [More Than Medicine: Productivity Pro-Tips](https://epmonthly.com/article/more-than-medicine-productivity-pro-tips/) - Maximize your time without getting burnt out. Time is one of the most precious commodities in life. What if I told you that you could get back at least an hour of your day? We all wish we had more hours in the day to accomplish the tasks we set out to complete and often
- [7 Dangerous Physician Employment Contract Terms](https://epmonthly.com/article/7-dangerous-physician-employment-contract-terms/) - Avoid these potentially significant litigious clauses that could cost millions. https://youtu.be/NjrTsOhHIys A physician employment contract is legally binding regardless if the physician understands the terms. Unfortunately, some physician contract terms create significant dangers. Below are seven contract terms that should raise both red flags and a physician’s eyebrows. Indemnification Clauses Indemnification is a legal term
- [Night Shift: Suicidal Ideations](https://epmonthly.com/article/night-shift-suicidal-ideations/) - https://youtu.be/6u31ddYnUqE “Not another suicidal patient,” the charge nurse moaned as the chief complaint of a 14-year-old registering for the ER popped up on the screen. We have no psychiatric services at our hospital and we consider ourselves lucky to be able to disposition a suicidal patient within 12 hours. Doing so usually involves 20-30 telephone calls by
- [EM Coach: Crystal Clear](https://epmonthly.com/article/em-coach-crystal-clear/) - How does ethylene glycol poisoning present? https://youtu.be/EikovRSZeNA Question Stem A 51-year-old male presents to the emergency department for intoxication. He was found altered and stumbling around the street by bystanders. He is alert, but unable to provide any history. His vital signs are HR 122, BP 98/59, RR 33, SpO2 97% on room air. On
- [The Mask Debate](https://epmonthly.com/article/the-mask-debate/) - Two EP Monthly editorial board members square off on a controversial topic. Editor-In-Chief Salim R. Rezaie, MD debates Senior Board member William Sullivan, DO, JD, on the need for masks as an effective and necessary tool in helping to stave off the Coronavirus pandemic. https://youtu.be/DkUAPojPfVU Masks Work The key is how you define work. Clearly
- [Information Gap](https://epmonthly.com/article/information-gap/) - Taking a methodical approach to the medical resuscitation of a critically-ill patient. A 78-year-old woman presented to the Emergency Department via medics. The patient had baseline dementia, and medics were uncertain of her mental status baseline. On arrival, the patient was hypothermic, hypotensive, and hypoxic; no medications or fluids were given during transport. On initial
- [You don’t have to win, just don’t lose](https://epmonthly.com/article/you-dont-have-to-win-just-dont-lose/) - It’s vital not to miss a key diagnosis than consistently being proven correct. I was introduced to “The Rules” of PEM by Dr. Richard Saladino and his team during my Pediatric Emergency Medicine Fellowship at Children’s Hospital of Pittsburgh of UPMC. This became the inspiration behind my podcast, PEM Rules. On the podcast, I reflect
- [Brain on Fire](https://epmonthly.com/article/completing-the-ed-workup-with-point-of-care-brain-monitoring/) - Nonconvulsive seizures are more prevalent than physicians realize. Trained to care for high-risk patients, emergency physicians are used to monitoring all of the critical vital signs, especially those of patients with unclear presentation. But even emergency physicians at state-of-the-art hospitals have had to forgo one crucial element of the workup of a neurologic patient: electrographic
- [Navigating a 99-Year-Old Through our Health Care System](https://epmonthly.com/article/navigating-a-99-year-old-through-our-health-care-system/) - Is ageism undermining your ED’s medical decisions? https://youtu.be/YknXpDFhiU0 Imagine: it's 6 a.m. and you go off shift in an hour. EMS brings in a 95-year-old female with abdominal pain. You go in to eyeball her and order a work up. On exam, she has a Murphy’s sign. Aside from signing the patient out at 7
- [Director's Corner: How to Quit Your Job](https://epmonthly.com/article/directors-corner-how-to-quit-your-job/) - The best way to avoid a messy departure. https://youtu.be/9BgJwf78q34 Dear Director, I’m starting to look for a new job. When should I tell my current medical director that I’m leaving? With the return of ED volume, I’m definitely seeing the job market improve and we’re seeing some movement of experienced docs go from one site
- [Rolling With COVID-19 Vaccinations](https://epmonthly.com/article/rolling-with-covid-19-vaccinations/) - An Emergency Department’s experience providing COVID-19 shots. https://youtu.be/sMgCL5GcbiI By March 2021, the State of Delaware was desperate to get more patients vaccinated. Our healthcare workers and high-risk patients were vaccinated and our vaccine clinic was beginning to look for patients around the hospital who could use the leftover doses from the clinic. ED physicians were
- [Director's Corner: Hitting the Mark](https://epmonthly.com/article/directors-corner-hitting-the-mark/) - Steps to take help improve performance of care at your department. https://youtu.be/TZASDAw-190 Dear Director, Our department quality review program hasn’t changed in 20 years and feels stale. What can I do to freshen it up and make a meaningful impact for our hospital and our patients? Managing an emergency department has become more complex over
- [Pros and Cons: Giddy Up on Ivermectin?](https://epmonthly.com/article/pros-and-cons-giddy-up-on-ivermectin/) - Editor-In-Chief Salim R. Rezaie, MD debates Senior Board member William Sullivan, DO, JD, on the use of Ivermectin in treating COVID-19. https://youtu.be/kIQwjUp7Dvk Just Say No to Ivermectin for COVID-19 Throughout the COVID-19 pandemic, numerous therapeutic agents have been repurposed and applied empirically and within clinical trials. Prophylactic medications for COVID-19 could have a huge benefit,
- [Night Shift: Chaos](https://epmonthly.com/article/night-shift-chaos/) - https://youtu.be/Rq5BkwYNrXo The ambulance blasted its grinding foghorn siren repeatedly as it rolled around the corner of the hospital to see a private vehicle blocking its path to the ambulance bay. “Get out of the damned way,” the EMT actually screamed at the old man who was unloading his hunched over wife into a wheel chair.
- [Vasculitis after COVID-19 Vaccination](https://epmonthly.com/article/vasculitis-after-covid-19-vaccination/) - Consider patients with known autoimmune conditions before treatment. A 31-year-old male with a past medical history of ulcerative colitis presented three days after receiving his first Moderna COVID-19 vaccination to the ED with a painful purpuric rash over the right deltoid region beginning two days after vaccination. He reported a raised area and pain over
- [Gut Feeling](https://epmonthly.com/article/gut-feeling/) - What is the etiology of this acute abdominal pain? A 63-year-old Caucasian male presented to the emergency department (ED) with five days of fever (maximum 40°C), three days of jaundice, malodorous urine and altered mental status. He had no significant past medical or surgical history. He had a 30-pack a year tobacco smoking history, but
- [Crash Cart: Llama antibodies fight COVID](https://epmonthly.com/article/crash-cart-llama-antibodies-fight-covid/) - REAL PHYSICIANS DISCUSS RECENT HEALTHCARE HEADLINES Have a story you want discussed? Sound off @epmonthly or email editor@epmonthly.online. Llama antibodies fight COVID https://www.upi.com/Health_News/2021/09/23/covid19-llama-antibody-human-treatment/8001632402502/ Nanobodies binding to a virus reducing viral loads in hamsters is not the same as decreasing mortality in humans. Let’s see some results in humans before jumping on yet another bandwagon that
- [Optimizing Your RVUs and Laceration Repair](https://epmonthly.com/article/optimizing-your-rvus-and-laceration-repair/) - Here’s how to strengthen your charting and reimbursement. For most emergency clinicians, providing high-quality care for our patients with lacerations is built into our DNA. Having a keen proficiency in wound management is just what we were trained to do. However, for many of us, our training did not include learning the skills of how
- [EM Coach: Solving a Rash of Problems](https://epmonthly.com/article/solving-a-rash-of-problems/) - Determining the cause of a skin breakout. https://youtu.be/BIoHNev96T4 A previously healthy 25-year-old female presents with an erythematous, maculopapular rash behind her knees, her lower back along the beltline and within the gluteal cleft shortly after a strenuous tennis match on a hot day. Which of the following is the most likely etiology of her condition?
- [EPM Talk Ep. 49 – Khan Siddiqui, MD of Hyperfine](https://epmonthly.com/article/epm-talk-ep-49-khan-siddiqui-md-of-hyperfine/) - Mark Plaster chats with Dr. Khan Siddiqui as he discusses his professional journey from implementing AI with Microsoft and creating grocery store blood pressure kiosks to his latest career as the Chief Medical Officer and Chief Strategy Officer at Hyperfine. Dr. Siddiqui shares the details of Hyperfine's portable MRI device, which has the potential to
- [Asymptomatic Hypertension = all about the follow-up](https://epmonthly.com/article/asymptomatic-hypertension-all-about-the-follow-up/) - Outpatient engagement is preferred over antihypertensive therapy in the ED. https://youtu.be/qVYMpfRFMUg Clinical Question: Is there an association between ED blood pressure levels and cardiovascular events in the subsequent two years? What They Did: Researchers performed a retrospective cohort study [1] using electronic medical records for all adults treated and discharged from the University of Alberta
- [Opioids in the ED](https://epmonthly.com/article/opioids-in-the-ed/) - When the choice, dose and route matter. https://youtu.be/fKa6z69xbBQ Opioids are one of the most common class of analgesics administered in the emergency department (ED) and prescribed at discharge. These agents exert their clinical analgesic effect by binding to the opioid receptors (mu, delta, kappa) in the brain, spinal cord and peripheral nervous system.[1] Parenteral opioids
- [D50 or D10 to Treat Hypoglycemia?](https://epmonthly.com/article/d50-or-d10-to-treat-hypoglycemia/) - One option favorably compares and is safer than its more commonly used alternative. https://youtu.be/V8Kwm15MLIU Hypoglycemia is commonly evaluated and managed in the emergency department. According to the CDC, there were 235,000 ED visits for hypoglycemia and 57,000 hospitalizations for hypoglycemia just among diabetic patients in 2016.[1,2] Compared to 7.6 million emergency department visits annually for
- [Train Yourself: Incision and Drainage](https://epmonthly.com/article/train-yourself-incision-and-drainage/) - Regardless of etiology and nomenclature, subcutaneous abscess management is often the same. https://youtu.be/Ih4pNkxum6I Soft-tissue infections are commonly encountered in the emergency department setting. While most are only minor to moderate severity, proper evaluation and management of these infections are essential to prevent possible progression/systemic toxicity. Subcutaneous abscesses, in particular, have the potential for complication and/or
- [Director's Corner: What Should I be Looking for in a Job? Part II](https://epmonthly.com/article/directors-corner-what-should-i-be-looking-for-in-a-job-part-ii/) - It’s not just about the payday. https://youtu.be/rBNikVZ3ess Dear Director, As I start my job search, what are the characteristics that I should be looking for in a job after residency? Last month we discussed the importance of location, people (including the medical director), hospital resources, the schedule and employment models when developing your priority list.
- [EM Coach: It’s Cold Outside](https://epmonthly.com/article/em-quiz-its-cold-outside/) - Treating a patient caught in snowstorm with dropping core temperature. https://youtu.be/HdjYVua8a88 Question: A 65-year-old male with a history of coronary artery disease presents to the emergency department after he and his mountaineering group were caught in a snowstorm. He is somnolent, but arousable and has a core temperature of 29°C. His EKG is shown. Which
- [Cancel Social Media?](https://epmonthly.com/article/cancel-social-media/) - Two EP Monthly editorial board members square off on a controversial topic. Editor-In-Chief Salim R. Rezaie, MD debates Senior Board member William Sullivan, DO, JD, on the benefits and downfall of social media. Social media isn't just bad, it's evil. Social media didn’t start out evil. However social media has changed from a medium in
- [Unlocking the Mystery behind Chronic Pelvic Pain](https://epmonthly.com/article/unlocking-the-mystery-behind-chronic-pelvic-pain/) - A case study in pudendal neuralgia. This is a true story involving several medical specialties, a plethora of doctor’s visits, multiple prescriptions of medication, and one depressed, anxious and nearly hopeless lady. I met Beverly nine months into her journey of chronic pain. By that time, she had been to doctors in each of the
- [Train Yourself: Getting a Hand on Chest Tube Thoracostomy](https://epmonthly.com/article/train-yourself-getting-a-hand-on-chest-tube-thoracostomy/) - Try this homemade method of ensuring proper placement. Chest tube thoracostomy is a procedure that all ED providers must feel comfortable doing. Regardless of the setting, this can be an emergent, life-saving procedure that needs to be practiced depending on the frequency a provider does them. To prevent losing skills in between exposures, we have
- [ABEM and COVID-19 Misinformation](https://epmonthly.com/article/abem-and-covid-19-misinformation/) - Organization seeks to temper the spread of statements that don’t line up with its standards. The American Board of Emergency Medicine (ABEM) recently had a Zoom seminar to update senior directors, including EPM board members, to provide updates on several important issues. ABEM president Marianne Gausche-Hill shared her thoughts with EPM on ABEM’s statement on
- [Night Shift - Due Process Demands More](https://epmonthly.com/article/night-shift-due-process-demands-more/) - This month EPM published an interview with ABEM President Marianne Gausche-Hill regarding ABEM’s decision to take action against emergency physician’s board certification for spreading COVID “misinformation.” Dr. Gausche-Hill provided additional context for ABEM’s position, but ABEM’s “stronger statement” also leaves many unanswered questions and creates potential constitutional issues in the process. ABEM’s statement cites “a
- [Heart treatment taking SCAPE](https://epmonthly.com/article/heart-treatment-taking-scape/) - Pilot study evaluated treatment with high-dose nitroglycerin and non-invasive ventilation. Hypertensive acute heart failure is a subgroup of acute congestive heart failure (CHF) patients. Physiologically, there is increased afterload and decreased venous capacitance both leading to fluid shifts resulting in pulmonary vascular congestion. Sympathetic crashing acute pulmonary edema (SCAPE) is a severe form of hypertensive
- [Director's Corner: Time to call it Quits?](https://epmonthly.com/article/directors-corner-time-to-call-it-quits/) - Focus on what is doable instead of what can’t be done. Dear Director, I’m really worried about how bad the winter is going to be. My ER is overwhelmed with volume and acuity and we’re losing nurses. I feel like I should wave the white flag and surrender as medical director. I’m considering leaving medicine
- [Not so BaSICS?](https://epmonthly.com/article/not-so-basics/) - Trial explored balanced solution vs. saline solution in critically-ill patients. One of the most common treatments in critically ill patients is the administration of intravenous fluids. Historically, 0.9% saline has been one of the most common solutions used in resuscitation. Background In 2015, we saw the publication of the SPLIT trial, which was a randomized
- [More Than Medicine: Being responsive instead of reactive](https://epmonthly.com/article/more-than-medicine-being-responsive-instead-of-reactive/) - A simple equation to overcome emotions of outcomes. Outcomes play a considerable role in our lives. Have you ever found yourself angry about an outcome, be it with a patient, something personal, about research, system-related or others? In trying to understand better how we arrive at outcomes, our team came across an equation, introduced first
- [Nebulized Ketamine for Pain Management in the ED](https://epmonthly.com/article/nebulized-ketamine-for-pain-management-in-the-ed/) - Determining efficacy of the analgesia via inhalation. https://youtu.be/A-2cUo-MCwo Background I am a big fan of ketamine analgesia. I do not believe a shift goes by when I do not use this medication to relieve pain in one or several patients in my care. It works. Maybe not all the time, but it works. And the
- [Ultrasound: Looks can be deceiving](https://epmonthly.com/article/ultrasound-looks-can-be-deceiving/) - Understanding sonographic differences in pediatric patients. https://youtu.be/UlgK6LInAps An appropriately restrained infant presents to your community hospital by ambulance directly from the scene of an MVC. The EMS crew notes that the parents are likely to arrive a few minutes later as the front doors of the vehicle are intruded. The infant is brought in still
- [Is Cooling no Longer Cool?](https://epmonthly.com/article/is-cooling-no-longer-cool/) - How to do more, not less for post-cardiac arrest patients. https://youtu.be/jK5vKF2BWK8 Background Information Hypothermia is back in the headlines. Two studies introduced this therapy back in 2002, The Treatment of Comatose Survivors of Out-of-Hospital Cardiac Arrest with induced Hypothermia and The Hypothermia After Cardiac Arrest Trial (HACA).[1] Although small, the HACA trial showed improved neurologic
- [Director's Corner: What Should I be Looking for in a Job? Part I](https://epmonthly.com/article/directors-corner-what-should-i-be-looking-for-in-a-job-part-i/) - Some factors to consider for the ideal employment scenario. https://youtu.be/UNZpj5w9RWU Dear Director, As I start my job search, what are the characteristics that I should be looking for in a job after residency? The job that works for you may be as unique as you are, as all of us consider different variables in finding
- [In Defense of Direct Laryngoscopy](https://epmonthly.com/article/in-defense-of-dl/) - Is direct laryngoscopy a dying skill? https://youtu.be/dcqt3443tCs “I will unequivocally state that it is wrong for people to practice direct laryngoscopy in 2012.” — Ron Walls on EMRAP September 2012. Those were awfully harsh words from the man who literally wrote the book on emergency airway management. This statement understandably caused a considerable amount of
- [Senate Bill 610— Lorna’s Legacy](https://epmonthly.com/article/senate-bill-610-lornas-legacy/) - Legislation takes proactive measures to promote wellness, mental health resiliency and suicide prevention for COVID-19 pandemic response healthcare professionals. https://youtu.be/7-scraCJDl4 The rates of depression, divorce, professional burnout and suicide for emergency physicians have exceeded the national average for decades. I recall being informed of this fact when I was an emergency medicine intern, and the
- [Spreading COVID misinformation proves costly](https://epmonthly.com/article/spreading-misinformation-proves-costly/) - Inaccurate COVID-19 info could lead to sanctions and revocations. https://youtu.be/JqKDEWMaZ1Q On July 29, 2021, the Federation of State Medical Boards (FSMB) announced that “Spreading COVID19 Vaccine Misinformation May Put Medical License At Risk” (https://b.link/FSMBthreat), stating that physicians may be subject to sanctions up to and including revocation of medical licensure if they disseminate COVID-19
- [More Disruption Please: ACEP Digital Health Innovators](https://epmonthly.com/article/more-disruption-please-acep-digital-health-innovators/) - Check out these ACEP20 Digital Health Innovators. In additional to the virtual lectures at ACEP20, the annual IncubatED featured a ‘shark tank’ pitch event highlighting four new digital health companies. These finalists created solutions for charting, patient triage, expert consultation and dynamic staffing. ACEP also launched ITS new EMergence podcast, which focuses on innovation for
- [Crash Cart: Amazon Alexa sued for HIPAA violations](https://epmonthly.com/article/crash-cart-amazon-alexa-sued-for-hipaa-violations/) - Real physicians discuss recent healthcare headlines. Muscle relaxants little help for low back pain https://www.bmj.com/content/374/bmj.n1446 This was a meta-analysis of 31 trials and 6,500 patients which showed very low to low evidence of improvement in low back pain using non-benzodiazepine antispasmodics. I think most physicians already realize this. However, in patients with NSAID allergies who
- [More Than Medicine: Giving more on Empty](https://epmonthly.com/article/more-than-medicine-giving-more-on-empty/) - Building happiness is better than fighting burnout. https://youtu.be/qbbmSqxeFmM Are you running on empty? At times like this, many of us are told that all we have to do to fill back up is to eat healthier, sleep more, exercise more and spend more time with the people we care about. While these are good suggestions,
- [More Disruption Please: ACEP20 Medical Device Innovators](https://epmonthly.com/article/more-disruption-please-acep20-medical-device-innovators/) - https://youtu.be/zVEkQqYciR4 During the most recent Scientific Assembly, IncubatED featured a virtual ‘shark tank’ competition highlighting four medical devices. These companies feature a portable MRI device, tools for securing IV access and draining abscesses, and point-of-care testing for coagulopathies. ACEP also launched their new EMergence podcast, which focuses on innovation for the Emergency Department. Hyperfine’s Swoop™
- [Ultrasound-Guided Peripheral Access: Part 2](https://epmonthly.com/article/ultrasound-guided-peripheral-access-part-2/) - https://youtu.be/XKJI_W2o8XY The following scene is all too familiar. You are approached by nursing because your patient does not have IV access. The patient is a middle-aged male with a history of type 1 diabetes and recurrent visits for gastroparesis and occasional diabetic ketoacidosis (DKA). Nursing has already attempted multiple times and ultrasound-guided peripheral intravenous (PIV)
- [Ticking Away](https://epmonthly.com/article/ticking-away/) - There’s more to worry about with the summer nuisance than corona and Lyme disease. https://youtu.be/TVieEFypVjI You are just starting your shift when a 74-year-old female shows up on the board. She reports three- to four-days of non-bloody diarrhea, malaise, fevers and confusion. She doesn’t appear that well, and vitals are notable for temperature 38.3oC (100.9oF),
- [Complications of Regional Anesthesia](https://epmonthly.com/article/complications-of-regional-anesthesia/) - Reviewing various management and prevention strategies for the procedure. https://youtu.be/B3AXENIMs9A A 73-year-old female presents to the Emergency Department (ED) with acute right sided hip pain after a fall at home. She states that she was walking down her staircase and tripped over the last step, landing on her right side. She was unable to bear
- [CCTA vs. Invasive Coronary Angiography in NSTEMI](https://epmonthly.com/article/ccta-vs-invasive-coronary-angiography-in-nstemi/) - Should we consider a new gold standard? https://youtu.be/-kUwfI0wStc Coronary pathology in patients with NSTEMI can range from structurally normal vessels to varying degrees of nonobstructive coronary artery disease (CAD) to extensive obstructive CAD affecting the coronary tree. The current diagnostic pathway to differentiate these different coronary pathologies is invasive coronary angiography (ICA). A routine invasive
- [Director's Corner: Succession Planning](https://epmonthly.com/article/directors-corner-succession-planning/) - Time to start preparing for the future. https://youtu.be/BpmVV0NmG_8 Dear Director, I’ve been the chair at my site for a long time. I anticipate stepping aside in a year or two. What should I be doing now to prepare to hand over the leadership reins of the department? Succession planning is the act of making sure
- [$26M Judgment Against EmCare in Wrongful Termination Lawsuit](https://epmonthly.com/article/26m-judgment-against-emcare-in-wrongful-termination-lawsuit/) - Hospitals or companies that sacrifice patient safety for corporate profits may be liable for substantial damages. https://youtu.be/ek4legfAEMk In Brovont v. KS-I Medical Services (an EmCare subsidiary), an emergency physician filed a lawsuit against EmCare for wrongful termination. The physician was fired for complaining about alleged patient safety issues. A jury awarded the physician $29 million in compensatory
- [Who gets the platelets?](https://epmonthly.com/article/who-gets-the-platelets/) - Decision-making in a community emergency medicine department. https://youtu.be/6gerJR5zGdA It is an already busy Saturday morning in my community hospital, and the following three patients are sitting in rooms 2, 3, and 4, directly in my line of sight… Room 2: A 59-year-old African American female presents for evaluation of altered mental status. She has a
- [Night Shift: Reality Testing](https://epmonthly.com/article/night-shift-reality-testing/) - https://youtu.be/O5-OYi_-rwE “Hey Dr. Plaster, we have a problem in Room 12,” the resident said taking a deep breath while shaking his head. “What’s up?” “It’s a middle aged guy with a straight forward STEMI.” “Is he crashing?” I interrupted. “Can you handle it? What are you doing standing here?” “No. He’s actually pretty stable.” “Then
- [EPM Talk Ep. 48 - Adam Power of REBOA](https://epmonthly.com/article/epm-talk-ep-48-adam-power-of-reboa/) - You could save a life from catastrophic exsanguination with a simple, recently refined device. Join Dr. Adam Power and Mark Plaster as they discuss Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA).
- [EM Coach: Bad Bite](https://epmonthly.com/article/em-coach-bad-bite/) - What culprit created this patient’s nasty lesion? https://youtu.be/I5gG68p9Q2s A 45-year-old male presents with the lesion shown below. He states that the day prior, he had been doing some trail maintenance and reached into a bush to pick up some trash. He felt a sharp pain on his hand and immediately withdrew it. The pictured wound
- [MedForums Crowdsources Knowledge](https://epmonthly.com/article/medforums-crowdsources-knowledge/) - Service aims to help healthcare providers find medical education resources. **This article was originally published in StartUp.Health.** Challenge Healthcare providers are required by law to stay up-to-date with the latest medical advancements. Doctors around the globe must complete annual continuing medical education (CME) to maintain their state licenses, hospital credentialing and membership in their specialty societies.
- [Night Shift: The Second Wave](https://epmonthly.com/article/night-shift-the-second-wave/) - Mark Plaster breaks down some of the physician weariness and frustration as the second wave of the pandemic rolls out.
- [Video Laryngoscopy First and Foremost](https://epmonthly.com/article/video-laryngoscopy-first-and-foremost/) - A counter point article to the Direct Laryngoscopy piece from Richard Cunningham, MD in the September 2021 edition of EPM.
- [EM Coach: Get Pumped!](https://epmonthly.com/article/em-coach-get-pumped/) - What’s the best approach adjuvant therapy to defibrillation? https://youtu.be/0RCF4WgQIzI A 55-year-old male with a history of atrial fibrillation and sick sinus syndrome, for which he has a pacemaker and takes amiodarone, self-presents to an emergency department triage with weakness and palpitations. Feeling nauseous, he took several leftover ondansetron pills and extra amiodarone without improvement. He
- [Ultrasound-Guided Peripheral Access: Part 1](https://epmonthly.com/article/ultrasound-guided-peripheral-access-part-1/) - Use this approach to ensure proper identification and placement of IVs. https://youtu.be/qz08EgybgJY The charge nurse walks over to your workspace and tells you, “The patient you just saw in bed 3 still needs an IV. Our nurses have tried both arms and still aren’t able to get a line. Can you put one in?” You
- [The Different Stages of an ER Doc's Career: Part I](https://epmonthly.com/article/the-different-stages-of-an-er-docs-career-part-i/) - Three very unique approaches to a pain in the pelvic area. https://youtu.be/hEt2FciKVx4 The following are possible scenarios of how Emergency Medicine physicians’ approaches to different cases can change over the course of their careers. The doctors and patients are amalgams of my own experiences and those of my colleagues. I am impressed with how well-trained
- [Director's Corner: Summer Reading](https://epmonthly.com/article/directors-corner-summer-reading/) - While enjoying some overdue down time, check out these books on leadership and personal growth. https://youtu.be/1qEmdFFAYPM It’s been a long time since most of us have had a real vacation and I don’t believe there’s any group more deserving than the emergency medicine community to chill on a beach, boat or a mountain with a
- [Oh, MYositis!](https://epmonthly.com/article/oh-myositis/) - Steps to treat patient with diabetic muscle infarction. https://youtu.be/lfDV23jsxhg HPI A 48-year-old obese female with past medical history of poorly controlled diabetes, hypertension, hyperlipidemia and hypothyroidism presents to the emergency department (ED) with a four-day history of constant and worsening left upper thigh pain. She describes the pain as sharp, throbbing, and localized to left
- [You gotta help us doc!](https://epmonthly.com/article/you-gotta-help-us-doc/) - Vertigo doesn’t have to be a dizzying proposition in your ED. https://youtu.be/uQ6qCqij4VM Vertigo can be a scary topic for emergency physicians. If you have been in the business long enough, you have heard of a patient sent home with a non-serious vertigo diagnosis, only to return with a posterior circulation stroke (PSC), moribund in a
- [Projecting the Future of Emergency Physician Workforce](https://epmonthly.com/article/projecting-the-future-of-emergency-physician-workforce/) - A variety of solutions needed to address supply/demand issues. https://youtu.be/_jIRNmr1B0g It is hard to believe that just 50 years ago, there were no board-certified emergency physicians. There were just a handful of residencies and it was unclear what the future of emergency medicine would look like. How many emergency physicians would be needed? Background A
- [A blood test for concussion](https://epmonthly.com/article/a-blood-test-for-concussion/) - A new innovation in brain injury evaluation using biomarkers. ***This article was written by one of EPM’s advertising partners as a promotional supplement.*** We don’t often use words like “breakthrough” or “game changer,” but when we do — and this is both, you don’t want to miss it. So here it is in a nutshell.
- [EM Coach: Getting on my nerves](https://epmonthly.com/article/em-coach-getting-on-my-nerves/) - What injury occurred with an elderly woman falling onto an outstretched arm? https://youtu.be/GnMgjJrTlGA A 72-year-old woman tripped and fell on an outstretched arm, sustaining the fracture depicted in the X-ray below. Which of the following nerve injuries is most commonly associated with this fracture pattern? A. Anterior interosseous nerve B. Axillary nerve C. Median nerve
- [Crash Cart: Drinking Cow Urine Prevents COVID?](https://epmonthly.com/article/crash-cart-drinking-cow-urine-prevents-covid/) - Drinking Cow Urine to Prevent COVID https://www.rt.com/news/524020-india-cow-urine-covid19/ As if it’s not hard enough to fight a pandemic in the hospitals, we also have to fight false claims on the internet too. The amount of misinformation on the internet is exhausting. Not only is there no scientific basis for this, but the possibility of picking up
- [Stuck at the top of his Mouth](https://epmonthly.com/article/stuck-at-the-top-of-his-mouth/) - Hard palate foreign body removal in the pediatric population. https://youtu.be/Z9pU8vPID5E Foreign body ingestion is a common problem in the pediatric population, but foreign body adherence to the hard palate is reported less frequently. Particular challenges in the pediatric population include the frequent lack of a clear ingestion history, inability to communicate symptoms well, and difficulty
- [Pott’s Puffy Tumor in an elderly woman](https://epmonthly.com/article/potts-puffy-tumor-in-an-elderly-woman/) - Instances are rare and early detection is essential. https://youtu.be/DlR1pJhlcis Case Patient was an 84-year-old female who presented to the urgent care complaining of painful forehead swelling for two days. She denied trauma, vision changes, sinus congestion/drainage, pharyngitis or previous episodes of similar symptoms. She also denied fever, loss of consciousness, dizziness, nausea/vomiting or balance problems.
- [Director's Corner: Navigating Staffing Shortage](https://epmonthly.com/article/directors-corner-navigating-the-staffing-shortage/) - As an applicant and director, the pandemic realities have changed the game. https://youtu.be/hVAjouLY6HU Dear Director, I have read the findings of the ACEP workforce task force and I am concerned about getting a job in 5 to 10 years. Why is the job market so tough right now and will it get better? The ACEP
- [Night Shift: Hope I don’t see you anymore](https://epmonthly.com/article/night-shift-hope-i-dont-see-you-anymore/) - https://youtu.be/myudMG9GHMI When you’ve been caring for patients in the emergency department long enough, banter with patients comes naturally. Sometimes the banter becomes a stand-up comedy routine. A child comes in after a car accident and I’ll ask “Were you driving?” If a patient getting stitches asks “Is this going to hurt,” my standard response is
- [GCS Less Than 8? Then Intubate!](https://epmonthly.com/article/gcs-less-than-8-then-intubate/) - Breaking down the old adage of GCS less than 8 and if that really warrants intubation.
- [EM Coach: Full-body Jerking](https://epmonthly.com/article/em-coach-full-body-jerking/) - What’s the next best step in treatment of this young woman? https://youtu.be/O8JOlGH1wkk A 23-year-old G1P0 EGA eight weeks female without significant medical or surgical history presents via ambulance after a witnessed episode of full-body jerking. Her husband states that she has been complaining of palpitations, nausea and vomiting for several days before the episode. She
- [EP Talk Ep. 44 - What’s Your Institutional Protocol to Get the Clot Out for VTE?](https://epmonthly.com/article/ep-talk-ep-44-whats-your-institutional-protocol-to-get-the-clot-out/) - In this episode of EP Talk, Mark talks to staff members of Manatee Memorial about blood clots.
- [Train Yourself: Simple Strategy for Suturing Setup](https://epmonthly.com/article/train-yourself-simple-strategy-for-suturing-setup/) - This homemade Laceration Trainer can quickly be assembled for practice. Lacerations are one of the most common injuries that present to the Emergency Department. As lacerations requiring repair occur frequently, all providers must be familiar with the various methods of tying sutures, as well as attaining an effective level of comfort while suturing live patients.
- [Best Short-Term Cycle for Children Facing Pneumonia?](https://epmonthly.com/article/best-short-term-cycle-for-children-facing-pneumonia/) - Is five days just as effective a treatment period as 10 days? It’s been a busy shift as you go down the hall to see the five-year-old in bed 3. Per the resident’s report, this is a previously healthy, fully-immunized boy who is here with a fever of 102. His mother reported that he had
- [Crash Cart: Another COVID-19 Myth Dies the Death](https://epmonthly.com/article/crash-cart-another-covid-19-myth-dies-the-death/) - Another COVID-19 Myth Dies the Death https://www.aier.org/article/another-covid-myth-dies-the-death/ No transmission of COVID by surface contact? Oh, no! How are we ever going to coax the germaphobes to ever come out again? – Mark Plaster, MD, JD It's good to know that Jeffrey Tucker is so prescient. These thoughts come to us from the American Institute for Economic Research,
- [Puff Puff Passing Asthma Regimen](https://epmonthly.com/article/puff-puff-passing-asthma-regimen/) - A discharge program to avoid repeat visits. An 18-year-old male presents to the emergency department due to concerns for worsening asthma. The patient is breathing okay, but has wheezing on lung auscultation and is coughing in the room. He states his inhaler was empty yesterday from increased use. Then due to school and work, he
- [EPM Talk: Ep. 45 - Jeannette Wolfe on COVID gender impact](https://epmonthly.com/article/epm-talk-ep-45-jeannette-wolfe-on-covid-gender-impact/) - Biologically men and women are definitely different when it comes to COVID, says Jeanette Wolfe, MD. But do you know how much? I didn’t. Hear some friendly banter and a lot of good info. Don't forget to rate, review and subscribe to EPM Talk.
- [EPM Talk Ep. 47 - Andreas Frank of Hillrom](https://epmonthly.com/article/epm-talk-ep-47-andreas-frank-of-hillrom/) - Mark chats with Andreas Frank, President of Frontline Care to discuss the huge advancements in the Welch Allen ophthalmoscope and otoscope.
- [Radiation and Risk](https://epmonthly.com/article/radiation-and-risk/) - The benefits of radiation exposure from diagnostic imaging requires nuance. https://youtu.be/__6AhAR6xpM I can recall as a medical student agonizing over the indications for computed tomography (CT) imaging in the emergency department. While trying to formulate my assessment and plan, I felt that ordering a CT scan was wasteful, harmful and a failure of the skills
- [It’s OK to be not OK](https://epmonthly.com/article/its-ok-to-be-not-ok/) - Why mental health care should be required, or at least strongly encouraged and incentivized. https://youtu.be/q3OKMeQa90Y Do you know that meme – the one with the cartoon dog surrounded by fire saying, “This is fine, I’m fine”? If you haven’t seen it, you can understand the sentiment. The Emergency Department can be a chaotic and under-resourced
- [Ensuring You're Insured](https://epmonthly.com/article/ensuring-youre-insured/) - Deconstructing the terms contained in a Certificate of Insurance. https://youtu.be/lcEtfwMgByE When applying for a position in a medical facility or signing medical employment contracts, physicians should request and review a “Certificate of Insurance” for the hospital program. Unfortunately, the terminology in a Certificate of Insurance (also sometimes referred to as a “Certificate of Coverage,” “Certificate
- [Diminishing the Pain](https://epmonthly.com/article/diminishing-the-pain/) - The case for ketamine with management in the ED. https://youtu.be/YVH-9WVqOAE Introduction Ketamine can be used as a non-competitive N-methyl-D-aspartate (NMDA)/glutamate receptor complex antagonist. It decreases pain by diminishing central sensitization (amplification of neural signaling within the CNS that elicits pain hypersensitivity), hyperalgesia (abnormally increased sensitivity to pain) and “wind-up” phenomenon (repetitive noxious stimulation of unmyelinated
- [More Than Medicine: Changing Culture Doesn’t have to be Chaotic](https://epmonthly.com/article/more-than-medicine-changing-culture-doesnt-have-to-be-chaotic/) - An honest evaluation can reveal why previous results weren’t cutting it. https://youtu.be/GRktdv1VaBI Change is hard; implementing successful and sustainable change is even harder. When change is implemented and doesn’t get the results we hoped for, the tendency is to view that change as a failure. But it may not be. The change you get is
- [Night Shift: Saturated](https://epmonthly.com/article/night-shift-saturated/) - https://youtu.be/xOXBaFlXi6Q Throughout my soon to be 40-year career in emergency medicine there were three things you could always count on: taxes, death and rising numbers of patients coming to the emergency department. It seemed that no matter what we did, we couldn’t keep up with the increased volume. I once knew an emergency department director
- [Director's Corner: 12 Months of COVID](https://epmonthly.com/article/12-months-of-covid/) - Reflecting on a year of uncertainty. https://youtu.be/CsilbiTEGGI As COVID-19 crept into our ERs in early 2020, my wife and I returned from the grocery store on March 13 in preparation for Maryland’s lockdown. After some wine, I made a Facebook post called an “Update from the Giant,” which included the store being low on anything
- [EPM Talk Ep. 46 - Dom Bagnoli of USACS](https://epmonthly.com/article/epm-talk-ep-46-dom-bagnoli-of-usacs/) - The physician partners of USACS bought the business back from it’s equity investors in a move that strengthens the mega-group practice and set them up for even greater success. Hear Dom Bagnoli, MD, chairman of the board discuss with me how this happened. Fascinating.
- [Crash Cart: Censorship coming for medical professionals](https://epmonthly.com/article/crash-cart/) - Censorship coming for medical professionals https://generaldispatch.whatfinger.com/censored-medical-legal-experts-viva-frei-dr-drew-zdoggmd-roundtable-rubin-report/ This is absolutely crazy. Non-medical independent fact checkers from big tech companies determining what is appropriate for medical professionals to discuss on social media?!? Censorship minimizes scientific conversation and minimizes important discussion. This not only decreases the addition of new data/knowledge, but blunts science moving forward to answer questions
- [EM Quiz: Eye pain and irritation](https://epmonthly.com/article/em-quiz-eye-pain-and-irritation/) - What’s the most likely diagnosis for this adult male? https://youtu.be/9H_EYHytSIg A 32-year-old male who recently emigrated from West Africa presents with eye pain and irritation. The pertinent physical exam is shown below. Which of the following is the most likely diagnosis? Question Answer Choices Ascariasis Loiasis Onchocerciasis Paragonimiasis Trichuriasis Question Explanation Correct answer: B. Loiasis
- [So TXA Doesn’t Stop Everything that Bleeds?](https://epmonthly.com/article/so-txa-doesnt-stop-everything-that-bleeds/) - The NoPAC Trial: Gauging the measure of effectiveness in epistaxis. https://youtu.be/8S30-muCEco Epistaxis is a common complaint seen in the emergency department. Standard care involves holding pressure, use of local vasoconstrictors, topical application of silver nitrate, cautery and if all else fails, anterior nasal packing. This final step is even more common in patients who are
- [To the ambucycle!](https://epmonthly.com/article/to-the-ambucycle/) - United Hatzalah offers fast and free response through Israel. https://youtu.be/Xr0drwXL51Q Introduction: Imagine rush hour in downtown Tel-Aviv, and an emergency call goes out for help at the scene of a motor vehicle collision. A large, white ambulance from the Magen David Adom (the “Red Shield of David”) Organization will take nine minutes to arrive. While
- [It’s Not Just About Wearing Masks](https://epmonthly.com/article/its-not-just-about-wearing-masks/) - Infection reduction goes beyond COVID-19. https://youtu.be/rU0o7ksacI0 Face masks have been such a controversial topic since the beginning of the COVID-19 pandemic. On one hand they can potentially reduce transmission of respiratory viruses as a direct barrier. On the other hand, naysayers state that there is no good evidence supporting masks and therefore they are useless.
- [George Has My Heart Racing](https://epmonthly.com/article/george-has-my-heart-racing/) - A case of DiGeorge Syndrome presenting in SVT. https://youtu.be/0avAwnVAzuE Case A previously healthy and fully immunized eight-year-old female presented to a Children’s Emergency Department with palpitations after minor chest trauma. While playing at home she was hit in the chest by her cousin, and subsequently felt a sensation of her heart racing. She additionally endorsed
- [Death From a Stuffy Nose](https://epmonthly.com/article/death-from-a-stuffy-nose/) - Complicated sinusitis can sometimes have devastating effects. https://youtu.be/tl_Bko8N-qE Background Sinusitis is inflammation of the paranasal sinus mucous membranes. It is characterized by drainage, congestion, anosmia, cough, facial tenderness or headache. Involvement of all four sinuses; maxillary, sphenoid, frontal and ethmoid is called pansinusitis. [1] Complications of sinusitis are rare, occurring in approximately 15% of complicated
- [Conventional Troponin Testing in the Evaluation of Chest Pain](https://epmonthly.com/article/conventional-troponin-testing-in-the-evaluation-of-chest-pain/) - Is it safe to do one and done? https://youtu.be/2FHmR-o_-KE History Chest pain is one of the most common reasons for Emergency Department (ED) visits. While most of these presentations are at a low risk for cardiac events, it is generally required to perform a full work-up to rule out an Acute Coronary Syndrome (ACS), including
- [Big Head, Big Problems!](https://epmonthly.com/article/big-head-big-problems/) - POCUS can be a life-saving tool that can change clinical management when used appropriately. https://youtu.be/vqMSsS1BkEc You have just arrived to the emergency department for the 6 a.m. shift. The census is low and the few patients remaining have all been dispositioned. As you finish taking sign-out, the charge nurse alerts you of a request for
- [Night Shift: A Really Unusual Year](https://epmonthly.com/article/night-shift-a-really-unusual-year/) - https://youtu.be/5u-24UI7tKI The calendar year usually starts with January and ends in December. But March 2020 to March 2021 will be remembered “the year of COVID.” This time last year we were being told that we would be under a national quarantine for “15 days to flatten the curve.” Now after a year of quarantine, over
- [EPM Talk Ep. 43 - Joe Anderson of Reflex Protect](https://epmonthly.com/article/epm-talk-ep-43-joe-anderson-of-reflex-protect/) - Personal protection in the ED as well as in the parking lot after a shift is essential. Joe Anderson, co-founder of Reflex Protect, describes the product as “silly string in a can” except that it has the kick of CS, tear gas. Don’t miss this episode.
- [EPM Talk Ep. 41 - Dr. Lisa Moreno of AAEM](https://epmonthly.com/article/epm-talk-ep-41-dr-lisa-moreno-of-aaem/) - In this installment of EPM Talk, Mark chats with Dr. Lisa Moreno, the president of the American Academy of Emergency Medicine (AAEM), a group that represents the rank and file of Emergency Medicine particularly its support of workplace fairness. Dr. Moreno explains due process and its importance for physicians pertaining to disciplinary actions. Tune
- [EPM Talk Ep. 42 - Mick Connors of Anytime Pediatrics](https://epmonthly.com/article/epm-talk-ep-42-mick-connors-of-anytime-pediatrics/) - Mark Plaster chats with Mick Connors of Anytime Pediatrics about his physician career and the creation of his company that seeks to connect patients to accessible quality healthcare in a telemed environment. Tune in and get some amazing insight on this very useful service that found even greater usage during the pandemic.
- [EM Coach: The Pathology of DVT](https://epmonthly.com/article/em-coach-the-pathology-of-dvt/) - Edema, pain and an increasingly discolored leg. https://www.youtube.com/watch?v=RKHZz38pmWI A 56-year-old woman who was diagnosed with a left lower-extremity deep vein thrombosis (DVT) six months ago presents to the emergency department complaining of persistent edema and pain. She now is showing increasing discoloration in the affected leg. The patient has been compliant with the oral anticoagulant
- [Finding the BEST Solution](https://epmonthly.com/article/finding-the-best-solution/) - Benchmark used to measure patient experience in EDs and immediate care centers. Introduction Patients who perceive their providers to be competent, compassionate and good communicators are more satisfied with their care and have better outcomes.[1] Moreover, an excellent patient experience increases caregiver trust and leads to stronger adherence to aftercare recommendations. A 2013 meta-analysis validated
- [Humanism in Death](https://epmonthly.com/article/humanism-in-death/) - A perspective on the golden moment after ending a code. https://youtu.be/3Y0ivBxWbIo “Next pulse check in 30 seconds,” the nurse announces from the corner of the resuscitation bay. As you consider all that you've done for this patient in cardiac arrest, you share with your team your next plan: if there is no pulse, no shockable
- [Diagnosing without formal imagery](https://epmonthly.com/article/diagnosing-without-formal-imagery/) - Handling the difficult detection of testicular torsion. https://youtu.be/mZjnLjlRG9g It’s around 2 a.m. on a Tuesday morning after a busy Monday evening in the emergency department. You’ve spent the majority of the evening so far putting out proverbial “fires” after coming on to cover the nocturnal shift at the local rural community hospital. The waiting room
- [COVID allowed us to see the future quicker](https://epmonthly.com/article/covid-allowed-us-to-see-the-future-quicker/) - ACEP President Mark Rosenberg continues his discussion with EPM Editor-in-Chief Salim Rezaie, Board member Mike Silverman and Managing Editor Jeffrey Lyles as he details his ideas for patient volume, innovation strategies and the controlled chaos of emergency medicine. https://youtu.be/BeALGeCAb2Y SALIM REZAIE: We all know emergency medicine is not an easy job. It’s just not. It’s
- [Breaking through the blockage](https://epmonthly.com/article/breaking-through-the-blockage/) - Diagnosing and treating acute abdominal pain s/p gastric bypass. https://youtu.be/KxXHN91HN5I A 60-year-old male presented to the emergency department with his wife via personal vehicle for acute onset of abdominal pain with associated nausea and non-bloody, non-bilious emesis that began just prior to arrival. The patient described the pain as severe, diffuse, yet sharp and stabbing.
- [Night Shift: Breaking Guidelines](https://epmonthly.com/article/night-shift-breaking-guidelines/) - https://youtu.be/_vlxGF0XSvM “Medic One is inbound to your facility with a 78-year-old male from a local nursing facility. We were called to the scene for a patient with high blood pressure and mental status changes who was being combative with staff …” The inbound ambulance report was interrupted by a telephone call which happened to be
- [Universal Imaging for All?](https://epmonthly.com/article/universal-imaging-for-all/) - The devastating consequences if Blunt cerebrovascular injury is left undiagnosed. https://youtu.be/vkFZaWnc25k Blunt cerebrovascular injury (BCVI) is defined as carotid or vertebral artery injury due to blunt trauma. There are several screening criteria that have been developed to screen for this injury, however many patients may not reliably be identified with these screening criteria. Although this
- [Director's Corner: VIP Patients in the ER](https://epmonthly.com/article/vip-patients-in-the-er/) - Sometimes cutting the line is expected and acceptable. https://youtu.be/yUm0-M1yeEU Dear Director, Our medical director and CMO frequently call in referrals of hospital VIPs and expect us to drop everything to care for them. Don’t they realize there’s a pandemic going on and we can’t stop everything for a hospital donor? Everyone ultimately needs the emergency
- [EPM Talk Ep. 40 - CLEAN3 Trial with Prof. Mimoz](https://epmonthly.com/article/epm-talk-ep-40-clean3-trial-with-prof-mimoz/) - In this installment of of EPM Talk, Mark Plaster chats with Professor Oliver Mimoz, head of the emergency department at Hôpital Universitaire de Poitiers, France and the principal researcher of the CLEAN 3 trial. The study, which was published in The Lancet Infectious Diseases, revealed a vascular care solution helped to reduce IV failures and
- [Crash Cart: Honoring COVID Cleaners](https://epmonthly.com/article/crash-cart-honoring-covid-cleaners/) - Real physicians discuss recent healthcare headlines. Cleaners perform critical work in COVID ICUs https://abcnews.go.com/Health/wireStory/sight-cleaners-perform-critical-work-covid-icus-75559448 COVID is just highlighting a group of people who are ALWAYS overlooked. When was the last time you thanked the housekeepers in your department and told them they do a good job cleaning up your trauma bay or the bathrooms or
- ['Poppers' while at a nightclub](https://epmonthly.com/article/poppers-while-at-a-nightclub/) - What’s the treatment for this male patient’s illness? A 25-year-old male presents to the emergency department for evaluation of shortness of breath. The patient reportedly used amyl nitrite “poppers” at a nightclub shortly before the onset of his symptoms. He is noted to be cyanotic. His heart rate is 120 and his respiratory rate is
- [Taking the Pain Out of Clinician Licensing](https://epmonthly.com/article/taking-the-pain-out-of-clinician-licensing/) - Physician-founded startup MOCINGBIRD fights burnout and ultimately improves patient care. Challenge By and large, healthcare workers get into medicine to take care of patients, not the paperwork. They go to school and train and train for years to heal people and save lives — not to spend nights and weekends hunched over a computer stressing
- [EM Coach: Stuck through the hand](https://epmonthly.com/article/em-coach-stuck-through-the-hand/) - Differences in complications between a hammer and a pneumatic nail gun. https://youtu.be/Sr99X082RLA A 45-year-old construction worker presents to the emergency department with a pneumatic nail gun injury to the hand. This occurred immediately prior to arrival at the emergency department. He has a limited range of motion of the fifth digit, predominantly at the MCP.
- [Night Shift: How do I get you out of here?](https://epmonthly.com/article/night-shift-how-do-i-get-you-out-of-here/) - https://youtu.be/d6f6ZPSOHSM “What can I do to get you out of here?” The familiar question from the bright-eyed day shift doc at 7 a.m. as I finish my night shift, the same question I asked my bleary-eyed colleague when I’m the one coming in. It is a specific night-to-day question, not the “you ready to sign
- [Challenges with the DIFOCCULT Trial](https://epmonthly.com/article/challenges-with-the-difoccult-trial/) - Would new paradigms result in better patient identification? https://youtu.be/r_tmZ4M6Ano Prior to the discovery of thrombolytics, clinicians could only observe their patients completing their myocardial infarctions and then classify them according to whether their subsequent ECGs developed Q waves. When trials showed a clear survival benefit with thrombolytics (especially in STE) this shifted the paradigm from
- [Diagnosing Necrotizing Fasciitis](https://epmonthly.com/article/diagnosing-necrotizing-fasciitis/) - Case proves far more than just lip service. https://youtu.be/g--mcoRUTt8 Case Presentation: A 60-year-old male with a past medical history of diabetes and hypertension presented to the ED with the chief complaint of lower lip swelling over two days. He denied any trauma to his lip, exposure to new foods, or history of food or drug
- [Train Yourself: Lateral Canthotomy](https://epmonthly.com/article/train-yourself-lateral-canthotomy/) - Learn the steps of this potential vision-saving technique. https://youtu.be/t8kc2xQZ-oQ Lateral canthotomy is an extraordinarily rare, but potentially vision-saving procedure. It is used to relieve increased intraocular pressure found in orbital compartment syndrome in the emergency setting. If not done or performed incorrectly, it is associated with severe morbidity —vision loss. Although this procedure is within
- [‘The Future of Emergency Medicine is Bright’](https://epmonthly.com/article/the-future-of-emergency-medicine-is-bright/) - New ACEP president envisions optimistic times ahead for physicians with tech, staffing and initiative enhancements. https://youtu.be/6XlaXKRa2jc Mark Rosenberg, the current ACEP president, recently spoke with EPM Editor-in-Chief Salim Rezaie and Senior Editor Michael Silverman about his vision for the organization. This is the first part of the interview concerning the fallout of the COVID-19 pandemic,
- [Sometimes it isn’t the Heart](https://epmonthly.com/article/sometimes-it-isnt-the-heart/) - Look for ECG abnormalities in SAH. https://youtu.be/UEA-uqOoQRw Case Report: A 60-year-old female with a significant past medical history of hypertension presented to the emergency department with the chief complaint of double vision, headache and elevated blood pressure. She stated she was cleaning her house a week prior to arrival when she felt an acute onset
- [COVID-19 can offer some silver linings](https://epmonthly.com/article/covid-19-can-offer-some-silver-linings/) - Finding the positives during a worldwide pandemic. https://youtu.be/W8HqGMNWmYM Viewpoint The COVID-19 Pandemic continues to dominate our lives as cases are again on the rise both in the US and in many other countries world-wide. Over 66 million global infections have been documented at the time of this writing and over 1.5 million deaths have occurred,
- [RX Pad: Allergy Sabotage](https://epmonthly.com/article/rx-pad-allergy-sabotage/) - https://youtu.be/yiEV-z6Bjsk How many times have you designed the perfect antibiotic treatment plan for a patient only to be sabotaged by an allergy flag in the electronic medical record? Beta-lactam antibiotics are often the preferred option for many bacterial infections and account for almost 60% of the total antibiotics sold in the United States.[1] However, beta-lactam
- [More Than Medicine: Just a dose of aggression is too much](https://epmonthly.com/article/more-than-medicine-just-a-dose-of-aggression-is-too-much/) - Putting out the flames of subtle jabs and misconceptions in the ED. https://youtu.be/Mo01IcLRv6s Unfortunately, microaggressions have all either had it happen to us or seen it happen to someone else. Sometimes it’s very obvious and other times extremely subtle, but these small acts called microaggressions can really tear our coworkers and us down over time.
- [Director's Corner: Coping with cut hours](https://epmonthly.com/article/directors-corner-coping-with-cut-hours/) - Mike Silverman discusses the challenges of navigating through decreased hours for staff in the midst of a pandemic.
- [Crash Cart: Earwax used to check hormone stress levels](https://epmonthly.com/article/crash-cart-earwax-used-to-check-hormone-stress-levels/) - The EPM Crash Cart team breaks down some of the latest physician headlines including studies linking earwax to stress levels.
- [When elbow pain is not so funny](https://epmonthly.com/article/when-elbow-pain-is-not-so-funny/) - Breaking down why an ultrasound to the elbow really isn't a funny manner.
- [A Tool For Risk Stratifying Admitted COVID-19 Patients](https://epmonthly.com/article/a-tool-for-risk-stratifying-admitted-covid-19-patients/) - Exploring a new option that could aid in risk stratifying COVID-
- [Remote CIED Interrogator Usage in the Emergency Department](https://epmonthly.com/article/remote-cied-interrogator-usage-in-the-emergency-department/) - Breaking myths about the potential of CEID devices and their benefits in the emergency department.
- [Director's Corner: Reducing the Length of Stay](https://epmonthly.com/article/directors-corner-reducing-the-length-of-stay/) - In the latest Director's Corner column, Mike Silverman explores different approaches to reducing your patients' length of stay.
- [Making a Stronger Hero (Act)](https://epmonthly.com/article/making-a-stronger-hero-act/) - William Sullivan breaks down the limitations of the latest Hero act, which doesn't do enough to protect physicians from losing out on due process.
- [Another Option?](https://epmonthly.com/article/another-option/) - Hyperbaric Oxygen Therapy is emerging as a new strategy in treating severe COVID-19 patients. Here's the pros and cons of this approach.
- [Night Shift: Y2K turns 21](https://epmonthly.com/article/night-shift-y2k-turns-21/) - https://youtu.be/r-Vf39At86E “Happy New Year, sweetheart,” my wife said softly as she met me at the door. Following my mandatory COVID vaccination, she had finally relented on the front porch strip tease routine and allowed me to come inside before stripping off my scrubs just before the real winter blast had hit. “How was your night?”
- [The CODA Trial — Antibiotics vs. Appendectomy](https://epmonthly.com/article/the-coda-trial-antibiotics-vs-appendectomy/) - What’s the preferred method for patients with acute appendicitis? The standard treatment for acute appendicitis is appendectomy, but what does the CODA trial reveal?
- [What does 2021 hold for EM?](https://epmonthly.com/article/what-does-2021-hold-for-em/) - The Emergency Physicians Monthly board members share their thoughts on what the future looks like in Emergency Medicine for 2021.
- [EPM Talk Ep. 37 - CT Chat with Dr. Jarvis of Abbott Labs](https://epmonthly.com/article/epm-talk-ep-37-ct-chat-with-dr-jarvis-of-abbott-labs/) - Mark Plaster chats with Dr. Jarvis of Abbott Labs about the use of CT for mild head injury in this latest installment of EPM Talk.
- [Deciphering MCP Joint Deformity](https://epmonthly.com/article/deciphering-mcp-joint-deformity/) - Joint deformity can be tricky in to decipher. Guess which solution would work best in your ED.
- [High-Yield RVU Generation in Emergency Medicine](https://epmonthly.com/article/high-yield-rvu-generation-in-emergency-medicine/) - Follow these tips to generate high-yield reimbursements even during the crush of the pandemic.
- [Your Critical Care Reimbursement and COVID-19](https://epmonthly.com/article/your-critical-care-reimbursement-and-covid-19/) - How to rise to the challenge through the pandemic. https://youtu.be/Uxe5qyJp9yM Surviving This Surge of COVID-19 — Now is the Time: Since the spring, emergency medicine groups have been maneuvering daily to stay financially afloat. While at the onset of the COVID-19 pandemic some epicenters of coronavirus disease were overwhelmed by an influx of patients, the
- [STEMI Management in COVID-19 Times](https://epmonthly.com/article/stemi-management-in-covid-19-times/) - Handling new challenges in acute coronary syndrome from the pandemic. https://youtu.be/FJdYu1kah2g Case: A 45-year-old male with past medical history of hyperlipidemia and hypertension presents to the emergency department via EMS complaining of severe substernal chest pain and shortness of breath. His ECG on arrival shows significant ST elevations (STE) in several anterior and lateral leads,
- [Splenic Infarction After Recovery From COVID-19](https://epmonthly.com/article/splenic-infarction-after-recovery-from-covid-19/) - Is a low threshold for contrasted abdominal imaging for patients following virus recommended? https://youtu.be/7-VSEqRb8a4 Background Thrombotic complications are a common presenting complaint in COVID-19 associated illnesses. This case report details the presentation and management of a patient who presented with splenic infarction after being discharged following diagnosis with COVID-19. Introduction Abdominal pain is a common
- [Re-Analysis, Reversal and Reflection](https://epmonthly.com/article/re-analysis-reversal-and-reflection/) - Getting acute ischemic stroke treatment right is better than doing it wrong. https://youtu.be/A5DNF-gRHXc The use of alteplase for acute ischemic stroke has been described as the biggest, baddest controversy in emergency medicine.[1] I have published and spoken widely on the subject and describe it as the gift that keeps on giving. Some people argue that
- [Answering the call for stoicism](https://epmonthly.com/article/answering-the-call-for-stoicism/) - Dealing with the daily disruptions. https://youtu.be/UFP5t8L0GX4 As we navigate these and future turbulent times, it’s essential to remain calm, alert and stoic. Whether you’re a busy ER physician, stressed out resident or med-student, we all are facing adversity and disruption in our daily lives. In these times, it is essential to remember the words of
- [Night Shift: A Rush to Judgment](https://epmonthly.com/article/night-shift-a-rush-to-judgment/) - https://youtu.be/pw-jcCIKzTs It was one of the first cases of the evening. I had all the time in the world in the ED to do the work up. But if the patient needed admission, we were approaching the holidays when it would be really difficult to get specialists to stop their charge out the door to
- [Director's Corner: Filling the Call Out](https://epmonthly.com/article/directors-corner-filling-the-call-out/) - Juggling last minute scheduling changes even in the midst of a pandemic. https://youtu.be/Lxw5yww5TS4 Dear Director, It doesn’t happen often, but we do have docs who get sick and call out at the last minute. I’m concerned about finding coverage, particularly if a doc needs to quarantine. What are some options for emergency backup coverage? Most
- [EPM Talk Ep. 39 - A Safer Solution](https://epmonthly.com/article/epm-talk-ep-39-a-safer-solution/) - Do you have an idea to make our practice safer? Marc Levine MD did and he made a simple device. Listen to Marc explain his product and how his idea came to market. Read more about the device here.
- [EPM Talk Ep. 38 - COVID-19: Frontline physicians produce frontline solution](https://epmonthly.com/article/epm-talk-ep-38-covid-19-frontline-physicians-produce-frontline-solution/) - I love it when real ER docs make a product out of need. Four providers in a small ER, that serves a huge population, tackled the problem of how to provide negative pressure in COVID potential patients with respiratory therapy needs. The simple elegance of their products are a real eye opener. Tune in for
- [EM Coach: Fever, malaise, rash and more](https://epmonthly.com/article/em-coach-fever-malaise-rash-and-more/) - Which lab value would you expect to be abnormal? https://www.youtube.com/watch?v=7cTaq7Tj6Ko&feature=youtu.be A fully vaccinated 7-year-old male presents to the emergency department with three days of fever and malaise after camping with his family in the woods of North Carolina. Yesterday, his mother noticed an erythematous, blanching, macular rash on the bilateral hands and feet including palms
- [ABEM President Responds to EPM Critique Calling for Greater Transparency](https://epmonthly.com/article/abem-president-responds-epm-critique-calling-greater-transparency/) - Dear Editor, In his opinion column, Nicholas Genes, MD, PhD, maintains that ABEM should set an example of transparency, particularly financial transparency. We believe we have. ABEM complies with all federal reporting requirements, making detailed Form 990 financial information available to anyone. At the recent 2017 ACEP Council, ABEM presented distributions of assets and expenses,
- [Pandemic protection](https://epmonthly.com/article/pandemic-protection/) - Physicians devise shield to offer measure of relief from virus transmission. ***This article was written by one of EPM’s advertising partners as a promotional supplement.*** The global COVID-19 pandemic has changed the way we practice medicine. Seemingly overnight routine procedures that have been performed the same way for decades have become life-threatening encounters for medical
- [Taking the bite out of epulis](https://epmonthly.com/article/taking-the-bite-out-of-epulis/) - Breaking down the various causes of the oral mass. https://youtu.be/nSs9oxiIR8A A 38-year-old African American male presented to the emergency department with an oral mass. He was struck on the mouth by a wrench handle about two years ago and since then has had a growing mass originating from the gingiva of his left front upper
- [The Oseltamivir Debacle](https://epmonthly.com/article/the-oseltamivir-debacle/) - Does the evidence demonstrate conclusive proof of benefit over harm? https://youtu.be/y-Tm8IUkBMI Oseltamivir (Tamiflu), a neuraminidase inhibitor, was approved by the FDA in 1999. The majority of the evidence supporting the use of the medication came from trials funded by Roche, the maker of the drug. Safety issues with the drug began sprouting up in 2009,
- [Like Drinking from a Firehose](https://epmonthly.com/article/like-drinking-from-a-firehose/) - Trying to keep up with the evolution of steroids during COVID-19 isn’t easy. https://youtu.be/xA21IKdls20 Since our world has been turned upside down by the COVID-19 pandemic, many of us have spent countless hours trying to process the massive amounts of data being published worldwide in attempt to stay ahead of the surge. One quick search
- [A Brief History of the Endotracheal Tube](https://epmonthly.com/article/a-brief-history-of-the-endotracheal-tube/) - Key events of the essential lifesaving tool. https://youtu.be/oDCi0aJ4zE4 Modern endotracheal tubes, airway protective devices, which promote safe passage of a wide array of gases in both medical and surgical settings, have a colorful history of development. Centuries of innovation, trial and error have created our current endotracheal airway technology. The journey began thousands of years
- [Director's Corner: Connect for Your Team’s Satisfaction](https://epmonthly.com/article/directors-corner-connect-for-your-teams-satisfaction/) - Retention interviews help to build trust between managers and their docs. https://youtu.be/LsE3uIGfaGw Dear Director, Between meetings not taking place in person and a lack of social interaction, I’m feeling really disconnected from my doc team. As a chair, I relied on those interactions to check in with everyone. How can I do it in today’s
- [Baloxavir for Household Influenza Prophylaxis?](https://epmonthly.com/article/baloxavir-for-household-influenza-prophylaxis/) - One pill to help not get ill. https://youtu.be/xAJLjQd29VI Baloxavir (trade name Xofluza) was approved for the treatment of acute, uncomplicated influenza in patients > 12 years of age in October 2018. However, high-quality data has been underwhelming at best for its efficacy in treatment. Consistent with every other study on anti-viral medications for influenza, baloxavir
- [Not So Soft](https://epmonthly.com/article/not-so-soft/) - A case report of pediatric rubber bullet injury. https://youtu.be/POeAUTHrtm0 Rubber bullet injuries are considered to be relatively rare in the United States. However, recent widespread protests combined with crowd control tactics used by police have increased the incidence of these injuries. We present a case report of a pediatric patient, who to our surprise, suffered
- [Mitigating adverse job actions due to COVID-19 part 2](https://epmonthly.com/article/mitigating-adverse-job-actions-due-to-covid-19-part-2/) - Addressing proposed reductions, terminations of contract during pandemic. https://youtu.be/JDfBxsR_Rxc Read Part 1 here. As hospitals struggle with declining patient volumes, they may request that physicians agree to reduce their hourly rates or agree to reduce staffing in the emergency departments. While agreeing to such concessions will help the hospital meet its budget and may show
- [Crash Cart: Nursing Homes Oust Unwanted Patients](https://epmonthly.com/article/crash-cart-nursing-homes-oust-unwanted-patients/) - Nursing Homes Oust Unwanted Patients With Claims of Psychosis https://www.nytimes.com/2020/09/19/business/coronavirus-nursing-homes.html This was unfortunately too common a practice before COVID-19 and even more so now. Demented patients are hard to care for as they can’t speak up for themselves and require 24/7 care, but this doesn’t mean we shouldn’t do everything we can to care for
- [EM Quiz: Ill-appearing, minimally responsive patient](https://epmonthly.com/article/ill-appearing-minimally-responsive-patient/) - What’s the next step in treatment? A 76-year-old man with a history of end stage renal disease and a prior ventricular tachycardia arrest without other arrhythmias is brought to the emergency department by ambulance after being found minimally responsive at home by a neighbor. He is minimally verbal and unable to provide any medical history.
- [EPM Talk Ep. 36 - When Minutes Matter: Dr. Este O’Daniell on Syndromic Infectious Disease Testing for Meningitis](https://epmonthly.com/article/epm-talk-ep-36-este-odaniell-on-syndromic-infectious-disease-testing/) - Dr. Este O'Daniell joins Mark Plaster to chat about syndromic infectious disease detection of meningitis/encephalitis. It could change the way you approach this deadly condition and spare some parents from stress at the thought of it impacting their children.
- [So you’ve been sprayed and gassed…](https://epmonthly.com/article/so-youve-been-sprayed-and-gassed/) - Treatment techniques for patients exposed to riot control agents. https://youtu.be/cc3qR8NpxC8 Overview: Riot control agents are non-lethal chemical compounds that are used to incapacitate exposed individuals via intense irritation of the airway, respiratory tract, eyes and skin.[1,2,3] These agents have been used as crowd control agents by law enforcement during protests, riots or civil unrest. These
- [EPM Talk. Ep 28 - He Said, She Said with Jeannette Wolfe](https://epmonthly.com/article/epm-talk-ep-28-he-said-she-said-with-jeannette-wolfe/) - “Ever wonder why more men have died of COVID 19 than women? There are a lot more differences in how men and women respond to disease than you might expect. Join me for another ‘He Said, She Said' EP Talk with Jeannette Wolfe, MD.
- [EPM Talk Ep. 15 - Getting on Call With Tim Peck](https://epmonthly.com/article/epm-talk-ep-15-getting-on-call-with-tim-peck/) - Emergency physician Tim Peck believes in looking at the problem from the ground up before proposing solutions. That’s why, when he wanted to solve the problem of unnecessary transfers from nursing homes to ERs, his first step was to move into a nursing home…for three months. The result was a company Call9. It’s a fascinating
- [The Red Flags of Impending Gallbladder Rupture](https://epmonthly.com/article/red-flags-impending-gallbladder-rupture/) - Ultrasound and subtle lab findings may convince you to admit that patient with RUQ pain. It’s another hectic day in paradise when your resident asks if she can present a case to you. The patient is a 49-year-old female who presents to the ED for abdominal pain. The patient states that three days ago she
- [The HALT-IT Trial – TXA in Acute GI Bleeds](https://epmonthly.com/article/the-halt-it-trial-txa-in-acute-gi-bleeds/) - Do the results back up the theory of its usefulness? https://youtu.be/-KsixgFF75E Background: Acute gastrointestinal bleeding (GIB) is a common diagnosis dealt with by emergency clinicians. Definitive therapy for acute GIB often includes endoscopy or surgery. Proton pump inhibitors, somatostatin analogues, antibiotics and blood products may also be instituted as part of the acute resuscitation of
- [The 65 Trial: Less is More?](https://epmonthly.com/article/the-65-trial-less-is-more/) - Determining what MAP should be targeted. https://youtu.be/P7nbxTvt634 An 85-year-old from a nursing home arrives with a blood pressure of 85/40 and a possible urinary tract infection. After a dose of antibiotics and 30 mL/kg of fluid she remains hypotensive so you start an infusion of norepinephrine. As you get up to see the next patient,
- [Telemedicine in the Age of COVID-19](https://epmonthly.com/article/telemedicine-in-the-age-of-covid-19/) - The time is now to get acquainted with the new guidelines. https://youtu.be/JSyuYw5wa1I A New Horizon for Emergency Physicians: The application of telehealth services in Emergency Medicine always seemed like an intriguing idea. It just was never practical...until now. With the arrival of COVID-19, a number of sweeping policy developments have come into play that have
- [Saving a Life by a Nose: Intranasal Naloxone](https://epmonthly.com/article/saving-a-life-by-a-nose-intranasal-naloxone/) - Prescription lacks addictive potential or danger and is a vital intervention for patients. https://youtu.be/wR4eGPEoLNc You may work in an ED deep in the heart of opioid abuse. The opioid epidemic was responsible for over 47,000 deaths in the U.S. in 2017, and over 130 people die from opioid toxicity in the U.S. daily.[1-5] Illicit fentanyl
- [Probing for cellulitis](https://epmonthly.com/article/probing-for-cellulitis/) - Tips for performing a soft tissue ultrasound for necrotizing fasciitis. https://youtu.be/H9Hh5rqbiwg You are working in the emergency department when you see a 29-year-old obese female present with right groin pain and swelling beginning three days prior. She states she came to the emergency department as her pain was getting significantly worse. She denies fever, vomiting
- [Night Shift: Fast Track](https://epmonthly.com/article/night-shift-fast-track/) - https://youtu.be/UYep77A1qZE “This is all going to end soon,” I said to my wife holding out the garbage bag for my scrubs on the front porch. What started as a funny little scene, stripping on the front porch, was beginning to wear thin, especially as the weather was cooling off. I could just see myself shivering
- [Director's Corner: COVID-era Leadership Part 2](https://epmonthly.com/article/directors-corner-covid-era-leadership-part-2/) - Essential lessons to take once the pandemic subsides. https://youtu.be/d8qkASLbj-4 (Part 2 of 2) The first few months of the COVID pandemic were among the most challenging of my career. I think my hospital and our ED did a pretty good job in gearing up to manage the influx of patients while protecting our staff. Last
- [Fundamental Attribution Error](https://epmonthly.com/article/fundamental-attribution-error/) - Avoiding the jump to conclusion mat. https://youtu.be/EQvN0DZuDgI In today’s climate it is easy to find ourselves upset or frustrated by what is going on around us. Although there are many things worth being upset about, sometimes it's important to perform a self query to see if some of our frustration may be misguided or misinformed.
- [EM Coach: CT angiogram indications](https://epmonthly.com/article/em-coach-ct-angiogram-indications/) - A patient with knee pain and is unable to bear weight A 58-year-old woman presents to the emergency department with an acute right knee injury. She reports “stepping wrong” and twisting it with a painful “pop” of the knee. She has been unable to bear weight on the extremity since the injury. Her medical history
- [Where have all of our emergency room patients gone? ](https://epmonthly.com/article/where-have-all-of-our-emergency-room-patients-gone/) - Having a sound revenue cycle plan in place to protect revenues is a must! ***This article was written by one of EPM’s advertising partners as a promotional supplement.*** When COVID-19 first struck, EDs quickly prepared for the influx of round-the-clock visitors to the emergency department by redesigning makeshift ICUs and repurposing various hospital units to
- [Crash Cart: Occult Ingested Foreign Body](https://epmonthly.com/article/crash-cart-occult-ingested-foreign-body/) - REAL PHYSICIANS DISCUSS RECENT HEALTHCARE HEADLINES Below is an excerpt from the full conversation, which is available on epmonthly.com. Have a story you want discussed? Sound off @epmonthly or email editor@epmonthly.online Fitness watches generate useful information, raises patient anxiety https://www.science.ku.dk/english/press/news/2020/fitness-watches-generate-useful-information-but-increase-patient-anxiety/ Like anything in life…too much information can be a bad thing…it’s a signal to noise
- [Invincible no more!](https://epmonthly.com/article/invincible-no-more/) - Evolution of an emergency physician in the face of a pandemic. I am emergency medicine. It lives in my blood, and it is what made and mold me into what I have become. I am a leader, resilient, innovative, dynamic, forward-thinking, unwavering in the midst of adversities and I possess what my late mentor Dr.
- [Risk Management: Focusing on Fingers](https://epmonthly.com/article/risk-management-focusing-on-fingers/) - Using a safe tourniquet to obtain a bloodless field is critical to reduce risk. ***This article was written by one of EPM’s advertising partners as a promotional supplement.*** Finger lacerations are one of the most common injuries we see. With greater than five million visits annually, they account for 4% of ED visits. These injuries
- [In the Emergency Department after the Beirut Blast](https://epmonthly.com/article/in-the-emergency-department-after-the-beirut-blast/) - **This article was originally published in Emergency Physicians International.** https://youtu.be/bZ74teg1AcA “Even when you think you know what to do after a blast, there will always be another one to push your technical, logistic and emotional boundaries.” It was Aug. 5, the day after an explosion rocked downtown Beirut. Amin Antoine Kazzi, a professor of Clinical
- [EM Coach: Sicker than Sick](https://epmonthly.com/article/sicker-than-sick/) - Deciphering sequela of multiple diseases. https://www.youtube.com/watch?v=TZw-6h2JXJQ&feature=youtu.be A 75-year-old female with multiple comorbidities — stage IV lung cancer, hypertension, coronary artery disease and diabetes mellitus type 2 — presents with confusion and septic shock. She is febrile, tachycardic and hypotensive. Her urinalysis is consistent with a significant urinary tract infection. Her serum labs also show leukocytosis,
- [Night Shift: Lone Ranger](https://epmonthly.com/article/night-shift-lone-ranger/) - Pain-in-the-neck risk analysis https://youtu.be/WY76ju9YdRM “Stop right there big boy, and take everything off!” my wife said meeting me on the front porch. She sounded more like a Marine Corps Commanding Officer than my wife of 46 years. Well, actually my CO was a bit nicer. “You know to doff your coat and scrubs without contaminating
- [Winter is Coming](https://epmonthly.com/article/winter-is-coming/) - Time to stop reacting to COVID challenges and become proactive in order to thrive. https://youtu.be/Z124voQrScs I have over 15 years of clinical experience in Emergency Medicine and never did I imagine I would witness the significance that one illness could have on such a global scale. I am working in one of the epicenters of
- [RX Pad: Mad as a hatter or right on?](https://epmonthly.com/article/rx-pad-mad-as-a-hatter-or-right-on/) - A how-to guide for physostigmine reversal of anticholinergic toxicity. https://youtu.be/G-TzgRWlZWo A 22-year-old female is brought to the Emergency Department for altered mental status by her boyfriend. Vitals: HR 150-160; BP: 146/82; Temp 99.6°F orally. On physical exam her pupils are dilated to 6 mm and sluggishly reactive to light, she has mumbled, disorganized speech and
- [Director's Corner: Leadership in the Age of COVID  Part 1 of 2](https://epmonthly.com/article/directors-corner-leadership-in-the-age-of-covid-part-1-of-2/) - What lessons can you take with you once the pandemic subsides? https://youtu.be/xANNt4FioBM (Part 1 of 2) Raise the warning flag Last fall I wrote about crisis recognition and defined it as being ill prepared for managing the situation. There’s not a lot of crises in our world. We are the crisis experts within the hospital.
- [Can they do That?](https://epmonthly.com/article/can-they-do-that/) - Mitigating Adverse Job actions due to the COVID Crisis. https://youtu.be/T3mxt5VCiY0 COVID isn’t just making patients ill, it is dramatically affecting the job market. A May 2020 article in Business Insider described how Google rescinded more than 2,000 job offers due to uncertainty from the coronavirus.[1] Google and other companies including Yelp, Glassdoor and the National
- [Burnout from Flame to Ashes](https://epmonthly.com/article/burnout-from-flame-to-ashes/) - Avoiding the stress inducing pitfalls that can lead to a wipe out. https://youtu.be/8KHYbLghNKQ This is a story of my transformation Transformation From Transformation To A proud & exuberant EM PGY 1 A disgraceful PGY2 who saw no esteem in EM A cheerful, kind team player A grumpy bully insulting doctors and nurses A
- [EPM Talk Ep. 35 - Weathering the ED Volume Storm with DuvaSawko](https://epmonthly.com/article/epm-talk-ep-35-weathering-the-ed-volume-storm-with-duvasawko/) - I never thought I’d see it happen, but even EM has taken a big hit from Covid-19 resulting in lower ED volumes, revenues, and even layoffs. This might be semi-permanent. What can we do? Listen in to my conversation with Charles "Chuck" Duva of DuvaSawko for a great way to weather the storm.
- [EPM Talk Ep. 34 - Putting it Together with Pulsara](https://epmonthly.com/article/epm-talk-ep-34-putting-it-together-with-pulsara/) - Ever had a phone to both ears talking to two different parties about the same case trying to coordinate care? I have and it’s maddening. Listen in to this conversation with Dr. James Woodson, founder of Pulsara, and learn about a new platform that connects everyone on the team in a smooth seamless manner. It’s
- [EPM Talk Podcast Ep. 33 - Combating Viral Transmission with the Aerosolve Helmet](https://epmonthly.com/article/epm-talk-podcast-ep-33-combating-viral-transmission-with-the-aerosolve-helmet/) - Mark chats with Ben Bassin, Sridhar Kota and Nathan Haas, part of a team from the University of Michigan that has recently created a portable negative pressure procedural tent as well as isolation helmet to reduce the possibility of COVID-19 viral transmission to healthcare providers during aerosol generating procedures (AGPs). Get the scoop on the
- [Crash Cart: Scent Dogs Detecting COVID-19](https://epmonthly.com/article/crash-cart-scent-dogs-detecting-covid-19/) - Scent Dogs Detecting COVID-19 https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05281-3 I had to read this paper three times to make sure this wasn’t a joke. Scent dogs identify COVID-19 with a sensitivity of 82.6% and specificity of 96.4%. This is even better than the current SARS-CoV-2 tests we have now. Two thoughts come to mind after reading this trial: 1)
- [An Elegantly Simple Solution to Protection](https://epmonthly.com/article/an-elegantly-simple-solution-to-protection/) - Protective shield device proves beneficial in COVID coverage. *This article was written with one of EPM’s advertising partners as a promotional supplement.* I was recently contacted by emergency physician, Dr. Marc Levine about his new product — The Pro-Tect Mobile Shield. Levine co-developed with his brother-in-law, Dr. Abe Bronner, a dental clinician. After experiencing a
- [Why I opted to work for a humanitarian organization in a war-torn country](https://epmonthly.com/article/why-i-opted-to-work-for-a-humanitarian-organization-in-a-war-torn-country/) - Well, I could say the main reason is because I want to eliminate human suffering and be “the savior of the world,” but that would only be partially true. For me the reason is also to fill a void, to find answers, created by a certain personal loss. The need for adventure — and the
- [A Signal of Hope?](https://epmonthly.com/article/a-signal-of-hope/) - Convalescent Plasma Therapy offers reasons for optimism in COVID-19 treatment. https://youtu.be/XYASqKAAnTg Unfortunately, when it comes to treatment options for COVID-19, the results thus far have been far from promising. Convalescent plasma therapy (CPT) is not a new or novel therapeutic option. It involves taking the plasma from patients who have recovered from an illness and
- [COVID-19 Related Respiratory Failure: A Non-Invasive Approach](https://epmonthly.com/article/covid-19-related-respiratory-failure-a-non-invasive-approach/) - Exploring a controversial procedure in treating pandemic. https://youtu.be/vRjCGwvt3S0 Background Novel coronavirus disease of 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can precipitate a spectrum of respiratory compromise from mild illness to severe respiratory failure. [1,2] The use of high flow nasal cannula (HFNC) or non-invasive positive pressure ventilation (NIV) in
- [Director's Corner: I Just Want my Weekend!](https://epmonthly.com/article/directors-corner-i-just-want-my-weekend/) - Navigating the tricky minefield of email communication. https://youtu.be/zXXLTWosPgM Dear Director, My medical director likes to send out emails with things I need to do on weekends, and it drives me crazy. The last thing I want to do on my weekend is think about work. I got into emergency medicine thinking I wouldn’t have an
- [No, it’s not a Migraine](https://epmonthly.com/article/16359/) - Breaking down the head pain of Occipital Neuralgia. https://youtu.be/cqzzujm_10I Introduction: This is not an academic review on headaches, but rather an attempt to bring awareness to a condition often unrecognized and misdiagnosed, and therefore untreated. Occipital Neuralgia (ON) is a type of head pain that offers a great combination of easy diagnosis, and effective and
- [Searching for Therapeutic Options to Fight SARS-CoV-2](https://epmonthly.com/article/searching-for-therapeutic-options-to-fight-sars-cov-2/) - Hydroxychloroquine is ineffective as Post-Exposure Prophylaxis. https://youtu.be/XHnkJYrGd2c Background Early in the COVID-19 pandemic, there was great excitement around the use of chloroquine (CQ) and its derivative, hydroxychloroquine (HCQ), as potential therapies. Both medications have shown in vitro activity against SARS-CoV, the virus responsible for the 2005 SARS epidemic, and SARS-CoV-2, the virus responsible for COVID-19
- [Patient Volume amidst the Coronavirus Pandemic](https://epmonthly.com/article/patient-volume-amidst-the-coronavirus-pandemic/) - https://youtu.be/hU2YDAeg9uY Health care is proving vulnerable during the Coronavirus-induced recession. Near the end of January, emergency departments across the country were nearing the end of the winter flu season and families were getting ready making plans for the upcoming Spring break. As an emergency physician, I was glad it was mild despite early concerns by
- [Three Traits of Inclusion](https://epmonthly.com/article/three-traits-of-inclusion/) - Are you considering these big ideas in your efforts? https://youtu.be/lzgUtjeeq2Y What do you think of when you hear the word inclusion? When you examine your life (friends, co-workers, workgroups, personal board of directors, etc.) do you see yourself being inclusive? Now more than ever it is important that we reflect and consider this in our
- [Night Shift: The Right Kind of Distance](https://epmonthly.com/article/night-shift-the-right-kind-of-distance/) - https://youtu.be/w6paTSPNREI I once knew an emergency physician who would do anything he could to avoid touching his patients. In today’s environment of contagious disease he might be considered ahead of his time. But it wasn’t that he was afraid of getting or giving an infectious disease or even being afraid of touching a patient so
- [EPM Talk Ep. 32 - Healing with Hemigard](https://epmonthly.com/article/epm-talk-ep-32-healing-with-hemigard/) - Mark Plaster chats with Bill Lear, co-founder of the Hemigard Adhesive Retention Suture Device, which could be a game-changer in terms of smoothly protecting the skin from tearing and allowing sutures to be retained even longer.
- [Syndromic Testing for Meningitis/Encephalitis: A Game Changer](https://epmonthly.com/article/syndromic-testing-for-meningitis-encephalitis-a-game-changer/) - Time frame for results can shift from days to hours. ***This article was written by one of EPM’s advertising partners as a promotional supplement.*** Syndromic testing is a symptom-driven, broad grouping of probable pathogens into a single, rapid diagnostic test. When a patient is suspected of meningitis/encephalitis, traditional CSF culture methods can take up to
- [Crash Cart: How Accurate is Dr. Google?](https://epmonthly.com/article/crash-cart-how-accurate-is-dr-google/) - Study on accuracy of Dr. Google https://www.onlinelibrary.wiley.com/doi/full/10.5694/mja2.50600 The internet, specifically search engines (Google and others) can be a great source of medical information, but it is not set up to input symptoms and output an accurate diagnosis. Maybe someday, but not yet and we are not anywhere close, which is supported by the numbers in the
- [Saving Vena Amoris](https://epmonthly.com/article/saving-vena-amoris/) - One device to the rescue. ***This article was written by one of EPM’s advertising partners as a promotional supplement.*** How do you remove a ring that is stuck on someone’s finger? Easy. You cut it off… uh, the ring. Not the finger! Right? I’ve done it hundreds, if not thousands of times. But then it
- [EM Coach: Sudden onset chest pain](https://epmonthly.com/article/sudden-onset-chest-pain/) - What’s the next step in management for this elderly patient? https://youtu.be/uyOaLM7oHgc A 72-year-old male with a history of hypertension, coronary artery disease and diabetes mellitus type 2 presents with sudden onset chest pain radiating to his back. His ECG is below. A stat CT chest angiogram shows an acute Stanford type A aortic dissection. His
- [EPM Talk Ep. 31 - Finding the range with Wilson Electronics' Fleet Signal Boosters](https://epmonthly.com/article/epm-talk-ep-31-finding-the-range-with-wilson-electronics-fleet-signal-boosters/) - As we become more and more dependent on cellular service for personal as well as professional use, we cannot afford to have holes in coverage. Join Mark Plaster as he chats with Terri Wolcott of Wilson Electronics about the company's Fleet Signal Boosters for a discussion of how you can get coverage anywhere any time.
- [Addressing ED Workplace Violence](https://epmonthly.com/article/addressing-ed-workplace-violence/) - Dealing with an often unrepresented issue starts with prevention and care collaboration. https://youtu.be/_AVKnjgp7CE Sexual assault, physical assault and other forms of violence in the emergency department (ED) no longer shock clinicians — especially those who work in understaffed, high-volume hospitals. Alarmingly, many healthcare workers come to expect workplace violence, so much so that it is
- [Director's Corner - Who works the COVID Unit?](https://epmonthly.com/article/who-works-the-covid-unit/) - Front line communication and coordination is essential in protecting your team. https://youtu.be/igf1hDGzY8Q Dear Director, I have a couple of docs who are older or are at higher risk of a bad outcome if they get COVID and have asked not to see these patients. What do you think? We have about 200 people who work
- [Trauma Transfer Pearls](https://epmonthly.com/article/trauma-transfer-pearls/) - Juggling management challenges when handling an agitated patient. https://youtu.be/JRhudXR7Qvk When trauma rolls into the non-trauma center, it can create a number of management challenges. A lot will be dictated by your hospital, EMS system and transport times. When the patient is in extremis, a lot of decisions become simple. Yet, a lot of patients fall
- [The Metabolic Cocktail: Neither Shaken nor Stirred](https://epmonthly.com/article/the-metabolic-cocktail-neither-shaken-nor-stirred/) - How effective did trials prove in determining quicker septic shock resolution? https://youtu.be/5zg2FSLrH98 Background Information Sepsis, defined as a dysregulated host’s response to infection, is responsible for millions of deaths worldwide. Two independent cohort studies found that sepsis contributed to one in every two to three deaths.[1] Patients who develop septic shock substantially increase their mortality
- [Crash Cart: Providers Rally in Support of Black Lives Matter Movement](https://epmonthly.com/article/crash-cart-providers-rally-in-support-of-black-lives-matter-movement/) - REAL PHYSICIANS DISCUSS RECENT HEALTHCARE HEADLINES Below is an excerpt from the full conversation, which is available on epmonthly.com. Have a story you want discussed? Sound off @epmonthly or email editor@epmonthly.online https://youtu.be/fFmSSLy7EfQ Across the country, providers rally in support of Black Lives Matter movement https://www.beckershospitalreview.com/hospital-physician-relationships/across-the-country-providers-rally-in-support-of-black-lives-matter-movement.html I was raised to not see skin color, but the
- [She’s too old for That Diagnosis!](https://epmonthly.com/article/shes-too-old-for-that-diagnosis/) - Deciphering abdominal pain in an elderly patient. https://youtu.be/amdOGpF5XBg The new intern approaches you with your next patient to staff: a 75 year-old female with abdominal pain. She has experienced diffuse abdominal pain for five days that is getting progressively worse. The patient has been nauseated with several episodes of non-bloody emesis and reports a subjective
- [Night Shift: Game Face](https://epmonthly.com/article/night-shift-game-face/) - https://youtu.be/5glw7kUIsjE It had been a quiet, peaceful summer afternoon and I wan’t really into the chaos that I knew was waiting for me in the ED. Two ambulances were empty with the doors still standing ajar and two more were parked over in the parking spaces. I stopped for one last moment to look
- [A Conundrum: Clotting in COVID-19](https://epmonthly.com/article/a-conundrum-clotting-in-covid-19/) - What’s the evidence for therapeutic anticoagulation in severely ill patients battling the virus? https://youtu.be/rRbJ94_QG3o Case: A 55-year-old male presents with shortness of breath, fevers and congestion. He has a past history of hypertension and hypercholesterolemia. His vital signs include temperature 101 F, heart rate 108, respiratory rate 28, oxygen saturation 80%, and blood pressure 128/70
- [Thank You for Your Service](https://epmonthly.com/article/thank-you-for-your-service/) - Hero treatment proves challenging in face of pandemic. https://youtu.be/ZnkoiqbN5ic “Thank you for your service,” the food delivery man said, slowing slightly as he biked past me. I’m on the sidewalk waiting for a Lyft to take me to my shift, wearing my scrubs, with my hospital ID badge on my chest. I buckle in the
- [EPM Talk Ep. 30 - ED Pregnancy Perspective with Elizabeth Clayborne](https://epmonthly.com/article/epm-talk-ep-30-ed-pregnancy-perspective-with-elizabeth-clayborne/) - Emergency Medicine is experiencing fundamental change as the result of more women entering the specialty, particularly as it pertains to how we deal with pregnancy. Don’t miss Dr Plaster’s interview with Dr. Liz Clayborne, a physician who discusses issues like maternal leave, salary and COVID-19. Find out how you can improve the quality at your
- [EPM Talk Ep. 29 - Getting Relief with Ring Rescue](https://epmonthly.com/article/epm-talk-ep-29-getting-relief-with-ring-rescue/) - In this week's installment of EPM Talk, Mark Plaster chats with Kevin Spencer of Ring Rescue, a company with a device that helps remove rings from swollen fingers. Mark has a personal experience as at ACEP 2019, he had his wedding ring that he hadn't taken off for 40 years removed via the device. Tune
- [COVID-19, Remdesivir and the new Tamiflu](https://epmonthly.com/article/covid-19-remdesivir-and-the-new-tamiflu/) - Trials show encouraging results for early treatment of pandemic. There has been a huge influx of new research for COVID-19, including possible treatment. To date, in vitro studies of remdesivir have demonstrated inhibition of SARS-CoV-2. Unfortunately, in vitro studies do not always extrapolate to clinical care or patient-oriented outcomes. For the first trial, Grein et
- [EM Coach: Treating Testicular Pain and Swelling](https://epmonthly.com/article/em-coach-treating-testicular-pain-and-swelling/) - What is the diagnosis for this male patient? https://www.youtube.com/watch?v=4sPaHcpuLj0&feature=youtu.be A 28-year-old male presents for evaluation of severe left testicle pain and swelling that developed over the past two days. His vital signs are unremarkable. On exam, his left testicle is tender, but with normal lie. The right testicle is unremarkable. The scrotum is generally painful
- [Clinical Focus: Strangulation and Hanging Injuries](https://epmonthly.com/article/clinical-focus-strangulation-and-hanging-injuries/) - A 31-year-old male was brought in by ambulance after attempting to hang himself. He was found hanging from a tow rope in the back yard by his brother who immediately cut him down. He was unconscious when he was cut down and had been hanging for an unknown amount of time. A common method for
- [Coping with COVID-19 in Iran](https://epmonthly.com/article/coping-with-covid-19-in-iran/) - An international look at the pandemic response. https://youtu.be/uPm_jJAvzqQ I am the first board certified woman in emergency medicine in Iran — graduated in 2008. I am an associate professor of emergency medicine in Mashhad University of medical sciences. Mashhad is the largest city of Iran, after Tehran. Our hospital is the largest academic hospital in
- [In Custody with COVID-19](https://epmonthly.com/article/in-custody-with-covid-19/) - Physicians need to advocate for proper care of prisoners. https://youtu.be/iB5Z6ENUWYo Over the past few weeks, our emergency department has been seeing the same type of patient: the prisoner transferred to us after a few days of worsening shortness of breath, cough and fever. We see these patients fighting hard for every breath, traversing the same
- [Optimizing Your Reimbursement During COVID-19](https://epmonthly.com/article/optimizing-your-reimbursement-during-covid-19/) - What’s the best way to maintain your money in the midst of a pandemic? A Novel Threat and Surprising New Challenges: With the arrival of the COVID-19 pandemic to the United States, Emergency Medicine physicians are realizing that more than just our clinical skills are needed to endure through these difficult times. Affected by opposite
- [When to Choose the Infant Approach](https://epmonthly.com/article/when-to-choose-the-infant-approach/) - Alzheimer’s and dementia patients might respond better to simpler strategies. https://youtu.be/mH6ZgqT5jC8 The Geriatric Emergency Department Collaborative (GEDC) (https://gedcollaborative.com/about/) and the Geriatric Emergency Department Accreditation Program (GEDA) (https://www.acep.org/geda/) are two major national efforts to help Emergency Departments provide better care for all geriatric patients, including those with Alzheimer’s disease (AD) and other forms of dementia. While
- [He Stuck a Piece of String Where???](https://epmonthly.com/article/he-stuck-a-piece-of-string-where/) - Using POCUS to aid in foreign body causing urinary retention. https://youtu.be/WhQRX5xDu4E A 13-year-old male, otherwise healthy, presented to the emergency department with a chief complaint of difficulty urinating. On further history, the patient admitted to placing a 12-inch rigid plastic string in his urethra 1.5 days prior to presentation. He noted that he had “an
- [Pregnant on the Frontlines](https://epmonthly.com/article/pregnant-on-the-frontlines/) - Managing emergency department shifts and the COVID crisis while preparing for motherhood. https://youtu.be/QObmtXfaAD4 As an emergency physician during the COVID-19 crisis, I have seen the ways in which our ideals of safety and protection have completely changed. Providing care in the historically underserved area of Prince George’s County, Maryland, the coronavirus has become an all-consuming
- [Is it advisable to teach my replacement? Part 2](https://epmonthly.com/article/is-it-advisable-to-teach-my-replacement-part-2/) - Focus on the advantages the next generation can bring to the group. https://youtu.be/q9uTNBM6bOM Dear Director, We’ve had PA and NP students rotate through the ED for years. But now I feel like my hospital might be looking to replace docs with a cheaper option and I’m afraid I’m actually teaching them to replace me. Should
- [A Deadly Shower](https://epmonthly.com/article/a-deadly-shower/) - What clinical clues reveal the emergent conditions? https://youtu.be/7aw4xR9eb-E History of present illness: A 60-year-old male presented to an emergency department complaining of a rash he noticed on his shins that began earlier that day. He described the rash as a few, small red spots without associated itching or pain. Nine hours later, he noted worsening
- [Droperidol: Magic bullet or toxic tincture?](https://epmonthly.com/article/droperidol-magic-bullet-or-toxic-tincture/) - Like haldol, only better. https://youtu.be/4aNpLzbPSRE When someone mentions droperidol (Inapsine®), the drug seems to incite very different reactions. Some seem to remember it fondly as an effective drug for rapidly sedating severely agitated patients or as a powerful antiemetic. Others murmur about the potential for the drug to induce torsades de pointes (TdP). Droperidol is
- [EPM Talk Ep. 27 - Honed in with Hardy Diagnostics](https://epmonthly.com/article/epm-talk-ep-27-honed-in-with-hardy-diagnostics/) - Mark Plaster chats with Chris Catani of Hardy Diagnostics to discuss the group's microbiology labs, which potentially could play a significant role during the COVID-19 pandemic. Tune in for an enlightening discussion with one of the industry leaders in the field in this latest episode. Don't forget to rate, review and subscribe.
- [Poppers, Meet Methylene Blue](https://epmonthly.com/article/poppers-meet-methylene-blue/) - In this case study, a single administration of methylene blue resolved significant amyl nitrate intoxication and critical methemoglobinemia. A 26-year-old female with no known medical history presented via EMS to the emergency department at an urban community hospital in Chicago, Illinois, with the chief complaint of intoxication after falling at a local bar and sustaining
- [Looking into intraocular eye pressure](https://epmonthly.com/article/looking-into-intraocular-eye-pressure/) - What’s the next step in treatment for this patient’s emergent pain? A 53-year-old male photographer presents to the emergency department via ambulance complaining of headache, nausea and vomiting. His symptoms started after he was developing photographs and abruptly left the darkroom to use the telephone. He states that his pain is concentrated in the right
- [Communication Matters Even More With COVID-19](https://epmonthly.com/article/communication-matters-even-more-with-covid-19/) - With the pandemic changing the information flow, how it’s delivered is essential. How we communicate with one another has always fascinated me. Since I was young, my preferred means of communication has always been writing. I find it therapeutic, organizing and limitless. Working clinically for nearly 15 years now, I believe I’ve gotten better at
- [EPM Talk Ep. 25 - Syndromic Testing a Game Changer for Meningitis/Encephalitis](https://epmonthly.com/article/epm-talk-ep-25-syndromic-infectious-disease-testing-with-dr-neath/) - In the era of pandemics, knowing within two hours whether you have a college student with bacterial meningitis, or a more benign viral etiology could be hugely important to many people. Dr. Sean-Xavier Neath joins Mark Plaster for a discussion of syndromic infectious disease detection of meningitis/encephalitis. It could change the way you approach this
- [EPM Talk. Ep 26 - Getting Beyond Lucid with Jonathon Feit](https://epmonthly.com/article/epm-talk-ep-26-getting-beyond-lucid-with-jonathon-feit/) - Don’t wait for the CDC to tell you that the COVID tsunami is taking out your frontline providers. Manage the problem in real time with a truly innovative program from Beyond Lucid technology. Hear my rapid fire discussion with the CEO of Beyond Lucid, Jonathon Feit.
- [Time to get hyped about the Hyperion Trial?](https://epmonthly.com/article/time-to-get-hyped-about-the-hyperion-trial/) - Cooling post-cardiac arrest patients with non-shockable rhythms. https://youtu.be/K2XTlSVhShY Background Information Cardiac arrest from non-shockable rhythms now accounts for the majority of out of hospital cases and are associated with a poor prognosis.[1] Less than 15% of these patients have good neurologic outcomes when compared to the 65% that suffer a cardiac arrest with a shockable
- [EPM Talk Ep. 24 - Tuned in with Sound Physicians](https://epmonthly.com/article/epm-talk-ep-24-tuned-in-with-sound-physicians/) - If you are not familiar with this fast growing group you might think 'Sound Physicians’ is a group of ER doc rockers touring the US. But they are ‘sound physicians.’ Join me and Drs. Mike Presley (not related to Elvis) and Nathan Ruch as we talk about how this group combines in and out of
- [COVID and Immunity From Liability Under the Federal PREP Act](https://epmonthly.com/article/covid-and-immunity-from-liability-under-the-federal-prep-act/) - What is and what isn’t covered with legislation. https://youtu.be/OH9_eqitGB4 The Public Readiness and Emergency Preparedness Act (PREP Act) was enacted in 2005 to provide limited liability protections to those “Covered Persons” who use “Covered Countermeasures” in response to a pandemic or epidemic. The liability protections afforded by the PREP Act are not always in effect.
- [Hepatic Encephalopathy: More Than Just a Change in Mental Status](https://epmonthly.com/article/hepatic-encephalopathy-more-than-just-a-change-in-mental-status/) - Early intervention key to improving patient outcomes. https://youtu.be/jzxrNZJbrTI Case The emergency medical service box crackled again during a busy Monday evening shift: “84-year-old obese male, found obtunded in bed.” When the paramedics arrived, they started normal saline intravenously and intubated the patient. Vitals included blood pressure, 113/62 mmHg; heart rate, 70 beats/min (bpm); respiratory rate,
- [Hydroxychloroquine and Chloroquine: Past, Present…Future?](https://epmonthly.com/article/hydroxychloroquine-and-chloroquine-past-presentfuture/) - High-potential for toxicity remains for potential COVID-19 medication. https://youtu.be/ngBiNguxMYc Introduction: Currently, there is no U.S. Food and Drug Administration approved medications or best available treatment for COVID-19. The management mainly involves meticulous infection-control for prevention and aggressive supportive care. Given the rapid escalating pandemic, healthcare providers have been administering experimental medications based on in-vitro and
- [Is the Use of Peripheral Vasopressors Safe?](https://epmonthly.com/article/is-the-use-of-peripheral-vasopressors-safe/) - New studies attempt to resolve the issue. https://youtu.be/AhYs7TfPgPw Background: Traditionally, vasopressors have been given through central venous catheters (CVCs) in the critically ill. However, the time it takes to place a CVC, the patient is left potentially hypotensive. Early initiation of vasopressors may be associated with reduced mortality by increasing end-organ perfusion. Therefore, there has
- [Night Shift: Shared Decision Making](https://epmonthly.com/article/night-shift-shared-decision-making/) - https://youtu.be/GKz-xq4ve18 “Please don’t make me do this,” the young woman standing in the hallway wailed with her hands over her face surrounded by nurses and paramedics. I was on my way out the door after a long shift and I was ready to be done. Honestly, to my shame, I was tempted to ignore
- [Take a Deep Breath and Scan](https://epmonthly.com/article/take-a-deep-breath-and-scan/) - Lung POCUS in the clinic. https://youtu.be/_gQwgY1Nvls Background: Finally! The last patient of the day has arrived in your community pediatric emergency clinic and is quickly rushed to triage for vitals. Your medical assistant reminds you that the patient’s mother called the ED earlier after being seen by her primary medical doctor (PMD) yesterday. Their PMD’s
- [Director's Corner: Staffing Parameters in the time of COVID](https://epmonthly.com/article/staffing-parameters-in-the-time-of-covid/) - Adjusting can be difficult as EDs endure or brace for the surge. https://youtu.be/X4UqD9jgBMY Dear Director, Our volumes are markedly down since everyone began social distancing during the COVID pandemic. Are you making staffing adjustments? My department averages about two acute appendicitis cases a day. When I talk to our surgeons, they tell me they have
- [Spanish Influenza – Looking at a Pandemic From 100 Years ago](https://epmonthly.com/article/spanish-influenza-looking-at-a-pandemic-from-100-years-ago/) - How does it compare to the current COVID-19 outbreak? https://youtu.be/oCEywZmMPvI In striking similarity to the current Coronavirus pandemic, the Spanish Influenza of 1918 was devastating, reaching all corners of the world and killing an estimated 20 million to 50 million people. As with the current pandemic, reports of illness and mortality due to influenza were
- [EPM Talk Ep. 20 - Back to School with EM Coach's Andrew Phillips](https://epmonthly.com/article/epm-talk-ep-20-back-to-school-with-epm-coachs-andrew-phillips/) - If you thought that all board prep courses are variations of the same you would be wrong. Dr. Andrew Phillips discusses how EM Coach uses artificial intelligence to help you build a strong and deep understanding of emergency medicine ensuring that you will ace the exam. Join Mark as he catches up with one of
- [Telemed's Legacy as Connected Care](https://epmonthly.com/article/telemeds-legacy-as-connected-care/) - Judd Hollander dishes on the distant service actually providing a superior care delivery mechanism. https://youtu.be/_GghYSexfwU Judy Tintinalli recently spoke with Judd Hollander, the senior vice president for healthcare delivery innovation at Thomas Jefferson University, to discuss his telemedicine fellowship, his institutional telemed activities and why he telemedicine is more a state of being than destination.
- [More Disruption Please: ACEP19 Medical Device Innovators](https://epmonthly.com/article/more-disruption-please-acep19-medical-device-innovators/) - Four new potentially game changing solutions to emergency room problems. During ACEP19, four medical device innovations were featured at the InnovatED area of the Exhibit Hall. All four competed in a “shark tank” style pitch competition sponsored by AngelMD. Brava, a team focused on improved diagnostics of myocardial infarctions, won the competition. Other innovations included
- [EM Coach Team: The COVID-19 Bounce Back](https://epmonthly.com/article/the-covid-19-bounce-back/) - Managing patient complications. Question Stem A 67-year-old homeless female is brought by ambulance to the emergency department in a refractory polymorphic ventricular tachycardia arrest. Hospital records show she received hydroxychloroquine and azithromycin for a confirmed case of COVID-19. She had normal vital signs at discharge two days prior to this presentation. Which of the following
- [EPM Talk Ep. 23 - Candid COVID-19 Convo with Salim Rezaie](https://epmonthly.com/article/epm-talk-ep-23-candid-covid-19-convo-with-salim-rezaie/) - Mark is joined by EPM board member Salim Rezaie to talk about the COVID-19 pandemic and its impact on society, the success of physical distancing, impact on the economy, the importance of New York physicians and the likelihood of an even more dangerous second wave. Listen in to one of EPM Talk's more fascinating discussions
- [EPM Talk Ep. 22 - Night Shift: Shared Decision Making](https://epmonthly.com/article/epm-talk-ep-22-night-shift-shared-decision-making/) - Mark shares one of his more recent encounters and frustrations in balancing a family's wishes as a relative prepares for treatment for COVID-19 against standard hospital procedures. It's a powerful glimpse of the emotional toil of a situation where there isn't a best possible outcome.
- [EPM Talk Ep. 21 - COVID-19 PPE need with Amer Aldeen of USACS](https://epmonthly.com/article/epm-talk-ep-21-covid-19-ppe-need-with-amer-aldeen-of-usacs/) - PPE, PPE, PPE. Take care of yourself and your co-workers. That’s the mantra of Amer Aldeen MD, CMO for USACS. You’ll enjoy this personal wide-ranging discussion of how COVID-19 has changed our perspectives on EM.
- [Treating WPW Syndrome](https://epmonthly.com/article/treating-wpw-syndrome/) - What’s the best next step in management for this pediatric patient? A 17-year-old male with a history of Wolff-Parkinson-White syndrome awaiting ablation presents to the emergency department with palpitations. He is ambulatory to triage and talking comfortably with the nurse. His triage ECG is below. ECG showing atrioventricular nodal reentrant tachycardia (nodal pathways) vs orthodromic
- [EPM Talk Ep. 14 - Putting a T-RING on it With Bill Green](https://epmonthly.com/article/epm-talk-ep-14-putting-a-t-ring-on-it-with-bill-green/) - Mark chats with his good friend Bill Green, the inventor of the T-RING and why he came up with such a useful device for handling finger injuries. Learn more about the T-RING at http://www.thetring.com/
- [EPM Talk - Ep. 19 - He Said, She Said with Jeannette Wolfe](https://epmonthly.com/article/epm-talk-ep-19-he-said-she-said-with-jeannette-wolfe/) - Jeannette Wolfe and Mark Plaster discuss the differences of men and women in the ED and how a "sports mentality" lead to some very distinct approaches on confrontation on the work force. Mark also challenges Jeannette's notion on a hospital's culture of safety best helps patients.
- [Bring 'em All video spotlights frontline medical workers](https://epmonthly.com/article/bring-em-all-video-spotlights-frontline-medical-workers/) - Eugene Richards, who handled the photography and interviews for the ACEP 50th anniversary book, Bring 'em All, put together a video in honor of the medical workers. Richards said it was hard to see the headlines about frontline workers treating those dealing with COVID-19 without thinking of the people he profiled in the video, which
- [How One Las Vegas ED Saved Hundreds of Lives After the Worst Mass Shooting in U.S. History](https://epmonthly.com/article/not-heroes-wear-capes-one-las-vegas-ed-saved-hundreds-lives-worst-mass-shooting-u-s-history/) - The night that Stephen Paddock opened fire on thousands of people at a Las Vegas country music concert, nearby Sunrise Hospital received more than 200 penetrating gunshot wound victims. Dr. Kevin Menes was the attending in charge of the ED that night, and thanks to his experience supporting a local SWAT team, he'd thought ahead
- [Pressors for Hemorrhagic Shock](https://epmonthly.com/article/pressors-for-hemorrhagic-shock/) - AVERT trial shows vasopressin decreases transfusion requirements. https://youtu.be/z8MjVfhouBQ Introduction Hemorrhage accounts for up to 72% of trauma mortality within the first 24 hours.[1] Early hemorrhagic shock management is largely dogmatic: volume resuscitation with early use of balanced blood products and timely hemorrhage control.[2] Historically the use of any vasoactive agent in the resuscitation of hemorrhagic
- [Director's Corner: Should I be teaching my replacement?](https://epmonthly.com/article/directors-corner-should-i-be-teaching-my-replacement/) - Part 1 https://youtu.be/416qTg18HZE Dear Director, We’ve had PA and NP students rotate through the ED for years. But now I feel like my hospital might be looking to replace docs with a cheaper option and I’m afraid I’m actually teaching them to replace me. Should we stop letting them rotate in the ED? Advanced Practice
- [Night Shift: Reassurance](https://epmonthly.com/article/night-shift-reassurance/) - “Your EKG doesn’t look so good,” the tired night shift ER doc tells his patient in the age old ER doc cocktail story. “Doc, am I going to die?” the frightened patient asks. “Not on my shift,” the doctor replies checking his wristwatch. https://youtu.be/CkgkiwHqg70 The fact is that reassuring patients in times of stress is
- [Hoffman La Roche Sued for $1.5 Billion Over Tamiflu Claims](https://epmonthly.com/article/hoffman-la-roche-sued-for-1-5-billion-over-tamiflu-claims/) - Unproven claims that Tamiflu could “stop the flu” and “reduce complications” at issue. https://youtu.be/zUyEBQvftyY An investigator with the Cochrane acute respiratory infections group has filed a whistleblower action against Hoffman La Roche on behalf of the US government and 29 states for Hoffman La Roche’s claims that its drug Tamiflu is effective in stopping the
- [It Just Takes a Spark…](https://epmonthly.com/article/it-just-takes-a-spark/) - Looking back at the history of the use of electricity in the ED. https://youtu.be/-_8Gf7wwNWk One of the most famous tropes in movies involves a frantic physician running back and forth around a table that obviously has a dead body on it. Sparks are flying, capacitors are buzzing, there is a whining noise in the background.
- [Tackling and Treating COVID-19](https://epmonthly.com/article/tackling-and-treating-covid-19/) - Combating an unprecedented global pandemic. https://youtu.be/vhGch1nzi60 The novel coronavirus 2019, was first reported on in Wuhan, China in late December 2019. The outbreak was declared a public health emergency of international concern in January 2020. With the latest update just this month, the world health organization stated this is a worldwide pandemic. As the rate
- [Sample ED Coronavirus Discharge Instructions](https://epmonthly.com/article/coronavirus-101-for-concerned-patients/) - With the rapid spread of coronavirus (COVID-19), many people have questions regarding possible coronavirus infections and treatment. https://youtu.be/iCaVWKMHauk Coronavirus is one type of virus. Many types of coronavirus cause symptoms of the "common cold." COVID-19 is a disease caused by a unique strain of coronavirus. Even though most patients will have "common cold" or "flu-like"
- [Debunking Coronavirus Myths vs. Truth](https://epmonthly.com/article/debunking-coronavirus-myths-vs-truth/) - Spreading facts among an outbreak of fears and rumors. https://youtu.be/x_C2Er74MDE Everyone's talking about - and wondering about - Coronavirus (COVID-19). Here are the answers to some common assertions, to better educate your patients, families, and colleagues. Coronavirus is a family of viruses that typically causes the common cold and upper respiratory symptoms. It is spread
- [Places We Go: El Paso, Texas](https://epmonthly.com/article/places-we-go-el-paso-texas/) - Providing aid to migrants at border sites. https://youtu.be/AWRfny_8U4s Overview: Over the past two years, many Central American countries have been beset by violence, economic strife and instability. The Northern Triangle countries — Guatemala, El Salvador and Honduras — have been hardest hit leading to a migrant population arriving at the US-Mexico border. Many of these
- [VIDEO: Take COVID-19 Seriously](https://epmonthly.com/article/video-take-covid-19-seriously/) - EPM contributor Seth Truger and some of the physicians and medical experts at Northwestern Medicine recorded a video on the COVID-19 pandemic encouraging people to take the virus seriously. https://www.youtube.com/watch?v=LzE8k7_7w8Q&feature=youtu.be Using selfie video messages filmed in their workplaces – in many cases between breaks from helping patients -- the experts urged everyone to stay home
- [EPM Talk Ep. 18 - John Martin on the Butterfly Ultrasound's Impact on COVID-19](https://epmonthly.com/article/16119/) - Cost effective, personal handheld ultrasound is no longer a thing of the future. Dr. John Martin will even show how the Butterfly Ultrasound device can give real time information for the management of coronavirus patients. It’s a real eye opener.
- [EPM Talk Ep. 17 - The Plasters Explore the Tech Side of Coronavirus](https://epmonthly.com/article/epm-talk-ep-17-the-plasters-explore-the-tech-side-of-coronavirus/) - Mark Plaster is joined by his sons, Graham and Logan, for a special EPM Talk discussion on the Coronavirus pandemic and how it's impacting the tech EM field. The Plasters also consider the potential positive developments from COVID-19 once the smoke settles particularly remote delivery and telemedicine. And is hording toilet paper really necessary during
- [EPM Talk - Ep. 16 - He Said, She Said with Jeannette Wolfe](https://epmonthly.com/article/epm-talk-ep-16-he-said-she-said-with-jeannette-wolfe/) - "He said, she said" and "Men are from Mars, Women are from Venus only confirm that men and women see the world differently, even in the world of EM. Join Drs. Jeannette Wolfe and Mark Plaster as they "compare and contrast" their views on a range of topics, professional and personal. On this episode, Jeannette
- [Night Shift: The Dark Ages](https://epmonthly.com/article/night-shift-the-dark-ages/) - Almost two decades ago, our oldest son was entering the United States Naval Academy for “plebe summer,” the first time the new students are put to the rigorous tests of academy life. The chaplain met with all the anxious parents in the cavernous Alumni Hall. He started off by stating solemnly that every one of
- [Places We Go: Borderland—El Paso, Las Cruces and Ciudad Juarez](https://epmonthly.com/article/places-we-go-borderland-el-paso-las-cruces-and-ciudad-juarez/) - Metering out aid at the US/Mexico border. https://youtu.be/ft6jdiCjC94 On my return trip to El Paso this past July to continue helping migrants arriving from Central America, I decided to make it a broader effort in the Borderland. The New Mexico Medical Reserve Corps put out a call seeking help at one of their shelter sites,
- [Omadacycline, NEJM and Non-Inferiority Studies](https://epmonthly.com/article/omadacycline-nejm-and-non-inferiority-studies/) - Subjective endpoints, potential bias and conflicts of interest should raise questions about conclusions. https://youtu.be/uAooL8MyJGs Introduction: The production and release of new antibiotics is rare and should be celebrated by clinicians. As antibiotic resistance continues to mount our options narrow and in turn our patients suffer. Recently, the New England Journal of Medicine (NEJM) published two
- [EM Monthly Quiz: Severe Testicular Pain](https://epmonthly.com/article/em-monthly-quiz-severe-testicular-pain/) - What’s the diagnosis for this male patient’s pain and swelling? A 28-year-old male presents for evaluation of severe left testicle pain and swelling that developed over the past two days. Vital signs are unremarkable. On exam, his left testicle is tender, but with normal lie. The right testicle is unremarkable. The scrotum is generally painful
- [CorePendium: An Emergency Medicine Origin Story](https://epmonthly.com/article/corependium-an-emergency-medicine-origin-story/) - Assembling a better one stop resource. Everyone loves an origin story. Where did Wolverine get those claws? Where did Superwoman come from? Why is the Joker so evil? In medicine we also have our origin stories, but we are often too busy with the importance of the daily work to write them down. While it
- [RX Pad: When push comes to shove](https://epmonthly.com/article/rx-pad-when-push-comes-to-shove/) - Push dose pressor considerations in the ED. https://youtu.be/-MLxrsWtdOg It is common to have patients arrive hypotensive to the ED, and some of the initial thoughts by healthcare providers are, “What is the cause of their hypotension?” and “What can we do to make it stop?” We know that hypotension is associated with poor outcomes, resulting
- [Work-Life, Health & Happiness: Is the Perfect Mix Possible?](https://epmonthly.com/article/work-life-health-happiness-is-the-perfect-mix-possible/) - How to slow down and focus on what’s really important. https://youtu.be/y0a2CNbIrko There is much consternation over the term “work-life balance” as it seems to suggest unrealistic notions. It implies when we are finally “balanced,” we will have “perfect” lives where we get everything done that we need/want to do and will have finally figured everything
- [Modified Valsalva Maneuver for SVT](https://epmonthly.com/article/modified-valsalva-maneuver-for-svt/) - Three trials show this simple procedure increases converts SVT to NSR in up to 46% of patients. https://youtu.be/wEee-bLKA3Y Background: In patients with hemodynamically stable supraventricular tachycardia (SVT), vagal maneuvers are the traditional first step in management. The success rate of the Valsalva maneuver alone is documented at 5 to 20%. According to guidelines, the next
- [Director's Corner: Time to join the committee?](https://epmonthly.com/article/directors-corner-time-to-join-the-committee/) - Signing up might not be that disruptive to your work-life balance. https://youtu.be/XCTYGDek6i0 Dear Director, I’m getting asked to sit on committees at the hospital and encouraged to join the local medical society. I’ve been there several years and am really happy with my “work hard, play hard” life. Can I keep saying no? Congratulations I
- [Balance Billing: The Surprise Insurance Gap](https://epmonthly.com/article/balance-billing-the-surprise-insurance-gap/) - Ban could contribute to an unexpected emergency medical care discrepancy. https://youtu.be/HQH-jflVJgE You’ve seen the headlines: Patient gets a $1,000 bill. Patient gets a $2,000 bill. Patient gets a $10,000 bill. There has been endless press lately regarding “balance billing,” with patients getting huge bills after seeking emergency medical care. So what is really going on
- [Is Emergency Triage, Treat and Transport the Future of EMS?](https://epmonthly.com/article/is-emergency-triage-treat-and-transport-the-future-of-ems/) - Triaging low acuity 911 calls to telehealth services may save money…and emergency department visits. https://youtu.be/e_NQ3BM1Yd0 It seems like an eternity since leaders in Emergency Medical Services (EMS) began calling for the decoupling of EMS triage, response, assessment and treatment from the requirement to transport. The perverse incentive to transport not only increases emergency department (ED)
- [It’s a Wonderful Home Dad Life](https://epmonthly.com/article/its-a-wonderful-home-dad-life/) - Challenge of being married to emergency physician isn’t always easy, but rewarding. https://youtu.be/EjttnGJ6zL8 Six years ago, my life changed forever. My daughter was born. I went from being a chef to a stay at home dad. Shortly after our family grew, my wife joined the Emergency Psychiatry team at the University of North Carolina in
- [Director's Corner: Discharging PE Patients](https://epmonthly.com/article/directors-corner-discharging-pe-patients/) - Implementing evidence-based practices is key to outpatient referral. https://youtu.be/xrL7Z1i0MSI Dear Director, As our ED group has started reducing work ups on patients with asymptomatic hypertension and begun discharging low risk PE patients, I’m getting more and more complaints from our PMDs who refer patients to us. They’re questioning our quality and decision making. How can
- [Peeling away the challenge of Stevens-Johnson Syndrome](https://epmonthly.com/article/peeling-away-the-challenge-of-stevens-johnson-syndrome/) - A potentially fatal dermatologic problem. https://youtu.be/37Z5PpPaFE0 Case Report: A three-year-old healthy female presented to the emergency department with the chief complaint of fever, sore throat and a diffuse rash for a period of five days. Her past medical history is not significant for any major illness and she is up-to-date with her immunizations. The patient
- [Just One Pill Can Kill](https://epmonthly.com/article/just-one-pill-can-kill/) - Which pediatric medication ingestions may require hospitalization and which probably don't? https://youtu.be/j-WbQCqMh5s Originally published at www.emDocs.net and reviewed by Cynthia Santos, MD, Medical Toxicologist, Assistant Professor - Emergency Medicine and Toxicology at Rutgers University Hospital; Alex Koyfman, MD, FACEP, FAAEM; and Brit Long, MD, FACEP Background Pediatric patients comprised 45.2% of the 2.6 million toxic
- [Back Pain in the Elderly](https://epmonthly.com/article/back-pain-in-the-elderly/) - The great masquerader strikes again. https://youtu.be/PK9GLryWLlo It’s a typical busy Monday afternoon when you sign up to see your next patient, a 78-year-old woman with back pain. As you walk in the room, you see an elderly woman sitting on the stretcher and talking to her family. She turns and says with a strained smile,
- [EPM Monthly Quiz: Living with altered mental status](https://epmonthly.com/article/epm-monthly-quiz-living-with-altered-mental-status/) - What’s the treatment for this female patient’s agitation? https://youtu.be/8IdYQNXxERQ An 81-year-old female is brought to the emergency department by her family for altered mental status. The patient lives with her family due to a gradual decline in cognition over the last few years. She is normally able to care for herself, but she has
- [More Disruption Please: ACEP19 Digital Health Innovators](https://epmonthly.com/article/more-disruption-please-acep19-digital-health-innovators/) - At ACEP19, the InnovatED area of the Exhibition Hall featured four digital health innovators. InnovatED was sponsored by AngelMD, and these companies participated in a “shark tank” pitch contest. Competition winner, Hippo Health, is focused on increased connectivity between patients and their physicians. DICOM Director increases imaging portability and creates 3D holographic imaging from CT
- [Leading innovation](https://epmonthly.com/article/leading-innovation/) - EM physicians get out ahead of trends, government and insurance companies. When Dr. Tim Peck made his pitch to potential investors in 2015 for support of his new startup company, Call9, his basic premise was one that had been obvious to experienced emergency physicians for decades: treating elderly patients in place before subjecting them to
- [Handling Pediatric Mass Casualty](https://epmonthly.com/article/handling-pediatric-mass-casualty/) - Check out these strategies to consider in dealing with youth trauma management. Mass casualty incidents are defined as events that “[overwhelm] the local healthcare system, where the number of casualties vastly exceeds the local resources and capabilities in a short period of time.”[1] Prevalence is unfortunately rising, and historically, pediatric populations have not been at
- [Hemolytic Anemia after Brown Recluse Envenomation](https://epmonthly.com/article/hemolytic-anemia-after-brown-recluse-envenomation/) - A 31-year-old African American male without any significant medical history presented to the emergency department with complaints of left arm pain, vomiting, and dark urine. One week prior to his presentation, he felt a sudden burning sensation to his arm and then developed redness, swelling, and pain. Two days later, the pain became worse, and
- [EM Monthly Quiz - Procedural sedation medications](https://epmonthly.com/article/procedural-sedation-medications/) - Which medication can cause severe inspiratory stridor followed by apnea? https://www.youtube.com/watch?v=_Mgt_BUrWE8&feature=youtu.be You are performing procedural sedation to assist an otolaryngologist in removing a fishbone from a patient’s pharynx. Approximately one minute after the sedation medication is given; the patient develops severe inspiratory stridor followed by apnea. Before ENT removed the fiberoptic endoscope for airway management,
- [Useful Keys to Avoid Litigation](https://epmonthly.com/article/useful-keys-to-avoid-litigation/) - Quality documentation can make all the difference. https://youtu.be/vBbIyBU9pBw If you’ve ever navigated through a lawsuit in Emergency Medicine, you know that the nuances of the case often have nothing to do with the actual quality of care that has been provided. In the past decade, verdicts ranging from $ 125,000 up to $ 2,599,000 were
- [The Horse is Out of the Barn](https://epmonthly.com/article/the-horse-is-out-of-the-barn/) - Care Crisis — Physicians terminated from all Edward-Elmhurst Health System clinics replaced by APPs. https://youtu.be/FFx-44zpHY0 Effective April 1, 2020, all seven urgent care clinics of the Edward-Elmhurst Health System will replace physicians with nurse practitioners. At least 15 physicians have been eliminated, and physicians will no longer provide patient care or medical direction in the
- [Second Best: The EcLiPSE and ConSEPT trials](https://epmonthly.com/article/second-best-the-eclipse-and-consept-trials/) - https://youtu.be/EctGuQdd-Ag Did either prove effective in confronting the most common pediatric neurological emergency? Every EM physician who has cared for a sick child in status epilepticus can relate to the anxiety provoking feeling that you get when first-line benzodiazepines are not working. As the child continues to seize before you, and you concomitantly are managing
- [Night Shift: Tattletale](https://epmonthly.com/article/night-shift-tattletale/) - https://youtu.be/m59J7nr8NQI It happened decades ago so I’m probably safe to tell it now without legal repercussions. But I will never forget the pit in my stomach as it happened. I wandered into the room of a young female patient who had presented to the emergency department with the complaint of abdominal pain. I knew the
- [Places we go: Rwanda & Burundi](https://epmonthly.com/article/places-we-go-rwanda-burundi/) - Desperate conditions led to greater desire to help. https://youtu.be/TEu3pa3J7fc Background Rwanda is unfortunately perhaps best known for the tragic genocide that occurred there in the summer of 1994, in which approximately 1,000,000 people lost their lives in three short months. Since then, this small beautiful country of perpetual green has worked to establish itself among
- [My Hometowns: A Medical Student’s Experience Working at the US-Mexico Border](https://epmonthly.com/article/my-hometowns-a-medical-students-experience-working-at-the-us-mexico-border/) - A look at how physicians and volunteers provide vital care for asylum seekers. https://youtu.be/ABDD_VuyYtc Two cities, dos ciudades, El Paso, Texas and Ciudad Juárez, Mexico are my home. They comprise one of the largest binational metropolitan areas in the Western Hemisphere and represent a rich, continuous interchange of language, people and culture. For me, this
- [Meaningful Use, 10 years Later Part II](https://epmonthly.com/article/meaningful-use-10-years-later-part-ii/) - The growing role of clinical informaticists in making EHRs more satisfying. https://youtu.be/L90bkd2OvQ8 Last month I reflected on the 10 years that have passed since the Meaningful Use incentive program spurred widespread adoption of electronic health records (EHRs). In EDs, we mostly went from an eclectic mix of paper systems and customized (‘best of breed’) ED
- [EPM looks to the future of EM in 2020](https://epmonthly.com/article/epm-looks-to-the-future-of-em-in-2020/) - The Emergency Physicians Monthly board dusted off their respective crystal balls and traded their stethoscopes for prognosticator caps to predict potential trends and big events for 2020. Will their take on areas like technology, the 2020 elections, telemedicine and insurance industry prove correct, way off or will the truth be somewhere in the middle? Take
- [An ounce of PreVent-ion](https://epmonthly.com/article/an-ounce-of-prevent-ion/) - To bag or not to bag – does it affect RSI outcomes? https://youtu.be/r36-eD2ne9M It is a busy day in the Emergency Department, and you’re faced with a critically ill patient. He’s 64, short of breath, coughing, febrile and has become more hypoxic over the course of the last hour. With a non-rebreather mask on, his
- [Wheezing in the Village](https://epmonthly.com/article/wheezing-in-the-village/) - Saluting the true heroes of remote medicine. https://youtu.be/zbHzyWfVPnw Just below where the massive Hudson’s Bay finishes its plunge into the heart of the northern Canadian Shield lies a small village called Chisasibi. Nestled between the south shore of La Grande River and the northeastern shore side of James Bay, Chisasibi holds an entirely unique geographic
- [Ultrasound for the drowning heart: Part 2](https://epmonthly.com/article/ultrasound-for-the-drowning-heart-part-2/) - So you’ve diagnosed tamponade. What’s next? https://youtu.be/JsU1Pdtma8I Briefly recalling our patient from last month, a 52-year-old female status post aortic valve replacement that presented with progressive shortness of breath. On bedside ultrasound she was found to have a pericardial effusion with right ventricular diastolic collapse, and a clinical picture consistent with pericardial tamponade. She initially
- [The Ultimate Guide to Health Savings Accounts: Part 3](https://epmonthly.com/article/the-ultimate-guide-to-health-savings-accounts-part-3/) - Money saved can be money earned. https://youtu.be/NqA0PQBhz5g In two previous articles I explained the basics and features of health savings accounts (HSAs). Let’s wrap up by discussing some advanced strategies: Lower insurance premiums and invest the difference Remember that you are eligible to contribute to the HSA if you have a high deductible health insurance
- [Director's Corner: Resolve to be a Better Colleague](https://epmonthly.com/article/directors-corner-resolve-to-be-a-better-colleague/) - https://youtu.be/LXqQkfmCUw8 Enhance your ED by enhancing yourself first. December is a crazy month, with a lot to do professionally and personally. At least professionally speaking, there’s likely a couple of holiday parties to attend and/or plan, insure you’ve made your annual contribution to your hospital foundation and time to plan your end of your review
- [Places We Go: Al-Mafraq, Jordan](https://epmonthly.com/article/places-we-go-al-mafraq-jordan/) - “Inspiration exists, but it has to find you working”—Pablo Picasso https://youtu.be/VQ-3pFGh49I Background The Syrian Civil War began nearly nine years ago and continues to have reverberations to the region with millions of displaced refugees in neighboring countries. Jordan, a land-locked country in the Middle East has long accepted its share of refugees from regional conflicts.
- [ReCAP: Key Updates from the new CAP guidelines](https://epmonthly.com/article/recap-key-updates-from-the-new-cap-guidelines/) - Carefully consider each patient’s risk factors. https://youtu.be/OO1P8LI6arc Introduction: It’s that time of the year again! Emergency Departments all over the country are brimming with long lines of patients with signs and symptoms of respiratory illnesses. Community acquired pneumonia (CAP) is one of the most common diagnoses encountered in any ED, but clinical practice guideline recommendations
- [COACT: Do Patients Benefit from Immediate Angiography?](https://epmonthly.com/article/coact-do-patients-benefit-from-immediate-angiography/) - They survived an out of hospital cardiac arrest, but don’t have a STEMI. https://youtu.be/E0yx5Q2DOAM Nearly 70% of the cardiac deaths in the United States occur out of hospital, usually presenting as sudden cardiac arrest.[1] There is a high prevalence of acute coronary artery occlusions in out-of-hospital cardiac arrest (OHCA) patients with return of spontaneous circulation,
- [Night Shift: A Little Holiday Cheer](https://epmonthly.com/article/night-shift-a-little-holiday-cheer/) - https://www.youtube.com/watch?v=f-elpxUOPto&feature=youtu.be “I see you volunteered to work Thanksgiving Day,” my wife said looking over my shoulder at the group calendar on the computer. “You do remember that my entire extended family will be coming to our house that day…right?” “It’s a tough shift to fill,” I said weakly while swallowing hard and envisioning the
- [A Game Changer for Measuring Intraocular Pressure](https://epmonthly.com/article/a-game-changer-for-measuring-intraocular-pressure/) - Keep an eye or two on the Diaton Tonometer. **The following is a paid promotional piece from one of EPM's sponsors.** Measuring the intraocular pressure (IOP) no longer requires placing something on the surface of the cornea. The FDA has approved the use of a new device, called Diaton Tonometer, which measures IOP through the
- [EPM Talk Ep. 13 - Biofire, Karl Storz and PhyCon](https://epmonthly.com/article/epm-talk-ep-13-biofire-karl-storz-and-phycon/) - For Ep. 13, Mark Plaster is back with a trio of vendor conversations from ACEP 2019. Mark talks with Steve Michalik, the associate director of marketing for Biofire. Bill Wise, VP of Emerging Markets for KARL STORZ where they chat about the leading endoscope manufacturer. Additionally, Mark catches up with Paul Orcutt from PhyCon to
- [Helicopter Air Ambulances: Billing Changes Aloft](https://epmonthly.com/article/helicopter-air-ambulances-billing-changes-aloft/) - https://youtu.be/dSKYpBb6hY8 One year ago, EP Monthly published a feature examining the exorbitant fees frequently charged to patients by the helicopter air ambulance (HAA) industry. Response to the piece was spirited, to say the least, particularly from for-profit HAA companies. The largest of these companies, Air Methods, subsequently reached out to EP Monthly to clarify their
- [EPM Talk: Ep. 12 - Chatting with Hyperfine, Wild Med Adventures and Gen. Sutur](https://epmonthly.com/article/epm-talk-ep-12-chatting-with-hyperfine-wild-med-adventures-and-gen-sutur/) - We're continuing our series of interviews from ACEP 2019 in Denver as Mark Plaster catches up with representatives from Hyperfine to chat about their potentially groundbreaking portable MRI device. Mark also chats with Ben Mattingly, the founder of Wild Med Adventures about his latest trip and his company's goals. Finally, Mark meets up with his
- [EM Monthly Quiz: Sizing up a seizure](https://epmonthly.com/article/sizing-up-a-seizure/) - What’s your first test in examining this female patient? A 23-year-old obese female patient with a history of irregular menses presents to the ED after suffering a witnessed generalized seizure. Her companions report that she was acting normally just before the seizure occurred. Point of care glucose obtained by EMS was 89, and she is
- [Crash Cart: Shortage of mental illness care leading to health crisis](https://epmonthly.com/article/crash-cart-shortage-of-mental-illness-care-leading-to-health-crisis/) - Shortage of mental illness care leading to health crisis https://www.npr.org/2017/11/30/567477160/how-the-loss-of-u-s-psychiatric-hospitals-led-to-a-mental-health-crisis Here is another shocker…Government health care doesn’t work in the US. Our system is broken and only getting worse. Extra workloads to meet the government’s rules and protocols, but no time allotted to provide education, review charts, or discuss cases, and let’s not forget no
- [Meaningful Use, 10 years later](https://epmonthly.com/article/meaningful-use-10-years-later/) - An Informaticist takes stock of electronic health records in EDs. Part 1 of 2 I saw a Facebook post the other day – an EM doc lamented, “we go live on our new EHR next week – so there are four retirement dinners this week.” My heart sank. It's 2019, and Emergency Medicine careers are
- [EM Quiz: How can you see baseline visual acuity?](https://epmonthly.com/article/how-can-you-see-baseline-visual-acuity/) - https://www.youtube.com/watch?v=GXa8TMu1Th4&feature=youtu.be A previously healthy 42-year-old female presents to the Emergency Department the day after being rear ended while at a stop light. She is complaining of headache and left sided neck pain. She has no midline neck tenderness and non contrast CT scan of the head and cervical spine are negative. On exam you notice
- [ACEP 2019 Videos](https://epmonthly.com/article/acep-2019-videos/) - Weren't able to make it out to ACEP 2019? EPM was on hand and met with several inventors to discuss their latest creations. We'll have longer form videos/interviews up soon, but here's just a sample of some of what we encountered this year. Mark meets with Roman Iospa of Diaton Tonometer to try out the
- [EPM Talk Ep. 11 - Latha Ganti dishes on her limitless enthusiasm for research](https://epmonthly.com/article/epm-talk-ep-11-latha-ganti-dishes-on-her-limitless-enthusiasm-for-research/) - Mark chats with Dr. Latha Ganti, the the Vice Chair for Research Academic Affairs & Faculty Development at Osceola Regional Medical Center in the Kissimmee, Florida area. Tune in for one of EPM Talk's most energetic and exciting discussions with a physician that's so passionate about research. Here's some more information about Dr. Ganti: As
- [Handling Acute Facial Droop?](https://epmonthly.com/article/handling-acute-facial-droop/) - Time to choose best management solution. https://www.youtube.com/watch?v=bRG7hifNz8E&feature=youtu.be A 64-year-old female with a history of CML on active chemotherapy presents as a stroke code for acute right-sided facial droop. She keeps telling everyone that what really bothers her is an incredible burning on her left flank. The stroke workup is negative. Upon inspection of her left
- [EM Monthly Quiz: Verifying Venous Vascular Disorders](https://epmonthly.com/article/em-monthly-quiz-verifying-venous-vascular-disorders/) - Determining a solid management plan for deep vein thrombosis. https://www.youtube.com/watch?v=fH7prXmXJXM&feature=youtu.be A 78-year-old woman currently being treated for pancreatic cancer presents with a swollen, painful left calf, progressive over three days. She denies trauma, fevers, chest pain, new shortness of breath, or change in her exercise tolerance. She denies hormone medications, recent long trips, travel, surgeries,
- [EM Quiz: Be Mindful of the Five Terrible T’s](https://epmonthly.com/article/em-quiz-be-mindful-of-the-five-terrible-ts/) - Tips are useful in properly treating cyanotic congenital heart disease. https://www.youtube.com/watch?v=qnV4VMn368s&feature=youtu.be A 5-day-old female is brought to the emergency department with lethargy. Physical exam reveals an ill-appearing neonate with poor tone, cyanosis and delayed capillary refill. Point-of-care glucose is 55 mg/dL. Chest X-ray is shown below. What is the most appropriate next step in management?
- [EM Quiz: Treating a rash of problems](https://epmonthly.com/article/em-quiz-treating-a-rash-of-problems/) - Handling an annoying case of the scratches. https://www.youtube.com/watch?v=IZS4svcCL3c&feature=youtu.be A 7-year-old girl complains of itching and a rash for the last two to three days. The patient attends public school. Her parents said she has not been camping recently and is acting like her normal self except for constant scratching. Her vital signs are unremarkable,
- [EM Monthly Quiz: Fighting fat embolism syndrome](https://epmonthly.com/article/em-monthly-quiz-fighting-fat-embolism-syndrome/) - What’s the best step in management? https://www.youtube.com/watch?v=3d3wKto4IUQ&feature=youtu.be A 27-year-old male patient is transported to the ED with shortness of breath and hypoxemia. He was found struggling to breathe at an acute rehab facility, recovering from the fracture depicted here. His vital signs are HR 109, BP 103/66, RR 22, SpO2 97% (non-rebreather), T 37.1°C (98.8°F).
- [EPM Talk: Ep. 10 - ACEP 2019 Part 2 - Mindray, VEP Healthcare, Money Script](https://epmonthly.com/article/epm-talk-ep-10-acep-2019-part-2/) - For our second round of ACEP 2019 interviews, Mark meets Yohance Harrison from Money Script Wealth Management, LLC to discuss financial strategies. Maher Elhihi, the director of marketing for Mindray North America shares some insight about the company's patient monitoring, anesthesia and ultrasound imaging devices. Steve Maron, the president and CEO of VEP Healthcare stops
- [EPM Talk: Ep. 9 - ACEP 2019 Roundup Part 1](https://epmonthly.com/article/epm-talk-ep-9-acep-2019-roundup-part-1/) - EPM was in snowy Denver for the annual ACEP convention and Mark spoke with a variety of friends, peers and innovators at this year's event. Tune in for his first round of interviews including EPM's own Judith Tintinalli and Greg Henry; Rick Bukata and Andrew Phillips of EM Coach. This is just the first of
- [Pregnant? No way!](https://epmonthly.com/article/pregnant-no-way/) - An ectopic pregnancy after tubal ligation. https://youtu.be/YcfXeSMV-L0 Case Report: A 38-year-old female presented to the emergency department after a positive urine pregnancy test at her primary care physician’s office. Additionally, there were concerns for a possible ectopic pregnancy on a pelvic ultrasound. Upon further questioning, this was her sixth ED visit in the past
- [EHR Multitasking in the ED](https://epmonthly.com/article/ehr-multitasking-in-the-ed/) - A new study found that limiting the number of open charts doesn’t reduce wrong orders. https://youtu.be/cAiCMm2T_Js How many electronic charts will your hospital let you open, simultaneously? What you may think is a technical constraint is, in fact, a local policy decision - and until recently, one without any good evidence behind it. Surveys suggest
- [No More Heparin for NSTEMI?](https://epmonthly.com/article/no-more-heparin-for-nstemi/) - A retrospective review showed no mortality benefit, but more bleeding. Background: The 2014 AHA guidelines for the management of NSTEMI, recommend unfractionated heparin with an initial loading dose of 60IU/KG (maximum 4,000 IU) with an initial infusion of 12 IU/kg/hr (maximum 1,000 IU/hr) adjusted per active partial thromboplastin time to maintain therapeutic anticoagulation according to
- [Ultrasound for the drowning heart, Part 1](https://epmonthly.com/article/ultrasound-for-the-drowning-heart-part-1/) - When should you have a high index of suspicion for cardiac tamponade? https://youtu.be/VsEvRTGmRP8 You are working in the emergency department when you see a 52-year-old female present with several days of dyspnea and fatigue. She states that over the past few days she has felt increasingly short of breath in her daily activities, and today
- [The Ibuprofen Analgesic Ceiling](https://epmonthly.com/article/the-ibuprofen-analgesic-ceiling/) - Determining how much is just right can prove challenging. https://youtu.be/VyUcVkGiM-c Case Introduction A 32-year-old male with no past medical history presents to your emergency department complaining of right ankle pain since yesterday evening. The patient thinks he may have strained his ankle while stepping off the curb and crossing the street. He thought he
- [Night Shift: Thanks](https://epmonthly.com/article/night-shift-thanks/) - https://youtu.be/P3hS17-Cw70 Is that so hard for a patient to say? Just for…let’s see, like saving their life…or maybe relieving them of excruciating pain? But nooo. How many times has one of your patients actually come back to say thanks for what you did for them? I guess I actually learned this dark side of
- [MDCalc Corner - Improving PE workup with the revised Geneva score](https://epmonthly.com/article/mdcalc-corner-improving-pe-workup-with-the-revised-geneva-score/) - When and why this update was necessary now. The revised Geneva score has been used clinically for over 10 years, but it still remains valid and clinically relevant. MDCalc talked to the lead clinician-researcher, Grégoire Le Gal, MD, PhD, who developed the score about how and why to use it. Why did you develop the
- [Product Review: Butterfly iQ Ultrasound](https://epmonthly.com/article/product-review-butterfly-iq-ultrasound/) - Close contest in choosing best portable ultrasound device. This review culminates our series evaluating the field testing of the three main available portable ultrasound devices—Clarius, Lumify and Butterfly iQ. After putting the Clarius and Lumify to the test on prior international mission trips, we were eager to see if the iQ lived up to the
- [Overcoming Barriers to ED-Initiated Buprenorphine](https://epmonthly.com/article/overcoming-barriers-to-ed-initiated-buprenorphine/) - Stretching our scope to save lives in the midst of an epidemic. https://youtu.be/7coJEUDTb9Y Like many clinicians practicing in the midst of the present epidemic of opioid addiction and overdose, we in emergency medicine have expanded the scope of our practice to reduce opioid-related morbidity and mortality, across three broad strategies. Those strategies are judicious opioid
- [Coming Soon to your Neighborhood](https://epmonthly.com/article/coming-soon-to-your-neighborhood/) - Urgent care just for children. https://youtu.be/bm9ddhj2OC4 The daycare calls and tells you that your 18-month-old is running a fever. What are your options? It used to be that all you could do was try to get an appointment with your child’s primary care provider. If there were no appointments available, you could wait a day
- [Director’s Corner - Checking the right box](https://epmonthly.com/article/directors-corner-checking-the-right-box/) - Physicians will have to be aware of changing pre-authorization mandates. https://youtu.be/GjuBeD7XYNM Dear Director, I’ve been told by radiology that I need to start checking the right box when it comes to radiology ordering. Often, I find the computer tells me I’m not ordering the right test. This is frustrating and wasting my time. What’s going
- [Not Yet Time to Increase the Window for TPA in Stroke](https://epmonthly.com/article/not-yet-time-to-increase-the-window-for-tpa-in-stroke/) - Going beyond 4.5 hours might prove beneficial if ischemic penumbra can be saved. https://youtu.be/q8gxy-okZug Background: No matter which side of the debate you sit on in regards to systemic thrombolysis in acute ischemic stroke (AIS), there is one truth. Systems have been changed to ensure tPA is offered to patients in the ≤ 4.5-hour window.
- [Closing the Gap: DKA Management Pearls](https://epmonthly.com/article/closing-the-gap-dka-management-pearls/) - Diagnosis is not always straightforward, here’s what you need to consider. Case: A 27-year-old female with a history of insulin-dependent diabetes and recurrent episodes of diabetic ketoacidosis presents with polyurea, polydipsia, blurry vision, and “high” blood glucose readings. You diagnosed her with diabetic ketoacidosis (DKA) due to a pH of 7.18, positive serum ketones, and
- [Pump the Brakes on Andexanet alfa](https://epmonthly.com/article/pump-the-brakes-on-andexanet-alfa/) - Biologic effects of expensive DOAC reversal agent may not translate into improved clinical outcomes. https://youtu.be/kwINoEyNf_I Background: Over the past few years we have seen a surge in the use of oral Factor Xa inhibitors (apixaban, rivaroxaban etc) for anticoagulation. The reason for this is the ease of use; standard dosing with no levels to check
- [Welcome to the Hard Rock Cafe of Healthcare](https://epmonthly.com/article/welcome-to-the-hard-rock-cafe-of-healthcare/) - Amidst chaos, ethical principles remind emergency physicians why we do what we do. https://youtu.be/YvCWqnsyOdc It’s that time of the year again…new interns and new medical students are trying hard to impress us for a chance at a late autumn interview. After explaining for what seemed to be the 10th time this shift that “all patients
- [Night Shift: Let's Talk](https://epmonthly.com/article/night-shift-lets-talk/) - https://youtu.be/OXjRMCMVotY “Hello everyone, this is Dr. Mark Plaster, Senior Executive Editor of Emergency Physicians Monthly and you’re listening to EPM Talk, where real emergency physicians aka ER docs “get real “ about issues that affect our personal as well as professional lives.” And so begins every installment of our new podcast of EPM Talk. It’s
- [EPM Talk Ep. 8 - Bat Bite on Butt and An Easy Decision](https://epmonthly.com/article/epm-talk-ep-8-bat-bite-on-butt-and-an-easy-decision/) - Join Mark Plaster as he provides a double dose of stories from his acclaimed Night Shift book. Some medical histories are hard to listen to with a straight face. Especially when they involve a bat winding up in a woman's bedroom. An Easy Decision: A little experience can make the easiest decision agonizing. No one
- [Every Village Needs Emergency Medicine](https://epmonthly.com/article/every-village-needs-emergency-medicine/) - Bridging the training gap to avoid treatable, preventable deaths. Septic, ashen, profusely sweaty, no blood pressure. Pulse oximeter won’t read. We have a problem. Patients like this fill Emergency Departments across the cities and towns of the United States and much of the developed world. “IV, O2, monitor, advanced airway equipment to the bedside. Commence
- [Director's Corner: It’s Not Just a Cup of Coffee](https://epmonthly.com/article/directors-corner-its-not-just-a-cup-of-coffee-useful-feedback/) - Insightful feedback can be achieved in non-formal settings. Tweetable: There are a variety of minor performance issues that need to be addressed, and usually a more casual technique may be appropriate. Dear Director, Although I’ve been a director for a while, I’m looking for ways to soften my tone when it comes to giving feedback
- [Telling a Story](https://epmonthly.com/article/telling-a-story/) - Medical decision making process is often overlooked by “click-box” approach to record keeping. In many cases, emergency physicians have become “clickologists,” says Dr. Paul Orcutt, CEO of PhyCon, Inc, an emergency physician billing company located in Oklahoma City, Oklahoma. He’s referring, of course, to the way many EMRs have tied up emergency physicians with a
- [RX Pad: A new medication to treat an old problem](https://epmonthly.com/article/rx-pad-a-new-medication-to-treat-an-old-problem/) - Fidaxomycin shows promise in managing recurrent clostridioides difficile infections. C. diff recently got an extreme makeover. It has a new name, new severity criteria, and new first line treatment agents. However, it remains a nasty player in the world of nosocomial infections and antibiotic-associated diarrhea. Introduction Clostridoides (previously Clostridium) difficile infection (CDI) is a common
- [Cancer Immunotherapy: What it is and where it’s going](https://epmonthly.com/article/cancer-immunotherapy-what-it-is-and-where-its-going/) - Clinical trials could mean another option for patients trying to save their lives. When a patient receives a cancer diagnosis, they immediately want to know what options they have to fight back. Radiation therapy, chemotherapy, and surgery are the most traditional and well known types of cancer treatment. However, the past 10 years of cancer
- [Night Shift: Job Security](https://epmonthly.com/article/night-shift-job-security/) - “Come to our town. Run this ER. Raise your families here. As long as I live, you will have this contract,” said the vice president who recruited us. My friend from residency and I were thrilled and honored to be offered a contract to run an emergency department in a nearby town. But there were
- [More Disruption: Call in Contacts Renewal, CME Tools among Conference Highlights](https://epmonthly.com/article/more-disruption-call-in-contacts-renewal-cme-tools/) - Medicine, Innovation and Entrepreneurship convention spotlights many promising developments. Back in April, the Medicine, Innovation, and Entrepreneurship Conference featured lectures, education and networking specifically for physician innovators. Two of the featured speakers, Dr. Joseph Habboushe and Dr. Leah Houston, are emergency physicians. They are focused on medical education and increasing physician autonomy. Other speakers included
- [EP Talk Ep. 7 - Talking Contracts with EPM's Bill Sullivan](https://epmonthly.com/article/ep-talk-ep-7-talking-contracts-with-epms-bill-sullivan/) - If you enjoyed Mark and Bill’s last discussion of emergency physician career options, don’t miss this next installment where they go at it from another angle. These could be the most rewarding discussions of your professional career.
- [There’s Something Toxic in the Water](https://epmonthly.com/article/theres-something-toxic-in-the-water/) - When exposure can be dangerous: Vibrio and Aeromonas infections. https://youtu.be/d4SrfnOlgnU Necrotizing soft tissue infections (NSTI) can include cellulitis, fasciitis and myositis. These severe infections are associated with significant tissue destruction, toxicity, morbidity and mortality. Necrotizing fasciitis is often divided into several categories, dependent on the number and types of microbes. Type I is polymicrobial, while
- [Night Shift - Red Flags and Black Boxes](https://epmonthly.com/article/night-shift-red-flags-and-black-boxes/) - By the time you are reading this the mass shootings of the weekend of Aug. 3-4 may be old news, replaced by some further atrocity, followed by more political posturing, pontification and finger pointing. However, one thing is clear, despite the fact that mass shootings, incidents involving four or more deaths, is a small percentage
- [Rattlesnakes, Stabbings, Hyperthermia and a Visualized Appendicitis? Music Fest Medical Care Recap](https://epmonthly.com/article/rattlesnakes-stabbings-music-fest-medical-care-recap/) - The challenges of treating the ill and injured at a 30,000 person festival. https://youtu.be/-mE-QawmYII When staffing music festivals, be prepared to treat an interesting mix of pathology. While much of the pathology is predictable based on the specific type of festival and a historical analysis of the previous medical care provided, patient presentations are quite
- [Adam M. Vieder, D.O.](https://epmonthly.com/article/adam-m-vieder-d-o/) - Adam M. Vieder, D.O. Emergency Medicine Physician at Beaumont Hospital, Farmington Hills, MI. Teaching Hospital of Michigan State University.
- [Lespwa fè viv (Hope Keeps You Alive)](https://epmonthly.com/article/lespwa-fe-viv-hope-keeps-you-alive/) - A pair of Haitian doctors face incredible struggles to become two of the first EM physicians in their country. https://youtu.be/OicXlqMcSSc For five centuries, our tiny island nation has endured countless struggles. Stricken by colonialism, slavery, crippling debt, corrupt leadership, environmental devastation, extreme poverty, collapsing infrastructure and violent revolution, Haiti is still having a hard time
- [Eye spy a detached retina](https://epmonthly.com/article/eye-spy-a-detached-retina/) - How to gaze properly to detect painless vision loss complaints. https://youtu.be/AldBjPT08-8 You’re sitting at the physician workstation in the ED, contemplating another cup of coffee, when a new patient passes you on the way to his room. He appears to be walking slowly and holding on to his wife. You sign up to see him
- [Director's Corner: Am I Obligated to my Patient or the Police?](https://epmonthly.com/article/directors-corner-am-i-obligated-to-my-patient-or-the-police/) - Priorities can be complicated when an officer asks for body searches of suspects. https://youtu.be/ges-nG49NNc Dear Director, We’ve started to have patients brought in custody by the police with a search warrant requesting a body cavity search. I feel like we’re always reinventing the wheel about what to do when this happens. Can you advise
- [More Than Just Splenomegaly: Secondary to Infectious Mononucleosis](https://epmonthly.com/article/more-than-just-splenomegaly-secondary-to-infectious-mononucleosis/) - Tackling a case of cholestatic hepatitis. A 23-year-old male presented to the emergency department (ED) with the chief complaint of nausea, abdominal pain and dark urine. The patient noted one-week of congestion, sore throat, body aches and subjective fever, followed by onset of abdominal pain. Abdominal pain was described as achy in nature localized to
- [Does the IRIG-8 Irrigation Device Hold Water?](https://epmonthly.com/article/does-the-irig-8-irrigation-device-hold-water/) - The pros and cons of an alternate method to wound irrigation in the ER. IRIG-8 by Centurion http://irig-8.centurionmp.com Video of IRIG-8: https://www.youtube.com/watch?v=mcELVBVGAhA&feature=youtu.be Adequate wound irrigation of acute injuries and lacerations is one of the most frequent clinical scenarios facing emergency medicine providers every shift. The most common technique employed historically is the “fill and flush”
- [Crash Cart: Hackers Find Fatal Flaw in Insulin Pump](https://epmonthly.com/article/crash-cart-hackers-find-fatal-flaw-in-insulin-pump/) - Below is an excerpt from the full conversation, which is available on epmonthly.com. Have a story you want discussed? Sound off @epmonthly or email editor@epmonthly.online. Hackers Find Fatal Flaw in Insulin Pump https://www.wired.com/story/medtronic-insulin-pump-hack-app/ Another really cool article that highlights the classic tradeoff with security - making it harder for bad guys to hijack your implanted
- [Pigtail Insertion](https://epmonthly.com/article/pigtail-insertion/) - It’s a typical busy Saturday night in your ED. The next chart you pick up is a 15-year-old male with cough shortness of breath and chest pain for one day. He is tall, with normal vitals and in no distress, and you note decreased breath sounds on his right side. Chest X-ray confirms it: pneumothorax.
- [EPTalk Ep. 6 - Talking With Tintinalli](https://epmonthly.com/article/eptalk-ep-6-talking-with-tintinalli/) - If you don’t know this name, you’re not an emergency physician. Judy has been assembling this foundational text book series for nine editions and counting. Her knowledge of voluminous. But her personality is even larger. Meet the lady behind the legend. Join me for an extended conversation with the one and only Judy Tintinalli.
- [D10 for Acute Hypoglycemia: Safe Cure for an Ongoing Shortage?](https://epmonthly.com/article/d10-for-acute-hypoglycemia-safe-cure-for-an-ongoing-shortage/) - Limited supply of D50W has forced the need to identify alternative solutions. https://youtu.be/fUJaDMPRLck Introduction: Diabetic emergencies are a frequent cause of ED visits, and as the diabetic population in the US increases, severe hypoglycemic emergencies including hypoglycemic or diabetic “shock” are becoming more common. In the US, the mainstay of treatment for severe hypoglycemia consists
- [D-dimer in Pregnancy: Ready for Prime Time?](https://epmonthly.com/article/d-dimer-in-pregnancy-ready-for-prime-time/) - Determining if the strategy use in the evaluation of PE is ready for the spotlight. The evaluation of dyspneic pregnant patients at risk of pulmonary embolism (PE) presents a significant challenge to most emergency physicians. Background Pregnant women are usually young and otherwise healthy, but the consequences of a missed PE can be disastrous, and
- [Tips, Tricks and Pitfalls in the Intubated Child](https://epmonthly.com/article/tips-tricks-and-pitfalls-in-the-intubated-child/) - How to approach pediatric mechanical ventilation in the emergency department. https://youtu.be/RyywD2gc8SU Case A previously healthy, full term, 4 kg 3-week-old male is referred to the emergency department from his pediatrician with retractions and hypoxia. This was preceded by two days of cough and congestion. On arrival to the emergency department he appears mottled, with intercostal
- [MDCalc Corner - Gauging ED Exacerbations with the Ottawa COPD Risk Scale](https://epmonthly.com/article/mdcalc-corner-gauging-ed-exacerbations-with-the-ottawa-copd-risk-scale/) - Method has merit, but scope might be too limited. Ian Stiell and colleagues are at it again with another clinical prediction rule from Ottawa. This time, they’re tackling COPD exacerbations in the ED with the Ottawa COPD Risk Scale. THE GOOD Why Use It Allows for clinician judgment - EKG and chest x-ray interpretation are
- [Director's Corner: Running the chair is a Marathon](https://epmonthly.com/article/directors-corner-running-the-chair-is-a-marathon/) - Follow these steps to prevent against early burnout. https://youtu.be/M9hYmkZG9Rg Dear Director, I’ve been a chair for several years, but I feel like I’m burning out on the job. I like the work, but I can’t get control over my schedule and I feel like I’m always at the hospital and on-call. What secrets do long-term
- [Finding Cracks in the Head](https://epmonthly.com/article/finding-cracks-in-the-head/) - Discovering what lies beneath the scalp hematoma can be even trickier with an infant. https://youtu.be/ekg-xPf5HSs On a mid-afternoon shift, your upper-level resident presents a three-week-old female twin infant who was delivered at 33-weeks that was just seen in clinic 20 minutes ago for a well-check. She was sent to the emergency department to be evaluated
- [The Ultimate Guide to Health Savings Accounts: Part 2](https://epmonthly.com/article/the-ultimate-guide-to-health-savings-accounts-part-2/) - Managing the risks and rewards of this financial plan. https://youtu.be/oFf6DQfl4RE In my last article I gave you an overview of health savings accounts (HSAs), including who is eligible to contribute and the tax benefits of doing so. Let’s discuss some other aspects of HSAs: How much can you contribute to an HSA? The amount you
- [Crash Cart: Flies Carrying "Super Bugs"](https://epmonthly.com/article/crash-cart-flies-carrying-super-bugs/) - REAL PHYSICIANS DISCUSS RECENT HEALTHCARE HEADLINES Have a story you want discussed? Sound off @epmonthly or email editor@epmonthly.online. https://youtu.be/9cLyGa8bsLI Flies carrying "superbugs" https://nypost.com/2019/06/25/hospital-flies-are-carrying-antibiotic-resistant-bacteria-study/ Well, if flies in hospitals are carrying dangerous bacteria, hospitals simply need more powerful pesticides. I can't see a downside! - Nicholas Genes, MD, PhD As if it’s not scary enough in
- [AFib: Wait-and-See or Early Cardioversion?](https://epmonthly.com/article/afib-wait-and-see-or-early-cardioversion/) - Determining which strategy makes the most sense in obtaining normal sinus rhythm. https://youtu.be/qjM1KZMf_GQ Atrial fibrillation (AF) is a common cardiac dysrhythmia encountered in the emergency department (ED), affecting 2.7 million to 6.1 million Americans annually. Hospitalizations with AF as the primary diagnosis total >467,000 annually. It is associated with a five-fold increased risk of ischemic
- [Night Shift: The Problem of Pain](https://epmonthly.com/article/night-shift-the-problem-of-pain/) - I hate pain. Not just my pain, though I hate that, too. But I hate everybody’s pain. I’ll take fever, vomiting, diarrhea any day over pain. I want to find out what’s causing the pain so I can fix it so there won’t be any more pain. But the patient just wants me to stop
- [On the Radar: 2019 AMA House of Delegates Report](https://epmonthly.com/article/on-the-radar-2019-ama-house-of-delegates-report/) - Opioid treatment, burnout and hospital consolidation among key topics. https://youtu.be/7WQ_aFeu5XU The 2019 Annual Meeting of the AMA House of Delegates convened recently in Chicago, starting off with a bang with a demonstration by a group against the American Medical Association’s position on “Medicare for All.” Other notable events during the meetings, held June 8-12, included
- [Two Buckets and an Emergency Department](https://epmonthly.com/article/two-buckets-and-an-emergency-department/) - Teamwork won’t function without everyone operating together. When someone mentions the name Coach John Calipari, people usually think of Calipari’s tremendous impact on emergency medicine provider engagement and performance. Okay, maybe that’s just me. Coach Calipari is known for his incredible coaching ability, recruiting and talent management. Year-after-year, his teams have become staples in the
- [EP Talk Ep. 5 - Chatting With Rick Bukata](https://epmonthly.com/article/ep-talk-ep-5-chatting-with-rick-bukata/) - Rick Bukata as been a mainstay of cutting edge emergency medicine for decades. His depth of practical knowledge paired with his acerbic wit have made keeping up with the latest research actually fun. Listen in Or watch the conversation: https://youtu.be/J1bo8pwUDuU MORE: The Ultimate Guide to Health Savings Accounts: Part 1 Summer Reading 2019 Crash
- [Seeing Clearly Now](https://epmonthly.com/article/seeing-clearly-now/) - How to examine, diagnose and treat non-traumatic eye complaints in an austere setting. https://youtu.be/0bynBpY6XY0 A 75-year-old man was seen during a field clinic at a refugee camp last year. He complained of blurred vision and a red eye that was originally painful, but that has lessened over a month. There was no history of known
- [Acute MI Missing STEMI Criteria](https://epmonthly.com/article/acute-mi-missing-stemi-criteria/) - ECG findings you don’t want to miss. https://youtu.be/ieGM_y6I8No A 56-year-old male presents to your emergency department complaining of substernal chest pain, mild dyspnea and fatigue. He has a history of hyperlipidemia and hypertension. You obtain an electrocardiogram, but are not sure whether it represents acute MI as it does not meet traditional STEMI criteria. Background
- [Emergent Complications of a Common Pediatric Diagnosis](https://epmonthly.com/article/emergent-complications-of-a-common-pediatric-diagnosis/) - Gradenigo syndrome is rare, but has serious potential complications. https://youtu.be/4MZWmr4yA7g Case Description A nine-year old boy presents to the emergency department complaining of headache, left sided facial pain, blurry vision, diplopia and vomiting. Previously, he had been seen on two other occasions by his primary doctor for drainage from the left ear and had been
- [Is the Los Angeles Motor Scale better than FAST or NIHSS for diagnosing stroke?](https://epmonthly.com/article/is-the-los-angeles-motor-scale-better-than-fast-or-nihss-for-diagnosing-stroke/) - Compared to other options, scale system measures up favorably. https://youtu.be/OvZHCh4-mVg Large vessel occlusion (LVO) stroke is a major cause of morbidity and mortality in emergency patients, and prompt recognition and treatment is critical for improving outcomes. The Los Angeles Motor Scale (LAMS) is an easy-to-use scale that is widely used by prehospital (EMS providers) and
- [The Ultimate Guide to Health Savings Accounts: Part 1](https://epmonthly.com/article/the-ultimate-guide-to-health-savings-accounts-part-1/) - Learn why the HSA acts like a Roth IRA on steroids. https://youtu.be/H_2s_SmKou0 A few months back I discussed the importance of having a taxable investment account as part of your retirement plan. While the taxable account is underutilized by many physicians (one reason is that you may not be saving enough – tsk tsk!), it’s
- [Seeing Through Tunnel Vision](https://epmonthly.com/article/seeing-through-tunnel-vision/) - Diagnosing a patient with extraocular movement deficits. https://youtu.be/4csmW-FQtnc A 32-year old woman presented to the emergency department with nausea and eye pain on upgaze, tunnel vision, ataxia, headache and blurry vision that developed two days before presentation. Her past medical history was significant for multiple sclerosis, hypertension, eczema, migraines and asthma. She noted that she
- [Summer Reading 2019](https://epmonthly.com/article/summer-reading-2019/) - Catch up on some worthwhile guides to enhance your leadership. https://youtu.be/f7e-X_BmWR8 Summertime is great for relaxing at the beach and spending time with family. It’s also an opportunity to catch up on your reading. I always seem to have a few books on my nightstand that I don’t get around to while my kids are
- [Troublesome Adventures on the High Seas](https://epmonthly.com/article/troublesome-adventures-on-the-high-seas/) - Cruises aren’t always a relaxing getaway for some passengers. https://youtu.be/9tKObj8FhHQ Summer is back, and it’s time for that vacation you’ve always wanted: a cruise. Cruise ship voyages are consistently rated as one of the best value for money options: the all-inclusive nature with great food, entertainment, lodging, itineraries, and activities are definite highlights. Cruises
- [Billing and Collecting With Care](https://epmonthly.com/article/billing-and-collecting-with-care/) - PhyCon Inc. uses real time performance measures to help physicians stay accountable. ***This article was written by one of EPM’s advertising partners as a promotional supplement.*** What does an emergency physician do when he or she is confronted by a problem that doesn’t seem to have just the right answer? They invent a new approach,
- [Crash Cart: Teens Aren't Getting STI Prescriptions Filled](https://epmonthly.com/article/crash-cart-unfilled-teen-sti-prescriptions-state-licenses/) - Have a story you want discussed? Sound off @epmonthly or email editor@epmonthly.online. Arizona is first to recognize all out-of-state occupational licenses https://cronkitenews.azpbs.org/2019/04/10/license-bill/ Arizona will be the first state to recognize out-of-state occupational licenses. What a concept…sarcasm intended. Someone trained and licensed in another state doesn’t forget that training when they cross a state border. I
- [Try a Little “TLC” to Handle Finger Lacerations](https://epmonthly.com/article/try-a-little-tlc-to-handle-finger-lacerations/) - Suturing isn’t the best option for the majority of digit injuries. Finger injuries are one of the most common injuries seen in emergency departments, with estimates exceeding 5 million visits in the U.S. annually. Millions more are seen in urgent care centers and private offices. About 80-90% involves soft tissue injury that may require wound
- [EP Talk Ep. 4 - Are You Working in Your Ideal Job?](https://epmonthly.com/article/ep-talk-ep-4-are-you-working-in-your-ideal-job/) - In the latest installment of EP Talk, EPM Senior Editor William Sullivan joins Mark Plaster in the first of a two-part series discussing career opportunities. Are you working in the ideal job for YOU? What is the ideal job? Join Mark and Bill for a lively discussion of an evaluation of the vast array of
- [Green Skin? Google it.](https://epmonthly.com/article/green-skin-google-it/) - Practical Pediatrics Your next patient is a 16-year-old male with a chief complaint of “turning green”. Your next patient is a 16-year-old male with a chief complaint of “turning green”. You glance at the triage note – normal vital signs and no symptoms except that the child’s skin has been turning green off and
- [Three Days Pain/Swelling Below Right Jaw](https://epmonthly.com/article/three-days-painswelling-below-right-jaw/) - It’s been another busy night, mostly flu patients but a few other scattered maladies and injuries to keep life interesting. The next case, for instance, doesn’t sound much like flu. The nurse has just put a 15-year-old boy in bed 10 with a complaint of fever and facial swelling. Variety is the spice of life.
- [No Need to Worry, Mom. It’s Normal.](https://epmonthly.com/article/no-need-to-worry-mom-its-normal/) - One steady source of business in the emergency department comes from a group described as the “worried well.” Anxious new parents are frequent members of this tribe and come into the ED at all hours to point out perceived abnormalities or areas of concern in their little ones. 10 common neonatal concerns that have non-threatening
- [Serve Your Country, Save Lives](https://epmonthly.com/article/serve-your-country-save-lives/) - More than three million service members utilize Army Medical Department facilities. https://youtu.be/4EKQrualw5Q Being passionate about America and those that protect its borders is what the U.S. Army looks for in health care professionals. Army Medicine provides sustained health services and state-of-the-art research in support of our readiness while caring for America’s Sons and Daughters.
- [Night Shift: Four Fathers](https://epmonthly.com/article/night-shift-four-fathers/) - Anyone who has practiced emergency medicine for a few years can sympathize with Keanu Reeves’ epic rant on bad fathers in the movie Parenthood, (“You know, Mrs. Buckman, you need a license to buy a dog. You need a license to drive a car. Hell, you even need a license to catch a fish. But
- [Director's Corner: Clicking that Matters](https://epmonthly.com/article/clicking-that-matters/) - Gaming the system looks good, but ultimately creates more problems than it solves. https://youtu.be/ZpYkzL83zV8 Dear Director, Our chair has instructed the group to “click” on the patients’ box indicating that we’re with them as soon as they get to the ER. Sometimes, this is a long time before I actually see the patients. It seems
- [Prescribing Opioids: You Can’t Manage What You Don’t Measure](https://epmonthly.com/article/prescribing-opioids-you-cant-manage-what-you-dont-measure/) - Sharing data can help reduce variability among providers. There is little dispute that the United States is facing a catastrophic epidemic of opioid dependence with far-reaching health, economic and social consequences. Many forces are responsible for this epidemic, but overprescribing of opioids is certainly one of them. As physicians, we have the obligation and power
- [Measles: The Sequel](https://epmonthly.com/article/measles-the-sequel/) - The unfortunately necessary recap of a previously eliminated disease. Background: In 2000, the US achieved the elimination of measles, defined as the absence of sustained transmission of the virus for more than 12 months [3,7]. Unfortunately, this success was short-lived. According to the CDC, more than 800 cases of measles in 23 states have already
- [So You Want to Implement MTP… Part 2](https://epmonthly.com/article/massive-transfusion-protocol-the-brass-tacks-part-2/) - Ensuring a well-designed protocol is able to run itself. You have activated massive transfusion protocol (MTP) for your hemodynamically unstable patient. What do you need to consider? What products comprise MTP? Does your hospital have a system or protocol for MTP? This is the second of a two-part series on MTP. Part 1 evaluated the
- [Fever and Rash, during a Measles outbreak](https://epmonthly.com/article/fever-and-rash-during-a-measles-outbreak/) - Even classic presentations of common illness can be crowded out of your differential, during a public health outbreak emergency. The electronic alert fired at triage: fever and rash and overseas travel. Mask the patient. Airborne isolation. Assess for measles. Call Infection Prevention. The patient, a man* in his early 40s, had been worried about it,
- [RX Pad: Just Tramadon’t!](https://epmonthly.com/article/just-tramadont/) - The many reasons to avoid the “light” opioid option in the ED. Introduction: For many years, tramadol has been used to treat acute and chronic pain. It is often considered a “light” opioid option, and has enjoyed a reputation of being a “safer” opioid in terms of adverse effects and abuse potential. In recent years,
- [Crash Cart: Patient learned he was dying from a robot](https://epmonthly.com/article/crash-cart-patient-learned-he-was-dying-from-a-robot/) - Real physicians discuss recent healthcare headlines. E-record rules are burning out doctors and killing patients https://nypost.com/2019/03/28/e-record-rules-are-burning-out-docs-and-killing-patients/ While I think we will all agree that we spend too much time on computers, whether it’s at home or work, the author should have stopped at that without trying to make too many political points. Being spurred to
- [For Esther Choo it's time to speak and tweet out!](https://epmonthly.com/article/time-to-speak-and-tweet-out/) - From papers, podiums, and mobile devices, Esther Choo is getting her message out about ED discrimination. Esther Choo was waiting for a hero. A charismatic, incredibly knowledgeable presence with a passion to speak out about issues of injustice, disparities in the health field and advocacy for women, minorities and equity on a national scope. Choo
- [EP Talk Ep. 3 - Tales from the Night Shift: Discomfort Zone](https://epmonthly.com/article/ep-talk-ep-3-tales-from-the-night-shift-discomfort-zone/) - In this latest episode of EP Talk, Mark Plaster shares one of his precarious earlier encounters that left an indelible impression in this tale from the Discomfort Zone. Have you ever been bitten by a dog? I’ll bet you don’t reach down to pet a stray anymore. Well there are lots of things in emergency
- [How to make intravenous access easier](https://epmonthly.com/article/how-to-make-intravenous-access-easier/) - Your patient is a previously healthy five-month-old infant who arrived following a brief generalized seizure associated with the recent onset of fever. Because he is too young (< 6 months) to fit the diagnosis of presumed simple febrile seizure, diagnostic studies and intravenous access are indicated prior to admission for observation. Unfortunately, the ED nurses
- [EP Talk Ep. 2 - Director's Chat With Mike Silverman](https://epmonthly.com/article/ep-talk-ep-2-directors-chat-with-mike-silverman/) - Most of us have worked for bad ED directors from time to time. But I got to work for Mike Silverman when he was a relatively new director. And from the start I knew that Mike was special. And while leading a groups of emergency physicians can be like herding a bunch of ornery cats,
- [What a pain in the leg!](https://epmonthly.com/article/what-a-pain-in-the-leg/) - Performing a proximal lower extremity ultrasound for DVT. https://youtu.be/HiteRDat5DM You’re working a busy emergency department (ED) shift, and the next patient to be picked up on the track board is a 55-year-old man with “leg pain.” You immediately look at the clock and realize that ultrasound has just left for the night and won’t be
- [Turn Your Kid Into A Millionaire Without Winning The Lottery](https://epmonthly.com/article/turn-your-kid-into-a-millionaire-without-winning-the-lottery/) - Set up an early Roth IRA to begin establishing wealth. https://youtu.be/JhQlluwltRE Many physicians find it tough to save for retirement because of the many financial obligations that occur when raising children. Imagine then how difficult it is to convince your teenage children to save for retirement rather than upgrading to the newest iPhone. What if
- [Setting the Standard](https://epmonthly.com/article/setting-the-standard/) - Geriatric ED accreditation is improving care for older patients. https://youtu.be/yg1D-w0HjDk You care for this patient every shift. An older person with multiple medical problems who is trying to live at home. Are they normally slightly confused? Does lying in bed for six hours in the ED during your work up without eating or drinking do
- [Ride Health Makes Getting Home a lot Easier for Patients](https://epmonthly.com/article/ride-health-helps-patients-get-home/) - Ride share service is reducing no-shows to help hospitals save money and not get taken for a ride. https://youtu.be/LX9sSASjxhI When Imran Cronk began his studies at the University of Pennsylvania, starting a company was the last thing on his mind. But an experience while volunteering in a North Carolina emergency department during his freshman year
- [Kava – What you should know](https://epmonthly.com/article/kava-what-you-should-know/) - This herbal remedy is brewing up significant anxiety and stress relief. https://youtu.be/Q5uj9KoWFlc Kava is growing in popularity as an herbal remedy that is used to treat anxiety and range of other symptoms or conditions including insomnia, ADHD, stress, restlessness, psychosis, cancer, and benzodiazepine withdrawal to name just a few. It is important to know how
- [MTP: Fill 'er Up – Part 1](https://epmonthly.com/article/mtp-fill-er-up-part-1/) - When to pull the trigger on your Massive Transfusion Protocol. https://youtu.be/9Hhcddzn1VY EMS calls with a trauma activation at 0130 for a 46-year-old male who fell asleep on the train tracks. He suffered amputations at the mid-humeral level and the right leg above the knee. EMS placed tourniquets high and tight on the right extremities, but
- [From Battle Royale to a Toxic Seizure](https://epmonthly.com/article/from-battle-royale-to-a-toxic-seizure/) - Treating toxic seizure from Benadryl OD. https://youtu.be/VdVQNTXDy3M Case: A 20-year-old male presented to the emergency department (ED) after an overdose. EMS was called to the house after family/friends witnessed a generalized seizure lasting at least 1 minute. The patient was reportedly playing Fortnite, a popular online video game, in the basement with friends. After losing
- [Fever at home, no fever in the ED](https://epmonthly.com/article/fever-at-home-no-fever-in-the-ed/) - How to handle vanishing symptoms once you see the patient. https://youtu.be/OZ3zykRwQ0U Your next patient is a four-week-old girl brought in by her parents due to fever. At home this evening, she felt warm and had a rectal temperature of 100.9 (38.3). The parents brought her immediately to the ED. They gave no antipyretic medications prior
- [Cutting out (some) complaints](https://epmonthly.com/article/cutting-out-some-complaints/) - Getting started on the right path with the patient. https://youtu.be/q4le2rZiAbc Dear Director, Our department has received a variety of complaints from patients where it just seems like the docs didn’t get off to a good start with the patients. Do you have any tricks to help establish a bond with the patient? Fortunately, providers generally
- [Door to Discharge in 60 Minutes?](https://epmonthly.com/article/door-to-discharge-in-60-minutes/) - Reviewing the HOUR with Naloxone rule. https://youtu.be/l9K3okXRtR8 Background: Over the last decade, deaths from drug overdose have continued to rise in the United States. In 2017, nearly 68% of all overdose deaths involved an opioid, and though deaths from prescription opioids and heroin remained stable between 2016-2017, deaths from other synthetic opioids have continued to
- [A little harmless pot](https://epmonthly.com/article/a-little-harmless-pot/) - https://youtu.be/G4ctlFZJYVU I understand addiction. After “retiring” from a 35 year career in emergency medicine several years ago, it was only a few months before I was back picking up random shifts with my old group. I don’t know if the best term for my behavior was relapse or recidivism. The point is I know what
- [Decoding the proper triage sequence](https://epmonthly.com/article/decoding-the-proper-triage-sequence/) - What’s the key to saving the most lives possible? https://youtu.be/51lt4KWyEy8 There were once two quarreling brothers who pulled their pistols on each other. One had a 9mm and the other had a .45 pistol. Their injuries left questions that I could not find answers in the medical literature. How did only one survive with a
- [Stopping the flow](https://epmonthly.com/article/stopping-the-flow/) - The Role of Inhaled TXA in Hemoptysis. https://youtu.be/NQZumOdfIZE Background information The antifibrinolytic medication Tranexamic Acid (TXA) has been gaining more popularity in its use to stop various types of bleeding. By preventing activation of plasmin and clot breakdown, this synthetic derivative’s ability to reduce bleeding has applied to post-partum hemorrhage, intracranial hemorrhage, epistaxis and
- [Just let me die, doc!](https://epmonthly.com/article/just-let-me-die-doc/) - Handling suicidal ideation is not as easy as determining a mental illness. https://youtu.be/zZkJhtsreO8 Case Scenario It’s 3 a.m. and you’re on your fourth overnight in a row. The track-board still says there are several patients waiting to be seen. You have managed to clear the sickest of the bunch, but you notice the chief complaint
- [Ready for the Measles’ Comeback?](https://epmonthly.com/article/ready-for-the-measles-comeback/) - Emergency medicine physicians and other emergency personnel are the gatekeepers for the hospital. We examine, test and attempt to diagnose all patients who come through the door. As disease patterns evolve, so too must we. Being aware of emerging illnesses and remaining diligent in identifying their presence ensures a safe environment for the patient and
- [Night Shift: Tough Case, Bad Law](https://epmonthly.com/article/night-shift-tough-case-bad-law/) - Many years ago a dear family friend came to me to ask “a medical question.” When we were in private he explained his elderly mother seemed to be near death from a variety of causes, though none was obviously “the one thing” that would predictably end her life. https://youtu.be/1gyyG2ATBcI His question was that she was
- [ED/EQ: They won’t like you when you get angry](https://epmonthly.com/article/ed-eq-they-wont-like-you-when-you-get-angry/) - Invest in your emotional IQ and reap a giant ROI. https://youtu.be/QC59VHSIFeI If you’ve been following this column you have seen the many ways that using emotional intelligence can make your shifts easier, more enjoyable and less conflicted. Emotional intelligence (or EQ as it is abbreviated) is simply recognizing your feelings and the feelings of others
- [Look in the Mouth!](https://epmonthly.com/article/look-in-the-mouth/) - Don’t neglect an oral health exam for older patients. https://youtu.be/9_XP8OeI-mY It is easy to be rushed and cut corners in the ED, and for my residents this often means a less than thorough (if any) examination of the mouth. If the chief complaint is not "dental pain" or "sore throat" the mouth seems to fall
- [How do I use early plasma in the ED?](https://epmonthly.com/article/how-do-i-use-early-plasma-in-the-ed/) - Logistics of use are complicated, but future options are even more promising. https://youtu.be/u57gwEzI3VI A Case for Plasma: A 46-year-old male unrestrained driver is brought in by EMS to your emergency department following a collision in which he struck a tree at highway speed. The patient was extricated from the vehicle and complains of severe 8/10
- [Headache Relief with a Nerve Block](https://epmonthly.com/article/headache-relief-with-a-nerve-block/) - Try this technique to get under migraine’s nerves. https://youtu.be/XT01ew9oNF0 Current estimates indicate that over one million patients visit the ED annually for acute migraines [1]. Not only are these attacks debilitating in the short-term, they have long-term effects on overall quality of life. The management of migraines is complicated by a wide range of analgesic
- [Director's Corner: Crisis Recognition and Management](https://epmonthly.com/article/directors-corner-crisis-recognition-and-management/) - Dear Director, My CEO lit into me for a patient complaint about a missed diagnosis and I just didn’t see this coming. Now he’s questioning our overall quality of care and I feel like this went from a routine case review to a potential crisis that puts our contract at risk. How did I miss
- [Crash Cart: Nurse Charged with Reckless Homicide](https://epmonthly.com/article/crash-cart-nurse-charged-with-reckless-homicide/) - Nashville nurse charged with reckless homicide after administering wrong medication. https://fox17.com/news/local/nurse-charged-with-patient-abuse-reckless-homicide-after-death-at-vanderbilt https://youtu.be/wbUFOW_TGXM This is textbook manslaughter. This nurse “knew or should have known” that such a reckless disregard for patient safety would put the patient in danger of death. My guess is that she was either arrogant, ignorant or both. So sad. - Mark Plaster,
- [More Disruption Please: ACEP Digital Health Leaders](https://epmonthly.com/article/more-disruption-please-acep-digital-health-leaders/) - Innovations to enhance efficiency, patient communication and code outcomes. During ACEP18, AngelMD highlighted several medical innovations at the InnovatED area of the Exhibit Hall. While the last edition of More Disruption Please focused on medical devices, this edition focuses on four digital health innovations. UBQ increases ED efficiency, NavigatER enhances patient communication, HealthPals assists clinical
- [EP Talk Ep. 1 - Talking Informatics with Nick Genes](https://epmonthly.com/article/talking-informatics-with-nick-genes/) - Informatics is on the leading edge of emergency medicine. And Nick Genes is on the leading edge of emergency medicine informatics. Nick was seeing and preparing for the world of EM informatics when most of us were still trying to decide if social media was going be a real thing or not. Unlike many info-geeks,
- [Buprenorphine induction in the ED: the missing link in a broken system?](https://epmonthly.com/article/buprenorphine-induction-in-the-ed-the-missing-link-in-a-broken-system/) - Why the pressure is on to help patients dealing with opioid overdoses. https://youtu.be/eZeDVPR3pyU Introduction: The opioid crisis has become a household term over the last few years. As deaths from opioid overdoses rise, so does the pressure to find better ways to intervene and help patients before they suffer adverse consequences or reduce the harm
- [Out-of-hospital cardiac arrest airway management](https://epmonthly.com/article/out-of-hospital-cardiac-arrest-airway-management/) - What have we actually learned about running codes in the ED? As the debate for the best airway in out-of-hospital cardiac arrest continues and remains largely inconclusive, what can we learn as emergency physicians running codes and managing the airway in the emergency department? Minimally interrupted chest compressions of adequate depth and rate and early
- [Bedside Ultrasound Evaluation in Right Lower Quadrant Pain](https://epmonthly.com/article/bedside-ultrasound-evaluation-in-right-lower-quadrant-pain/) - Follow these tips to be sure not to miss a big surprise. You’re working an overnight shift in the emergency department with a new medical student. A 22-year-old female patient with abdominal pain appears on the tracking board and he eagerly signs up and leaves the work area to evaluate her. He returns after a
- [Blood Gases: ABG vs. VBG](https://epmonthly.com/article/blood-gases-abg-vs-vbg/) - Determining if there are clinically important distinctions between the two results. https://youtu.be/Q2keQkUIPVk Arterial and venous blood gases provide crucial information about the acid-base status of critically ill ED patients. Arterial blood gases (ABGs) are considered the gold-standard, but they come at a cost. ABGs can be more difficult to obtain, are more painful and require
- [Replace What’s Lost with What’s Lost? ](https://epmonthly.com/article/replace-whats-lost-with-whats-lost/) - Considering Prehospital Whole Blood for Life-Threatening Bleeding. https://youtu.be/gb19DabhKco "Permissive hypotension in trauma" is a term with which we are now all well-acquainted. Severely injured victims of trauma suffering shock from incompressible hemorrhage do not benefit by being inflicted with the old school intravascular crystalloid flood, converting their remaining blood to dilute Kool-Aid, inducing acidemia, hypothermia
- [Do we need a dress code?](https://epmonthly.com/article/do-we-need-a-dress-code/) - Consider the purpose for setting up a standardized look before enforcing a uniform policy. https://youtu.be/SrIrHpsWSWg Dear Director, I’ve been concerned about how some of my team dresses and am considering implementing a dress code for our docs. What do you think about that? Just like we form an impression of the patient and their likely
- [Crash Cart - About that strip club called Emergency Room...](https://epmonthly.com/article/crash-cart-about-that-strip-club-called-emergency-room/) - Below is an excerpt from the full conversation, which is available on epmonthly.com. Have a story you want discussed? Sound off @epmonthly or email editor@epmonthly.online. https://youtu.be/qatZT1T7YCQ A Llama Antibody Could be the Key to Universal Flu Vaccine https://www.biospace.com/article/a-llama-antibody-could-be-the-key-to-a-universal-flu-vaccine/ Good news: Study using llama antibodies shows promise in creating influenza vaccine for humans. Bad news: Study
- [Don't Miss the Most Common Abdominal Emergency](https://epmonthly.com/article/dont-miss-the-most-common-abdominal-emergency/) - Catching the countless challenges to diagnosing appendicitis. https://youtu.be/4V2C0mC20-8 Appendicitis is the most common surgical emergency in the United States. Approximately nine percent of all men and seven percent of all women will be afflicted at some point in their life.[1] Despite this ubiquity, there are countless pitfalls one can encounter before reaching the diagnosis and
- [MDCalc Corner: Stay cool — use the Parkland Formula for burns](https://epmonthly.com/article/mdcalc-corner-stay-cool-use-the-parkland-formula-for-burns/) - Pearls and pitfalls to calculating fluid requirements for patients. https://youtu.be/SBXL1aL9PRY A 65-year-old patient with a history of congestive heart failure is brought to your emergency department after sustaining second and third degree burns to her chest and upper extremities. Once the patient is stabilized, you use MDCalc to determine the patient’s initial fluid requirements using
- [Top 10 Benefits of Investing in a Taxable Account: Part 2](https://epmonthly.com/article/top-10-benefits-of-investing-in-a-taxable-account-part-2/) - More ways to avoid the crunch of ‘Uncle Sam.’ https://youtu.be/2Jzn-FQVHCg Last month I discussed five reasons why you should consider investing in a taxable account: no contribution limits, no income restrictions, ultimate flexibility, potentially lower cost and more diversified investment options, and tax diversification. Here are five more benefits to investing in a taxable account.
- [Night Shift: Overpaid?  Not Quite](https://epmonthly.com/article/overpaid-not-quite/) - A friend from Maine recently sent me the front page of the Bangor (Maine) Daily News with the lead headline “Hospital visits for some Mainers could become more costly.” The news was that TeamHealth, “a company based more than a 1,000 miles away,” — no regional bias there of course — had taken over staffing
- [Assault with a steel pole to the face](https://epmonthly.com/article/assault-with-a-steel-pole-to-the-face/) - Why watching for the OCR becomes a critical reflex. https://youtu.be/8FZKX95i_9Q A 22-year-old male presented to our community ED with a facial injury after an assault to his face. He stated he was in an altercation with another individual during which he took repeated hits to his left eye with a steel pole, approximately four-hours prior
- [From the Front Lines of Hurricane Florence](https://epmonthly.com/article/from-the-front-lines-of-hurricane-florence/) - From battling bats to devising innovative response techniques, North Carolina EPs shared their experiences. In September, Hurricane Florence devastated eastern North Carolina, with 800,000 coastal evacuees transported to the Central Piedmont region and to the Appalachian foothills for safety. A conglomeration of shelters, conference centers, tent hospitals and even a vacant former psychiatric hospital were
- [The Brave New World of Tele-triage](https://epmonthly.com/article/the-brave-new-world-of-tele-triage/) - Now is the time to get a jump on preparing for the pay-for-value model. https://youtu.be/kwQ00w-nnhs When the world of medicine finally makes the complete transition from fee for service to pay-for-value, emergency medicine physicians are likely to be in a prime position to be the universal entry point for patients of all kinds. A small
- [Plotting the course of the next 50 years of EM](https://epmonthly.com/article/plotting-the-course-of-the-next-50-years-of-em/) - Breaking down the highlights of the interim AMA HOD meeting. https://youtu.be/wi0eL8hC4vM Long ago, emergency medicine focused on its grand idea: developing the specialty, gaining academic and institutional recognition, developing residencies and fellowships, and kick-starting research programs. Fifty years later, the big question is what’s next? Emergency Medicine is one of the top 10 in-demand specialties
- [ED/EQ: The Choice is Yours](https://epmonthly.com/article/ed-eq-the-choice-is-yours/) - People love to choose for themselves. Give them choices during their ED visit and watch this transform your practice. https://youtu.be/E9JY5PhbLhg Americans love being able to choose. Just look at the rental car business, where customers are allowed to pick between cars of the same rental class on the lot. Upscale hotels offer pillow menus. Even
- [Night Shift: Eat this, you’ll feel better](https://epmonthly.com/article/night-shift-eat-this-youll-feel-better/) - “You’re not going to write another poop story, are you?” my wife said as she saw me at the computer. https://youtu.be/FU4TQVRiLiQ “I can’t help it, sweetheart,” I said, shaking my head while tapping away. “You can’t make this stuff up. Some pharmaceutical firm has finally decided to sell freeze dried poop in a capsule to
- [MDCalc Launches EM Guideline Summaries](https://epmonthly.com/article/mdcalc-launches-em-guideline-summaries/) - MDCalc, synonymous with easy-to-use bedside tools for most emergency physicians, is now doing for guidelines what it’s been doing for medical calculators for over a decade. https://youtu.be/zJy9yBJMan4 Guidelines are notoriously difficult to access—a report from the New England Health Institute (NEHI)[1] cited inconvenience as one of the primary barriers to regular use of guideline recommendations
- [Alternative to Opioids: Ultrasound Guided Femoral Nerve Block](https://epmonthly.com/article/alternative-to-opioids-ultrasound-guided-femoral-nerve-block/) - When the meds aren’t working. https://youtu.be/jYbOWMkezxY In sign out you receive an elderly patient with a hip fracture waiting to be admitted for surgery. You are having trouble controlling her pain. She is continuing to require multiple doses of opioid pain medication with little relief. Her nurse calls you, “Is there anything else we can
- [Getting Back What You’re Owed](https://epmonthly.com/article/getting-back-what-youre-owed/) - If your group doesn't pay you for the services you provided, you may need to act quickly to protect your interests and to recover your lost wages. https://youtu.be/1Zw0nVLaj4k A December 2018 article in the Philadelphia Enquirer Daily News described a very good pay dispute between two staffing companies, three hospitals and the emergency physicians providing
- [Director's Corner: Difficult conversations with patients](https://epmonthly.com/article/directors-corner-difficult-conversations-with-patients/) - Ways to stay positive when dishing out negative responses. https://youtu.be/-dHIoB5In74 It’s not unusual for my docs to let me know about difficult conversations they’ve had with patients. Sometimes they’re giving me a heads up in case the patient complains. Other times, they’re looking for advice so the conversation is smoother next time. Through the years,
- [Is Cricoid Pressure Showing Cracks?](https://epmonthly.com/article/is-cricoid-pressure-showing-cracks/) - Background: Cricoid pressure is dead, right? Many have made this claim including a brilliant argument against its use by Dr. John Hinds (https://vimeo.com/96709226). Despite the many eulogies, we continue to hear about cricoid pressure, including in the recent trial in JAMA Surgery: Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence
- [Top 10 Benefits of Investing in a Taxable Account: Part 1 of 2](https://epmonthly.com/article/top-10-benefits-of-investing-in-a-taxable-account-part-1of-2/) - Why it’s time to start rethinking how to file your savings. https://youtu.be/zxrEVMN_7qE We all know about employer-sponsored retirement plans such as a 401k and you’ve always heard that maxing out your pretax retirement accounts is a great way to save for retirement. While I agree with that, many emergency medicine physicians will need to save
- [RX Pad: Are Docs Dying a Slow Death from Night Shifts?](https://epmonthly.com/article/rx-pad-are-docs-dying-a-slow-death-from-night-shifts/) - Be aware of the potential health risks of rotating work. https://youtu.be/dJmUODfaJNw One of the defining features of Emergency Departments is that they are always open: 24/7/365. However, research shows that providing care at all hours of the day and night comes with a cost. The physicians and staff who give up their sleep and their
- [Night Shift: Street Medicine](https://epmonthly.com/article/night-shift-street-medicine/) - OK everybody, raise your hand if you’ve ever stopped at a car accident to offer/render medical care, helped someone on the street or helped a relative/neighbor with a medical problem. I’ll bet it’s almost everyone. Emergency medicine is not just a job or even a specialty. It’s a genetic condition. It’s in our DNA to
- [Saddling up](https://epmonthly.com/article/saddling-up/) - A Pulmonary Embolism Presenting with a DVT and Sinus Tachycardia https://youtu.be/xYIWU24k2Q8 Case Report: A 60 year-old male with a significant past medical history of chronic obstructive pulmonary disease, morbid obesity and tobacco dependence presented to the emergency department (ED) for treatment of a deep vein thrombosis (DVT) found on an outpatient Doppler ultrasound. He had
- [2019 Resolutions](https://epmonthly.com/article/2019-resolutions/) - Taking care of yourself is more than dieting and exercise. https://youtu.be/ny7WSPRvAN0 Happy New Year! Many of us struggle for an appropriate resolution for the New Year, so I’d like to offer a variety of options. It’s important as a busy professional to reflect on opportunities to improve and grow in our careers, and having a
- [Suck it Up with SALAD](https://epmonthly.com/article/suck-it-up-with-salad/) - Techniques to Handle Extreme Regurgitation https://youtu.be/fWo4Jj23qlQ A 53-year-female presents with recurrent emesis. She is hypotensive, hypoxic, tachycardic and confused. She is recurrently coughing in between her periods of emesis and her lungs have crackles. You are concerned about her airway. Fortunately, your stellar nurse has already obtained bilateral intravenous access and brought the airway equipment
- [Collision Course](https://epmonthly.com/article/collision-course/) - Properly reviewing sports-related concussions. Concussions are largely thought to be a result of functional, rather than structural disruption, which can result in a wide variety of signs and symptoms that may include a loss of consciousness and which cannot be explained by other etiologies (toxicology, other trauma, comorbidities, etc). https://youtu.be/LW3fsykSJoU According to the 2016 Berlin
- [ED/EQ: A Matter of Perspective](https://epmonthly.com/article/ed-eq-a-matter-of-perspective/) - A 28-year-old man presented to the ED with an inability to move his right arm. He was hastened to the back because he and his wife both thought he was having a stroke. But a quick exam revealed that it was a peripheral neuropathy so the emergency physician started down the diagnostic tree. There was
- [4 Financial Planning Strategies Every Young Physician Must Know](https://epmonthly.com/article/4-financial-planning-strategies-every-young-physician-must-know/) - Don’t delay in mapping out a game plan. Young physicians, even with their high earning potential face financial challenges. They have their massive student loans to pay off and manage their day-to-day expenses too. One thing that can help them through is financial planning. https://www.youtube.com/watch?v=DGEhgAaw6Mg&feature=youtu.be The earlier you plan, the better your chances are of
- [Meet Xofluza (baloxavir) — a new alternative to Tamiflu](https://epmonthly.com/article/meet-xofluza-baloxavir-a-new-alternative-to-tamiflu/) - It’s one dose – but is it worth it? On Oct. 24, 2018, the FDA approved a new orally administered, single-dose influenza antiviral drug, baloxavir marboxil (XofluzaTM). Baloxavir is a polymerase acidic endonuclease inhibitor, and is effective for the treatment of influenza type A or B strains. Mechanism of Action Baloxavir inhibits the endonuclease activity
- [Setting Systems in Place for Emergency Department Efficiency](https://epmonthly.com/article/setting-systems-in-place-for-emergency-department-efficiency/) - Dear Director, We’ve tried LEAN techniques and “thin slicing” but our average productivity still lags behind other EDs in our hospital’s network. What are some ways we can get docs to work more efficiently? As you have pointed out, provider productivity and department efficiency are inextricably linked. Often the search for productivity focuses entirely on
- [When to decide between fatigue and CLL](https://epmonthly.com/article/when-to-decide-between-fatigue-and-cll/) - A 71-year-old male presents to your ED with a temperature of 99.7F and extreme fatigue. The triage nurse makes him an ESI 3 with concern for an infection. Your medical student picks up the case and finds a small rash made of some mildly erythematous plaques on his chest which Mr. Jones states do not
- [ED/EQ: Fighting Through Cognitive Fatigue](https://epmonthly.com/article/ed-eq-fighting-through-cognitive-fatigue/) - How to bring clarity to your thoughts and make your shifts easier. https://youtu.be/Ai-x4ucB16c Medicine is about decision making —especially in Emergency Medicine. Making difficult decisions based on imperfect information is one of the cardinal features of EM and the single most common reason that people leave EM for other specialties. In no other field of
- [Gastric volvulus: A truly rare, but life-threatening cause of upper abdominal pain](https://epmonthly.com/article/gastric-volvulus/) - Left untreated condition can lead to 30% to 50% mortality rate. https://youtu.be/xMW_49c5N9c Case: A 52-year-old female with a history of peptic ulcer disease presented to the emergency department (ED) with the chief complaint of lower chest pain and upper abdominal pain. The patient and family were eating dinner at a local restaurant when she developed
- [Doc, my ear hurts when I talk](https://epmonthly.com/article/doc-my-ear-hurts-when-i-talk/) - When it’s time to suspect mastoiditis for patient pain. https://youtu.be/N_XvSACTcyw HISTORY A 25 year old male presented with progressive pain and drainage to his right ear over two weeks. The pain became worse with talking, chewing or palpation. He had also noted a subjective fever, chills, anorexia and a decrease in hearing acuity. He denied
- [Rx Pad: Could ketadex be the next ketofol?](https://epmonthly.com/article/rx-pad-could-ketadex-be-the-next-ketofol/) - Dexmedetomidine might be the sedative agent of choice. Introduction: ED physicians regularly perform procedural sedation for painful or invasive procedures. Many factors influence the choice of sedating agent, such as safety and efficacy, but also drug shortages, a push to reduce use of opioid analgesia and the need to quickly see rising patient volumes. The
- [Crash Cart: Non-addictive painkiller alternatives?](https://epmonthly.com/article/crash-cart-non-addictive-painkiller-alternatives/) - REAL PHYSICIANS DISCUSS RECENT HEALTHCARE HEADLINES Below is an excerpt from the full conversation, which is available on epmonthly.com. Have a story you want discussed? Sound off @epmonthly or email editor@epmonthly.online. https://youtu.be/_Y-h49u1pQI Study on animals discovers non-addictive painkiller alternative [https://tinyurl.com/yb55nm2n] I'm still trying to figure out how researchers can figure out that mice had pain
- [Administrative or Clinical Decision?](https://epmonthly.com/article/administrative-or-clinical-decision/) - How one physician clashed with his hospital employer over his ED choices. https://youtu.be/eVXQrM9OA0E If you are an employed physician, your contract probably states your employer will not interfere with your exercise of clinical judgment in providing medical care. Typical language in hospital-physician employment contracts include: “Hospital shall not interfere with physician's exercise of clinical medical
- [10 Ways to Maximize Your Money at Year End](https://epmonthly.com/article/10-ways-to-maximize-your-money-at-year-end/) - Follow these tips to avoid surprising losses or penalties come tax season. https://youtu.be/oGuXcZhD9Mw The holiday season can be particularly stressful for emergency medicine physicians: higher volume of sick patients, higher volume of non-emergent patients affecting your patient satisfaction scores and higher spending on your family and relatives (hey you’re a “rich” doctor aren’t you?). There’s
- [A Winter Wonderland of Emergencies](https://epmonthly.com/article/a-winter-wonderland-of-emergencies/) - With holidays come a unique set of potential catastrophes. It’s the holiday season, which means it’s that time to gather around and enjoy some quality family moments. Regardless if you enjoy the holidays, with the cold and snow come several specific wintertime emergencies. This piece will look at several of these conditions, but before we
- [Night Shift: O Tannenbaum](https://epmonthly.com/article/night-shift-o-tannenbaum/) - I’m not working Christmas Eve this year. I don’t think I can take any more holly, jolly. It gives me indigestion. I saw a Christmas tree shaped light bulb recently in Home Depot. You’ve probably seen something like it. It’s normal sized, but has a triangular shape and form of a Christmas tree. I don’t
- [Developing a Winning Department Culture](https://epmonthly.com/article/developing-a-winning-department-culture/) - Building a high-performer leads to success in performance, productivity and retention. https://youtu.be/OjWVki59Qn4 Dear Director, I can’t get my ER to “click.” I feel like we have a good plan but we haven’t been able to get the results that I’ve wanted. “Culture eats strategy for breakfast” - Peter Drucker I’m a huge advocate for building
- [More Disruption Please - ACEP18 InnovatED Edition](https://epmonthly.com/article/more-disruption-please-acep18-innovated-edition/) - Spotlighting a trio of potential technology game changers. During ACEP18, AngelMD hosted exhibits and “Shark Tank” style pitch competitions featuring several healthcare companies with new medical devices and digital health innovations. This article focuses on three of those medical devices: an AED for cardiac patient’s homes, an AI-driven tool to measure ejection fraction, and a
- [MDCalc Corner: Alvarado Score](https://epmonthly.com/article/mdcalc-corner-alvarado-score/) - To scan or not to scan?’ That’s the (app-y) question. Alvarado Score Signs Right lower quadrant tenderness +2 Elevated temperature (>37.3°C or 99.1°F) +1 Rebound tenderness +1 Symptoms Migration of pain to the right lower quadrant +1 Anorexia +1 Nausea or vomiting +1 Lab Values Leukocytosis > 10,000 +2 Leukocyte left shift +1 Acute
- [Teaming up with the Hospitalists](https://epmonthly.com/article/teaming-up-with-the-hospitalists/) - Dear Director, I’m having trouble working with my hospitalist leader and group. How important is it that we “get along?” Our interactions with the hospitalist medicine (HM) group can often make or break a shift. I’ve worked with HM groups who were the bane of my existence, but more often, I’ve been fortunate enough to
- [Best Practices: Excelling with EKGs](https://epmonthly.com/article/excelling-with-ekgs/) - How to Optimize Your Reimbursement: EKG and Cardiac Monitor Interpretations. Your Successful Reimbursement to be Realized In Emergency Medicine, it’s easy to overlook the value of the services we provide. At many sites, revenue of $150,000 per year can be generated based on the interpretation of EKGs alone. [1] Similarly, hospital-based Emergency Medicine groups can
- [From Lecture Hall to Chest Tube in Saint Lucia](https://epmonthly.com/article/from-lecture-hall-to-chest-tube-in-saint-lucia/) - Educational course outreach in Saint Lucia quickly leads to life-saving procedure. Introduction Volcanic in origin, Saint Lucia is one of many small islands that comprise the Caribbean's Windward chain. Renowned for its iconic twin peaks of Gros Piton and Petit Piton, Saint Lucia is a popular vacation destination. The International Emergency Medicine and Ultrasound Divisions
- [Riding the roller coaster of MCI triage](https://epmonthly.com/article/riding-the-rollercoaster-of-mci-triage/) - Mass shootings revealed the old paradigm’s shortcomings - here’s how an upgrade would look. The Aurora, Colo. police department made the first big paradigm shift in a penetrating mass casualty incident (MCI) on July 20, 2012, when they used police vehicles to scoop-and-run victims in police cruisers to the hospital. For the first time in
- [7 Ways to Solve the ED Boarding Challenge](https://epmonthly.com/article/7-ways-to-solve-the-ed-boarding-challenge/) - Strategies to increase efficiency and involvement. In 2011, nine out of 10 hospitals reported boarding patients in the emergency department while they awaited inpatient beds. The Joint Commission has since made boarding part of its survey process because it’s a patient care and safety issue. But the negative effects don’t stop at safety and clinical
- [PRISMS: Alteplase vs Aspirin](https://epmonthly.com/article/prisms-alteplase-vs-aspirin/) - Aspirin was safer in mild stroke, and worked just as well. Despite the limited evidence for its benefit, and ample evidence of harm, alteplase is still guideline-recommended care for patients with acute ischemic stroke with disabling neurological deficits. Most of the prior major stroke trials (i.e. NINDS, ECASS, Atlantis, etc.) explicitly excluded patients with mild
- [Kratom, a Legal Drug of Abuse](https://epmonthly.com/article/kratom-a-legal-drug-of-abuse/) - Why users might be coming to an ED near you. Intro: Kratom is an old drug that has made a new appearance on the recreational drug scene in the last few years. It is derived from the mitragyna speciose plant found in Southeast Asia, and has been used in its native areas for personal use,
- [Product Review: Lumify Ultrasound](https://epmonthly.com/article/product-review-lumify-ultrasound/) - Evaluating how the device stacks up compared to the competition. This review continues a series on portable ultrasound devices tested in a field setting. We again combined our military experience with actual device usage during a humanitarian mission to evaluate pros and cons. The Lumify device by Phillips was evaluated during a weeklong trip to
- [Night Shift - Burnout](https://epmonthly.com/article/night-shift-burnout/) - “You look really exhausted, sweetheart,” my wife said sympathetically as I trudged into the house and plopped down at the breakfast table. “Did you have a hard night? Are you feeling OK?” I just sat there in fatigued stupor. “No, I’m finally getting burned out,” I said with a sigh. “I think we need to
- [Ketamine for Suicidal Patients: a chance for meaningful psychiatric care in the ED](https://epmonthly.com/article/ketamine-for-suicidal-patients-a-chance-for-meaningful-psychiatric-care-in-the-ed/) - Developing technique could reduce emotional distress and risk of self-harm within minutes after infusion. Despite our best efforts, management of suicidal patients in the ED generally leaves both patient and provider less than satisfied. These patients often arrive in the ED as a result of a long, knotted string of psychosocial and emotional stressors that
- [ED/EQ: You Had a Bad Day](https://epmonthly.com/article/ed-eq-you-had-a-bad-day/) - Simple things you can do to turn that shift around https://youtu.be/vQvtv5Sh_7o One of the great things about Emergency Medicine is that when you push those doors open into the ED the waves of activity and sound and urgency wash over you and carry away any cares and concerns. Usually. Sometimes and rarely if we are
- [OP-ED: Hospitals Don’t Have a Monopoly on ED Patients](https://epmonthly.com/article/op-ed-hospitals-dont-have-a-monopoly-on-ed-patients/) - Surprise Insurance Denials are Real Culprit in Broken Health Care. The latest uninformed opinions about the costs and value of emergency medicine have come from Glenn Melnick, Ph.D. who, according to his bio at the University of Southern California, is a "world-renowned expert in health economics and finance." https://youtu.be/GUbdjHoXJZc Dr. Melnick created an opinion piece
- [Crash Cart - Should patients go to Google before physicians?](https://epmonthly.com/article/crash-cart-should-patients-go-to-google-before-physicians/) - REAL PHYSICIANS DISCUSS RECENT HEALTHCARE HEADLINES Have a story you want discussed? Sound off @epmonthly or email editor@epmonthly.online. Study shows Googling symptoms helps patients interact better with doctors https://youtu.be/muCMRClpu3U William Sullivan, DO, JD Informed patients are great. Misinformed patients can sometimes drain the life blood from your soul. Unfortunately, I've seen probably an order of
- [Navigating Through the Turbulent Skies](https://epmonthly.com/article/haa-turbulent-skies/) - Helicopter Air Ambulance (HAA) Fees Present Policy Challenges When making the decision to transport a critically ill patient by helicopter air ambulance (HAA), the emergency medicine physician must now face the perverse prospect of saving the patient’s life only to devastate that patient’s financial well-being. https://youtu.be/N_PFW4TuVgg Helicopter air ambulance services have proliferated over the past
- [With Age, Comes Wisdom and Maybe a new D-dimer Cutoff?](https://epmonthly.com/article/with-age-comes-wisdom-and-maybe-a-new-d-dimer-cutoff/) - Get with the guidelines and avoid over-scanning. Case 1: A 72-year-old female presents with mild shortness of breath for several days. She has a history of hypertension and hyperlipidemia. She was tachycardic initially, which has resolved. The rest of her exam is normal, with clear lungs and normal lower extremities. Her ECG is unactionable, and
- [Night Shift: Congratulations?](https://epmonthly.com/article/night-shift-congratulations/) - Some nights it seems like everyone has belly pain. And with so many people requiring CT to rule out the bad stuff, combined with CT being slow, I’m always glad when I get one of those “uncomplicated” belly pains. So it appeared as I headed to the room with my arms full of charts and
- [Did You Capture the (Financial) Bull?](https://epmonthly.com/article/did-you-capture-the-financial-bull/) - How have your investments performed over this historic run? You may have heard recently that the stock market had its longest run-up – called a bull market - in history. A bull market is defined as a period that starts at the previous bottom (usually a 20% drop) and continues without another drop of 20%.
- [Director's Corner: Addressing lousy employee satisfaction scores](https://epmonthly.com/article/directors-corner-addressing-lousy-employee-satisfaction-scores/) - Dear Director, The results of the hospital’s annual employee satisfaction just came back and the ED didn’t score well. I’m frustrated the efforts the nursing director and I are making weren’t recognized and I’m afraid the hospital will think I’m not doing my job. What should I do? Hospitals typically conduct large, professionally performed surveys
- [Places We Go: Destination Haiti](https://epmonthly.com/article/places-we-go-destination-haiti/) - Relief trip offers valuable lessons in outreach preparation I led a group of 13 volunteers to Miragoane, Haiti for a weeklong medical mission trip in August. IMANA (www.imana.org) has organized the twice a year trip since 2010. Mufti Shaheed Mohammed and his family hosted us on his farm in an area called Chalon-2. Like much
- [Topical capsaicin for cannabinoid hyperemesis syndrome](https://epmonthly.com/article/topical-capsaicin-for-cannabinoid-hyperemesis-syndrome/) - Inexpensive, safe and highly effective Introduction: Emergency physicians are increasingly confronted with cases of cannabinoid hyperemesis syndrome (CHS). It is a challenging syndrome to manage, comprised of chronic cannabis abuse and cyclic and/or intractable episodes of nausea, vomiting and abdominal pain.[1,2] Recurrent presentations to the ED are common and the diagnosis is frequently missed if
- [More Disruption Please – SimX, Through the Cords and WoundZipper](https://epmonthly.com/article/more-disruption-please-simx-through-the-cords-and-woundzipper/) - Three innovations to make education and procedures easier. ACEP and AngelMD have partnered to introduce innovative medical equipment and technology as part of ACEP’s annual Scientific Assembly. ACEP17’s InnovatED featured SimX, an augmented reality teaching platform, and WoundZipper, a novel device for wound closure using magnets. AngelMD will host a “shark tank” competition at ACEP18’s
- [Oxygenate, Ventilate, Do No Harm: Ventilating Challenging Patients Part 3 of 3](https://epmonthly.com/article/oxygenate-ventilate-do-no-harm-ventilating-challenging/) - Strategies for managing frequently encountered respiratory physiology. Introduction Emergency physicians must be prepared to manage the ventilator in patients with challenging pulmonary physiology. As discussed in parts one and two, keeping Vt (tidal volume) < 6-8 mL/kg, plateau pressure ≤ 30 cm H2O, and rapidly decreasing the FiO2 to prevent the harmful effects of hyperoxia
- [Medupreneurs turning dreams into new career paths](https://epmonthly.com/article/medupreneurs-turning-dreams-into-new-career-paths/) - Emergency physicians are, without a doubt, the most entrepreneurial of all the medical specialists. Natural problem solvers, we’re always looking for novel ways to solve the myriad of daily obstacles we face. We also have the highest burnout rate of any of the medical specialties. As a result, many EPs are constantly creating new inventions,
- [Crash Cart: Reducing ED Super Utilizers and Medicaid capping ER emergencies](https://epmonthly.com/article/crash-cart-reducing-ed-super-utilizers/) - REAL PHYSICIANS DISCUSS RECENT HEALTHCARE HEADLINES Below is an excerpt from the full conversation, which is available on epmonthly.com. Have a story you want discussed? Sound off @epmonthly or email editor@epmonthly.online. Reducing ED “Super Utilizers” Thanks to a new partnership, Regional One Health has seen encouraging results in reducing emergency room super users who average
- [ED/EQ: Handling the Angry Patient](https://epmonthly.com/article/ed-eq-handling-the-angry-patient/) - Don’t get sucked in to the Dark Side when patients lash out and administrators move in. A post on EM Docs generated hundreds of comments on the topic of a hospital’s response to an angry patient. The hospital’s “angry patient protocol” led to an upsetting interruption that hindered the emergency physician’s ability to care for
- [Outpatient Treatment for DVT… Ready for Primetime?](https://epmonthly.com/article/outpatient-treatment-for-dvt-ready-for-primetime/) - Determining the best therapy options for patients with lower extremity issues. Case: A 43-year-old female presents with right lower extremity swelling one week after an overseas plane flight. She has normal vital signs and her right lower extremity displays significant edema and redness. An ultrasound displays a DVT. Does she need admission for anticoagulation? What
- [Do not unpack the sepsis bundle](https://epmonthly.com/article/do-not-unpack-the-sepsis-bundle/) - The triage nurse has alerted you that he just put a febrile 4-year-old in Bed 6 and the patient’s vitals have triggered the sepsis alert flag. This flag was instituted by your ED as part of a quality improvement initiative to better your compliance with sepsis identification and management. You go into the room to
- [Keeping the ACEP Leadership Fire Going](https://epmonthly.com/article/keeping-the-acep-leadership-fire-going/) - Two rising board members share thoughts on recruiting and retaining the next generation leaders. The first 50 years of ACEP and Emergency Medicine were so exhilarating — EPM wants to stir up the same energy today! Aisha Liferidge and Gillian Schmitz, two exceptional young emergency physicians on the ACEP Board of Directors discuss their EM leadership
- [Night Shift: White Glove Service](https://epmonthly.com/article/night-shift-white-glove-service/) - For over 25 years I had, what some would consider, the worst emergency medicine job in the world. I was a full-time locum tenens physician and I only worked at night. At one time I had over 15 state medical licenses. My full-time practice was to help hospitals that were in staffing crisis. I would
- [Ketamine vs. Morphine in the Elderly ED Patient](https://epmonthly.com/article/ketamine-vs-morphine-in-the-elderly-ed-patient/) - Sergey Motov discusses his new study and the approach to managing pain in this challenging population. Nicholas Genes: Hello Sergey! Great to talk with you again, and congratulations on the new publication. We know the problem of oligoanalgesia in the elderly – they may be unable to advocate for themselves, may have varying degrees of
- [CALC Corner: HEART Score vs. EDACS](https://epmonthly.com/article/calc-corner-heart-score-vs-edacs/) - Chest pain is one of the most common chief complaints of patients presenting to the emergency department. While management of patients with clear ST-elevation MI is obvious, there remains some variation in the evaluation and management of undifferentiated chest pain patients in the emergency department. By improving on the identification of low risk chest pain,
- [The Search for Satisfaction Often Lies Beyond the ED](https://epmonthly.com/article/search-for-satisfaction/) - Combating the grind of the daily shift can be overcome by branching out Dear Director, I’m an experienced emergency physician but I’m looking for more than just seeing patients. What ideas do you have for me? I think the first few years after residency are about learning and mastering your craft as a physician, and
- [Product Review: Clarius Portable Ultrasound](https://epmonthly.com/article/clarius-portable-ultrasound-review/) - Breaking down device’s strengths and limitations on aid mission While working at a relief camp in Bangladesh in March, Debjeet Sakar, MD and second year medical student AJ Folsom used the device for obstetrics and set up a small ultrasound area to provide pregnant women basic ultrasound images of their babies. As the role of
- [Stay cool while treating heat-related illnesses](https://epmonthly.com/article/stay-cool-while-treating-heat-related-illnesses/) - How to be observant and proactive in helping patients endure warmer temperatures. Exhausted after making a wrong turn and out of water, emergency physician Sarah Beadle, left her daughter and nephew, ages 10 and 11, alone in the shade on the basement floor of the Grand Canyon to look for help. The children were later
- [Shocking Truths about Lightning Strikes](https://epmonthly.com/article/shocking-truths-about-lightning-strikes/) - Don’t wait in seeking shelter from the storm https://youtu.be/l_fV0HhKKI4 The 16-year-old girl was sitting at the school’s picnic table, watching the storm, when a friend yelled out and advised her to come inside. She replied, “I love storms.” The friend then heard a “bang” and witnessed the girl being directly struck and thrown to the
- [Avoiding Chart Wars](https://epmonthly.com/article/avoiding-chart-wars/) - Disagreements are as common as patients with back pain and just as challenging. https://youtu.be/N0O95N-nzhU One of the most frequent calls I get from providers is about how to document disagreements. Disagreements are inevitable and always need to be handled delicately. This article will give some suggestions on how to have CYA documentation that shines with
- [ED triage systems fail in MCIs](https://epmonthly.com/article/ed-triage-systems-fail-in-mcis/) - Why it’s important to take aim at out of the box strategies. https://youtu.be/v1FGrkGhkCE Triage is the most important step in increasing the survival rate in a Mass Casualty Incident (MCI). On the night of Oct. 1, 2017 in Las Vegas, triage was the key to organizing the largest surge of penetrating traumatic injuries that has
- [Oxygenate, Ventilate, Do No Harm](https://epmonthly.com/article/oxygenate-ventilate-do-no-harm/) - https://youtu.be/bvXm8v8ayDc Vent Basics for Emergency Physicians - Part 2 of 3 (Read Part 1 here) Introduction The emergency physician must know how to safely manage the ventilated patient. This includes interpretation of waveforms and alarms, proper sedation and implementation of vent bundles that can save lives. As discussed in Part One, your patients will benefit
- [Oxygenate, Ventilate, Do No Harm: Vent Basics for Emergency Physicians Part 1 of 3](https://epmonthly.com/article/oxygenate-ventilate-do-no-harm-vent-basics/) - Introduction Emergency physicians (EPs) are experts in emergent airway management and thus must be confident managing mechanical ventilation. Hospital-wide bed shortages mean that EPs will be managing admitted patients for longer periods of time, and if you work in a hospital without intensivist coverage you must be the ventilator expert. A recent study suggests implementing
- [Your Critical Care Reimbursement: How to Optimize “Out-of-the-Box”](https://epmonthly.com/article/your-critical-care-reimbursement-how-to-optimize-out-of-the-box/) - https://youtu.be/SUdnaT4htHQ Clinician, There is Value in What You Do In all likelihood, the Critical Care services you provide have the potential to substantially contribute toward your reimbursement. Based on the 2018 Medicare Physician Fee Schedule, Critical Care time (30 to 74 minutes) is reimbursed at $226.80 per encounter.(1) Considering 8.1% of emergency room visits
- [More Disruption Please](https://epmonthly.com/article/more-disruption-please-2/) - https://youtu.be/fIEhvmpXufc Spotlighting three medical innovations to aid physicians and patients. These three medical innovations were featured at InnovatED, an interactive demonstration of new healthcare technology at ACEP17. ACEP18’s InnovatED will feature a Pitch Event hosted by AngelMD. To learn more about this event, or to enter your company into the competition, go to info.angelmd.co/acep. Alive
- [Is Capillary Refill Time Useful in Pediatric Patients?](https://epmonthly.com/article/is-capillary-refill-time-useful-in-pediatric-patients/) - https://youtu.be/lEh0GkdcWXw Docs are all told to check it, but here’s why that might not be necessary On a busy shift the triage nurse comes to find you. She has just put an infant in a room and reports that he has prolonged capillary refill. She walks off before you can ask about the other vital
- [Not too late to get in some summer reading](https://epmonthly.com/article/not-too-late-to-get-in-summer-reading/) - https://youtu.be/ZEkATEFdKMU My background is in medicine; not business, management or leadership, but as a medical director, I need to continue to get educated in these areas. Fortunately, I love to read and there’s a lot we can learn from experts outside of medicine that will make us more successful at our jobs. So, whether it’s
- [Crash Cart: Flying hot dogs; Berating Patients; Concierge EM Services](https://epmonthly.com/article/crash-cart-flying-hot-dogs-berating-patients-concierge-em/) - https://youtu.be/ot9-656OMtA California emergency physician fired after berating basketball player suffering from anxiety that reportedly couldn't inhale and couldn't move body and asks patient “Are you dead, sir?” (ABC News) Mark Plaster, MD, PhD: There by the grace of God… If anyone says that they haven’t at least felt like that ER doc once or twice
- [Maxed Out Your 401k? Here’s What To Do Next](https://epmonthly.com/article/maxed-out-your-401k-heres-what-to-do-next/) - https://youtu.be/9pN1FwIc8zM Question: “Last year I contributed the maximum allowed to my retirement plan and I’ve already done the same this year. Where should I invest extra money?” First, congratulations on maxing out your tax deferred accounts. I know many physicians who can’t get close to the max despite making several hundred thousand dollars in gross
- [Night Shift: Sick or Not Sick](https://epmonthly.com/article/night-shift-sick-or-not-sick/) - https://youtu.be/BpRoUasHngk “I just poked my head into Room 21 to see someone that I didn’t think was sick, but I think he has really questionable lesion. So I set him up for CT. And they have been really slow today. I hate to ask you, but can you follow up on this?” my partner asked
- [For Physicians Suicide Watch Isn’t Just for Patients](https://epmonthly.com/article/for-physicians-suicide-watch-isnt-just-for-patients/) - Docs have higher rates than general population. https://youtu.be/F42-bg6jVZM Kate Spade. Anthony Bourdain. Two high profile individuals who recently took their own lives. As physicians, we frequently care for individuals who demonstrate suicidal ideations. We also care for individuals who attempt suicidal acts, such as drug ingestions and other self-harm behaviors. But are celebrities and our
- [Your Critical Care Reimbursement: Learn how to succeed](https://epmonthly.com/article/your-critical-care-reimbursement-learn-how-to-succeed/) - Don’t miss out for failing to properly document. https://youtu.be/gEXb469NmcI What you document makes a difference. Astutely charting the detail of your service can allow your coders to distinguish between a level 5 and level 4 chart resulting in a revenue of $56.52. Properly distinguishing between “complex” and “simple” abscess drainage provides an increased reimbursement of
- [Places We Go: Bangladesh](https://epmonthly.com/article/places-we-go-bangladesh/) - In this limited series, we present personal write-ups from emergency providers that do international medicine. We hope by sharing stories, we can learn from each other and build a network of ideas and experiences. https://youtu.be/4NbeOZkkf8o Background In August 2017, there was an accelerated, forced exodus of Rohingya Muslims from Rakhine State in Myanmar to Bangladesh.
- [Avoid Unnecessary Broad-Spectrum Antibiotics with the DRIP Score](https://epmonthly.com/article/avoid-unnecessary-broad-spectrum-antibiotics/) - How do you decide which patients with bacterial pneumonia are likely to have antibiotic resistance? Decrease use of unnecessary coverage with the Drug Resistance in Pneumonia (DRIP) Score Use the DRIP Score to predict the risk of community-acquired pneumonia due to drug-resistant pathogens. Calculate the total points for both Major and Minor Risk Factors. A
- [Night Shift: Who's the Patient?](https://epmonthly.com/article/night-shift-whos-the-patient/) - https://youtu.be/ZZbFhvCVJ0c I enjoy the cultural diversity of the patient population that I serve, but it is not uncommon for me to march into the patient’s room glancing at the chart only to realize that I don’t have a clue how to pronounce the patient’s name. I usually try to make a stab at it, but
- [Looking Beyond the Stars](https://epmonthly.com/article/looking-beyond-the-stars/) - Understanding the ED’s Impact on Non-CMS Hospital Quality Rankings https://youtu.be/sOyrgg2bWqA Dear Director, I have seen a variety of hospitals advertise different awards. How do they differ from the CMS Star Quality Rating? CEOs are no different than us when it comes to awards. We all have a section on our CV that lists our awards
- [Medical Decision Making Capacity in the ED](https://epmonthly.com/article/medical-decision-making-capacity-in-the-ed/) - Patients aren’t always in the right state of mind to choose correctly. https://youtu.be/44pXCLKZiFI Which of these patients has decisional capacity? A 52-year old schizophrenic with chest pain who declines admission for ACS work-up because she is afraid of getting a lethal infection by staying in the hospital? A 73-year old male with a history of
- [Captains, call for help!](https://epmonthly.com/article/captains-call-for-help/) - Keeping an ED running smoothly shouldn’t be a one person job. “Loneliness is the penalty of leadership….” -Ernest Shackleton https://youtu.be/pP0bx6O1nlU Fresh out of residency, I headed for my first job in a community hospital in Los Angeles where the ED director gave me a pep talk and told me to never forget that the emergency
- [Clevidipine for hypertensive emergencies](https://epmonthly.com/article/clevidipine-for-hypertensive-emergencies/) - Clevidipine is rapid acting, easily titratable, low risk of hypotensive overshoot Introduction As emergency physicians, we frequently face the clinical scenario of hypertensive emergency: a patient’s blood pressure rises to a critical tipping point, which can lead to the development of life-threatening end-organ damage such as hypertensive encephalopathy, hemorrhagic stroke, acute pulmonary edema, aortic dissection
- [Troublesome testimony](https://epmonthly.com/article/troublesome-testimony/) - Having an expert offer insight can prove costly if their opinions are inappropriate and make for a troublesome testimony. The National Practitioner Databank isn’t just a list of malpractice payments. Medical boards, hospitals, and professional societies are also required to report certain adverse actions taken against physicians. This case illustrates how inappropriate expert testimony can
- [The Fluid Debate: Balanced or Unbalanced](https://epmonthly.com/article/the-fluid-debate-balanced-or-unbalanced/) - DEK: Considering the benefits of shifting away from normal saline. Introduction We prescribe and administer intravenous fluids (IVF) every shift for rehydration, resuscitation and treatment. The usual options include normal saline (0.9% saline) or balanced fluids (Lactated Ringer’s and Plasma-Lyte.) If you are like most emergency physicians, your default IVF is normal saline, which may
- [Summer Breaks](https://epmonthly.com/article/summer-breaks/) - Getting set for a season of bumps, bruises and bites. The weather is beautiful, the kids are out of school, it’s grilling season and you can’t wait to get to the beach. Summer is finally here! Though this season is a great time for outdoor and family activities, summer brings with it the potential for
- [Navigating Salary and Benefit Negotiations](https://epmonthly.com/article/navigating-salary-and-benefit-negotiations/) - Dear Director, I’m a rising senior resident about to start the job search. What can I expect for salary and benefits and are these negotiable? With the recent release of the MedScape physician salary survey, it’s possible to view average salary and benefits of emergency physicians around the country. Salary and benefits are just two
- [7 Ways to Lower Your Investment Costs](https://epmonthly.com/article/7-ways-to-lower-your-investment-costs/) - In my last article I discussed some ways you can lower your disability insurance premiums. Now let’s turn our attention to a more exciting topic: investments. Going along with the previous theme, there are ways you can reduce your investment costs and maybe boost your bottom line at the same time: Lower the expense ratio
- [How to Chart Smarter and Optimize for the Best](https://epmonthly.com/article/how-to-chart-smarter-and-optimize-for-the-best/) - Time is valuable in emergency medicine. Here’s how those costs might be hitting your wallet. Critical Care services account for about 8% of the total revenue derived in a typical Emergency Department.(1) In caring for “sick” patients, it’s likely a large portion of the service you provide. That said, every year more than $160,000,000 is
- [ED/EQ: Just as soon as you file that paperwork, Doc](https://epmonthly.com/article/ed-eq-just-as-soon-as-you-file-that-paperwork-doc/) - Paperwork isn’t nearly as exciting as saving lives, but in order to set a consistent tone with RNs, Here is a case where problems with written orders led to a strained work environment for a trauma surgeon and an RN and how it could have been resolved. You know you are watching a TV show
- [Review: The Resident is television malpractice](https://epmonthly.com/article/review-the-resident-is-television-malpractice/) - The Resident just got renewed for a second season on Fox – and that’s a problem. I’d heard the controversy about the show — that it ‘peels back the curtain’ and portrays doctors as greedy and corrupt. I saw the show’s creator trolling healthcare professionals on Twitter, and learned they have a medical consultant who’s
- [Who is the Poor Historian?](https://epmonthly.com/article/who-is-the-poor-historian/) - Patients might not have the best recollection or understanding of what’s important in their visit. Here’s why physicians need to ask the right questions to get the necessary history. Larry Nassar’s sexual assault of hundreds of Olympic gymnasts is horrendous for innumerable reasons, not the least of which is that he abused his position as
- [Market Report: Trends in EM Practice Consolidation](https://epmonthly.com/article/market-report-trends-in-em-practice-consolidation/) - The Six Factors Driving Mergers and Acquisitions in Emergency Medicine in 2018 Merger and Acquisition (M&A) activity in the $20 billion emergency medicine (EM) market is expected to remain strong in 2018 with more transactions on the way this year. The overarching narrative is straightforward: sellers are trying to adapt to new regulatory, technology, and
- [Strategies to Avoid Contested Admissions](https://epmonthly.com/article/strategies-to-avoid-contested-admissions/) - How to stop getting your patients blocked When medical students ask about the downsides of emergency medicine practice, experienced docs commonly identify issues such as burnout, difficult-to-use electronic medical records, stressful work conditions, and working night shifts, weekends, and holidays. But near the top of any list are “contested admissions,” situations when ED docs and
- [RX Pad: Reducing Relapses Through Opioid Maintenance Therapy](https://epmonthly.com/article/rx-pad-reducing-relapses-through-opioid-maintenance-therapy/) - Opioid Maintenance Therapy can lower the endless quest for the next high. Opioid misuse and abuse is rampant in the United States, with an estimated three million people suffering from an opioid use disorder.(1) A key contributor to the ongoing epidemic is the fact that treatment of opioid addiction is notoriously difficult. Use of behavioral
- [Aftermath: The Night Shift Season 1 Finale Review](https://epmonthly.com/article/aftermath-the-night-shift-season-1-finale-review/) - It’s strange calling this a season finale, because it’s only been an 8-episode summer run, and nearly every episode has had the kind of stunts associated with The Night Shift Season 1 finale. It’s strange calling this a season finale, because it’s only been an 8-episode summer run, and nearly every episode has had
- [A Laughing Matter](https://epmonthly.com/article/rx-pad-a-laughing-matter-why-a-little-daily-lol-is-important/) - While not a substitute for traditional curative measures, laughter does offer many positive health benefits including stress reduction and elevates hope. Maybe it’s time to stop being so serious? The origin of the phrase “laughter is the best medicine” is unknown. Some date it as far back as the time of Solomon (approx 950 BCE),
- [ED/EQ: When are you going to see Room 8?](https://epmonthly.com/article/ed-eq-when-are-you-going-to-see-room-8/) - Patient prioritization can be a challenge and a stressor for the doctor and ED nurse. It is an example of how different mindsets can lead to frustration and a breakdown of a collaborative approach. We show how the principles of emotional intelligence could resolve this situation before it became a proble: Recently a nurse filed
- [App Review: eBroselow, LactMed and Med Sketch](https://epmonthly.com/article/app-review-ebroselow-lactmed-and-med-sketch/) - A menu of healthcare apps you can actually put to use. This month EPM looks at eBroselow SafeDose Pro, LactMed and Med Sketch. Essential App - eBroselow SafeDosePro When seconds count and dosing is tricky, use eBroselow Safedose to treat pediatric patients during critical situations. Research featured in the Journal of Pediatric Pharmacology and Therapeutics
- [Night Shift: Mind Game](https://epmonthly.com/article/night-shift-mind-game/) - I was just getting my scrubs on to go to work when my cell phone rang with a call from the director. That’s odd, I thought, for him to call me in the evening, just before work. “Hello, Dr. Plaster,” he said formally. I could tell in his voice that something was wrong. We’ve known
- [Tension Pneumopericardium From Blunt Force Trauma: Resuscitating the Red Baron](https://epmonthly.com/article/tension-pneumopericardium-from-blunt-force-trauma-resuscitating-the-red-baron/) - Trauma Center faced an atypical crash scenario where pilot wrecked his World War 1 replica Triplane. A 60-year-old gentleman presented via ambulance to a Level Two Trauma Center following the crash of his World War 1 replica Triplane. Want to know why planes aren’t built like that anymore? They fly poorly. Aeronautical science was budding
- [Five Ways to Lower Disability Income Insurance Costs](https://epmonthly.com/article/five-ways-to-lower-disability-income-insurance-costs/) - Coverage for future revenue stream does not have to be as big a financial burden as initially feared. Here’s how to make the option more affordable. While you may think that your investment portfolio or your home is your biggest asset, for most emergency medicine physicians, the ability to produce income (future income stream) usually
- [Why Your Veteran RNs are Leaving and Simple Steps to Retain Them](https://epmonthly.com/article/why-your-veteran-rns-are-leaving-and-simple-steps-to-retain-them/) - Experienced nurses are leaving the ED at a quicker rate than their peers decades ago. Although docs aren’t on the front lines in recruiting nurses, they do play an important role in keeping them. Here’s how to keep them in your ED longer. Dear Director, It seems like just about every shift we are down
- [Behind the Music: Medical Care at Asia’s Largest Music Festival](https://epmonthly.com/article/behind-the-music-medical-care-at-asias-largest-music-festival/) - The Djakarta Warehouse Project, which attracts 90,000 attendees to Indonesia each year, presents a unique challenge – and learning opportunity – for mass gathering medicine. Every December since 2011, Jakarta, Indonesia hosts the largest music festival in Asia and, consequently, one of the largest mass gatherings. Once an underground warehouse rave, the Djakarta Warehouse Project
- [Who Needs Chaperones? The Patient… or You?](https://epmonthly.com/article/who-needs-chaperones-the-patient-or-you/) - Patients and Doctors are Cautious about Unwitnessed Physical Exams. Disgraced former USA gymnast doctor, Larry Nassar, will spend his entire life in prison for his sexual assault activity. Without question, his crimes have ultimately damaged the implicit trust between patient and physician. As emergency physicians, we now are facing an environment of increased skepticism regarding
- [Extinguishing Burnout with a Little Mindfulness](https://epmonthly.com/article/extinguishing-burnout-with-a-little-mindfulness/) - For the frequently stressed out emergency physician, devoting time to focusing could help relieve some of the profession’s occupational hazards. INTRODUCTION Let’s face it. The topic of burnout has becoming increasingly more prevalent both in academic literature and general news.(1, 2) As emergency physicians, we seem to be even more at risk than physicians in other
- [I’m Sending You a Patient . . .](https://epmonthly.com/article/im-sending-you-a-patient/) - Signouts and handoffs, whether they’re from an outgoing doctor, mid-level provider or transferring hospital, are ripe for consternation, anger and medico-legal risk. Here’s a real case of a PA-physician conflict and how it could be peacefully resolved. The Story A PA staffing an urgent care clinic calls the nearby emergency department to tell the physician
- [Turning Chaos to Calm](https://epmonthly.com/article/turning-chaos-to-calm/) - A guide to mastering the fine art of verbal de-escalation in the face of increasing emergency department violence. A 56-year-old male presents to the emergency department for back pain. According to the triage note, he suffers from chronic back pain, but it has worsened after lifting a heavy box 2 days ago. It is a
- [A Novel Approach To Toddler Forearm Fractures](https://epmonthly.com/article/a-novel-approach-to-toddler-forearm-fractures/) - Bedside ultrasound has the potential to dramatically speed up the diagnosis and treatment of classic FOOSH injuries in children. “What I did was save us a whole lot of time. The patient is a 4-year-old who tripped and extended her arm to break her fall—a classic axial-load ‘FOOSH’ injury. She affirmed point tenderness near her
- [Match Day](https://epmonthly.com/article/match-day/) - I recently had the privilege of watching my son-in-law open his envelope to learn where he had matched to receive his post graduate training in emergency medicine. Having worked so hard for so many years to get to this point, I’m sure he felt both a sense of exhaustion and relief. Every program nationwide had
- [Your Shoulder Will Be Fine, But There's Something in Your Lung](https://epmonthly.com/article/your-shoulder-will-be-fine-but-theres-something-in-your-lung/) - The careful and intentional handling of incidental findings in the emergency department will improve overall patient care and lower your ED’s malpractice risk. Here’s how to do it. Dear Director: We’re trying to establish a consistent way to talk to patients and document incidental findings on X-rays. Do you typically arrange follow-up testing for these
- [Breaking the Cycle of Domestic Violence](https://epmonthly.com/article/breaking-the-cycle-of-domestic-violence/) - Nearly half of women who are killed as a result of intimate partner violence present to the ED in the two years prior to their deaths, most with evidence of battering. Yet, only 1 in 7 emergency physicians report having a standardized intervention checklist. Let's change that. It is 3:20 a.m. in your busy ED.
- [Hepatitis Cured](https://epmonthly.com/article/hepatitis-cured/) - With cure rates as high as 95% and few side effects, the new direct-acting antivirals for HCV are a life changing breakthrough for many patients. In the last five years, there has been a revolution in the treatment of hepatitisC infections with the advent of direct-acting antivirals (DAAs). Curerates for chronic hepatitis C are now
- [The Smartphone Doctor Has Arrived](https://epmonthly.com/article/the-smartphone-doctor-has-arrived/) - Increasingly popular smartphone apps put evidence-based decision support in the clinician’s pocket, but they still can’t replace clinical judgment. It’s 5:20 a.m. A 35-year-old woman with diabetes and hypertension arrives at your ED complaining of sudden-onset left chest pain waking her from sleep. You know to rule out life-threatening causes of chest pain, but how
- [The Most Common Cause of a Pause](https://epmonthly.com/article/the-most-common-cause-of-a-pause/) - Don’t just assume it's a sinus node dysfunction. A 60-year-old woman presents with episodes of lightheadedness. She has no significant PMH and is on no medications. She denies syncope, vertigo, chest pain, or shortness of breath. Vital signs on arrival are BP 110/70, HR 55, R 22, O2sat 98%. Brief physical exam is unremarkable. An
- [Complicated UTI Part II: Understanding Special Populations](https://epmonthly.com/article/complicated-uti-part-ii-understanding-special-populations/) - Indication for urine culture within several unique UTI patient groups 74-year-old female presents with recurrent falls. She denies dysuria, urgency, incontinence, and frequency. A urinalysis sent from triage demonstrates 5 WBCs,trace LE, and 5 squamous cells, but nitrites are negative. A diagnosis of UTI is made. But does this patient really have a UTI, and
- [A Win-Win for Opioid Abuse Treatment](https://epmonthly.com/article/a-win-win-for-opioid-abuse-treatment/) - Throughout the majority of my career in emergency medicine, I would have to say that the patient I dreaded the most was the patient with “drug seeking behavior.” I didn’t dread them because they presented some novel condition that I didn’t know how to treat. I dreaded them because I believed that there wasn’t anything
- [Problems with Punctuality](https://epmonthly.com/article/problems-with-punctuality/) - Creating a culture that respects clocks—and colleagues Dear Director: I have a couple docs who routinely show up late to work, and I don’t know how to get them to understand the importance of showing upon time. Help! -- My daughter’s lacrosse coach told the kids (and parents) at the first practice that his expectation
- [Should We Screen Patients for Opioid Abuse Potential?](https://epmonthly.com/article/should-we-screen-patients-for-opioid-abuse-potential/) - New screening tools have been created, but which, if any, are right for you ED? It is a given that pain is the most common reason why patients seek care in the ED. So emergency physicians must be experts at treating acutely painful conditions. For many years, the Joint Commission mandated treating pain as a
- [Paying it Forward](https://epmonthly.com/article/paying-it-forward/) - Sometimes saving a life means giving up a piece of your own. Matt Harmody has often been reminded of his father while working in the emergency department over the last 20 years. When dialysis patients come in to his North Carolina ED, he sees his father, who died of renal failure while needing a kidney
- [Prudent Layperson, Meet Imprudent Payer](https://epmonthly.com/article/prudent-layperson-meet-imprudent-payer/) - Anthem has announced that it will not cover "inappropriate" emergency department visits, as judged after the fact. This flouting of the law is bad policy, and patients are going to get hurt. In the past year, insurance giant Anthem has announced that in six states, they would not cover “inappropriate” ED use. While I’m not
- [Neuropsych Complications of the Flu Virus](https://epmonthly.com/article/neuropsych-complications-flu-virus/) - What do you do when the treatment is as bad as the illness? You discharged a teenage patient after having diagnosed flu and initiated oseltamivir. Risk management asks to speak with you a few days later about the patient’s apparent suicide. You feel a pit in your stomach as you wonder whether you could have
- [Should I Be Concerned about Tide Pods?](https://epmonthly.com/article/concerned-tide-pods/) - Teenagers injesting detergent capsules is the latest in a string of ill-advised internet trends. Here's what you need to know. It’s been a busy evening shift. Gastroenteritis is widespread in the community, and you have seen so many vomiting children that you’ve lost count. You’re not surprised that the next chart in the rack is
- [A Better Way to Treat Hypoxia](https://epmonthly.com/article/a-better-way-to-treat-hypoxia/) - High-flow nasal cannula is a good first option. A 72-year-old man with a history of smoking and hypertension presents to the emergency department (ED) with cough, fever, and shortness of breath. His initial oxygen saturation is 81% on room air and the nurse places a non-rebreather (NRB) facemask to maintain an oxygen saturation of >90%.
- [Rule Out SAH with… The Ottawa Subarachnoid Hemorrhage Rule](https://epmonthly.com/article/rule-out-sah-with-the-ottawa-subarachnoid-hemorrhage-rule/) - What’s better than a champagne tap? Not having to do an LP in the first place. THE GOOD Why Use It +~100% sensitive for SAH + The only wellvalidated calc for SAH rule-out THE BAD Limitations – Strict inclusion criteria, so only applicable to small number of patients – 40 years or older? (a.k.a. every
- [News in Telemedicine: February 2018](https://epmonthly.com/article/news-telemedicine-february-2018/) - The big news this month was the passage of the CHRONIC Care Act of 2017 which includes changes to Medicare and Telehealth reimbursement. This move was an important step because reimbursement limitations make institutions think twice about beginning a telemedicine program. What it entails: Dialysis patients (2019) – People with at-home dialysis will be able
- [More Disruption Please](https://epmonthly.com/article/more-disruption-please/) - 3 New Products Reshaping Healthcare THE ROUNDER Innovator Health created Rounder (pictured above) to improve telehealth by moving from impersonal laptopbased consults to more life-like consultations. By using a combination of improved graphics, direct eye-contact technology, and a 3D video platform, Rounder helps patients forget about the hardware. The HIPAA-compliant conferencing technology can also operate
- [Aftershock](https://epmonthly.com/article/aftershock/) - Without a doubt, it was the worst night of my entire life. It had started out as the usual crazy busy Friday night shift. Our administration thought that 36 hours of physician coverage a day was enough to see over 40,000 patients per year. That meant that our ER docs were tasked with seeing three
- [Dilaudid in Detail: The Problem with Hydromorphone](https://epmonthly.com/article/dilaudid-detail-problem-hydromorphone/) - Pain expert Sergey Motov speaks with EPM editor Nicholas Genes about the do's and don'ts of using hydromorphone (Dilaudid) for pain care in the emergency department. Nicholas Genes, MD, PhD You gave a talk recently, citing that US ED use of hydromorphone essentially doubled from 2005-2010. These cover the years I was in training, when
- [Is Due Process Good for Emergency Physicians?](https://epmonthly.com/article/due-process-good-emergency-physicians/) - Due process should protect physician rights, but it is sometimes used – or waived – to a physician’s detriment. Hospital management changes. Doctors whose care had never been questioned with the prior administration are now being told that if they don’t see a minimum average of 2.2 patients per hour within the next 60 days,
- [The New Tax Code: Seven Things You Need to Know](https://epmonthly.com/article/new-tax-code-seven-things-need-know/) - New rules and regulations that could impact your tax filings in April. Now that we’re a month into the new year and you’re thinking about filing last year’s tax return, it’s a good idea to anticipate what’s coming this year, especially because of major revisions to the tax code passed at the end of 2017.
- [Trust Your Gut! And other lessons I learned when I swapped a lab coat for a hospital gown](https://epmonthly.com/article/trust-gut-lessons-learned-swapped-lab-coat-hospital-gown/) - Twas the night before a shift, and I felt like crap. Nauseated, bloated, and uncomfortable. Having had no booze or inappropriate food to ‘earn’ such discomfort, I was mildly suspicious that something was brewing in my unhappy abdomen. I slept with a bowl beside my bed and set my alarm for my shift early the
- [Navigating the Penicillin Pseudo-Allergy Pandemic](https://epmonthly.com/article/navigating-penicillin-pseudo-allergy-pandemic/) - Nine out of ten patients who claim a penicillin allergy don't actually have one. Here's how to handle this all-too-common situation. A whopping 10% of patients in the United States report a penicillin allergy, earning penicillin the dubious distinction of most common drug allergy. However, the good news is that only 1 in 10 of
- [Ultrasound-Assisted Intraosseous Insertion](https://epmonthly.com/article/ultrasound-assisted-intraosseous-insertion/) - "I need a doctor in Trauma 1 right now!" You run into the resuscitation room, and before you is a swarm of ED staff surrounding what appears to be a minimally responsive infant. Your staff is so well-trained that one of them has already appropriately positioned the airway while your respiratory therapist entered the room
- [Dyspnea After a Heroin Overdose](https://epmonthly.com/article/dyspnea-heroin-overdose/) - An old school problem in the modern era. A 55-year-old man was brought to the emergency department by a friend after he became unresponsive shortly after snorting heroin. He became alert and conversant after receiving 1 mg of IV naloxone immediately upon arrival. He denied any past medical history other than heroin use. Over the
- [The Lowly Urinalysis: How to Avoid Common Pitfalls](https://epmonthly.com/article/lowly-urinalysis-avoid-common-pitfalls/) - You may think you know everything about the humble pee test, but there are subtleties you might be missing. A 53-year-old female presents with malodorous urine. She denies dysuria, urgency, incontinence, and frequency, but she is concerned for UTI. She had one UTI several years ago, but at that time had dysuria and urgency. A
- [Cost Disease and Emergency Medicine: Can We Do More With Less?](https://epmonthly.com/article/cost-disease-emergency-medicine-can-less/) - Over the past two decades, U.S. emergency department (ED) visits have increased dramatically to greater than 140 million yearly, [1] resulting in more crowded EDs filled with increasingly complex, older patients. [2] The ED workforce has not grown at the same pace, and staffing shortages have become widespread, particularly in rural areas. [3] More recently,
- [Why Don't More Emergency Departments Cardiovert?](https://epmonthly.com/article/why-dont-emergency-departments-cardiovert/) - Cardioversion and discharge of recent onset AF is pretty much the accepted treatment in almost every country in the world with the exception of the United States. Nine years ago, a 55-year-old male presented to the ED with an irregular heart rate of approximately 167 bpm for 4 hours. Recommendations were made for a diltiazem
- [Improving the Patient Experience](https://epmonthly.com/article/improving-patient-experience/) - Your CEO has told you she needs to see your department's patient satisfaction scores improve or she'll be looking for a new chairman. What do you do next? CEOs of hospitals know that patient experience scores are basically the hospital’s reputation, and that ED scores correlate with inpatient scores, but this feeling may not trickle
- [Scoop & Run: Get Ready for a Massive Influx of Untriaged Patients](https://epmonthly.com/article/scoop-run-get-ready-massive-influx-untriaged-patients/) - When it comes to mass casualty planning, it’s not a game—it’s a philosophy. When a mass casualty incident occurs, emergency physicians are quickly thrust onto the front lines. That is precisely what happened on October 1st at Sunrise Emergency Department in Las Vegas the night Stephen Paddock opened fire on a music concert, killing 58
- [The Butterfly Effect](https://epmonthly.com/article/the-butterfly-effect/) - Butterfly's revolutionary chip technology could disrupt the portable ultrasound market by creating a device consumers can afford. It still rings in my ears. “If you can’t take care of the equipment appropriately, maybe you shouldn’t be allowed to use it at all!” As a newly minted 4th year, I had just tangled the ultrasound transducer
- [Reasonable Practice: Should This EP Have Done More?](https://epmonthly.com/article/reasonable-practice-ep-done/) - The Case by Brady Pregerson, MD A 55-year-old male with a history of hypertension and GERD was brought by ambulance to the emergency department for a syncopal episode that occurred while he was at his doctor’s office. The day prior he had been to the same physician for evaluation of a two-week history of dry
- [Pushing Back on Push Dose Pressors](https://epmonthly.com/article/pushing-back-push-dose-pressors/) - A quick and easy life-saving solution, or an unjustifiable risk to patients? As a resident, I was fortunate to regularly hear Scott Weingart speak at our Wednesday conference. So to me, bolus-dose vasopressors (or as Scott coined them, push-dose pressors) have just always been a useful thing to have nearby. Say you have a crashing
- [Case Study: Penetrating Cardiac Injury from BB Gun](https://epmonthly.com/article/case-study-penetrating-cardiac-injury-bb-gun/) - Traumatic cardiac injuries are uncommon in the pediatric population. Of reported traumatic cardiac injuries, contusions account for 95% of injuries, and penetrating trauma is rare. We report the case of a 9-year-old girl who sustained a BB gun-associated penetrating cardiac injury that was complicated by a central nervous system stroke resulting from the BB pellet
- [Management Strategies for Outpatient PE](https://epmonthly.com/article/management-strategies-outpatient-pe/) - Treatment options, management approach, and bleeding risks for the outpatient handling of pulmonary embolism CASE: Your patient is a 33-year old female with newly diagnosed left segmental PE. She was initially tachycardic, which has since improved with acetaminophen. Her ECG and biomarkers are unremarkable. She appears well and scores 0 on sPESI and Hestia Criteria.
- [Not His Day to Die](https://epmonthly.com/article/not-day-die/) - The chief complaint was “weak and dizzy.” I had to shake my head. How many thousands of these have I seen in the last 35 years? Usually a vaso-vagal syncope. Maybe an arrhythmia, labyrinthitis? Sometimes it was serious – but usually not. But as soon as I laid eyes on Francis Howard, age 94, I
- [Why Don't More Emergency Departments Cardiovert?](https://epmonthly.com/article/dont-emergency-departments-cardiovert/) - Cardioversion and discharge of recent onset AF is pretty much the accepted treatment in almost every country in the world with the exception of the United States. Nine years ago, a 55-year-old male presented to the ED with an irregular heart rate of approximately 167 bpm for 4 hours. Recommendations were made for a diltiazem
- [Healthy Habits for the New Year Start With the Emergency Department Chairman](https://epmonthly.com/article/healthy-habits-new-year-start-emergency-department-chairman/) - The new year offers a unique opportunity for directors to implement important department improvements. While January typically brings high volumes and high acuity, it’s important not to take our eyes off the administrative ball. The new year brings an opportunity to refocus our administrative agenda for the upcoming year and maybe gives us an excuse
- [Due Process Now](https://epmonthly.com/article/due-process-now/) - In the February 2012 issue of EPM, in an article titled “Due Process in Due Time,” Dr. Ron Hellstern argued against the exercise of due process rights by emergency physicians.1 Contrary to assertions by Dr. Hellstern, multiple statutes and case law require hospitals to extend due process rights to practicing physicians. Whether a physician may
- [Tintinalli's Year in Review: What We Learned in 2017](https://epmonthly.com/article/tintinallis-year-review-learned-2017/) - 2017 was, shall we say, complicated. Here are the issues that dominated our headlines and will continue to drive conversations in 2018. Tragedy in Las Vegas brings out the best in emergency medicine It took our breath away. 500+ shooting victims and 59 deaths in a massacre aimed randomly at the thousands who were celebrating
- [No Better Friend](https://epmonthly.com/article/no-better-friend/) - The overhand right found its mark on the left zygomatic arch and it was lights out for the man who was now sitting in the administrator's office watching the replay unfold on a giant security screen. As the former team physician for the U.S. Naval Academy boxing team, I’d seen this more than a few
- [Why "Be More Like Pilots" Just Doesn't Fly in Emergency Medicine](https://epmonthly.com/article/like-pilots-just-doesnt-fly-emergency-medicine/) - The book "Why Hospitals Should Fly" misses a big part of what makes emergency medicine unique. When I went through orientation at my latest hospital, there was a lot of talk about building a culture of patient safety and emphasis on how the organization wanted to reach that goal. As part of that effort, we
- [Hyperammonemia: Is It the Liver or Something Else?](https://epmonthly.com/article/hyperammonemia-liver-something-else/) - A review of the cirrhotic and non-cirrhotic causes of hyperammonemia that may be encountered in the emergency department. Sol volatile, or “smelling salts,” are ammonium salts that release ammonia gas, and were frequently used in Victorian England to revive the alarmingly-prevalent swooning woman. Ammonia causes mucosal irritation in the nasal passages and lungs, triggering inhalation.
- [What Caused This Man's Pruritis?](https://epmonthly.com/article/caused-mans-pruritis/) - A 64 year-old-male with a history of MI, CAD, HTN, DM, alcohol and tobacco use disorder presented to the ED for jaundice, itching and abnormal LFTs. The patient stated that he had been experiencing itching for the last three to four weeks along with jaundice and icterus. It was worse when he showered and was associated
- [Capnography: Not Just for Cardiac Arrest and Sedation Anymore](https://epmonthly.com/article/capnography-not-just-cardiac-arrest-sedation-anymore/) - Five conditions where this respiratory assessment could come in handy. You just walked in to your evening shift in the small, ten bed community ED. Two patients await you: The first is a 22-year-old male who presents with tachycardia, nausea, and vomiting. He has a history of type 1 diabetes, with a home glucose reading
- [Did You Sign Away Your Livelihood?](https://epmonthly.com/article/sign-away-livelihood/) - Your signature may allow other others to make defamatory statements about you or your job performance. While a medical resident was completing his final year of a 4-year training program, a new program director was hired. Subsequently, the resident received several negative performance evaluations. While the resident argued that the negative evaluations were due to
- [App Review: ERres, Neuro Toolkit & Doximity Dialer](https://epmonthly.com/article/app-review-erres-neuro-toolkit-doximity-dialer/) - A menu of healthcare apps you can actually put to use. Essential App: ERres ERres includes a complete collection of reference material all in one app. In addition to medical calculators, treatment guidelines and pediatric dosing recommendations, it includes instructions for procedures and bedside ultrasound studies. It's user friendly and can be used at bedside for
- [App Review: MDCalc, Pedi STAT, One Minute Ultrasound](https://epmonthly.com/article/three-medical-apps-youll-actually-use/) - Need to know loading dose for Keppra in a 5kg kid? What labs do you get for a porphyria exacerbation? Want to review renal ultrasound technique on the way to your next patient with flank pain? We got you. We'll be giving you a handful of apps every month so you can put that computer
- [App Review: Medscape, EMRashes, Read by QxMD,](https://epmonthly.com/article/july-2017-apps-youll-actually-use/) - We'll be giving you a handful of apps every month so you can put that computer in your pocket to work, not only when you have a little extra time between patients, but also when you're at the head of the bed getting ready to intubate. The Essential App: Medscape A handy app you can use
- [App Review: 10 Second EM, Orthobullets, GoodRx for Doctors](https://epmonthly.com/article/october-2017-best-medical-apps-month/) - A monthly menu of healthcare apps you can actually put to use. The Essential App: 10 Second EM 10 Second EM is a rapid reference tool for ACLS, PALS, RSI, and pressor meds. It also features a database of toxidromes, orthopedic imaging guidelines, and scoring tools like the Wells Criteria and NIH Stroke Scale. Some of
- [The Painful Reality Behind America's Surge in Tramadol Prescriptions](https://epmonthly.com/article/painful-reality-behind-americas-surge-tramadol-prescriptions/) - Tramadol provides suboptimal pain relief, is a high risk for abuse and addiction, has multiple drug-drug interactions and bad side effects. So why in the world is it surging in popularity? A conversation between Drs. Sergey Motov and Nicholas Genes. Nicholas Genes: Is it just my imagination, or am I seeing a rise in tramadol
- [Think Twice Before Hitting 'Reply All'](https://epmonthly.com/article/think-twice-hitting-reply/) - Dear Director: I send group emails to our emergency department on a fairly regular basis. About every other week, one of my docs will reply to the entire group with an overtly political message. I worry about members of my group being offended and relationships being strained. Can I make him stop? Let’s face it: A
- [Diagnose This Painful Groin Mass](https://epmonthly.com/article/diagnose-painful-groin-mass/) - The otherwise healthy 27-year-old thinks it's an abscess. Do you agree? You are working Friday the 13th in the fast track area of your ED when you go in to see the first patient of your shift. He is a 27-year-old single male with no significant past medical history who is there for 4 days
- [Four West Virginia Cities Sue The Joint Commission](https://epmonthly.com/article/four-west-virginia-cities-sue-joint-commission/) - Suit alleges that JCAHO's misrepresentation of opioid risks contributed to West Virginia's opioid crisis. On November 2, 2017, four cities in West Virginia teamed up to file suit against The Joint Commission over the organization’s handling of pain management standards. The move follows more than a decade of public sparring over the role that the
- [Don't Forget These Important Year-End Financial Deadlines](https://epmonthly.com/article/dont-forget-important-year-end-financial-deadlines/) - 2017 is almost in the rearview mirror. While your mind may be more on presents than on savings, the end of the year is an important time to make sure you don’t miss annual financial deadlines. Here are a few common ones to consider. 1. 401k/403b/457 Plan If you are an employee of a hospital
- [Kevin Rodgers, President of AAEM, Killed in Apparent Robbery](https://epmonthly.com/article/kevin-rodgers-president-aaem-killed-apparent-robbery/) - The untimely death of this Army veteran and decorated educator leaves unanswered questions, and a medical specialty in mourning. The staff of Emergency Physicians Monthly was shocked and heart broken to learn of the untimely death of Kevin Rodgers, a great educator and friend. On November 10, Rodgers, 61, was shot and killed in his
- [The Current State of Refractory VF](https://epmonthly.com/article/current-state-refractory-vf/) - Given the difficulty in converting RVF to a perfusing rhythm, here are a few strategies beyond the standard therapy to add to your toolbox. Refractory ventricular fibrillation (RVF) is a life-threatening cardiac arrhythmia unresponsive to traditional methods of defibrillation and advanced cardiovascular life support (ACLS). RFV has been defined as “ventricular fibrillation that is resistant
- [4 EMS Myths, Busted](https://epmonthly.com/article/4-ems-myths-busted/) - EMS is often criticized for not having the same evidence base as hospital-based medicine. Backboards, c-collars, and even ALS as a whole has been criticized as not efficacious. Here, we’ll debunk some recent EMS myths and examine the evidence (or lack thereof) behind them. The myth: Prolonged CPR in out-of-hospital cardiac arrest does not lead to
- [Just Do The Next Right Thing](https://epmonthly.com/article/just-next-right-thing/) - When burnout threatens, sometimes it's the hardest cases that re-ignite our passion. Around 5:30 in the morning I am called to see a patient with chest pain. In the stretcher, I see a skinny bordering on cachectic man around 50 years old. Not a great story for cardiac angina, but he is a heavy smoker
- [How to Care For A Racist Patient](https://epmonthly.com/article/care-racist-patient/) - Dear Director: Occasionally I have a patient refuse to let me care for them because they don’t like my gender/skin color/nationality, and they want another doctor. Should I give in to them and get a colleague or tell them it’s me or the highway? I was on my last call night at the trauma center during residency
- [Case Study: Can You Name This Eye Problem?](https://epmonthly.com/article/case-study-can-name-eye-problem/) - An up-close look at a common eye lesion. A 35-year-old woman presented to the emergency department reporting a three day history of right eye redness and pain. She endorsed constant irritation and redness, and she denied fever, itching, tearing, visual changes, or trauma to the eye. She reported that she had spent the prior week
- [How To Confidently Rule Out Traumatic Arthrotomy of the Knee](https://epmonthly.com/article/confidently-rule-traumatic-arthrotomy-knee/) - A 23-year-old male presents after a bicycle accident. He reports falling onto his left knee, then sliding to a stop under a parked car, colliding with a grate on the street. He reports no medical problems or medications. Exam is notable for a deep laceration slightly inferior and lateral to his left patella. Bleeding is controlled;
- [Hippo Education Reviews EPM's November Issue](https://epmonthly.com/article/hippo-education-reviews-epms-november-issue/)
- [ICEM 2014: Tintinalli Headlines & Holliman Assumes Presidency](https://epmonthly.com/article/icem-2014-tintinalli-headlines-holliman-assumes-presidency/) - On June 11, EPM Editor-in- Chief and renowned educator Judith Tintinalli took to the stage in Hong Kong to address the 2014 International Conference on Emergency Medicine (ICEM). With more than 2000 attendees, this biennial meeting is the largest gathering of emergency physicians outside of the ACEP Scientific Assembly. More importantly, it’s the largest comprehensive
- [How One EP Transformed Mental Health Admissions in Virginia](https://epmonthly.com/article/how-one-ep-transformed-mental-health-admissions-in-virginia/) - Virginia EP Debra Perina combined her experience as a coroner with her time leading an ED to challenge the establishment and change the way Virginia handles mental health admissions. Dr. Debra Perina lives a double life. Her “day job” is Professor of Emergency Medicine and Director of the Prehospital Care division at the University of
- [Do EPs Need to Unionize?](https://epmonthly.com/article/eps-need-unionize/) - Emergency physicians often find themselves on an uneven playing field when it comes to contract negotiations. And yet a union's greatest weapon – the strike – runs contrary to the ethos of emergency medicine. Emergency physicians today often find themselves on an uneven playing field with their employers. Emergency physician practices have become increasingly consolidated,
- [Polish Residents On Hunger Strike Highlight a Specialty in Crisis](https://epmonthly.com/article/polish-residents-hunger-strike-highlight-specialty-crisis/) - Do we need to put emergency medicine on the endangered list? I was walking off the stage in Athens when a small group of Philippine emergency medicine residents rushed up to me. "Please help us in the Philippines," they pleaded. "We can’t continue working like this, 36 hours straight in the ED. Nobody wants to go
- [In Poland, EM Labor Battles Are A Matter Of Survival](https://epmonthly.com/article/poland-em-labor-battles-matter-survival/) - In March of 2017, I was among various members of AAEM who were invited faculty for the 26th Winter Conference for Emergency Medicine and Critical Care in Karpacz, Poland. We were distressed to learn that emergency medicine is under dire threat in Poland. When a resident matches into a residency slot at a given hospital
- [Got Calcium?](https://epmonthly.com/article/got-calcium/) - Humble calcium may be an old standby, but we're still finding novel uses for this abundant mineral, including treatment for acid burns. Calcium is the most abundant mineral in the body. It provides structural integrity to the skeletal system and is essential in countless physiologic processes including contraction of cardiac, skeletal, and smooth muscle, nerve
- [Redesigning Your ED for the Threats of Tomorrow](https://epmonthly.com/article/redesigning-ed-threats-tomorrow/) - Every day it seems that emergency departments become more hazardous places to work. But there are proven design strategies that can help create a safer zone for patients and providers. It’s a typical Thursday evening in the emergency department. Treatment stations are fully occupied. Physicians and nurses are busily tending to patients. Families come and
- [This Cause of Syncope May Be Both Predictable and Preventable](https://epmonthly.com/article/cause-syncope-may-predictable-preventable/) - Case #1 A 48-year-old woman is brought by ambulance after an episode of syncope at home. The syncope was not preceded by chest pain, headache, or other red-flag warnings. In the ED she appears mildly ill and says that she has had several days of nausea, vomiting, and diarrhea. There has been no hematemesis or
- [We Need to Consider Involuntary Treatment for Heroin Overdose](https://epmonthly.com/article/need-consider-involuntary-treatment-heroin-overdose/) - For too long we have waiting for drug addicts to hit rock bottom before intervening. But the costs to individuals, and to society, are simply too high. We must take firm, compassionate action, and it starts in the emergency department. How many times have we reversed a heroin overdose only to have the patient leave
- [ABEM Should Set an Example for Board Transparency](https://epmonthly.com/article/abem-set-example-board-transparency/) - ABEM is growing wealthy, alongside the other medical boards, but they should remember their roots and choose a path of transparency. Drolet and Tandon, in their research letter to JAMA on August 1, dug up some numbers and gave some context to what a lot of practicing physicians were undoubtedly wondering: How does my specialty’s
- [How to Cheat Death... Or at Least Stay Out of Probate](https://epmonthly.com/article/cheat-death-least-stay-probate/) - When you're planning for your future, consider strategies that can help you bypass the probate process and leave assets to your beneficiaries directly. When you die with a will, your estate goes through probate, which is a state court process that manages, settles, and distributes your property according to the terms of your will. As
- [To Scan or Not to Scan](https://epmonthly.com/article/scan-not-scan/) - When is it appropriate to bypass a stone-protocol CT scan in a young person? “Hey Eran, thanks for calling me back so quickly. I want to tell you about my 13-year-old female patient who has a 5 mm right-sided uretero-pelvic junction (UPJ) stone noted on point-of-care ultrasound (Figure 1 below). She experienced the sudden onset
- [Can David Seaberg Save Summa?](https://epmonthly.com/article/can-david-seaberg-save-summa/) - Dr. David Seaberg has launched residencies and helmed ACEP, but his latest challenge, leading Summa Hospital in Akron, Ohio, might be his greatest work to date. If he can accomplish his goal of not only saving the department and the residency but making Summa a model for the future, it will be the capstone on
- [Interview: Kowalenko on How Anti-MOC Bills Jeopardize Physician Self-Regulation](https://epmonthly.com/article/interview-kowalenko-anti-moc-bills-jeopardize-physician-self-regulation/) - There is no denying that maintenance of certification (MOC) by medical boards is under attack. EPM's Dr. Judith Tintinalli caught up with Dr. Terry Kowalenko, president of the American Board of Emergency Medicine (ABEM), to discuss the board's $33 million in assets and recent legislative action critical of ABEM certification. EPM: Terry, thank you for talking to EPM
- [Court Sense: Skirting Tort Reform](https://epmonthly.com/article/court-sense-skirting-tort-reform/) - A claim of "negligent credentialing" may allow plaintiff attorneys to circumvent state medical malpractice damage caps. In this case, a 34-year-old female with Down syndrome collapsed at home prior to coming to the ED. After a normal CT scan, the patient was diagnosed with a focal seizure, and anti-epileptics were administered. The patient's parents reportedly
- [Feds Increase EMTALA Penalties against Physicians and Hospitals](https://epmonthly.com/article/feds-increase-emtala-penalties-physicians-hospitals/) - The Office of Inspector General recently doubled the potential monetary penalty for violations of EMTALA, added a new physician decision-making scenario subject to the penalty, and modified the factors considered in determining the amount of the penalty. When the Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted in 1986, physicians or Medicare-participating hospitals
- [Emergency Physicians Respond to Viral Video of Gainesville Doctor Ejecting Patient from Medical Clinic](https://epmonthly.com/article/emergency-physicians-respond-viral-video-gainesville-doctor-ejecting-patient-medical-clinic/) - On Tuesday night, a video emerged on Facebook that showed a Florida doctor cursing at a patient and kicking her out of an urgent care clinic. The video has since gone viral, garnering thousands of views, and getting the attention of national news outlets. In the video, Gainesville doctor Peter Gallogly yells at Jessica Stipe, a patient
- [When Techie Baby Monitors Cry Wolf](https://epmonthly.com/article/techie-baby-monitors-cry-wolf/) - New at-home baby monitors that track everything from heart rate to oxygen saturation prove more alarming than helpful. It’s been a busy night in the Pediatric ED, and you’re exhausted. But you look as fresh as a daisy compared to the bleary-eyed young parents in Room 3. They are here because their 8-week-old infant’s apnea
- [Hospital Politics Don't Have to Be a Dirty Business](https://epmonthly.com/article/hospital-politics-dont-dirty-business/) - Dear Director: I’ve never liked hospital politics, but now that I’m a Chair, I realize I have to better understand them. How can I wade in without getting dragged down? Office politics can have a dirty connotation. We know that some people use politicking in a destructive way to get ahead in an organization. But we
- [When Cyclic Vomiting Has You Spinning Your Wheels](https://epmonthly.com/article/cyclic-vomiting-spinning-wheels/) - Cyclic vomiting and cannabinoid hyperemesis syndromes repeatedly bring patients through the doors of the ED. Here's your clinical refresher. The symptoms patients experience during an acute cyclic vomiting syndrome (CVS) or cannabinoid hyperemesis syndrome (CHS) episode can be difficult to manage, as the nausea is often resistant to typical anti-emetics like ondansetron and promethazine. There
- [SMACC: Flipping the Medical Conference](https://epmonthly.com/article/smacc-flipping-medical-conference/) - Social media-driven conferences like SMACC may represent a fundamental shift in how medical education meetings will be conducted in the future. Emergency providers are gearing up for another American College of Emergency Physicians (ACEP) Scientific Assembly in DC, looking forward to lectures by prominent emergency medicine figures, touring the exhibition hall and innovation zone, and
- [Stories of How Harvey and Irma Brought Out the Best in America's Emergency Responders](https://epmonthly.com/article/stories-harvey-irma-brought-best-americas-emergency-responders/) - This Fall has already seen record-breaking hurricanes in Texas and Florida. But we've also seen emergency responders and heroic citizens respond in ways that remind us of the best in humanity. Here are a few stories and pictures of hurricane heroics from both Harvey and Irma. Flood waters surround Ben Taub Hospital in Houston August
- [The Watch Made By Doctors, For Doctors](https://epmonthly.com/article/watch-made-doctors-doctors/) - Four French physicians with a passion for fine watches put their heads together to form Doplr, a Swiss-made watch with old school medical functionality. Doplr founder Vincent Azzola shares the story. For doctors, by doctors We wanted a watch which was useful in terms of our job, symbolically innovative with regard to the history of
- [Virtual Sponsors: A Vital New Weapon in the War on Addiction](https://epmonthly.com/article/virtual-sponsors-vital-new-weapon-war-addiction/) - Telemedicine has the ability to provide the personal accountability that opioid addicts so desparately need. Telemedicine, using a variety of adjunctive therapies, has the potential of mitigating one of the worst healthcare scourges of our generation – opiate addiction. Allow me to explain. The major problem with most addictions, be it smoking, eating, gambling,
- [Like the Now-Ubiquitous AED, the NaloxBox Could Provide Quick Access to Narcan](https://epmonthly.com/article/like-now-ubiquitous-aed-naloxbox-provide-quick-access-narcan/) - Emergency physician aims to make life-saving doses of naloxone more accessible. If you want to stop fires from spreading, keep fire extinguishers handy. If you want to prevent death by heart attack, you place defibrillators at strategic points of population. If you want to reduce opiate overdose deaths, you create the NaloxBox—and hope it becomes
- [Do Intravenous First-Line Benzodiazepines Terminate Seizures Faster Than Non-Intravenous Routes?](https://epmonthly.com/article/intravenous-first-line-benzodiazepines-terminate-seizures-faster-non-intravenous-routes/) - STUDY SUMMARY Article: Alshehri A, Abulaban A, Bokhari R, et al. Intravenous versus Non-Intravenous Benzodiazepines for the Abortion of Seizures: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Acad Emerg Med. 2017 Mar 25. Design: Systematic review and meta-analysis of randomized and quasi-randomized controlled trials. Population: Included: Adults and children treated with BZD for status epilepticus (seizures
- [The ABCs of BZDs: What You Need To Know About Benzodiazepines](https://epmonthly.com/article/abcs-bzds-need-know-benzodiazepines/) - Lorazepam, diazepam, midazolam: What’s the difference? Benzodiazepines (BZDs) are used on a daily basis in the ED. We routinely reach for lorazepam, diazepam, midazolam and other BZDs to treat seizures, alcohol withdrawal and acute agitation, and hiommonly administer them for anxiolysis and procedural sedation. But how do the various BZDs differ? Are particular BZDs preferred
- [Is Outpatient Treatment Finally an Option for Pulmonary Embolism?](https://epmonthly.com/article/outpatient-treatment-finally-option-pulmonary-embolism/) - Is this treatment modality finally a viable option? Your next patient is a 33-year-old female with chief complaint of dyspnea with exertion. She is mildly tachycardic at 102, but the rest of her vital signs are normal. She expresses that she returned from an overseas trip over one week ago, and since that time she
- [When Does EMTALA Apply? The Semantics of Emergency Care](https://epmonthly.com/article/emtala-apply-semantics-emergency-care/) - A recent court case challenges whether “urgent” care clinics will have to meet the same EMTALA standards as a dedicated emergency department. This month's case was highlighted in the Journal of Urgent Care Medicine in an article titled, “Federal Judge Says EMTALA Covers Hospital-Owned Urgent Care Center.” The article describes a Rhode Island US District
- [The Calculus of Emergency Medicine](https://epmonthly.com/article/calculus-emergency-medicine/) - Have you ever dealt with a patient or specialist who is confused about the scope of emergency medicine? Here's a quasi-mathematical way to think about it. As a relative newcomer to the pantheon of medicine, emergency medicine sometimes requires more of an explanation than other specialties. Patients ask emergency medicine residents, “So what type
- [Resident Expert: My First Year in Medicine](https://epmonthly.com/article/resident-expert-first-year-medicine/) - Interns reflect on their first year in emergency medicine. If becoming an attending is the physician equivalent of adulthood, then intern year is the coming-of-age. When Emergency Physicians Monthly asked interns about their first year of training, they described a year full of firsts. First resuscitations, first saves, first losses, and first realizations of the
- [Emergency Care Through the Eyes of the Stoics](https://epmonthly.com/article/emergency-care-eyes-stoics/) - My tour of duty in Afghanistan introduced me to the Stoic Philosophers, and a new way to see our specialty. Keep yourself simple, good, pure, serious, unpretentious, a friend of justice, god-fearing, kind, full of affection, strong for your proper work. Strive hard to remain the same man that philosophy wished to make you. Revere
- [Cat Scratch, No Fever](https://epmonthly.com/article/cat-scratch-no-fever/) - Ultrasound can succeed in mobilizing a surgeon when exam and labs fail to impress. You are working a Sunday morning fast track shift. Your first patient is a 72-year-old male with a history of DM and HTN who came to the ED for right hand pain and swelling after being scratched deeply on the dorsum
- [Viral Video of Nurse's Violent Arrest Undermines Physician-Police Partnership](https://epmonthly.com/article/viral-video-nurses-violent-arrest-undermined-partnership-doctors-police/) - We know about the occupational hazards of the emergency department. The agitated drunks, the mentally ill, the violent gang members. We’re trained to manage these situations, but we also take comfort that hospital security – and the police – have got our backs. That comfort was really shaken last week when this body-cam video surfaced
- [Meet Dr. Leana Wen, the Emergency Physician Taking on Baltimore's Health Crises](https://epmonthly.com/article/meet-leana-wen-emergency-physician-taking-baltimores-health-crises/) - Baltimore's health commissioner has plenty on her plate, from the city's crippling drug abuse problem to high infant mortality. But Dr. Leana Wen, a 34-year-old emergency physician, is taking it in stride. Interview by Logan Plaster EPM: How did your work as an emergency physician prepare for your role as Baltimore’s health commissioner? Dr. Leana Wen:
- [Rounding Right: How to Keep Tabs On Your Emergency Department](https://epmonthly.com/article/rounding-right-keep-tabs-emergency-department/) - Dear Director: I’ve heard about rounding, but what exactly am I supposed to do—and why am I doing it? Although I’ve blocked out most of the memories of my 3rd year med student internal medicine clerkship, the concept of going door to door checking on patients in the morning (and sometimes in the evening) is obviously
- [Snakebite Update: How Well Do You Know Your Pit Viper Anti-Venom?](https://epmonthly.com/article/snakebite-update-well-know-pit-viper-anti-venom/) - According to the CDC, between 7,000 to 8,000 people are bit by venomous snakes each year, and that number is going up. Stay up to date on the latest anti-venom updates. John, a 25-year-old avid hiker, is trekking through the woods enjoying the sunshine and fresh air of the countryside. As he looks off into
- [How the PMG Became the Mother of All Physician Support Groups](https://epmonthly.com/article/pmg-became-mother-physician-support-groups/) - How the Physician Moms Group (PMG) became one of the most powerful physician communities on the internet. On the day my husband’s mother fell suddenly into a coma, I was over an hour away, and I felt helpless. I sent my husband ahead immediately and then sweated it out as I waited for my own
- [Observation Status: The New Treatment, Payment Paradigm](https://epmonthly.com/article/observation-status-new-treatment-payment-paradigm/) - With Medicare's new MOON initiative, it's more important than ever for emergency physicians to understand the nuances of observation care. In the past several years, there has been a dramatic increase in the use of observation services in emergency departments (ED) and hospitals. The topic of “observation” tends to elicit a variety of reactions among
- [Drs. Tintinalli, Kass and Wolfe Respond to 'Parenthood and Medicine, Each in its Season'](https://epmonthly.com/article/three-women-respond-parenthood-medicine-season/) - Last month, Emergency Medicine News (EMN), a newsletter published by Wolters Kluwer, printed a letter to the editor that set off a firestorm. Penned by North Carolina emergency physician Geoffrey Martin, MD, the letter expressed the view that it is not within a woman's nature to balance professional work with motherhood. One line clearly summed
- [Be a Pain Care Pro with These Topical Analgesics](https://epmonthly.com/article/pain-care-pro-topical-analgesics/) - In the latest installment in our series on opioid-free pain care, Sergey Motov talks about the expanding role of topical analgesics. Interview by Nick Genes, MD, PhD. Nicholas Genes: There’s this perception—among patients and even among emergency physicians—that pain requires pills, or if it’s bad enough, an IV. I’m not sure where that comes from,
- [Here’s a Calendar to Help You Plan the Year’s Finances](https://epmonthly.com/article/heres-calendar-help-plan-years-finances/) - Your 2016 tax returns might be well in the rearview mirror, but now isn't the time to get financially lazy. Just like preparing for the ABEM Concert exam, taking your LLSA tests (aren’t those fun?), and getting your CME, keeping your financial house in order is an ongoing requirement – if you want to build
- [Why Did This 40 Year Old Have Chest Pain While Working Out?](https://epmonthly.com/article/pursuit-perfect-view/) - He's 40 years old and started experiencing chest pain while working out at the gym. What do you see? “Wow! Your new ED is seriously the length of a football field!” the Critical Care Fellow exclaims. Happy that he wore his steps tracker today, he is eager to see just how many steps he logs
- [Court Sense: Was This Fracture a Sign of Abuse?](https://epmonthly.com/article/court-sense-fracture-sign-abuse/) - Court Sense: A monthly review of important medico-legal cases This month our case involves a two-month-old who was brought to the emergency department in 2005 when he would not straighten his right leg and cried any time that his leg was touched. X-rays were read by a teleradiologist as being normal. The child was discharged.
- [What To Do When Patients Press Record in the Emergency Department](https://epmonthly.com/article/patients-press-record-emergency-department/) - Dear Director: It seems like more and more patients are trying to record me during my encounter with them. Sometimes it’s in the history portion, sometimes they want to record the procedure. I don’t want to end up going viral or get sued. Can I say no? How many times have you seen friends post a
- [It's Time for Physicians to Address the Cost of Care](https://epmonthly.com/article/time-physicians-address-cost-care/) - We've now set a record that should be a source of chagrin for all clinicians. We’ve exceeded spending over $10,000 per capita per year in the U.S. on healthcare. With this amount of annual spending, any reasonable observer would believe that the United States must have the best healthcare on the planet. But the facts are
- [The Party Drugs of Summer 2017](https://epmonthly.com/article/party-drugs-summer-2017/) - The year's major festivals have seen a surge in dangerous MDMA overdoses and a return to LSD. An unresponsive patient rolls in with the local volunteer EMS squad from a nearby music festival after a witnessed generalized tonic-clonic seizure lasting for approximately two minutes with a postictal period. He is tachycardic, warm to the touch,
- [Ashman's Beats – Long, Short, Weird](https://epmonthly.com/article/ashmans-beats-long-short-weird/) - A 65-year-old woman presents with palpitations and shortness of breath. Her initial vital signs include: BP 100/68, HR 180, R 26, O2sat 97%, 98.0°. A brief exam finds a mildly distressed woman, lungs clear, tachycardia, no peripheral edema. She has no history of atrial fibrillation, only hypertension and hyperlipidemia. Her medications include lisinopril and atorvastatin. An
- [Pro/Con: Are Medicaid Caps a Necessary Part of Healthcare Reform?](https://epmonthly.com/article/procon-medicaid-caps-necessary-part-healthcare-reform/) - Republicans and Democrats are once again fighting like cats and dogs on Capitol Hill. Republicans claim the Left refuses to come to the negotiating table; Democrats claim the Right wants to kill Americans by cutting health coverage. Even inside the house of emergency medicine, the debate burns with only a slightly lesser degree of vitriol.
- [One Last Night](https://epmonthly.com/article/one-last-night/) - Thirty-five years after I became an emergency physician I walked into an ED to work my final shift. Some things will never change. Some things I'll never understand. As I drove to the ER for the last time, I wondered out loud to myself, “What will this last shift be like?” Thirty five years ago
- [Summer's Water Woes](https://epmonthly.com/article/summers-water-woes/) - As the mercury peaks in August, a few pediatric ailments have their moment in the sun. 'Dry Drowning' No, it's not a thing, but you'll need to educate worried parents. The patient in bed two is an otherwise healthy four-year-old who is running around the room while you interview his worried mother. He has had
- [When the Patient is Related to the Doctor, Healthcare Perspectives Shift in a Moment](https://epmonthly.com/article/world-turns-upside/) - One moment you are the physician, moving calmly and confidently from case to case. The next second you are the family of a patient, feeling lost and worried. Let us never waste these precious lessons from the other side of the curtain. You’re driving to work for the first shift in a four-day string congratulating
- [Recurrent VTE Despite Anticoagulation](https://epmonthly.com/article/recurrent-vte-despite-anticoagulation/) - While recurrent venous thromboembolism is rare, it presents a unique challenge to emergency physicians seeking to understand the breadth of available anticoagulants. Here’s an essential run-down. A 43-year-old woman with a history of pulmonary embolism (PE) and antiphospholipid antibody syndrome taking rivaroxaban presented to the ED with shortness of breath, hemoptysis, and pleuritic chest pain. Chest
- [Four Innovations That Are Improving Medication Adherence](https://epmonthly.com/article/four-innovations-improving-medication-adherence/) - According to a CDC study, 20-30% of medication prescriptions are never filled, and about half of all prescribed medications are not continued as prescribed. As a result, medication non-adherence costs the U.S. healthcare industry $300 billion per year. Pharmacies and third party companies are introducing new strategies and gadgetry to track adherence in the hopes
- [FDA Puts the Kibosh on Fluoroquinolones – So Should You](https://epmonthly.com/article/fda-puts-kibosh-fluoroquinolones/) - The latest "black box" warning focuses on an array of neurological problems associated with these antibiotics. For emergency clinicians, the fluoroquinolone antibiotics have been a staple in combating both outpatient and inpatient infections. The first fluoroquinolone (ciprofloxacin/Cipro) came on the market in 1987, and since then there have been a raft of new quinolones added
- [6-Year-Old With Fever & Flank Pain](https://epmonthly.com/article/6-year-old-fever-flank-pain/) - A straight-forward pyelonephritis can turn out more complicated than you expect. You are early in your shift and still a little preoccupied with the group’s quarterly performance report posted earlier in the day. Perhaps most damaging to your ego, the “patients per hour” metric placed you at the 25th percentile, the lowest you’ve scored. For today’s
- [Non-Specific Symptoms Often Make Renal Infarction Diagnosis Difficult](https://epmonthly.com/article/non-specific-symptoms-often-make-renal-infarction-diagnosis-difficult/) - Treatment options exist – clinical trials and therapeutic guidelines not so much. A 42-year-old male presented with right flank pain for one day. He denied having a fever and reported a normal appetite. After urinating in the morning, he felt like he couldn't completely empty his bladder. Past medical history was significant only for hypertension. CBC
- [The Verdict: A 35-Year-Old Bounce Back with Arm Numbness](https://epmonthly.com/article/35-year-old-bounce-back-arm-numbness/) - Click here to read the original case. Were either of these physicians negligent? Case Analysis by Brady Pregerson, MD This case settled for a (large) undisclosed amount. Although there were a few other potentially confounding symptoms, this patient initially presented to the ED with bilateral arm numbness and bilateral leg weakness. These symptoms suggest spinal cord
- [Think Outside the Blocks: Creative Uses For Lidocaine](https://epmonthly.com/article/think-outside-blocks-creative-uses-lidocaine/) - Lidocaine is used routinely in the ED to numb up lacerations before repair and abscesses before I&D, or to perform digital blocks, hematoma blocks, nerve blocks, or intra-articular analgesia. Every medical student is taught how to infiltrate the skin with a thin needle, producing a blanching skin wheal. Lidocaine is also one of the ACLS
- [Insurers Begin Denying Payment for "Unnecessary" ED Care](https://epmonthly.com/article/insurers-begin-denying-payment-unnecessary-ed-care/) - New coverage policies by Blue Cross Blue Shield of Georgia and others could bankrupt patients – or worse. In May 2017, Blue Cross Blue Shield (BCBS) of Georgia announced it will no longer cover “unnecessary” emergency department (ED) care, starting July 1. According to BCBS Georgia President Jeff Fusile, “…we have got to find a
- [Whole-Body Cryotherapy Fad Leaves Science Out in the Cold](https://epmonthly.com/article/whole-body-cryotherapy-fad-leaves-science-cold/) - Humans naturally avoid extremely cold temperatures, but entrepreneurs promising medical benefits from cold exposure have some patients paying for the experience in recent years. The winds of trendy changes have brought a new cold front into town. Whole Body Cryotherapy (“WBC”) ‘cryo-spas’ are appearing in strip malls next to tanning booths, claiming everything from “improving
- [Violence Against EMS: Rolling With the Punches](https://epmonthly.com/article/rolling-with-the-punches/) - For pre-hospital providers, violent patients may be part of the job, but understanding the cumulative effects of traumatic stress is essential to a thriving workforce. “Officer needs help. Officer down." These kinds of calls heard over the radio send chills down the spines of first responders and the public way too often. And now the
- [Battlefield Lessons for Post-Trauma Recovery](https://epmonthly.com/article/battlefield-lessons-post-trauma-recovery/) - Workplace violence in emergency situations is so common it's often considered a part of the job. Incidents frequently go unreported due to staff’s desensitization to it and a lack of time to fill out lengthy reports. However, the cost of workplace violence impacts both the physical and emotional wellbeing of the staff, which shows up
- [This Summer, Pack A Better Beach Book](https://epmonthly.com/article/summer-pack-better-beach-book/) - Dear Director: I’m looking to bring a few books along for my summer vacation that will improve my leadership and management skills. What can you recommend? It’s summertime, and who doesn’t love a good book as you sit on the beach or relax during your vacation? I spent my vacation last summer prepping for my board
- [Give Me Some Sugammadex](https://epmonthly.com/article/give-me-some-sugammadex/) - Should you reach for this agent the next time you can’t intubate and can’t ventilate? Airway management is perhaps the most important skill of the emergency physician, and the decision to intubate is not taken lightly. Once RSI is undertaken and a paralytic is administered, the patient is at considerable risk if the airway cannot
- [When Doctors Become Patients](https://epmonthly.com/article/doctors-become-patients/) - It started out like any other night. My wife took a shower, put on a T-shirt and some sweatpants, and walked downstairs to let the dogs out one final time for the evening. I heard her close the front door as I laid in bed watching the news. It's odd how one look can change things.
- [Fosfomycin (Monurol)](https://epmonthly.com/article/fosfomycin-monurol/) - You may want to consider this old stand-by now to cover drug-resistant bacteria. High Points This old drug is being used in new ways. It boasts single dose administration for certain indications and good coverage for multi-drug resistant bacteria. Major Indications It is FDA approved for un- complicated urinary tract infections (UTIs) in women as
- [So You Want To Start a Business](https://epmonthly.com/article/want-start-business/) - Six principles for medical entrepreneurs. In 2014, a physician and her husband founded the startup Heal, to provide house-calls as an alternative to lengthy ED visits. By October 2016, Heal closed a second round of financing worth $27 million, having rapidly grown the house-call market on the West Coast. This is one of dozens of
- [EP Inventor Is Shortening the Time to Identify Pathogens](https://epmonthly.com/article/ep-inventor-shortening-time-identify-pathogens/) - With every minute mattering in emergency medicine, Brett Etchebarne is fighting for more time—and winning. An assistant professor of emergency medicine in the College of Osteopathic Medicine at Michigan State University, he has developed a way to identify pathogens much faster than usual, reducing days to mere hours. Two or less, in fact. Utilizing his
- [Drone Use in Health Care: The Future Is Now](https://epmonthly.com/article/drone-use-health-care-future-now/) - A Practical, Interactive Webinar Presented by Emergency Physicians Monthly and Telemedicine Magazine. Join us June 7 at 12pm EDT/9am PDT for a groundbreaking webinar on the burgeoning use of drones and unmanned autonomous vehicles (UAVs) in emergency medicine, telemedicine, and health care in general. The webinar features two recognized innovators and experts in drone use: Jeremy Tucker,
- [Will Telemedicine Send Costs Up or Down?](https://epmonthly.com/article/will-telemedicine-send-costs/) - Don’t be misled by the recent RAND study — the jury’s still out. It is often said that “perception is reality.” And while I take exception to the philosophical underpinnings of this concept, it is true that, for some, once they perceive something to be true, they have a hard time seeing it any other
- [Lost in Translation? Here's a Map](https://epmonthly.com/article/lost-translation-heres-map/) - A critical look at current interpretation tools and new approaches on the horizon. It will come as no surprise to the emergency medicine (EM) physician that the linguistic and cultural barrier in healthcare is a monumental obstacle to providing competent care. The last two censuses reveal that from 1990 to 2010, the limited-English-proficient (LEP) population
- [Food Fight: Why Can't I Eat In Clinical Areas?](https://epmonthly.com/article/food-fight-cant-eat-clinical-areas/) - Dear Director: I don’t understand why I can’t have food and drink at my workstation during my shift. I never get a chance to take a break, and I really need my coffee. What does the Joint Commission have against us? I like (and rely) on my coffee as much as anyone in the ED I know.
- [Saving for the Future, in One Chart](https://epmonthly.com/article/saving-future-one-chart/) - A few months ago I showed you that your savings rate has far more impact on your retirement portfolio value than investment returns—especially early in your career. So the natural next question is, “How much should I save every year?” A good way to answer this question is to figure out what you’re spending now, what
- [Kenyan Physician Strike Highlights Desperate Healthcare Conditions](https://epmonthly.com/article/kenyan-physician-strike-highlights-desperate-healthcare-conditions/) - From December 2016 to March 2017, more than 5,000 doctors in Kenya’s public sector went on strike in an attempt to improve conditions for doctors and patients. 100 difficult days without public medical services followed. Outside of Kenyatta National Hospital in Nairobi, public hospitals were either closed or staffed only by nurses and clinical officers
- [New Study Casts Doubt on Significance of Contrast-Induced Nephropathy](https://epmonthly.com/article/new-study-casts-doubt-significance-contrast-induced-nephropathy/) - The Case: Six hours into a shift, you get a phone call from radiology CT technician. “This patient can’t get intravenous (IV) contrast; their creatinine is too high,” they tell you. You discuss with the CT technician that you are concerned that this 62-year-old male with a history of hyperlipidemia who presents with pleuritic chest
- [When Medicine Misses The Mark](https://epmonthly.com/article/medicine-misses-mark/) - Are we diagnosing and treating patients to meet their perceived needs? Studies show that our errors contribute to a trend of overprescribing. Recently my almost three-year-old grandson had a low-grade fever, and he said his ear hurt. His father was also sick — myalgia and a marginal fever. The morning after, mom took junior to
- [Praise & Polish: The Fine Art of Good Feedback](https://epmonthly.com/article/praise-polish-fine-art-good-feedback/) - Dear Director: One of our star docs, who’s also a good friend, has gotten a couple of complaints recently. I know I need to pull her into the office, but I’m dreading it, afraid it’s going to be very awkward. What advice can you offer for having a more comfortable “bad performance” talk? Providing feedback to
- [Big Fish or Tall Tale?](https://epmonthly.com/article/big-fish-tall-tale/) - “You won’t believe this, but we just delivered triplets from a 54-year-old woman in the ambulance bay!” you hear your colleague brag. Not to be outdone, your other colleague immediately retorts, “That’s pretty cool, but I just performed an escharotomy on a patient coding in the CT scanner while you were out there mucking around.”
- [Tips From a Recruiter: Don't Be Afraid to Pick Up the Phone!](https://epmonthly.com/article/tips-recruiter-dont-afraid-pick-phone/) - I get it. EM docs are really busy. And if a picture is worth a thousand words, why not save time and just use an emoji? According to research by RealityMine, millennials are about three times more likely to text than make a phone call. But when it comes to the job hunt, there are benefits
- [Let's Talk About Dex](https://epmonthly.com/article/lets-talk-dex/) - Dexamethasone is a long-acting steroid that can be used for a diverse range of conditions. Here is how it works and some common ED scenarios when you should consider reaching for it. How It Works Dexamethasone works like other glucocorticoids. It traverses the cell membrane and binds to cytosolic glucocorticoid receptors. Bound receptors are transported
- [Millennial, MD](https://epmonthly.com/article/millennial-md/) - Senior EM residents reflect on their training and upcoming attending life, giving a glimpse into the millennial mindset. July 1st marks a special transition in medicine every year. It is the first day that new residents step into a hospital as physicians, and the day graduated residents finally manage an ER by themselves as attendings.
- [The Problem with Pradaxa](https://epmonthly.com/article/the-problem-with-pradaxa/) - The FDA-approved drug dabigatran is being marketed as a safe alternative to Coumadin. But without a proven reversal agent available, it has the potential to create a new set of complications, and send unsuspecting patients right back to the ED. A 77-year-old patient presented to the ED a few months ago after gently falling over
- [Motov's Cocktails: Sub-Dissociative Ketamine](https://epmonthly.com/article/motovs-cocktails-sub-dissociative-ketamine/) - In this ongoing conversation with Dr. Sergey Motov, a vocal proponent of non-opioid analgesia, we discuss how ketamine can be a smart alternative to opioids if you know how to dose it. Interview by Nicholas Genes, MD, PhD. Sergey Motov has published a lot in recent years on the ED uses of ketamine, specifically two trials
- [Unpacking the Opioid Blame Game](https://epmonthly.com/article/unpacking-opioid-blame-game/) - How responsible are emergency physicians for opioid addiction? A couple studies shed important light on the subject. We've all been inundated with news about the prescription drug epidemic in the United States and its effect on heroin use and addiction. Really, the question is not whether or not you are aware of this problem but
- [The Junkie](https://epmonthly.com/article/the-junkie/) - Who was the cavalier physician who got this veteran re-addicted to opiates? Some people say that if you’ve seen one junkie, you’ve seen them all. But this guy really did look different. “What brings you to the ER tonight? . . . Mr. Johnson,” I said after quickly glancing at the chart. I knew why
- [Evolution Health’s EM-Led Telemedicine Program Reduced ED Costs by 19%](https://epmonthly.com/article/evolution-healths-em-led-telemedicine-program-reduced-ed-costs-19/) - Mobile-integration, command center operation are key components in early success. Emergency physicians are often caught in a paradox: trying to maintain the viability of an existing healthcare system while simultaneously knowing that many patients could be equally or better served by care outside the four walls of the traditional emergency department. Several years ago, as
- [Obamacare's Future: Repeal, Replace or Revise](https://epmonthly.com/article/repeal-replace-revise/) - While the first attempt to repeal and replace the ACA came up short, it's anyone's guess what will happen next. One thing is for sure: This isn't our first rodeo, and we'd be wise to take a few lessons from history. Repeal? Replace? Who will be covered? How will emergency care be affected? As emergency
- [Diagnosing Septic Arthritis](https://epmonthly.com/article/diagnosing-septic-arthritis/) - Remember that patient you thought had gout? Your first patient of the day is a 22-year-old woman who presents with right knee pain for one week. She has no past medical history and says, “The knee just keeps hurting. I don’t know what to do. Even ibuprofen isn’t helping.” Her vital signs are normal, and
- [The Mathematics of Syncope](https://epmonthly.com/article/the-mathematics-of-syncope/) - The PESIT trial deconstructed Syncope is a familiar complaint for emergency physicians, accounting for 1-3% of ED visits. In general, the causes are mostly benign and self-limited; however, sometimes syncope can be a symptom of a more serious condition, such as acute coronary syndrome, malignant arrhythmia, or even pulmonary embolism (PE). Nevertheless, the ED diagnostic evaluation
- [Remote Ischemic Conditioning: New Adjunct for STEMI Care?](https://epmonthly.com/article/remote-ischemic-conditioning-new-adjunct-stemi-care/) - Large, multicenter trials are still in progress, but is RIPC ready for prime time now? Its 11:00 p.m., and your hospital is alerted by a local EMS agency of a STEMI patient coming in. ETA is seven minutes and the cath lab has been activated. As soon as the patient comes in, you immediately go
- [An Uncomfortable Truth](https://epmonthly.com/article/an-uncomfortable-truth/) - One of your most experienced emergency medicine residents sits down next to you and conveys more than her usual air of certainty. “This patient with right-lower-quadrant pain was sent over by her PCP after being told we would obtain a CT for suspected appendicitis. Her office CBC was 13.2 while her urine pregnancy test and
- [Reader Beware: When Research Goes Wrong](https://epmonthly.com/article/reader-beware-research-goes-wrong/) - Over the years, my trust in medical research has slowly degraded as I've encountered the influence of both subtle bias and outright fraud. The first issue of Emergency Medical Abstracts was published in September of 1977. In starting EMA I firmly believed that the literature of emergency medicine was to be found in virtually all
- [Acetaminophen Toxicity](https://epmonthly.com/article/acetaminophen-toxicity/) - To avoid liver failure in most serious cases, start NAC treatment immediately. Acetaminophen or paracetamol is widely used globally for pain relief and fever. It is also combined with other medications in multi-symptom formulations for this purpose. Due to its effectiveness and relative safety, it is sold over the counter and is readily available. However,
- [Lo-Tech, High Touch in Amazon Medicine](https://epmonthly.com/article/lo-tech-high-touch-amazon-medicine/) - It was the beginning of the rainy, high-water season. The village, in the Amazonian flood plain, was enveloped in an ankle-deep slurry of water, silt, mud, and garbage. We were told this was just the beginning, and by its peak, the water would rise at least another 3 meters. Our first visit was to the
- [All About Praxbind: Pradaxa's Effective Yet Pricey Reversal Agent](https://epmonthly.com/article/praxbind-pradaxas-effective-yet-pricey-reversal-agent/) - New oral anticoagulants (NOACs) are skyrocketing in popularity. Here's what you need to know about this target-specific reversal agent for Dabigatran. A 67-year-old woman is brought in by EMS after she developed a severe headache at home with associated vomiting and altered mental status. Her past medical history is significant for hypertension and atrial fibrillation, for
- [The Case: 35-Year-Old With 2 1/2 Weeks of Numbness](https://epmonthly.com/article/case-35-year-old-2-12-weeks-numbness/) - A 35-year-old male presented to a large urban ED complaining of 2½ weeks of numbness in the ulnar aspect of both arms. The pain would occasionally shoot down both arms when he coughed or sneezed. In the prior week, he had developed numbness and tingling on the right side of his abdomen that had gradually migrated
- [The Pros and Cons of Utilizing Med Students in the ED](https://epmonthly.com/article/pros-cons-utilizing-med-students-ed/) - Dear Director: Our local medical school contacted me and asked if we’d be able to take physician assistant and medical students for rotations in the ED. It seems like they’re offering us free labor, so I wonder what the pros and cons are of having them in the ED? “Show me a BMS who only triples
- [Dysphoria](https://epmonthly.com/article/dysphoria/) - Some shifts the emergency department offers a glimpse into a distorted reality. It was well past midnight and I was starting to feel my 65 years, so I was somewhat relieved to pick up the chart and see “vomiting” as the chief complaint. “18 y/o female.” Hmm, I thought, either she has a bug or
- [Junctional Tourniquets: Life-Saving Gear Born on the Battlefield](https://epmonthly.com/article/junctional-tourniquets-life-saving-gear-born-battlefield/) - Saturday night turns into Sunday morning, and the ER waiting area finally starts to thin out when a panicked call comes in after a mass shooting at a nearby nightclub. Police have secured the scene and ambulances are heading your way. Multiple patients are brought in, with gunshot wound victims quickly overwhelming your department. One
- [Don't Let Hypertension Stress You Out](https://epmonthly.com/article/dont-let-hypertension-stress/) - A 55-year-old female presents to the emergency department from her family physician's office for concern for hypertension. The patient reports she had a routine appointment, and during the vital signs check, her blood pressure read 190/100 mmHg. The patient denies any significant medical history other than a carpal tunnel release one week ago, when she
- [Evaluating Lacerations to Extremities](https://epmonthly.com/article/evaluating-lacerations-extremities/) - Treating the Chainsaw Laceration. Did This EP Do Enough? Click here to read the original case Click here to read Dr. William Sullivan's response: The Chainsaw Verdict Evaluation for a laceration to the extremity should include examination for multiple potential complications: neurologic, vascular including compartment syndrome, tendon, and infection (open fracture or open joint). A good mnemonic, which I
- [The Chainsaw Verdict](https://epmonthly.com/article/the-chainsaw-verdict/) - Treating the Chainsaw Laceration. Did This EP Do Enough? Click here to read the original case Click here to read Dr. Brady Pregerson's response: Evaluating Lacerations to Extremities Wound exploration, antibiotics, and a patient's contributory negligence are at the heart of this decision. A patient comes to the emergency department for treatment of a 4-cm laceration to
- [Wu's Views: What Are the Greatest Obstacles Facing EM Educators and Administrators?](https://epmonthly.com/article/two-sisters-one-specialty/) - Drs. Teresa and Tina Wu are sisters who both went into emergency medicine. Now, one is a teacher while the other is an administrator. Here they share their candid discussion about the challenges of the emergency physician life. Dr. Teresa Wu is an associate professor in emergency medicine and the simulation curriculum director at The
- [Pertussis: Not Your Typical URI](https://epmonthly.com/article/pertussis-not-typical-uri/) - It’s been a quiet night so far in the ED. You see two patients appear on your tracking board, a 33-year-old female and 4-year-old male. The mother and son are placed in the same room by your triage nurse, both with normal vital signs. The mom states she has been experiencing a cough for three
- [Starting a Physician Callback Program](https://epmonthly.com/article/starting-physician-callback-program/) - Editor’s Note: Last month, Dr. Michael Jaffe wrote about his personal experience calling patients after each shift. Here's a bit more depth on the subject, for the hospital CEO who want a follow-up phone call process in place. Dear Director: My hospital president has asked our group to start a follow up phone call program. This
- [Are Helicopter Parents to Blame for Excessive ED Visits?](https://epmonthly.com/article/fever-phobia-helicopter-parents-blame-excessive-ed-visits/) - It is after midnight and the preschooler running around your ED is showing considerably more energy than you feel as you step in the room to talk to his parents. Your general rule: Children who are difficult to catch and examine are unlikely to be seriously ill. You’re fairly certain this belief is going to
- [Near-Syncope & Rectal Pain](https://epmonthly.com/article/near-syncope-rectal-pain/) - A 35-year-old female with a previously diagnosed ectopic pregnancy, status post methotrexate therapy presents to the ED for near syncope and rectal pain. She states that she usually has irregular periods, but thinks she was four weeks pregnant when she received her first dose of methotrexate 10 days ago. Three days ago, she received a second
- [What’s More Important: Savings Rate or Investment Returns?](https://epmonthly.com/article/whats-important-savings-rate-investment-returns/) - In emergency medicine we want results STAT – vital signs, oxygen, labs, urinalysis, admit or discharge. I believe that many of us are hardwired this way after practicing for a while. And I also think this attitude spills over into our expectations about our investments and finances. We want results (high portfolio returns) and we
- [TeamHealth Agrees to $60 Million Settlement](https://epmonthly.com/article/teamhealth-agrees-60-million-settlement/) - Part of a series: Click here to read the "Q&A with Lynn Masssingale, MD, the Co-Founder and Executive Chairman of TeamHealth" On the same day the company was officially taken private by The Blackstone Group, TeamHealth Holdings agreed to pay $60 million in fines to settle allegations that one of its subsidiaries deliberately overcharged government
- [Q&A with Lynn Masssingale, MD, the Co-Founder and Executive Chairman of TeamHealth](https://epmonthly.com/article/qa-lynn-masssingale-md-co-founder-executive-chairman-teamhealth/) - Part of a series: Click here to read "TeamHealth Agrees to $60 Million Settlement" When an emergency medicine contract management group pays a fine of $60 million and gets bought by private equity investors for over $6 billion, it usually gets the attention of everyone in the field. "How did they get to be worth so
- [Sergey Motov on the Proper Use of Ketorolac and the Fifth Vital Sign](https://epmonthly.com/article/sergey-motov-proper-use-ketorolac-fifth-vital-sign/) - In a follow-up to his recent Annals paper, Dr. Sergey Motov discusses optimal dosing of Ketorolac and a functional approach to measuring pain in the emergency department. Interview by Nicholas Genes, MD, PhD EPM: Congratulations on your recent Annals paper, where you show 10mg of IV ketorlac led to the same pain relief in ED
- [How War Shaped a Specialty](https://epmonthly.com/article/war-shaped-specialty/) - The Vietnam War left behind a positive legacy of improved trauma care. Most of the emergency physicians of my generation have unpleasant childhood memories of the long conflict—at its height in the mid 1960’s—that was the Vietnam War. Whether it was a family member or neighbor’s son killed in the jungles of Vietnam, the ugly
- [Do Patients Fare Better Under Female Physicians?](https://epmonthly.com/article/patients-fare-better-female-physicians/) - Dr. Esther Choo deconstructs the recent JAMA debate. JAMA Internal Medicine published a remarkable study in December 2016 on differences between clinical outcomes associated with care by male and female physicians, which created a clearly discernible buzz in the medical world. The authors started from a provocative premise – that “career interruptions for childrearing, higher rates
- [The Non-Opioid Pain Patch](https://epmonthly.com/article/non-opioid-pain-patch/) - Pain complaints are among the most common reasons patients visit emergency departments. As the epidemic of opioid abuse and misuse continues to balloon, healthcare providers are looking for safer, non-addicting analgesics to prescribe to patients with pain. The lidocaine patch is one such option that is effective for certain types of pain. It is safe
- [When Pancreatic Cancer Hits Home in the ED](https://epmonthly.com/article/pancreatic-cancer-hits-home-ed/) - I was at work when my cell phone rang. I glanced at the caller ID and saw that it was my mother-in-law. There was no dread, no surprise, because, unlike most sitcom characters, I genuinely love and get along wonderfully with her. Since I was with a patient, I figured I would call her back. Much
- [Cuba Libre](https://epmonthly.com/article/cuba-libre/) - Observations of life and medicine in modern Havana. Visiting Cuba and trying to learn about life there is like peering through a shimmering window. You can’t get inside, but you get close, sounds are muffled, and you can barely see what is going on. And then for a while you can see everything clearly. In
- [Your Staff Meetings Are Broken. Here's How to Fix Them.](https://epmonthly.com/article/staff-meetings-broken-heres-fix/) - Dear Director: I’ve taken over a department that didn’t really do staff meetings. Can you suggest a format I can use? What about virtual meetings? "If you had to identify, in one word, the reason why the human race has not achieved, and never will achieve, its full potential, that word would be 'meetings'.” -Dave Barry
- [It Was Never 'Just a Job'](https://epmonthly.com/article/never-just-job/) - We must never let the business of medicine rob us of our identity as physicians. The residents and I were stressing on a recent shift about who would take our injured patient to the OR. Hand is the logical service, but if Plastics is covering, they may not want this obvious open fracture. And technically,
- [Dexamethasone vs. Prednisone in Acute Asthma](https://epmonthly.com/article/dexamethasone-vs-prednisone-acute-asthma/) - One-time Dex is a reasonable choice for patients unlikely to fill a prescription. We’ve all seen that asthma patient bounce back, a few days later. I’ve usually attributed it to a tough home environment, or workplace triggers, or maybe just severe underlying disease. A few patients were probably non-adherent to steroids, I figured—but only a
- [Why I Call My Patients](https://epmonthly.com/article/why-i-call-my-patients/) - Why patient follow-up calls might actually deserve your time It’s 2:30 am, and I am taking a quick break in the call room after a busy start to the night shift in my small town ED. The nurse calls me out to see a 22-year-old male with abdominal pain. The patient has a history of
- [Systematic Science](https://epmonthly.com/article/systematic-science/) - “I’ll bet you a package of chocolate covered raisins that she has an anion gap acidosis.” Your intern overhears your bet with the nurse and looks at you with an expression of puzzlement. “Doc, what does that patient have? How do you know that she has an anion gap acidosis by looking at her?” he
- [What to Expect from the ACA Repeal](https://epmonthly.com/article/expect-aca-repeal/) - At the dawn of an administration that loves to buck trends, many are wondering what shape healthcare reform will take. Writing this on the eve of the inauguration with acknowledgment of how rapidly things can change, here's my best ACA prediction. The stated primary goal of the Affordable Care Act was to increase the number
- [Deal Breakers: The Summa Story](https://epmonthly.com/article/deal-breakers-summa-story/) - When contract negotiations go awry In the final days of 2016, a drama unfolded in Akron, Ohio, that made minor waves in the local press, but rocked the specialty of emergency medicine. According to headlines, the Summa Hospital System parted ways with its emergency physician staffing group with a mere four day’s notice, vaulting the
- [Editor's Opinion: A Case of Deja Vu](https://epmonthly.com/article/case-deja-vu/) - It was the summer of 1985. Rebecca, my wife, was eight months pregnant with our third child. Dr. Tom Kinney and I, friends from our residency at Akron General Medical Center, had been the co-chairmen of the emergency department at Mansfield General Hospital in Mansfield, Ohio for the last two years. We had labored tirelessly for
- [Editor's Opinion: Credentialing Contortions](https://epmonthly.com/article/credentialing-contortions/) - I want to focus on two overlooked aspects of this SEA/Summa debacle – an odd bureaucratic quirk, and the resurgence of independent social media. First, the bureaucracy. Everyone has seen staffing shortages made worse, because of delays in hospital credentialing and EHR training. Even if someone is hired months in advance, and all the paperwork is
- [Editor's Opinion: Contract Conundrums](https://epmonthly.com/article/contract-conundrums/) - The news of the sudden breakup between Summa Health and its longtime emergency department physicians sent shockwaves through the emergency medicine community. While there are many things we won’t know about what happened, we do know that the change occurred suddenly, that there were several conflicts of interest within the Summa/USACS partnership (which presented opportunities
- [Editor's Opinion: Creating Chaos](https://epmonthly.com/article/creating-chaos/) - As much as we can determine, the abrupt changes in ED management, IT processes, clinical care and resident supervision at Summa were highly disruptive. Disruptive enough to capture the attention of local news media and the national attention of ACEP, CORD, EMRA, AAEM, SAEM and the ACGME. Student EM rotations and residency interviews were canceled.
- [Q&A With Dominic Bagnoli, MD: CEO of USACS](https://epmonthly.com/article/qa-dominic-bagnoli-md-ceo-usacs/) - Dominic J. Bagnoli, Jr., MD, FACEP, FAAEM, serves as chief executive officer of US Acute Care Solutions (USACS), overseeing the strategic direction the company. EPM: A common thread from SEA executives is a mistrust of Summa leadership, specifically the problem of conflicts of interest, since Summa’s Chief Medical Officer, Dr. Vivian von Gruenigen, is your
- [How to Write Off Your Financial Advisor's Fees](https://epmonthly.com/article/write-off-financial-advisors-fees/) - Many physicians work with a financial advisor to manage their money but don’t realize that in some cases the fee you are paying an advisor might give you a tax break. Let’s take five scenarios and see how you could lower your taxes and net advisor fees. 1. Hiring a strictly commission-based financial advisor A
- [Mothers Matter: Improving Care for Postpartum Hemorrhage](https://epmonthly.com/article/mothers-matter-improving-care-postpartum-hemorrhage/) - Deliveries are relatively rare in the ED, but precipitous deliveries in the ED can evoke fear and anxiety in even the most seasoned EM practitioners. One institution reported that 1 in 160 deliveries occurred in its prehospital or ED settings with a wide variety of maternal and neonatal complications, including PostPartum Hemorrhage (PPH), and with
- [Fear of Rejection: Managing the Transplant Patient in the ED](https://epmonthly.com/article/fear-rejection-managing-transplant-patient-ed/) - A 52-year-old male with a history of chronic renal failure presents with fever and abdominal pain for one day. He has no appetite, with one episode of non-bloody, non-bilious vomiting. His vital signs reveal HR 118, BP 90/52, RR 22, T 100.8F, and O2 saturation 97% on room air. As you look at his abdomen,
- [Willy Wonka in Exam 1](https://epmonthly.com/article/willy-wonka-exam-1/) - A curious patient spurs one physician on to a life of research. For most people the name Willy Wonka conjures up images of chocolate, Oompa-Loompas and a little orphan boy named Charlie. But for Dr. Alex Spyropoulos, an anticoagulation and clinical thrombosis researcher, the name summons up an entirely different narrative. For him, Willy Wonka
- [Our Short Ride in a Fast Machine](https://epmonthly.com/article/short-ride-fast-machine/) - Rhythmic yet jaunty; harmonic yet complex – the soundtrack for a specialty. John Adams is an American contemporary classical composer. His most frequently performed piece, Short Ride in a Fast Machine, is a four-and-a-half minute orchestral masterwork composed in 1986, and it’s a great metaphor for our specialty. It’s quick and rhythmic—far from the dramatic
- [Missed Airways and How Not To Post HIPAA Violations On Social Media](https://epmonthly.com/article/missed-airways-not-post-hipaa-violations-social-media/) - Practical wisdom from Christina Shenvi, MD and Nikki Waller, MD. Want the docs to address a particular question? Write in to lplaster@epmonthly.online. I took care of a morbidly obese man in his 50s who came in with pneumonia and florid septic shock. I prepared to intubate him with video laryngoscopy, with a bougie available, and did
- [The Good Old Days of Residency](https://epmonthly.com/article/good-old-days-residency/) - Dear Director: I’m a young attending and while I enjoy work, I really don’t like all the focus on the metrics at our department meetings. I miss the interesting cases and the learning of residency. What can I do to survive in a metrics-driven world? I remember my first staff meeting as a community-attending physician. I had
- [IUDs in the ED](https://epmonthly.com/article/iuds-in-the-ed/) - To better understand what emergency physicians need to know about Intrauterine Devices (IUDs), EPM reached out to Jaiva Larsen, MD, and Patty Cason, FNP, who conducts trainings across the United States on placement, complications and management of intrauterine contraception. Q. How prevalent are IUDs? Over the last ten years, use of Intrauterine Devices (IUDs) has increased dramatically.
- [A Wrinkle in Time](https://epmonthly.com/article/a-wrinkle-in-time/) - A final meditation on the historical record, the American dream and the forgiveness of sins. I can agree this time with the bard when he says that “parting is such sweet sorrow.” I refuse to let the last Oh Henry degenerate into pure one-sided overly individualistic views of salvation and sentimentality. Such blathering is emotion in excess
- [New Tricks for an Old Ailment](https://epmonthly.com/article/new-tricks-old-ailment/) - Point-of-care ultrasound is a low-risk diagnosis technique for children with abdominal pain. This time will be different. “Doctor, I have the surgery resident on line 1 for you.” You present your case: “I have an 8-year-old male who I believe has appendicitis. He experienced the onset of periumbilical abdominal pain about 12 hours ago. The
- [Are Mobile CT Stroke Units Worth the Price Tag?](https://epmonthly.com/article/mobile-ct-stroke-units-worth-price-tag/) - Mobile stroke units reduce the time to treatment, but are we measuring treatment efficacy correctly? At the 2016 ACEP Scientific Assembly there was an exhibit of an ambulance that contained a head CT unit. The idea is to send the unit with appropriate staff to identify and treat stroke patients in the field based on
- [Reboot Your Career in 2017](https://epmonthly.com/article/reboot-career-2017/) - Three physicians share how you can breathe new life into your career in the new year. Reboot: Broaden your horizons with international E.M. with Joe Lex, MD Emergency medicine as a specialty has been established in 45 countries and is developing rapidly. If you have a sense of wanderlust, consider exploring your options teaching or
- [Wake Up and Smell the Modafinil](https://epmonthly.com/article/wake-smell-modafinil/) - Eugeroics offer a costly—but effective—alternative to caffeine for the sleep deprived. We all struggle with night shifts. The 4 a.m. mental fog that descends on everyone can make it difficult to focus on managing the minute-but-critical details of a department full of patients. Wouldn’t it be great if there were a way to clear that
- [5 Common 401K Rollover Mistakes](https://epmonthly.com/article/5-common-401k-rollover-mistakes/) - “I recently left my emergency medicine group for a new job. Should I rollover my old 401k or keep it where it is?” While practicing emergency medicine has its challenges, it also offers the flexibility to move relatively easily between jobs. That said, one tricky aspect of changing jobs is figuring out what to do
- [The Birth of EM Training – Why Cincinnati?](https://epmonthly.com/article/birth-em-training-cincinnati/) - The city of Cincinnati, nestled along the Ohio River, which separates it from Kentucky, has a rich history. Once referred to as Porkopolis for all the pigs it processed, and known in the 1800’s for its bustling steamboat trade and German breweries, Cincinnati is also the birthplace of emergency medicine (EM) residency training and has
- [Pulmonary Hypertension: No Ordinary Case of Dyspnea](https://epmonthly.com/article/pulmonary-hypertension-no-ordinary-case-dyspnea/) - A close examination of this rare disease with high morbidity and mortality Case – A 38-year-old female is brought in by ambulance for chief complaint of severe dyspnea. As you put down your coffee by your computer and step into the room, you see a patient in respiratory distress doing her best to breathe. Her
- [The Year in Review](https://epmonthly.com/article/the-year-in-review/) - From the opioid epidemic to out-of-control EpiPen pricing, it has been an eventful year for emergency medicine. Let’s recap some of the important issues that caught our eye in 2016. WORDS MATTER The words we use give powerful messages – so let’s get them right. Beginning last February we began writing about how "Reasonable Practice"
- [Have You Called Your Nurse Manager Lately?](https://epmonthly.com/article/called-nurse-manager-lately/) - Dear Director: My nurse manager and I can’t see eye to eye on how to get things done. Can I just work on my own agenda and let her worry about her issues or can you suggest some strategies that will help us work together? In most EDs, nursing and physician managers/leaders operate in different silos.
- [Kanavel is Still Kicking](https://epmonthly.com/article/kanavel-still-kicking/) - A real-world guide to pyogenic flexor tenosynovitis. A 24-year-old, healthy, left-hand dominant male presented to the emergency department (ED) for pain and swelling in his right third finger. He stated that he had been picking at a wart on the distal end of the finger and that approximately two days ago, he began noticing progressive pain
- [Limiting Variation in ED Admission Rates](https://epmonthly.com/article/limiting-variation-ed-admission-rates/) - EPs too seldom follow guidelines when making this expensive, impactful decision. If you were to do a search on the word “variation” in the EM Abstracts database for the last five years you would find that there are 155 emergency medicine-specific citations with the word “variation” in the title – a huge number. Emergency medicine
- [Beware the Patient Bearing Gifts](https://epmonthly.com/article/beware-patient-bearing-gifts/) - A box of donuts for Christmas? Huzzah! But what about a couple of crisp hundred dollar bills? Where do you draw the line on holiday handouts? Last week you saw a chronically ill child in the ED you have taken care of several times before. Tonight, as you come in to start your shift, there
- [How Many People Actually Die in the Emergency Department?](https://epmonthly.com/article/many-people-actually-die-emergency-department/) - There was a nearly 50% decrease in adult mortality in the ED between 1997 and 2011. A new study explores why. The Emergency Department (ED) is far from an ideal place to die. Yet over half of elderly adults in the United States visit the ED in their final month of life. ED visits ending
- [Looking for Glass?](https://epmonthly.com/article/looking-for-glass/) - Point-of-care ultrasound can help detect foreign bodies in murky water. Once upon a time you were working a Fast-Track shift with the usual rapid turnover of colds, UTI’s, lacerations, abscesses, sprains and the like when you look at the chief complaint for your next patient. It reads “Foreign Body for 3 months”. What emergency physician
- [Using TXA for Traumatic Bleeds](https://epmonthly.com/article/using-txa-traumatic-bleeds/) - Tranexamic acid (TXA) is an old, inexpensive drug that surgeons have been quietly using for decades during surgery to reduce perioperative bleeding. TXA has recently garnered international attention for its role in reducing mortality from trauma-related hemorrhage, a major cause of death worldwide. In addition, TXA shows promise for use in other bleeding conditions commonly
- [Pain Control Alternatives for Older Patients](https://epmonthly.com/article/pain-control-alternatives-older-patients/) - Think beyond pills with blocks, topical agents and physical therapy. You are examining your third elderly patient with a fall today. This 68 year old lady has a proximal humerus fracture. You’ve given her a dose of acetaminophen and a sling, but she still appears uncomfortable. She asks you, “Doctor, what can you do to
- [Quick Answers to Sticky Problems](https://epmonthly.com/article/quick-answers-sticky-problems/) - In this new series, EPM contributors Christina Shenvi, MD and Nikki Waller, MD offer sage advice on everyday practice dilemmas. Want them to address a particular question? Write in to editor@epmonthly.online. I am pregnant with my first child and am wondering how I will be able to pump after the baby is born while working
- [Kids with Asthma? Reach for Dexamethasone](https://epmonthly.com/article/kids-asthma-reach-dex/) - A one-time dose of dexamethasone in the ED might be superior to current pediatric asthma management. Check the research. You are working a moderately busy evening shift in the pediatric ED. The medical student has just finished presenting the kid he saw in bed 8. The patient is an 8-year-old boy with known asthma, here
- [The Plain Cervical Spine X-Ray is Almost Dead](https://epmonthly.com/article/plain-cervical-spine-x-ray-almost-dead/) - Ultra low-radiation CT technology is sounding the death knell of plain x-rays. I graduated from medical school in 1970 (shortly after the development of penicillin) so for me the invention of the CT scanner has been, without doubt, the single most important innovation in medical diagnostics. According to my highly reliable (?) internet sources, the CT
- [Treating the Chainsaw Laceration. Did This EP Do Enough?](https://epmonthly.com/article/treating-chainsaw-laceration-ep-enough/) - The Case A patient comes to the emergency department for treatment of a 4 cm laceration to his lower thigh that occurred when he accidentally hit his leg with a chainsaw while cutting wood shortly prior to arrival. The emergency department staff evaluated and cleansed the wound, then closed the wound using three staples. The patient
- [Naloxone to the Rescue](https://epmonthly.com/article/naloxone-to-the-rescue/) - In 2013, overdose deaths overtook motor vehicle collisions as the leading cause of injury-related death in the United States. Over 28,000 people die per year from opioid overdoses, and more than half of those deaths involve prescription opioids. This is the unfortunate tip of the addiction iceberg, with over 2 million people abusing or dependent
- [Navigating Between Occam’s Razor and Hickam’s Dictum](https://epmonthly.com/article/navigating-occams-razor-hickams-dictum/) - Should EPs be liable for initial CT interpretation? Click here to read the original case Click here to read Dr. Pregerson's Analysis: A Migraine With Big Red Flags Q. Was the patient's care within the scope of reasonable practice? Outcome: The case proceeded to trial. In addition to the above arguments, the defense also argued that earlier treatment would
- [A Migraine With Big Red Flags](https://epmonthly.com/article/migraine-big-red-flags/) - Should EPs be liable for initial CT interpretation? Click here to read the original case Click here to read Dr. Sullivan's Analysis: Navigating Between Occam’s Razor and Hickam’s Dictum Q. Was the patient's care within the scope of reasonable practice? Outcome: The case proceeded to trial. In addition to the above arguments, the defense also argued that
- [Miracle on Figueroa Street](https://epmonthly.com/article/miracle-figueroa-street/) - A man slumps to the ground at an L.A. Kings hockey game. Sujal Mandavia responds in seconds, knowing the man's life hangs in the balance. It was pre-season for the L.A. Kings ice hockey team, and Sujal Mandavia was in attendance with his wife. They were season ticket holders and Mandavia, a practicing emergency physician
- [TeamHealth Bought for $6.1 Billion](https://epmonthly.com/article/teamhealth-bought-6-1-billion/) - The purchase by Blackstone Group LP raises the bar for emergency medicine group acquisitions. TeamHealth Holdings Inc., the Knoxville, Tennessee-based hospital staffing giant, agreed on October 31 to be purchased by Blackstone Group LP, a private equity firm with $360 billion in assets under management. Under the terms of the $6.1 billion deal, which received
- [Naloxone Now](https://epmonthly.com/article/naloxone-now/) - Opioid overdose? Soon there could be an app for that, thanks to a tech competition hosted by the FDA, only the second of its kind. An initiative created by the FDA in September is calling for the creation of an app that will connect people overdosing on opioids with the nearest dose of naloxone. The
- [The Right Route: The Site of Injection Matters](https://epmonthly.com/article/the-right-route/) - Case 1 A 46 year old morbidly obese diabetic patient arrives in your ED with hypoglycemia, altered mental status and diaphoresis, and no peripheral venous access. You order IM Glucagon until IV access can be established and an amp of D50 can be given. The nurse gives the IM injection using the dorsogluteal site, and
- [The Business of Emergency Medicine – From Bullish Beginnings to Current Controversies](https://epmonthly.com/article/business-emergency-medicine-bullish-beginnings-current-controversies/) - Starting in 1961, with the original contract for full-time emergency medical services that was negotiated by James Mills, Jr., MD and Alexandria Hospital in Virginia, the business of emergency medicine (EM) has been promoted, analyzed, praised and decried – but has been in a bull cycle for the past 55 years. Because of this successful
- [Managing the Tracheostomy Patient](https://epmonthly.com/article/managing-tracheostomy-patient/) - Real-world strategies for handling this difficult airway Emergency providers are masters of airway management, no matter the condition or situation. One airway in particular can lead to significant trepidation: the tracheostomy. Patients with tracheostomies can suffer several complications, some which may be minor, while others are life-threatening. Before we continue, several key concepts of the
- [Relax, the Next President Isn't Going to Kill Your Portfolio](https://epmonthly.com/article/relax-next-president-isnt-going-kill-portfolio/) - Avoid the temptation to act rashly based upon who wins the presidential election. By the time you read this, we will have elected a new president. Regardless of who won, you will hear wildly differing views and theories about how the new president — through various economic and tax policies — will impact your investment
- [A Kernel of Truth in Every Complaint](https://epmonthly.com/article/kernel-truth-every-complaint/) - Dear Director: The ICU director just called me to say our ED docs aren’t working the patients up appropriately before calling the ICU team. He said he couldn’t give an examples but “in this case, perception is reality!” How do I respond to that? I’ve come to accept that perception is reality when it comes to
- [Mastering Forearm Injuries](https://epmonthly.com/article/mastering-forearm-injuries/) - Treating fractures of the radial and ulnar shaft Introduction The forearm is often seen as a static structure, when in reality, the complex nature of pronation and supination requires dynamic articulations independent of wrist movements and elbow. These movement are functionally as important or perhaps more important to essential activities of daily living. The injuries
- [Distal Radius Fractures: Reducing the Confusion](https://epmonthly.com/article/distal-radius-fractures-reducing-the-confusion/) - No available ortho call? With a brief refresher, that shouldn’t be a problem in the ED Simple interventions for common fractures, such as distal radius fractures, should be within the bread and butter skill set of all emergency physicians. For those practicing in resource-limited environments there is no choice. Distal radius fractures should not be
- [Dr. Rishi Madhok Introduces Ns1ghter, "a LinkedIn for your health" at The mHealth Toolbox [Video]](https://epmonthly.com/article/dr-rishi-madhok-introduces-ns1ghter-linkedin-health-mhealth-toolbox/) - This year EPM helped host The mHealth Toolbox, an interactive gear lab in ACEP's InnovatED. One of our esteemed panelists was Rishi Madhok, one of the founders of Ns1ghter.
- [Dr. Christina Shenvi on How to Spot – and Prevent – Physician Burnout [Video]](https://epmonthly.com/article/dr-christina-shenvi-spot-prevent-physician-burnout/) - At ACEP16 we caught up with EPM contributor Christina Shenvi who talked about physician burnout and her new podcast on geriatric emergency medicine.
- [Preparing for Today's Top Med-Legal Challenges, with Dr. Bill Sullivan [Video]](https://epmonthly.com/article/preparing-todays-top-med-legal-challenges-dr-bill-sullivan/) - At the ACEP Scientific Assembly this week in Vegas, EPM editor Logan Plaster hit the show floor looking for pearls. Check back for more clips this week.
- [Medgadet Editors Weigh In On the Future of Virtual Reality in Emergency Medicine [Video]](https://epmonthly.com/article/medgadet-editors-weigh-future-virtual-reality-emergency-medicine/) - More fun on the ACEP16 floor, this time with MedGadget contributors/editors Nick Genes, Michael Hoaglin and Osso VR creator Justin Barad. Of course, these gentlemen are much more than former editors at MedGadget, but that's what brought them together.
- [ACEP Then and Now – Greg Henry on 40+ Years of Scientific Assemblies [Video]](https://epmonthly.com/article/acep-now-greg-henry-40-years-scientific-assemblies/) - Greg Henry, a fixture of the ACEP Scientific Assembly, is never at a loss for words. We grabbed him in Las Vegas to get him to share some wit and wisdom.
- [Dr. Mike Silverman on Training Millennial Emergency Physicians [Video]](https://epmonthly.com/article/dr-mike-silverman-training-millennial-emergency-physicians/) - More floor interviews from ACEP16. Mike Silverman, author of Directors Corner, is a wealth of knowledge about administrative and management challenges. Always a pleasure to get his insights.
- [Under the Big Top: An Ode to ACEP](https://epmonthly.com/article/big-top-ode-acep/) - The annual ACEP Scientific Assembly is an absolute circus, but it's also an unparalleled display of talent, passion and innovation. I wouldn't miss it for anything. Last month in Las Vegas, the American College of Emergency Physicians met under an astrological event. Ever so often the moon is 15 percent closer to the earth and
- [Will DEA Regulations Hinder EMS Use of Controlled Substances?](https://epmonthly.com/article/will-dea-regs-hinder-ems-use-controlled-substances/) - Emergency medicine lobbyists fight for legislative change in the waning congressional session Scenario: EMS is called to a pediatric seizure. On arrival, the 2-year-old child, who has a known seizure disorder, is still seizing. Paramedic’s start an IV and check a glucose (98). The child persists in seizing and is becoming cyanotic. Paramedics draw up 2mg
- ['There's an Alien Inside Of Me!'](https://epmonthly.com/article/theres-alien-inside/) - Your next case looks like it might be more of a psych situation, but you start with a bedside ultrasound to get a better idea of what's happening. You try to hide your frustration as your patient yells at you “I have had numerous doctors from lots of places, including your own people, tell me
- [With Aetna Gone, Is ACA Dead?](https://epmonthly.com/article/aetna-gone-aca-dead/) - The latest blow to the ACA exchange is bad news indeed, but some perspective is warranted. Aetna announced they will be departing from the Obamacare marketplaces in 11 of the 15 states they currently offer plans. This certainly does not look like a good sign, particularly on the heels of UnitedHealth and Humana cutting back
- [Zika: Facts and Figures](https://epmonthly.com/article/zika-facts-figures/) - Click here for downloadable PDF.
- [Practicing Grace, One Snifter at a Time](https://epmonthly.com/article/practicing-grace-one-snifter-time/) - A recent literary dive into the history of gin taught me an unexpected lesson: Emergency Physicians need to drop their moral superiority and show grace to all comers. Whatever became of gentlemen? That person (man or woman) who could connect and comment learnedly on a variety of subjects. Who treated wait staff with respect and
- [An ACEP16 Special Edition](https://epmonthly.com/article/acep16-special-edition/) - “The greatest challenge to the concept of democracy is spending five minutes talking to the average voter.” -Winston Churchill Every year I attempt to give some perspective to what has transpired at the Annual Council Meeting of the American College of Emergency Physicians. I have no idea what will happen this week in Las Vegas, but
- [Restraints: All Holds Barred?](https://epmonthly.com/article/all-holds-barred/) - Dear Director: My hospital has just changed its restraints policy, wanting us to minimize any restraints and also prohibiting chemical restraints. What’s going on? Some patients just need restraints. For those of us old enough to remember the TV show M*A*S*H, they had a magical IM injection that could make a crazy patient, or Major Burns,
- [Cervical Radiculopathy](https://epmonthly.com/article/cervical-radiculopathy/) - Low-risk techniques to bring relief to this common complaint. A 52-year-old Caucasian female presents to the ED with intractable neck/shoulder pain and tingling down the left arm. Her physical exam is significant for slight weakness in left wrist extension. She denies trauma and the pain has persisted since she awoke with it one week ago despite
- [Big Pharma —  Enough is Enough](https://epmonthly.com/article/big-pharma-enough-enough/) - A recent BMJ study challenges the high price of new drugs In the old Popeye cartoons (many will have no idea what I’m talking about), our hero’s recurring line was “It’s all I can stands – I can’t stands no more.” That’s the way I’ve felt about big pharma for a very long time, but
- [EpiPen Pricing Has My Adrenalin Up!](https://epmonthly.com/article/epipen-pricing-adrenalin/) - EpiPens have become a model for 'prescription injustice' It was in the early 90s when my ED had two near-misses with epinephrine dosing—one in a child and one in an adult. It was easy to mix up the drug dose when trying to make a quick mental conversion between epi for cardiac arrest (1:10,000, 0.1mg/ml)
- [Taking PDMPs Up a Notch](https://epmonthly.com/article/taking-pdmps-notch/) - Three simple ways to optimize Prescription Drug Monitoring Programs According to the Centers for Disease Control and Prevention (CDC), 78 Americans die daily from opioid overdoses, a number that’s quadrupled since 1999 [1]. Paralleling this rise, the volume of opioid prescriptions has similarly quadrupled. Emergency physicians prescribe low quantities of opioids per prescription, yet we
- [Join EPM at ACEP16](https://epmonthly.com/article/join-epm-acep16/) - Emergency Physicians Monthly and Telemedicine Magazine will be exploring the ACEP floor looking for new stories starting Sunday, October 16. Come find us booth #S2227.
- [The PATCH Trial](https://epmonthly.com/article/the-patch-trial/) - Should we hold the platelets in spontaneous intracerebral hemorrhage? In the world of neurology, stroke can be divided into two major types: Ischemic and Hemorrhagic. Although ischemic stroke is far more common, hemorrhagic stroke still accounts for a decent portion strokes (Approximately 10 – 20%), and stroke morbidity/mortality. Spontaneous, non-traumatic, intracerebral hemorrhage (ICH) accounts for
- [Understanding Haloperidol](https://epmonthly.com/article/understanding-haloperidol/) - Paramedics bring in a disheveled-appearing, anxious man who appears to be in his 20s. He was found wandering through traffic, muttering incoherently. As you approach him to introduce yourself, he becomes agitated. Eyes darting to and fro, he screams, “The devil is coming!” He leaps off the cot as paramedics frantically struggle to restrain him. Does
- [Reading a Head CT When the Pressure is On](https://epmonthly.com/article/reading-head-ct-pressure/) - CT signs of elevated intracranial pressure Unenhanced or noncontrast brain CT is commonly performed in the Emergency Department to evaluate patients with complicated headache, head trauma, or altered mental status. Emergency Physicians must recognize CT findings of elevated intracranial pressure (ICP) to facilitate appropriate treatment and to avoid contraindicated procedures and therapies. It is important
- [The Crying Child](https://epmonthly.com/article/the-crying-child/) - What can bedside ultrasound tell you about this 10-month-old girl suffering from abdominal pain? It is a ridiculously busy Saturday night in your emergency department, made worse by the extra hour associated with the “fall-back” due to the change from daylight savings to standard time. At about 0400, a 10-month-old female is brought to
- [What is the Risk of VTE On a Long Haul Flight?](https://epmonthly.com/article/risk-vte-long-haul-flight/) - We are a global society, and long distance travel is a routine part of life for many of us, our colleagues, and our patients. For some, long distance travel by any modality that involves long periods of stationary positioning (i.e. car, plane, bus, train) carries the unfortunate risk of developing venous thromboembolism (VTE). Though the
- [Workplace Violence – The Resident's Perspective](https://epmonthly.com/article/workplace-violence-residents-perspective/) - 60% of residents reported sexual abuse and workplace violence We are vulnerable. The emergency department is among the most frequent locations for violent events in the health care setting as patient flow is ever changing and patients often present with undifferentiated complaints and social issues. If the mention of "workplace violence" made you recall experiences
- [I Said I'm Sorry, Now Get Over It!](https://epmonthly.com/article/said-im-sorry-now-get/) - Five steps towards a heartfelt apology – the kind that will begin the healing process with friends, patients, and colleagues alike. We all make mistakes. No doc in the ED has a golden stethoscope that prevents medical errors (and if anyone is funding a start-up for such a product, please count me in). We, as
- [Practicing Medicine, One Human at a Time](https://epmonthly.com/article/practicing-medicine-one-human-time/) - Society's obsession with new political ideas – and even with freedom itself – can come at a cost. A dose of nostalgia may be helpful in reminding us to slow down and treat each patient with the unique human dignity that they deserve. It is banal in the extreme to suggest we cannot live in
- [Ultrasound: By the Numbers](https://epmonthly.com/article/ultrasound-by-the-numbers/) - Initial results are in from EPM's point-of-care ultrasound survey. Here's the story they tell. The use of bedside point of care ultrasound (POCUS) has many applications in emergency medicine including rapid diagnosis of certain critical conditions such hemoperitoneum and pericardial tamponade and for evaluation of hypotension and cardiac arrest. Its use can also permit safe
- [Compartment Syndrome in Athletes](https://epmonthly.com/article/compartment-syndrome-athletes/) - You may know the 5 P's, but it's easy to be fooled Case A 28-year-old male presents to the emergency department at 4 pm with months of worsening bilateral lower extremity pain. He has experienced this pain multiple times in the past, usually while running. He states that he is an avid runner, and the
- [Rethinking EMS: Don't Knock 'Homeboy Transport'](https://epmonthly.com/article/rethinking-ems-dont-knock-homeboy-transport/) - From sirens to ALS, the medical literature continues to challenge pre-hospital dogma. Apple pie and motherhood. That’s how EMS systems have come to be viewed in this country. While in some locations this is a well-deserved perception, in many others, local EMS systems have become out of step with medical evidence. As the Associate Director
- [New Treatments for Angioedema](https://epmonthly.com/article/new-treatments-angioedema/) - An in-depth look at the latest medications for this emergency Few procedures in emergency medicine are as potentially disastrous as the management of a difficult airway. The patient with a gun-shot wound to the jaw, the tracheal crush injury, the diabetic with Ludwig’s, and the case of severe angioedema all occur regularly in the airway
- [MACRA Under the Hood, Part II](https://epmonthly.com/article/macra-hood-part-ii/) - How does the math work for emergency physicians in CMS’s new MIPS program? Last month we introduced you to the Medicare Access and CHIP Reauthorization Act (MACRA), likely the biggest change to physician payment in the United States since the creation of Medicare in 1965. In addition to replacing the Sustainable Growth Rate (SGR), which
- [Hold the Oral Contrast](https://epmonthly.com/article/hold-oral-contrast/) - Not all patients with undifferentiated abdominal pain in the emergency department require this treatment. Fine tuning our usage of oral contrast will decrease wait times and improve patient care. Abdominal pain is a common chief complaint in the emergency department setting representing approximately 7% of all annual ED visits [1]. A significant number of these
- [Treating the 33-Year-Old with a Severe Headache. Did This EP Do Enough?](https://epmonthly.com/article/treating-33-year-old-severe-headache-ep-enough/) - A 33-year-old female was brought to the emergency department by her husband for evaluation of a diffuse headache of 4 hours’ duration that began gradually and increased to an 8 of 10 intensity over 30 minutes. The headache was associated with bilateral facial and hand numbness, slurred speech, muffled hearing, and a brief syncopal event.
- [K2: From Fad to Enemy #1](https://epmonthly.com/article/k2-fad-enemy-1/) - Synthetic cannabinoids like K2 and Spice are more dangerous than ever, and they’re here to stay. Synthetic cannabinoids often referred to as K2, Spice, or ‘legal highs’ first appeared in the United States in 2008 and in Europe as early as 2004 [1]. While sold under a variety of names, they are all cannabinoids and
- [Adding a Case Manager To Your ED Line-Up](https://epmonthly.com/article/adding-case-manager-ed-line/) - Dear Director: My hospital has offered to put a case manager in the ED but asked me to create the job description. Can you give me a hand? Adding a case manager to the ED team can have a tremendously positive impact on ED patients and the hospital. Just like when we add physician staff,
- [Goodbye Standard of Care, Hello Reasonable Practice](https://epmonthly.com/article/goodbye-standard-of-care-hello-reasonable-practice/) - The term “Standard of Care” has been misused and abused. It is time to replace it with a phrase which more accurately conveys the realities of modern medicine. The term “standard” has become ubiquitous in our everyday conversation. In some cases, the term is used appropriately. For example, it is standard treatment to give antibiotics for
- [Was This Care Reasonable? You’re the Judge](https://epmonthly.com/article/was-this-care-reasonable-youre-the-judge/) - In this new series, we will present malpractice quandaries and give you, the reader, the chance to voice your verdict. A 30-year-old female with a history of hypertension and gastric bypass surgery was transported to a busy urban ED by ambulance for acute onset of abdominal pain an hour prior to arrival. The pain was
- [Was This Reasonable Care: The Verdict](https://epmonthly.com/article/was-this-reasonable-care-the-verdict/) - Last month, we presented a malpractice case to our readers and asked for your verdict. Here’s our final analysis. Brady Pregerson, MD: My opinion is that the care in this case, while not ideal, did represent reasonable practice, especially for an emergency physician working in a busy urban ED. The patient presented with vomiting and abdominal
- [Reasonable Practice: Should the PA Have Caught This Case of Compartment Syndrome?](https://epmonthly.com/article/reasonable-practice-pa-caught-case-compartment-syndrome/) - A 45-year-old patient came to the emergency department for evaluation of lower leg pain which had started the prior evening while playing soccer and had progressively worsened. There was no known injury. The patient was evaluated by a physician’s assistant (PA). The pain was significant and worst at the mid-shin. While the patient was able
- [Reasonable Practice: The Ruling](https://epmonthly.com/article/reasonable-practice-ruling/) - To read the original case: Click here THE RULING The plaintiff alleged that the PA was negligent for failing to consult his supervising attending or an orthopedist before ruling out such a serious diagnosis. The plaintiff alleged that after reviewing and signing off on the PA’s note, the attending physician should have recognized the patient
- [ACGME Going Global – Finally](https://epmonthly.com/article/acgme-going-global-finally/) - We need to stop treating our highly-skilled international colleagues as second-class physicians and be quick to learn from one another. Last week, many of us received great news from our good friend Antoine Kazzi, MD, founding chair of the Department of Emergency Medicine at the American University of Beirut (AUB). After a decade-long process, AUB
- [Hi-Tech Tools Enable High-Touch Care](https://epmonthly.com/article/hi-tech-tools-enable-high-touch-care/) - The efficiencies gained by telemedicine have the ability to free up physicians to spend more time on complicated, high-touch cases. One of the complaints I often hear about is the increase in the use of digital technology to interact with patients is that it takes the human touch out of medicine. Telemedicine technologies make the
- [How Will The Next President Really Impact Emergency Medicine?](https://epmonthly.com/article/will-next-president-really-impact-emergency-medicine/) - The next president will have continued influence over the practice of medicine. Thus, it is important to analyze each candidate’s positions statements and words as to their impact on the practice of emergency medicine. Beginning with Hillary Clinton, she has stated "as we see more consolidation in health care, among both providers and insurers, I'm
- [Inside the Medical Tent at the 2016 Republican National Convention](https://epmonthly.com/article/preparing-worst-inside-medical-tent-2016-rnc/) - EPM caught up with Thomas Collins, MD, the medical director for the department of Public Safety for the City of Cleveland, and talked about recent RNC prep, and how an ounce of prevention is worth a pound of cure. Interview by Logan Plaster. EPM: What public health concerns did you have going into the RNC that
- [What's the Deal with Osteopathic Medicine?](https://epmonthly.com/article/whats-deal-osteopathic-medicine/) - There has long been an air of mystery surrounding the practice of osteopathic medicine. What do these physicians study? What is manipulative medicine? John C. Prestosh, DO, president of the American College of Osteopathic Emergency Physicians (ACOEP) sheds some light on what DOs do. There has always been a mystery in the House of Medicine.

## Staff

- [Sierra Ohrn, MD](https://epmonthly.com/contributor/sierra-ohrn-md/) - Sierra Ohrn, MD, is a second-year resident at the Department of Emergency Medicine, MetroHealth Medical Center in Cleveland, Ohio.
- [Dan Hannan, MBA, BSN, RN](https://epmonthly.com/contributor/dan-hannan-mba-bsn-rn/) - Dan Hannan, MBA, BSN, BS, RN is a long time, emergency nurse clinician, administrator, ED operational consultant, and leadership coach specializing in optimizing ED throughput, patient experience, and staff engagement, currently as a partner with the CEO Advisory Network.
- [Casey Collins, MD](https://epmonthly.com/contributor/casey-collins-md/) - Dr. Casey Collins is the Chief Documentation Officer and Chairman of the Coding Procedures Advisory Committee for US Acute Care Solutions. His background includes extensive experience in clinician documentation education, coding guideline analysis, chart auditing, and insurance peer-to-peer denials review. Dr. Collins is a current member of ACEP Coding Nomenclature Advisory Committee. He is the
- [Emmanuelle C. Issa](https://epmonthly.com/contributor/emmanuelle-c-issa/) - Dr. Issa is a first-year internal medicine and pediatrics resident at Loma Linda University Medical Center and Children's Hospital. She is a graduate of Loma Linda University School of Medicine.
- [Peyton J. Ware](https://epmonthly.com/contributor/peyton-j-ware/) - Peyton J. Ware is a medical student at Loma Linda University School of Medicine.
- [Timothy P. Young, MD](https://epmonthly.com/contributor/timothy-p-young-md/) - Dr. Young is a professor of Emergency Medicine and Pediatrics at Loma Linda University School of Medicine. He is Director of Research and Scholarship for the Department of Emergency Medicine at Loma Linda University Medical Center and Children's Hospital.
- [Heidi Spady, MD](https://epmonthly.com/contributor/heidi-spady-md/) - Dr. Spady is an assistant professor of Emergency Medicine and Pediatrics at Loma Linda School of Medicine. She is a graduate of the Emergency Medicine and Pediatric Emergency Medicine training programs at Loma Linda University Medical Center and Children’s Hospital.
- [Garrett J. Cooper](https://epmonthly.com/contributor/garrett-j-cooper-2/) - Garrett J. Cooper is a medical student at Loma Linda University School of Medicine.
- [Paula Bitange, MD](https://epmonthly.com/contributor/paula-bitange-md/) - Dr. Bitange is a neurology resident at Stanford in her internal medicine preliminary year at Santa Clara Valley Medical Center. She is a graduate of Loma Linda University School of Medicine.
- [Brant Herman](https://epmonthly.com/contributor/brant-herman/) - Brant Herman, Founder and CEO of Dentistry.One LLC a virtual-first dental care network dedicated to advancing oral care through innovative virtual solutions. His leadership in developing Dentistry.One reflects his commitment to improving health outcomes, enhancing care delivery, and optimizing the patient experience. Contact him at Brant@Dentistry.One.
- [Herman DeBoard](https://epmonthly.com/contributor/herman-deboard/) - Herman C. DeBoard III is the CEO and founder of Airez, a technology company with products that focus on video and fiber optics using AI and machine vision capabilities for both marketing and security purposes. As a speaker, author, and successful entrepreneur, Herman draws on his diverse experiences, including his decorated service in the United
- [Michael Silverman, MD](https://epmonthly.com/contributor/mike-silverman-md/) - EXECUTIVE EDITOR Dr. Silverman is Chair of Emergency Medicine at VHC Health and a member of the USACS National Clinical Governance Board. He is a certified leadership and executive coach and previously taught a leadership development course for over a decade. Dr. Silverman’s practical wisdom is available in an easy-to-use reference guide, available on Amazon.
- [Joseph Callahan](https://epmonthly.com/contributor/joseph-callahan/) - Joseph Callahan is a serial entrepreneur, perpetual innovator, and award-winning business leader with over 30 years of experience in technology development. As CEO of Ciright, he has pioneered groundbreaking solutions across industries, holding multiple patents in digital media, IoT, fintech, and the metaverse. Callahan is a proud Drexel University graduate and has been recognized with
- [Dr. Nicholas Daniel](https://epmonthly.com/contributor/dr-nicholas-daniel/) - Dr. Daniel is an assistant professor of emergency medicine and the director of the wilderness medicine fellowship at Dartmouth-Hitchcock Medical Center.
- [Dr. Keith Hansz](https://epmonthly.com/contributor/dr-keith-hansz/) - Dr. Hansz is the chief resident for the emergency medicine residency program at Dartmouth Hitchcock Medical Center. He graduated from The University of Toledo College of Medicine.
- [Aaron Cain DO](https://epmonthly.com/contributor/aaron-cain-do/) - Aaron Cain DO, is a MBA chief resident MetroHealth Medical Center, Case Western Reserve, Cleveland, Ohio.
- [Brian Savino, MD, MPH](https://epmonthly.com/contributor/brian-savino-md-mph/) - Dr. Savino is an associate professor of emergency medicine and the program director for the EMS fellowship at Loma Linda University School of Medicine. He is an attending physician in the Department of Emergency Medicine at the Loma Linda University Medical Center.
- [Kimberly H. Park, MD](https://epmonthly.com/contributor/kimberly-h-park-md/) - Dr. Park is a third-year resident of emergency medicine at Loma Linda University.
- [Junwei Li, MD](https://epmonthly.com/contributor/junwei-li-md/) - Dr. Li is an emergency physician working in Orange County, California.
- [Andy T. Hsueh, MD](https://epmonthly.com/contributor/andy-t-hsueh-md/) - Dr. Hsueh is a third-year Emergency Medicine resident at UC Irvine Health, in Orange, California.
- [Chase Donaldson, MD](https://epmonthly.com/contributor/chase-donaldson-md/) - Chase Donaldson, MD is an EM intensivist at the Cleveland Clinic Foundation where he is the Assistant Program Director of the Cardiothoracic Critical Care Fellowship and the Quality Improvement Officer of the Cardiothoracic ICU.
- [Leeanne Stratton, MD MPH](https://epmonthly.com/contributor/leeanne-stratton-md-mph/) - Leeanne Stratton, MD MPH, is an assistant professor at the Cleveland Clinic Foundation in the Department of Intensive Care and Resuscitation. She is the Assistant Program Director for the Emergency Medicine-Anesthesia Critical Care Medicine Fellowship.
- [Hayley E. Andre, MD](https://epmonthly.com/contributor/hayley-e-andre-md/) - Hayley E. Andre, MD, is an EM intensivist at the Cleveland Clinic Foundation and works clinically in the Cardiothoracic ICU.
- [Danielle Goodrich](https://epmonthly.com/contributor/danielle-goodrich/) - Danielle Goodrich completed her residency at the Stanford/Kaiser EM program. She is an assistant professor at the Kaiser Permanente Bernard J Tyson School of Medicine. She is the lead instructor for the ultrasound curriculum at the school of medicine. She has served at the chair of the young physician section of AAEM and is the recent past
- [Molly Estes, MD](https://epmonthly.com/contributor/molly-estes-md/) - Molly Estes, MD completed her residency at the Stanford/Kaiser EM Program, and her fellowship in Medical Education also at Stanford. She currently works as an Assistant Professor and Clerkship Director at Northwestern University. She is the recipient of the AAEM Young Educator’s Award, the Joe Lex Educator of the Year Award, and the AAEM Women in Emergency
- [Kaitlin Bowers, DO](https://epmonthly.com/contributor/kaitlin-bowers-do/) - Kaitlin Bowers, DO is an Emergency Medicine physician at UNC Nash Healthcare and an adjunct assistant professor of Emergency Medicine at Campbell University School of Osteopathic Medicine. She completed her Emergency Medicine residency at OhioHealth Doctors Hospital in Columbus, OH where she received the Honor of Outstanding Emergency Medicine Resident of the Year awarded by
- [Dr. Sandy Najarian](https://epmonthly.com/contributor/dr-sandy-najarian/) - Dr. Sandy Najarian is an assistant professor of emergency medicine at Case Western Reserve University and attending physician in the department of emergency medicine at the MetroHealth Medical Center, in Cleveland, Ohio.
- [Dr. Seamus Mangan](https://epmonthly.com/contributor/dr-seamus-mangan/) - Dr. Seamus Mangan is an assistant professor at Case Western Reserve University and attending physician in the department of emergency medicine at the MetroHealth Medical Center, in Cleveland, Ohio.
- [Mark Goldstein, MD FACEP](https://epmonthly.com/contributor/mark-goldstein-md-facep/) - Mark Goldstein, MD FACEP is a Baltimore based emergency physician with USACS. He is a former department chair and system medical director. After choosing to take a brief administrative hiatus as a full-time clinician, he is now the interim medical director for several standalone ED’s in the Baltimore/Washington region.
- [Robert Jones, MD](https://epmonthly.com/contributor/robert-jones-md/) - Robert Jones, MD, is a professor of emergency medicine at Case Western Reserve University and attending physician in the department of emergency medicine at the MetroHealth Medical Center, in Cleveland, Ohio.
- [Kaitlyn Murphy, MD](https://epmonthly.com/contributor/kaitlyn-murphy-md/) - Dr. Kaitlyn Murphy is an assistant professor at Case Western Reserve University and attending physician in the department of pediatrics at the MetroHealth Medical Center, in Cleveland, Ohio.
- [Tsering Y. Dirkipa, MD](https://epmonthly.com/contributor/tsering-y-dirkipa/) - Tsering Y. Dirkipa, MD, is a pediatric resident in the department of pediatrics, MetroHealth Medical Center, Cleveland, Ohio.
- [Gavin Rogers MD, MS](https://epmonthly.com/contributor/gavin-rogers-md-ms/) - Gavin Rogers MD, MS, CCEeXAM, AEMUS-FPD, RDCS, RDMS aka "The Ultrasound_Nerd” on Instagram is the assistant director of the EM Ultrasound Fellowship at EVMS @ODU co-director of Ultrasound Education at EVMS @ODU.
- [Isable Bishop](https://epmonthly.com/contributor/isable-bishop/) - Isable Bishop is a 3rd year medical student at Loma Linda University School of Medicine.
- [Ja Tsun](https://epmonthly.com/contributor/ja-tsun-2/) - Ja Tsun is a 3rd year medical student at Loma Linda University School of Medicine.
- [Mason Clark](https://epmonthly.com/contributor/mason-clark-2/) - Mason Clark is a 3rd year medical student at Loma Linda University School of Medicine.
- [Kristen Doña](https://epmonthly.com/contributor/kristen-dona-2/) - Kristen Doña is a 3rd year medical student at Loma Linda University School of Medicine.
- [Joshua Guttman, MD](https://epmonthly.com/contributor/joshua-guttman-md/) - Joshua Guttman, MD is an Associate Professor of Emergency Medicine at Emory University and the founder of Peachtree POCUS consulting (https://peachtreepocus.com). He has a blog on POCUS operations (https://peachtreepocus.com/blog) and posts on X, @drjgutt
- [Marissa Koning, MD](https://epmonthly.com/contributor/marissa-koning-md/) - Marissa Koning, MD attending physician, department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio, clinical assistant professor Case Western University, Cleveland, Ohio.
- [Jason Kleppel, MD](https://epmonthly.com/contributor/jason-kleppel-md/) - Jason Kleppel, MD 3rd year resident, department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio.
- [Matthew Mervis, BS](https://epmonthly.com/contributor/matthew-mervis-bs/) - Matthew Mervis, BS, is a medical student at the University of Utah School of Medicine, class of 2025. He is interested in pursuing a career in physical medicine and rehabilitation with interests in ultrasound-guided interventional procedures, sports medicine, and medical education.
- [William Baughman, MD](https://epmonthly.com/contributor/william-baughman-md/) - William Baughman, MD, is a diagnostic radiologist at MetroHealth Medical Center and associate professor at Case Western University all in Cleveland, Ohio. He completed his Diagnostic Radiology training at MetroHealth Medical Center/ Case Western University in 2009 and an Abdominal Imaging fellowship at Washington University, St. Louis, Missouri in 2010
- [Jonathan Frommelt, MD](https://epmonthly.com/contributor/jonathan-frommelt-md-3/) - Jonathan Frommelt, MD, is an Emergency Physician at MetroHealth Medical Center and assistant professor Case Western University all in Cleveland, Ohio. He completed his Emergency Medicine Residency at Henry Ford Medical Center in Detroit, Michigan in 2015.
- [Nicholas Srnick, MD](https://epmonthly.com/contributor/nicholas-srnick-md/) - Nicholas Srnick, MD, is a third year resident in the department of Emergency Medicine MetroHealth Medical Center, Cleveland Clinic Foundation, and Case Western University all in Cleveland, Ohio.
- [Andrew Walayat](https://epmonthly.com/contributor/andrew-walayat/) - Andrew Walayat is a medical student in his third year at Loma Linda University School of Medicine.
- [Garrett J. Cooper](https://epmonthly.com/contributor/garrett-j-cooper/) - Garrett J. Cooper is a medical student in his third year at Loma Linda University School of Medicine.
- [Paula Bitange](https://epmonthly.com/contributor/paula-bitange/) - Paula Bitange is a medical student in her third year at Loma Linda University School of Medicine.
- [Sandra Werner, MD](https://epmonthly.com/contributor/sandra-werner-md/) - Sandra Werner MD, Ultrasound Fellowship Director, professor Case Western Reserve University, Department of Emergency Medicine MetroHealth Medical Center, Cleveland, Ohio
- [Kevin Caja, MD](https://epmonthly.com/contributor/kevin-caja-md/) - Kevin Caja MD, assistant program director, Emergency Ultrasound Fellowship, Assistant Professor of Emergency Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio
- [Gillian Michaelson](https://epmonthly.com/contributor/gillian-michaelson/) - Gillian Michaelson 3rd year medical student, Case Western Reserve University School of Medicine, Cleveland. Ohio
- [Drew White, MD](https://epmonthly.com/contributor/drew-white-md/) - Dr. Drew White is an emergency physician and Regional Vice President with USACS. He lives and works in Baltimore, Maryland.
- [Nick Poole](https://epmonthly.com/contributor/nick-poole/) - Nick Poole is an emergency medicine resident at Dartmouth Hitchcock Medical Center in Lebanon, NH. He has a strong interest in toxicology and health policy. Outside of the hospital he enjoys running, cycling, and climbing.
- [Victoria Valdes, DO](https://epmonthly.com/contributor/victoria-valdes-do/) - Victoria Valdes, DO is an Emergency Medicine resident at Dartmouth Hitchcock Medical Center. Victoria's interests include global disaster response and refugee/IDP health with an emphasis on sustained medical care and the development of WASH programs.
- [Jennifer L. Hemberg, MD](https://epmonthly.com/contributor/jennifer-l-hemberga/) - Jennifer L. Hemberg, MD is an assistant professor at Michigan State University, division of Pediatric Emergency Medicine at Helen Devos Children's Hospital in Grand Rapids, Michigan.
- [Tim Young, MD](https://epmonthly.com/contributor/tim-young-md/) - Tim Young, MD is a Professor of Emergency Medicine and Pediatrics at Loma Linda University School of Medicine. He is Program Director of the Pediatric Emergency Medicine Fellowship at Loma Linda University Medical Center and Children's Hospital.
- [Natalie Oberhauser-Lim, MD](https://epmonthly.com/contributor/natalie-oberhauser-lim-md/) - Natalie Oberhauser-Lim, MD is a 3rd year Emergency Medicine resident at Loma Linda University.
- [Isabel Bishop](https://epmonthly.com/contributor/isabel-bishop/) - Isabel Bishop is a 2nd year medical student at Loma Linda University.
- [Ja Tsun](https://epmonthly.com/contributor/ja-tsun/) - Ja Tsun is a 2nd year medical student at Loma Linda University.
- [Kristen Doña](https://epmonthly.com/contributor/kristen-dona/) - Kristen Doña is a 2nd year medical student at Loma Linda University.
- [Mason Clark](https://epmonthly.com/contributor/mason-clark/) - Mason Clark is a 2nd year medical student at Loma Linda University.
- [Emily Walsh, MD](https://epmonthly.com/contributor/emily-walsh-md/) - Emily Walsh, MD, 3rd year resident emergency medicine, department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio.
- [Vikas Jain, MD](https://epmonthly.com/contributor/vikas-jain-md/) - Vikas Jain, MD, staff physician, department of Radiology, MetroHealth Medical Center, Cleveland, Ohio.
- [Matthew Roehrs DO](https://epmonthly.com/contributor/matthew-roehrs-do-2/) - Matthew Roehrs, DO, attending physician, department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio.
- [Yaron Ivan, MD](https://epmonthly.com/contributor/yaron-ivan-md/) - Yaron Ivan, MD is a Pediatric Emergency Medicine Attending Physician in Las Vegas Nevada, He currently serves as the site director for the Pediatric Emergency Medicine fellowship at UNLV as well as the Child Abuse Medical director. He is the host and founder of PEM Rules, a dedicated pediatric EM podcast.
- [John G. Holstein, MA, MA](https://epmonthly.com/contributor/john-g-holstein-ma-ma/) - John G. Holstein, MA, MA has had a 37-year career serving, supporting and advocating for emergency medicine, specifically in the revenue cycle space. Combined industry presentations and publications totaling 75.
- [James L. Shoemaker, Jr., MD, FACEP](https://epmonthly.com/contributor/james-l-shoemaker-jr-md-facep/) - James L. Shoemaker, Jr., MD, FACEP: Secretary-Treasurer of the ACEP Board of Directors, and the Director of Quality for Elite Emergency Physicians, Inc., an independent emergency medicine physician group in Indiana.
- [J.J. Sverha, MD](https://epmonthly.com/contributor/john-sverha-md-facep/) - Dr Sverha is a Regional Quality Director for US Acute Care Solutions and Vice-Chair of the Emergency Department at VHC Health in Arlington, VA.
- [Jonathan Frommelt, MD](https://epmonthly.com/contributor/jonathan-frommelt-md-2/) - Jonathan Frommelt, MD, is an assistant professor at Case Western University in Cleveland, Ohio and is an attending physician, Department of Emergency Medicine with MetroHealth Medical Center in Cleveland, Ohio.
- [Jaklyn Horozov, D.O.](https://epmonthly.com/contributor/jaklyn-horozov-d-o/) - Jaklyn Horozov, D.O., is an Attending Physician with US Acute Care Solutions in Canton, Ohio
- [Sahil Gupta, MD](https://epmonthly.com/contributor/sahil-gupta-md/) - Sahil Gupta, MD is a fourth year Radiology Resident, MetroHealth Medical Center at Case Western Reserve University in Cleveland, Ohio.
- [Zachary Walker, MD](https://epmonthly.com/contributor/zachary-walker-md/) - Zachary Walker, MD is a third year Emergency Resident at MetroHealth Medical Center at Case Western Reserve University in Cleveland, Ohio.
- [Shannon Caliri, DO](https://epmonthly.com/contributor/shannon-caliri-do/) - Shannon Caliri, DO, is a resident doctor at AdventHealth in Orlando, FL.
- [Q. Vinh Tran](https://epmonthly.com/contributor/q-vinh-tran/) - Q. Vinh Tran is a PGY3 at AdventHealth Orlando EM's residency program.
- [Elizabeth Netherton](https://epmonthly.com/contributor/elizabeth-netherton/) - Elizabeth Netherton is a graduate from the University of Arizona with more than 10 years of professional management experience, three years as an Emergency Medicine Technician for the Southern Arizona Veteran Health Care System, a Home Health Aid, and a Restorative and Physical Therapy Assistant. She is an active volunteer in her community and will
- [Jondavid Landon, MD, RDCS, RDMS](https://epmonthly.com/contributor/jondavid-landon/) - Jondavid "JD" Landon, MD, RDCS, RDMS is a community faculty member of Emergency Medicine at Eastern Virginia Medical School. He is fellowship trained in ultrasound with interests in critical care, cardiac arrest and ECPR.
- [Lauren Gallion, MD, RDCS, RDMS](https://epmonthly.com/contributor/lauren-gallion-md-rdcs-rdms/) - Lauren Gallion, MD, RDCS, RDMS is a community faculty member of Emergency Medicine at Eastern Virginia Medical School in Norfolk, Virginia. She is fellowship trained in emergency medicine ultrasound with interests in critical care echo and endovascular procedures.
- [Caroline Abramovich, MD](https://epmonthly.com/contributor/caroline-abramovich-md/) - Caroline Abramovich, MD, is a surgical pathologist with MetroHealth Medical Center in Cleveland, Ohio
- [Jordan Smucker, MD](https://epmonthly.com/contributor/jordan-smucker-md/) - Jordan Smucker, MD, is an attending physician with the department of Emergency Medicine, MetroHealth Medical Center in Cleveland, Ohio.
- [EM Coach](https://epmonthly.com/contributor/em-coach/) - EM Coach provides artificial intelligence-driven customized study plans for the EM boards review with over 2,000 questions, high-yield textbook, engaging lectures and innovative visual aids. EM boards education redefined. Find out more at www.emcoach.org.
- [Andrew H. Erlich, DO](https://epmonthly.com/contributor/andrew-h-erlich-do-2/) - Andrew H. Erlich, DO, is an Assistant Professor of Clinical Emergency Medicine at Michigan State University School of Osteopathic Medicine
- [Jason P. Medler, MD](https://epmonthly.com/contributor/jason-p-medler-md-2/) - Jason P. Medler, MD, is an Assistant Professor of Clinical Emergency at Indiana University School of Medicine and Medical Director of the Emergency Department at IU Health Ball Memorial Hospital.
- [Christian C. Strachan, MD, MBA](https://epmonthly.com/contributor/christian-c-strachan-md-mba/) - Christian C. Strachan, MD, MBA, is an Associate Professor of Clinical Emergency Medicine and Executive Vice Chair of Clinical Affairs at Indiana University School of Medicine.
- [Gregory M. Taylor, DO](https://epmonthly.com/contributor/gregory-m-taylor-d-o/) - Gregory M. Taylor, DO, is an Assistant Professor of Clinical Emergency Medicine at Indiana University School of Medicine. He also serves as a physician and flight surgeon in the United States Air Force as the Agency Medical Director of the 434th Aerospace Medicine Squadron and Medical Director of the Grissom Reserve Fire Department at Grissom Air Reserve
- [Jeremy Boyd, MD, FACEP](https://epmonthly.com/contributor/jeremy-boyd-md-facep/) - Jeremy Boyd, MD, FACEP is Division Director, Emergency Ultrasound and Assistant Professor, Department of Emergency Medicine at Vanderbilt University Medical Center, in Nashville, Tennessee.
- [Dan Magdziarz, DO](https://epmonthly.com/contributor/dan-magdziarz/) - Dan Magdziarz, DO, is an attending ED physician practicing at Palos Hospital. His teaching, quality and reimbursement endeavors seek to promote excellence in Emergency Medicine. Share your interests and comments: dmagdziarz@chartoptima.com; EDPMA: QCDC.
- [Brian Acunto DO, EJD, FACEP, FACOEP](https://epmonthly.com/contributor/brian-acunto-do-ejd-facep-facoep/)
- [Matthew Young, MD](https://epmonthly.com/contributor/matthew-young-md/) - Matthew Young, MD is an emergency physician and board member of Wake Emergency Physicians. He graduated from the University of Cincinnati School of Medicine and completed his residency at the University of North Carolina. He currently spearheads initiatives in regional anesthesia for hip fractures, the treatment of sickle cell disease, and harm reduction strategies for
- [Graham E. Snyder, MD](https://epmonthly.com/contributor/graham-e-snyder-md/) - Dr. Snyder is an emergency physician and Director of Emergency Medicine Education for Wake Emergency Physicians in Raleigh, NC. He is the Associate Program Director for the University of North Carolina Department of Emergency Medicine, and is the director of the WakeMed Medical Simulation Center, helping to train thousands of physicians, nurses, physician assistants and
- [Fallon Bushee, MD](https://epmonthly.com/contributor/fallon-bushee-md/) - Fallon Bushee, MD, is a current Emergency Medicine resident at the Dartmouth-Hitchcock Medical Center. She is pursuing a Palliative Care Fellowship after her training.
- [Kathleen White, MD](https://epmonthly.com/contributor/kathleen-white-md/) - Kathleen White, MD, is a current Emergency Medicine resident at the Dartmouth-Hitchcock Medical Center. She is pursuing an Educational Fellowship after her training.
- [Liz Malik, MD](https://epmonthly.com/contributor/liz-malik-md/) - Liz Malik, MD is an Emergency Medicine physician at Dartmouth Hitchcock Medical Center. She completed her Emergency Medicine Residency at Denver Health Hospital in Denver, Colorado in 2021. Liz has a special interest in reproductive and human rights, refugee health, and the disproportionate effects of climate change on vulnerable populations world-wide.
- [Candace Leigh, MD](https://epmonthly.com/contributor/candace-leigh-md/) - Candace Leigh, MD is an Emergency Medicine and Palliative Medicine physician at Cleveland Clinic Akron General in Akron, Ohio.
- [Naira Goukasian, MD](https://epmonthly.com/contributor/naira-goukasian-md/) - Naira Goukasian, MD, is a resident physician at University of North Carolina at Chapel Hill. University of North Carolina at Chapel Hill.
- [Nikki Binz, MD](https://epmonthly.com/contributor/nikki-binz-md/) - Nikki Binz, FACEP. is the director of Emergency Medicine Residency Program Director, Education Fellowship Clinical Associate Professor.
- [Farah Mechref, MD](https://epmonthly.com/contributor/farah-mechref-md/) - Farah Mechref, MD is an Emergency Medicine Intern at the University of North Carolina at Chapel Hill.
- [Christine Perry, DO, MS, FACOEP](https://epmonthly.com/contributor/christine-perry-do-ms-facoep/) - Christine Perry, DO, MS, FACOEP, is the Emergency Department Medical Director of McLaren Greater Lansing Hospital and co-chair for Provider Wellbeing Committee for American Physician Partners.
- [Ja’Neil Humphrey](https://epmonthly.com/contributor/janeil-humphrey/) - Ja’Neil Humphrey is a medical student in her third year at Loma Linda University School of Medicine.
- [Shantal Tummings](https://epmonthly.com/contributor/shantal-tummings/) - Shantal Tummings is a medical student in her third year at Loma Linda University School of Medicine.
- [Jasmine Haddad](https://epmonthly.com/contributor/jasmine-haddad/) - Jasmine Haddad is a medical student in her third year at Loma Linda University School of Medicine.
- [Shannon Kiang](https://epmonthly.com/contributor/shannon-kiang/) - Shannon Kiang is a resident in emergency medicine at Loma Linda University Medical Center and Children’s Hospital.
- [Sierra Garrett](https://epmonthly.com/contributor/sierra-garrett/) - Sierra Garrett is medical student in her third year at Loma Linda University School of Medicine.
- [Matthew Tabbut, MD](https://epmonthly.com/contributor/m-tabbut-md/) - Matthew Tabbut MD, is a staff physician in the department of emergency medicine at the MetroHealth Medical Center in Cleveland, Ohio.
- [Jeremy Schiele, DO](https://epmonthly.com/contributor/j-schiele-do/) - Jeremy Schiele, DO, is an emergency medicine resident at MetroHealth Medical Center in Cleveland, Ohio.
- [Kathryn Oehlman, DO](https://epmonthly.com/contributor/k-oehlman-do/) - Kathryn Oehlman DO, is an emergency medicine resident ay MetroHealth Medical Center in Cleveland, Ohio.
- [Doreen C. Parkhurst, MD, FACEP](https://epmonthly.com/contributor/doreen-c-parkhurst-md-facep/) - Doreen C. Parkhurst, MD, FACEP is an emergency medicine physician in Florida who is currently engaged in telemedicine. She received her medical degree from Boston University School of Medicine and has been in medical practice for more than 30 years.
- [Eli Besser, D.O.](https://epmonthly.com/contributor/eli-besser-d-o/) - Dr. Eli Besser, D.O. is an emergency medicine resident at Desert Regional Medical Center in Palm Springs, CA
- [Nicholas Glover, D.O.](https://epmonthly.com/contributor/nicholas-glover-d-o/) - Dr. Nicholas Glover, D.O. is an emergency medicine resident at the Desert Regional Medical Center, Palm Springs, CA
- [Matt Friedman, MD](https://epmonthly.com/contributor/matt-friedman-md/) - Matt S. Friedman, MD is a board-certified EMS and Emergency Medicine physician. He completed an EMS fellowship with the Fire Department City of New York (FDNY). He is currently the Associate Medical Director of Prehospital Care and the EMS Fellowship director at Maimonides Medical Center in Brooklyn, NY. He also serves as the Lead House
- [Eric Quinn, MD](https://epmonthly.com/contributor/eric-quinn-md/) - Eric Quinn, MD is an Emergency Medicine Attending Physician & EMS Fellow at Cooper University Hospital. The prehospital division at Cooper manages both a ground and air EMS system along with providing medical direction to the surrounding counties. He completed his Emergency Medicine Residency and was one of the chief Emergency Medicine residents at Maimonides
- [Suneil Agrawal, MD](https://epmonthly.com/contributor/suneil-agrawal-md/) - Dr. Suneil Agrawal is an EM Attending physician at Desert Regional Medical Center in Palm Springs, CA.
- [Kevin Menes, MD](https://epmonthly.com/contributor/kevin-menes-md/) - Kevin Menes, MD is an emergency room physician who was working in Las Vegas the night of the Oct. 1 shooting. The team's non-standard approach to MCI was credited with saving hundreds of lives. He is a former tactical physician with the Las Vegas Metropolitan Police Department SWAT team. Menes has taught various military special
- [Miltiadis Kerdemelidis, MD](https://epmonthly.com/contributor/miltiadis-kerdemelidis-md/) - Miltiadis Kerdemelidis, MD is an emergency medicine resident in Orlando, Florida. He currently is a PGY-3 at Advent Health East Orlando. Prior to this he completed training and is board certified in family medicine.
- [Deena Bengiamin](https://epmonthly.com/contributor/deena-bengiamin/) - Dr. Bengiamin is an associate professor of emergency medicine at Loma Linda University School of Medicine. She is associate program director of the emergency medicine residency at Loma Linda University Medical Center.
- [Ricardo Chujutalli, MD, MBA](https://epmonthly.com/contributor/ricardo-chujutalli-md-mba/) - Ricardo Chujutalli, MD, MBA, is an incoming resident at Winter Park, Florida. He is completing his Masters in Bioethics from Loma Linda University. He is also the co-founder of Goostos, a meal prep and catering company intended for students.
- [Ogechi Nwankwo, BSN](https://epmonthly.com/contributor/ogechi-nwankwo-bsn/) - Ogechi Nwankwo, BSN is a first-year medical student at Loma Linda University School of Medicine. She is a passionate mentor, healthcare advocate and community leader.
- [Harry W. Severance, MD](https://epmonthly.com/contributor/harry-w-severance-md/) - Dr. Severance is an adjunct assistant professor in the Department of Medicine at Duke University School of Medicine. His clinical practice includes a position as an attending physician in the Division of Hyperbaric Medicine, Erlanger Baroness Medical Center, UT College of Medicine/Health Science Center in Chattanooga, TN. He frequently speaks to various issues in clinical healthcare
- [Lyman Wu](https://epmonthly.com/contributor/lyman-wu/) - Lyman Wu is a fourth-year medical student at the University of New England College of Osteopathic Medicine.
- [Elise Hernandez](https://epmonthly.com/contributor/elise-hernandez/) - Elise Hernandez is a MSD logistics director at Louisiana State University.
- [Joya Ahmad](https://epmonthly.com/contributor/joya-ahmad/) - Joya Ahmad is a first-year medical student and MSD logistics director at SUNY Downstate School of Medicine.
- [Michael Hohl](https://epmonthly.com/contributor/michael-hohl/) - Michael Hohl is a fourth-year medical student at the University of Mississippi Medical Center.
- [Pamela Soriano, MD MBA FAAP](https://epmonthly.com/contributor/pamela-soriano-md-mba-faap/) - Dr. Soriano is an Assistant Professor of Clinical Medicine at Indiana University School of Medicine.
- [Elizabeth Chiang, MD, PhD](https://epmonthly.com/contributor/elizabeth-chiang-md-phd/) - Elizabeth Chiang, MD, PhD is an ophthalmologist and oculoplastic surgeon at Ice Opthalmology in Painesville, Ohio.
- [Scott Powers, MD](https://epmonthly.com/contributor/scott-powers-md/) - Scott Powers, MD, is an emergency resident at MetroHealth Medical Center in Cleveland, Ohio.
- [Mark Reiter, MD, MBA, MAAEM](https://epmonthly.com/contributor/mark-reiter-md-mba-maaem/) - Mark Reiter, MD, MBA, MAAEM is professor and Residency Director at the University of Tennessee-Murfreesboro/Nashville, CEO of the AAEM Physician Group and an AAEM past president. He is also the CEO of Emergency Excellence.
- [Julieanna J. Sahouria-Rukab, MD](https://epmonthly.com/contributor/julieanna-j-sahouria-rukab-md-2/) - Julieanna J. Sahouria-Rukab, MD is a Pediatric Emergency Medicine attending physician, Department Chair, Associate Director of the Emergency Department, and Base Hospital Medical Director at Valley Children’s Hospital in Madera, California. She is a Clinical Instructor (affiliated) in the Department of Emergency medicine, Stanford University, School of Medicine.
- [Lauren M. Cantwell, MD ](https://epmonthly.com/contributor/dr-lauren-m-cantwell-md/) - Lauren M. Cantwell, MD is an Emergency Medicine and Pediatric Emergency Medicine attending physician at Renown Regional Medical Center in Reno, NV.
- [Michael Carson, MD](https://epmonthly.com/contributor/michael-carson-md/) - Michael Carson, MD is a Senior Emergency Medicine Resident in the Division of Emergency Medicine at the University of Vermont Medical Center.
- [Darren Cuthbert, MD](https://epmonthly.com/contributor/darren-cuthbert-md/) - Dr. Darren Cuthbert is an Emergency Physician at Jersey City Medical Center in Jersey City, NJ. He also serves as the Medical Director of Production Health Safety providing health consulting, COVID testing, and contact tracing within the film and entertainment industry. Dr. Cuthbert has published numerous articles, abstracts, research papers, and presentations on various topics
- [Ricardo Hernandez, MD](https://epmonthly.com/contributor/ricardo-hernandez-md-2/) - Ricardo Hernandez, MD is a third year Emergency Medicine Resident at the AdventHealth EM program in Orlando, FL
- [Steven Nazario, MD](https://epmonthly.com/contributor/steven-nazario-md/) - Steven Nazario, MD is the Emergency Medicine Program Director at the AdventHealth EM program in Orlando, Florida.
- [Laleh Gharahbaghian, MD](https://epmonthly.com/contributor/lehla-gharahbaghian-md/) - Dr. Gharahbaghian is the Medical and Quality Director of Emergency Medicine at Stanford University. Her research spans the study of various point-of-care applications in the management of critical patients, in the screening of trauma patients, and emergency department operations and quality care. She is a leader in the national bedside ultrasound educational impact, has led
- [Susan Musyimi Crafton, MD](https://epmonthly.com/contributor/susan-musyimi-crafton-md/) - Dr. Crafton is an Emergency Medicine Physician at Southern Arizona VA Healthcare System. She also serves as a preceptor for emergency medicine residents from University of Arizona Emergency Medicine residency program.
- [Bruce Nisbet, MD](https://epmonthly.com/contributor/bruce-nisbet-md/) - Dr. Nisbet is Chairman of the Emergency Department and EMS Medical Director at Saint Francis Hospital in Wilmington, Delaware.
- [Paul DeFlorio, MD](https://epmonthly.com/contributor/paul-deflorio-md/) - Dr. Paul DeFlorio is an Assistant Professor of Emergency Medicine at Wright State University.
- [Hillary McKinley, MD](https://epmonthly.com/contributor/hillary-mckinley-md/) - Dr. Hillary McKinley is a Chief Resident of Emergency Medicine at Wright State University.
- [Adam Blum, MD](https://epmonthly.com/contributor/adam-blum-md/) - Adam Blum, MD is a staff radiologist at MetroHealth Medical Center in Cleveland, Ohio.
- [Jonathan Glaab, MD](https://epmonthly.com/contributor/jonathan-glaab-md/) - Jonathan Glaab, MD is a staff radiologist at MetroHealth Medical Center in Cleveland, Ohio.
- [Clare Charbonnet, MD](https://epmonthly.com/contributor/clare-charbonnet-md/) - Clare Charbonnet, MD is an Emergency Medicine Resident at MetroHealth Medical Center in Cleveland, Ohio.
- [Diane Gramer, RDMS](https://epmonthly.com/contributor/diane-gramer-rdms/) - Diane Gramer RDMS, is the RVT, RT at MetroHealth Medical Center in Cleveland, Ohio.
- [Bhanu Banda, MD](https://epmonthly.com/contributor/bhanu-banda-md/) - Bhanu Banda, MD is an Emergency Medicine Resident at MetroHealth Medical Center in Cleveland, Ohio.
- [Donald F. Zimmer, MD](https://epmonthly.com/contributor/donald-f-zimmer-md-2/) - Donald F. Zimmer, MD, is a practicing Emergency Physician at Beacon Health System in South Bend Indiana and Assistant Clinical Professor of Emergency Medicine at Indiana University School of Medicine and Director of Co-director of Medical Education for Beacon Health System in South Bend, Indiana.
- [Jerome Pomeranz, MD](https://epmonthly.com/contributor/jerome-pomeranz-md/) - Jerome Pomeranz, MD, is a resident physician at Memorial Hospital Family Medicine Residency Program in South Bend, Indiana.
- [Algis J. Baliunas, MD](https://epmonthly.com/contributor/algis-j-baliunas-md/) - Algis J. Baliunas, MD is a practicing Emergency Physician at Beacon Health System in South Bend Indiana.
- [JJ Sverha, MD, FACEP](https://epmonthly.com/contributor/jj-sverha-md-facep/) - Dr. Sverha is the Vice Chair of Emergency Medicine at the Virginia Hospital Center in Arlington, VA. He also serves as the Chair of the Alteon Mid-Atlantic Clinical Operations Council. He is a recipient of the Choosing Wisely Champion Award presented by ACEP’s Quality and Patient Safety Committee.
- [Alyssa Woo, PT, DPT](https://epmonthly.com/contributor/alyssa-woo-md/) - Dr. Alyssa Woo is a Doctor of Physical Therapy specializing in pelvic health. She works as a staff physical therapist at Action Therapeutics LLC, an outpatient clinic in Henderson, NV that provides one-on-one treatments.
- [Kevin Tomescek, MD](https://epmonthly.com/contributor/kevin-tomescek-md/) - Kevin Tomescek, MD is the Clerkship Director and Faculty at the AdventHealth Orlando Residency.
- [Casey McGillicuddy, MD, MPH](https://epmonthly.com/contributor/casey-mcgillicuddy-md-mph/) - Casey McGillicuddy, MD, MPH is a second-year EM Resident at the AdventHealth Orlando Residency.
- [Ricardo Hernandez, MD](https://epmonthly.com/contributor/ricardo-hernandez-md/) - Ricardo Hernandez, MD is a third-year EM Resident at the AdventHealth Orlando Residency.
- [Marianne Gausche-Hill, MD, FACEP, FAAP, FAEMS](https://epmonthly.com/contributor/marianne-gausche-hill-md-facep-faap-faems/) - Marianne Gausche-Hill, MD, FACEP, FAAP, FAEMS is the president of the American Board of Emergency Medicine Board of Directors. Other roles include serving as the medical director of the Los Angeles County EMS Agency; a professor of Clinical Emergency Medicine and Pediatrics at the David Geffen School of Medicine at UCLA and a member of
- [Tyler Mills, DO](https://epmonthly.com/contributor/tyler-mills-do/) - Tyler Mills, DO is a senior resident at the AdventHealth Orlando EM residency.
- [Marco Propersi. MD](https://epmonthly.com/contributor/marco-propersi-md/) - Dr. Marco Propersi is an Assistant Professor in Clinical Emergency Medicine at Saint Joseph's Regional Medical Center in Paterson, New Jersey. He is passionate about medical education and FOAMed and contributes regularly to REBEL EM Blog. He is also currently enrolled at ALiEM's Faculty Incubator.
- [George Willis, MD](https://epmonthly.com/contributor/george-willis-md/) - Dr. Willis is an Associate Professor at UT Health Sciences in San Antonio, where he also serves as the Associate Residency Program Director.
- [Ethan Kremer, BS](https://epmonthly.com/contributor/ethan-kremer-bs/) - Ethan Kremer, BS is a second year student at NYIT College of Osteopathic Medicine (NYITCOM)
- [Paraskevi (Vivian) Papas, MS](https://epmonthly.com/contributor/paraskevi-vivian-papas-ms/) - Paraskevi (Vivian) Papas, MS is a second year student at St George's University.
- [Aaron Hess, MD](https://epmonthly.com/contributor/aaron-hess-md/) - Dr. Aaron Hess is a first year Orthopedic Resident at Garden City Hospital.
- [Laurie Wallace, MD](https://epmonthly.com/contributor/laurie-wallace-md/) - Dr. Laurie Wallace is the Clerkship Director and Core Faculty for the Beaumont Farmington Hills Emergency Medicine Residency and an Assistant Clinical Professor for Michigan State University College of Osteopathic Medicine.
- [Brandon Wallace](https://epmonthly.com/contributor/brandon-wallace/) - Brandon Wallace is a fourth year Medical Student at Michigan State University College of Osteopathic Medicine with an interest in Orthopedic Surgery.
- [Jessie Cable](https://epmonthly.com/contributor/jessie-cable/) - Jessie Cable is a fourth year medical student at Kansas City University who is applying to Emergency Medicine Residency this year. She also currently serves as the Vice Chair for the EMRA Wellness Committee.
- [Carol Cunningham, MD](https://epmonthly.com/contributor/carol-cunningham-md/) - Dr. Cunningham is the State Medical Director for the Ohio Department of Public Safety, Division of EMS, a board-certified emergency physician at Cleveland Clinic Akron General, and an Associate Professor of Emergency Medicine at the Northeast Ohio Medical University. As an avid musician, she serves on the Tri-C Jazzfest Board of Advisors and the Board
- [India Edwards](https://epmonthly.com/contributor/india-edwards/) - India Edwards is the editorial lead at StartUp Health, which chronicles the people, technology and ideas shaping the future of health.
- [Rob Ferre, MD](https://epmonthly.com/contributor/rob-ferre-md/) - Dr. Rob Ferre is an associate professor of clinical emergency medicine and the division chief of point-of-care ultrasound at Indiana University School of Medicine.
- [Haig Setrakian, MD](https://epmonthly.com/contributor/dr-haig-setrakian/) - Dr. Haig Setrakian is an assistant professor of clinical emergency medicine and pediatrics at Indiana University School of Medicine.
- [Richard Cunningham, MD](https://epmonthly.com/contributor/richard-cunningham-md-2/) - Dr. Cunningham is an emergency medicine resident at Maricopa Medical Center with interests in critical care, airway management and Oxford commas.
- [Mark Ramzy, DO](https://epmonthly.com/contributor/mark-ramzy-md/) - Mark Ramzy is an Emergency Medicine Physician with over 15 years of EMS experience. He is currently completing two simultaneous fellowships in Critical Care and Ultrasound at the University of Pittsburgh Medical Center in the United States. An author for REBEL EM and emDOCs, he has extensive interests in graphic design, medical education through infographics,
- [Christian Casteel, DO](https://epmonthly.com/contributor/christian-casteel-do/) - Dr. Christian Casteel is a PGY-1 Emergency Medicine Resident at Rush University Medical Center. He also currently serves on the ACEP/EMRA Leadership Academy.
- [Nicholas Daniel, DO, FAWM, DiMM](https://epmonthly.com/contributor/nicholas-daniel-do-fawm-dimm/) - Nicholas Daniel, DO, FAWM, DiMM is an assistant professor in emergency medicine and the associate director of the wilderness and austere medicine fellowship at Dartmouth-Hitchcock Medical Center in New Hampshire.
- [Johndavid Storn, MD, DIMM, NRP](https://epmonthly.com/contributor/johndavid-storn-md-dimm-nrp/) - Johndavid (Jd) Storn is an Emergency Physician and current Wilderness and Austere Medicine Fellow at Dartmouth-Hitchcock Medical Center. He also serves as Medical advisor for the Mount Washington Avalanche Center Snow Rangers and assistant medical director for the Upper Valley Wilderness Response Team and Hartford (VT) Fire Department.
- [Greg Zahn, MD](https://epmonthly.com/contributor/greg-zahn-md/) - Greg Zahn, MD, is an Associate Professor of Emergency Medicine at Indiana University School of Medicine, Methodist Hospital. He is fellowship trained in emergency medicine ultrasound and is a member of the IU ultrasound division. Follow on Twitter @IUEM_ultrasound.
- [Sarah Kennedy, MD](https://epmonthly.com/contributor/sarah-kennedy-md/) - Dr. Kennedy is an Associate Professor of Emergency Medicine at Indiana University School of Medicine. She completed a fellowship in emergency medicine ultrasound and is a member of the IU ultrasound division. Follow on Twitter @IUEM_ultrasound.
- [Dr. Katherine Fredlund](https://epmonthly.com/contributor/dr-katherine-fredlund/) - Katherine Fredlund
- [John R. Dayton, MD, FACEP](https://epmonthly.com/contributor/john-dayton-md/) - John Dayton is an emergency physician and entrepreneur. He is the first Medical Innovation and Design Fellow at Stanford’s Department of Emergency Medicine. In addition to prior service as President of Utah ACEP, he also founded Utah’s Society of Physician Entrepreneurs, advises medical startups and venture capital firms, and founded MedForums, a ‘yelp’ for medical education.
- [Lauren Bitterman](https://epmonthly.com/contributor/lauren-bitterman/) - Lauren Bitterman is a medical student at Loma Linda University School of Medicine, class of 2022.
- [Olivia Paradis](https://epmonthly.com/contributor/olivia-paradis/) - Olivia Paradis is a medical student at Loma Linda University School of Medicine, class of 2022.
- [Kimberly Park](https://epmonthly.com/contributor/kimberly-park/) - Kimberly Park is a medical student at Loma Linda University School of Medicine, class of 2022.
- [Robert Ohle, MD](https://epmonthly.com/contributor/robert-ohle-md/)
- [Peter Johns, MD](https://epmonthly.com/contributor/peter-johns-md/) - Dr. Johns is assistant professor at the University of Ottawa, Department of Emergency Medicine. He has taught others in person about vertigo for over two decades as well as having a YouTube channel (youtube.com/user/peterjohns84) about vertigo with five millions views.
- [Ellen Clark](https://epmonthly.com/contributor/ellen-clark/) - Ellen Clark is a fourth-year medical student at the University of Colorado School of Medicine.
- [Gillian Schmitz, MD, FACEP](https://epmonthly.com/contributor/gillian-schmitz-md-facep/) - Gillian Schmitz, MD, FACEP is an Associate Professor at the Uniformed Services University and an emergency physician at the Brooke Army Medical Center in San Antonio, TX. She currently serves as the President-elect and a member of the Board of Directors of the American College of Emergency Physicians (ACEP).
- [Aaron Wolfe, MD](https://epmonthly.com/contributor/aaron-wolfe-md/) - Aaron Wolfe, DO is an assistant professor of emergency medicine at Case Western Reserve University and the co-director of Emergency Simulation Medicine in the department of emergency medicine at the MetroHealth Medical Center in Cleveland, Ohio.
- [Mark L. Plaster, MD, JD](https://epmonthly.com/contributor/mark-l-plaster-md-jd/) - FOUNDER/EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than 30 years, working exclusively night shifts for the past 20 years in emergency departments across the country. During that period, he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly
- [Douglas MacAskill, DO](https://epmonthly.com/contributor/douglas-macaskill-do/) - Dr. MacAskill is a staff physician at Beaumont, Grosse Pointe, in Michigan. He is semi-retired, board certified in Family Practice and Emergency Medicine and a former director of a private EM group and was a team physician for US Diving and the Olympic Committee.
- [Ricardo J. Hernández, MD](https://epmonthly.com/contributor/ricardo-j-hernandez-md/) - Ricardo J. Hernández, MD is an Emergency Medicine resident at AdventHealth East in Orlando, Florida.
- [Peter Alamia, DO](https://epmonthly.com/contributor/peter-alamia-do/) - Peter Alamia, DO is an Assistant Director of the Emergency Department at AdventHealth East in Orlando, Florida.
- [Brittany Congress, MD](https://epmonthly.com/contributor/brittany-congress-md/) - Dr. Congress is Board Certified in Emergency Medicine and serves as the Lead Physician at one of the AFC Urgent Care Clinics in Knoxville, TN. She also serves as the regional lab director for the company.
- [Rachel Macak, MD](https://epmonthly.com/contributor/rachel-macak-md/) - Rachel Macak, MD, is a third-year resident in pediatrics at the University of Utah.
- [Andrew F. Kalnow, DO](https://epmonthly.com/contributor/andrew-f-kalnow-do/) - Andrew Kalnow is an emergency medicine physician and associate program director at OhioHealth Doctors Hospital in Columbus, OH. He is also a co-host for EM Over Easy, a podcast focusing on #MoreThanMedicine.
- [Richard Cunningham, MD](https://epmonthly.com/contributor/richard-cunningham-md/) - Dr. Cunningham is a second-year emergency medicine resident at Maricopa Medical Center with interests in critical care, airway management and Oxford commas.
- [Sergey Motov, MD](https://epmonthly.com/contributor/sergey-motov-md/) - Dr. Motov is an Attending Physician and Research Director in the Department of Emergency Medicine at Maimonides Medical Center with particular interest in safe and effective analgesia in the ED.
- [Tom Scaletta, MD, MAAEM, FACEP, CPXP](https://epmonthly.com/contributor/tom-scaletta-md-maaem-facep-cpxp/) - Tom Scaletta, MD, MAAEM, FACEP, CPXP, is past president of the American Academy of Emergency Medicine and president of Auscura, the technology company that developed BEST. Tom is the medical director of emergency and immediate care at Edward Elmhurst Health (Naperville, IL) and regularly works clinical shifts.
- [Dr. Puneet Gill, DO, MS](https://epmonthly.com/contributor/dr-puneet-gill-do-ms/) - Dr. Puneet Gill, DO, MS, is a second year Emergency Medicine resident physician at Kaweah Delta Medical Center in Visalia, California.
- [Benjamin Nti, MD, MS](https://epmonthly.com/contributor/benjamin-nti-md-ms/) - Dr. Nti is an Assistant Professor of Emergency Medicine and Pediatrics at Indiana University School of Medicine. He is the director of pediatric point-of-care ultrasound for Riley Hospital for Children at Indiana University Health.
- [Mark Hopkins, MD](https://epmonthly.com/contributor/mark-hopkins-md/) - Dr. Hopkins is an emergency medicine resident at Loma Linda University Health.
- [Deena I. Bengiamin, MD](https://epmonthly.com/contributor/deena-i-bengiamin-md/) - Dr. Bengiamin is an associate professor of Emergency Medicine at Loma Linda University School of Medicine. She is associate program director of the Emergency Medicine residency at Loma Linda University Medical Center.
- [Eric Stern, MD](https://epmonthly.com/contributor/eric-stern-md/) - Dr. Stern finished his emergency medicine residency at Loma Linda University Health in 2020. He is now practicing in the Sacramento, California area.
- [Baylee Arnold](https://epmonthly.com/contributor/baylee-arnold/) - Baylee Arnold is a medical student at Loma Linda University School of Medicine, Class of 2021.
- [Shubhro Bose, MS4](https://epmonthly.com/contributor/shubhro-bose-ms4/) - 2LT Bose is a Fourth Year Army Medical Student at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, MD. He will begin residency in Emergency Medicine at Brooke Army Medical Center in San Antonio, Texas in summer 2021.
- [Julieanna J. Sahouria-Rukab, MD](https://epmonthly.com/contributor/julieanna-j-sahouria-rukab-md/) - Dr. Julieanna J. Sahouria-Rukab, MD is a Pediatric Emergency Medicine attending physician, Department Chair, Associate Director of the Emergency Department, and Base Hospital Medical Director at Valley Children’s Hospital in Madera, California. She is a Clinical Instructor (affiliated) in the Department of Emergency medicine, Stanford University, School of Medicine.
- [Benjamin M. Gerretsen, MD](https://epmonthly.com/contributor/benjamin-m-gerretsen-md/) - Benjamin M. Gerretsen, MD (@bmgerretsen) is currently a first-year emergency medicine resident at Reinier de Graaf Gasthuis, the Netherlands.
- [Barbra Backus, MD](https://epmonthly.com/contributor/barbra-backus-md/) - Barbra Backus, MD is an emergency physician at the Erasmus University Medical Center in the Netherlands. She developed and validated the HEART score for chest pain patients at the emergency department and finished her thesis on HEART in 2012. She continued her research specialty on low-risk chest pain. Dr. Backus has co-authored several books and blogs
- [Isobel Y. Santos, MD](https://epmonthly.com/contributor/isobel-y-santos-md/) - Isobel Y. Santos, MD, is a surgical resident, at University Hospitals in Cleveland, Ohio.
- [Christopher Yutzy, DO](https://epmonthly.com/contributor/christopher-yutzy-do/) - Christopher Yutzy, DO, is an emergency resident at MetroHealth Medical Center in Cleveland, Ohio.
- [Loren Rood, MD, RDMS](https://epmonthly.com/contributor/loren-rood-md-rdms/) - Dr. Rood is Assistant Professor of Emergency Medicine at Indiana University School of Medicine. He is the associate director of the emergency ultrasound fellowship, and associate director of faculty POCUS education and development.
- [Al'ai Alvarez, MD, FACEP, FAAEM](https://epmonthly.com/contributor/alai-alvarez-md-facep-faaem/) - Al'ai Alvarez, MD, FACEP, FAAEM (@alvarezzzy) is an assistant clinical professor in Emergency Medicine and an assistant program director in the Stanford Emergency Medicine Residency Program.
- [Jennifer Kleven, MD](https://epmonthly.com/contributor/jennifer-kleven-md/) - Jennifer Kleven, MD is an assistant clinical professor in Emergency Medicine at Hackensack University Medical Center. Dr.Kleven focuses on the physician well being, resiliency, diversity, equity and inclusion, social justice, social determinants of health, and quality.
- [Salim R. Rezaie, MD](https://epmonthly.com/contributor/salim-r-rezaie-md/) - EDITOR-IN-CHIEF Dr. Rezaie is founder and editor of R.E.B.E.L EM.
- [Logan Plaster](https://epmonthly.com/contributor/logan-plaster/) - Logan Plaster is the editor-in-chief of StartUp Health, which chronicles the people, technology and ideas shaping the future of health. Logan is also the host of StartUp Health TV.
- [Yasmany Cartaya, MD](https://epmonthly.com/contributor/yasmany-cartaya-md/) - Dr. Yasmany Cartaya, is an PGY-3 EM Chief Resident at AdventHealth East in Orlando.
- [Camilo Mohar, DO](https://epmonthly.com/contributor/camilo-mohar-do/) - Dr. Camilo Mohar is an emergency medicine, attending physician at Advent Health East in Orlando.
- [David Ludlow, MD](https://epmonthly.com/contributor/david-ludlow-md/) - David Ludlow, MD, is an attending physician at the ENT department at the MetroHealth Medical Center in Cleveland, Ohio.
- [Benjamin Johnson, MD](https://epmonthly.com/contributor/benjamin-johnson-md/) - Benjamin Johnson, MD, is an ENT resident at University Hospitals in Cleveland, Ohio.
- [Vase Bari, MD](https://epmonthly.com/contributor/vase-bari-md/) - Vase Bari, MD, is a critical care fellow, Department of Anesthesiology at the Emory University School of Medicine.
- [Ashley McMellen, MD](https://epmonthly.com/contributor/ashley-mcmellen-md/) - Ashley McMellen, MD, is an emergency medicine resident at MetroHealth Medical Center, Cleveland, Ohio.
- [Anne Johnson, MD](https://epmonthly.com/contributor/anne-johnson-md/) - Dr. Johnson practices emergency medicine in Milwaukee, serves as EMS Director for her hospital, Medical Director for the MATC Paramedic Program, and is a Lieutenant Colonel in the US Army Reserves. She is the author of ROOM FOUR, a dramedy of emergency medicine.
- [Jessica L. Schad, PharmD, BCPS](https://epmonthly.com/contributor/jessica-l-schad-pharmd-bcps/) - Dr. Schad is an Emergency Medicine clinical pharmacist at Carilion Roanoke Memorial Hospital, a 760-bed Level I trauma center, where she has worked for the last 6 years since completing her critical care pharmacy residency. She is involved in pharmacy and EM residency education at Carilion and several local schools of pharmacy. Her practice interests
- [Joey I. Indiano, MD](https://epmonthly.com/contributor/joey-i-indiano-md/) - Joey I. Indiano, MD, is an Assistant Clinical Professor of Emergency Medicine at Indiana University School of Medicine.
- [Jan R. Kornilow, MD](https://epmonthly.com/contributor/jan-r-kornilow-md/) - Jan R. Kornilow, MD, is an Assistant Clinical Professor of Emergency Medicine at Indiana University School of Medicine.
- [Jessica L. Schad, PharmD, BCPS](https://epmonthly.com/contributor/jessica-l-schad-pharmd-bcps-2/) - Dr. Schad is an Emergency Medicine clinical pharmacist at Carilion Roanoke Memorial Hospital, a 760-bed Level I trauma center, where she has worked for the last six years since completing her critical care pharmacy residency. She is involved in pharmacy and EM residency education at Carilion and several local schools of pharmacy. Her practice interests
- [Daniel M. Fatovich, MBBS, FACEM](https://epmonthly.com/contributor/daniel-m-fatovich-mbbs-facem/) - Daniel M. Fatovich, MBBS, FACEM, is Professor of Emergency Medicine and Director of Research at Royal Perth Hospital, Western Australia; and the University of Western Australia. He is also Head, Centre for Clinical Research in Emergency Medicine (Twitter @CCREM2), Harry Perkins Institute of Medical Research.
- [Leen Albaihed, MD](https://epmonthly.com/contributor/leen-albaihed-md/) - Dr. Alblaihed is an emergency physician and director of residency education at University of Maryland Upper Chesapeake Medical System.
- [Jennifer White MD, FACEP](https://epmonthly.com/contributor/jennifer-white-md-facep/) - Jennifer White MD, FACEP is the director of clinical operations at the Thomas Jefferson University Hospital ED. She is a clinical associate professor at the Sidney Kimmel College of Medicine.
- [Tinh Le](https://epmonthly.com/contributor/tinh-le/) - Tinh Le is a third year medical student at the Case Western Reserve University School of Medicine and lead research assistant on the lab team.
- [James Neuenschwander MD, FACEP](https://epmonthly.com/contributor/james-neuenschwander-md-facep/) - James Neuenschwander MD, FACEP is the research director at Genesis Healthcare System’s Emergency Department and observation unit. He is an adjunct associate professor at the Ohio State University.
- [Todd Baker, MD, FACEP](https://epmonthly.com/contributor/todd-baker-md-facep/) - Todd Baker MD, FACEP, is an emergency medicine physician in Branson, Missouri and is affiliated with 360 Medicine and SafER Medical Products.
- [Natalie Mark](https://epmonthly.com/contributor/natalie-mark/) - Natalie Mark is a medical student at Indiana University School of Medicine South Bend Indiana.
- [Donald F. Zimmer, MD](https://epmonthly.com/contributor/donald-f-zimmer-md/) - Donald F. Zimmer, MD is a practicing Emergency Physician at Beacon Health System in South Bend Indiana and Assistant Clinical Professor of Emergency Medicine at Indiana University School of Medicine and Director of Co-director of Medical Education for Beacon Health System in South Bend, IN
- [Matthew Steimle, DO, FAAP](https://epmonthly.com/contributor/matthew-steimle/) - Matthew Steimle, DO, FAAP, is an Assistant Professor of Pediatric, University of Utah, division of Pediatric Emergency Medicine, University of Utah and is the Emergency Ultrasound Director.
- [Eric W. Glissmeyer, MD, FAAP](https://epmonthly.com/contributor/eric-w-glissmeyer-md-faap/) - Eric W. Glissmeyer, MD, FAAP is the Associate Professor of Pediatrics, University of Utah, Division of Pediatric Emergency Medicine, University of Utah, Medical Director.
- [Jorge Aceves, MD](https://epmonthly.com/contributor/jorge-aceves-md/) - Jorge Aceves, is a chief resident in the Emergency Medicine Residency at Cook County Hospital in Chicago.
- [Tarlan Hedayati, MD](https://epmonthly.com/contributor/tarlan-hedayati-md/) - Dr. Hedayati is an Associate Professor and Chair of Education for the Department of Emergency Medicine at Cook County Hospital in Chicago.
- [Morgan Ferros, MD](https://epmonthly.com/contributor/morgan-ferros-md/) - Dr. Ferros is a second year emergency medicine resident at University of Utah.
- [Han Wei Zheng, MD](https://epmonthly.com/contributor/han-wei-zheng-md/) - Han Wei Zheng, MD, is a resident physician at the Department of Emergency Medicine for MetroHealth Medical Center.
- [Eric Reilly](https://epmonthly.com/contributor/eric-reilly/) - Dr. Eric Reilly is an anesthesiologist in Dearborn, Michigan.
- [Anand Swaminathan](https://epmonthly.com/contributor/anand-swaminathan/) - Anand Swaminathan, MD, is an assistant clinical professor of Emergency Medicine St. Joseph’s Hospital in Paterson, NJ. His main interests are in resident education, resuscitation and knowledge translation. He is a deputy editor for EM: RAP and an associate editor for REBEL EM and REBELCast.
- [Matthew DeLaney, MD](https://epmonthly.com/contributor/matthew-delaney-md/) - Dr. DeLaney is an associate professor and the associate residency program director in the Department of Emergency Medicine at the University of Alabama at Birmingham. He is a co-host of Urgent Care Reviews and Perspectives and Lit Matters.
- [EM OVER EASY](https://epmonthly.com/contributor/em-over-easy/) - EM OVER EASY is a podcast by three EM physicians, Andy Little, Tanner Gronoowski and Drew Kalnow, with a focus on #MoreThanMedicine. The podcast can be found on Apple Podcasts, Stitcher and more. For more about the content and hosts, visit www.emovereasy.com and follow them on twitter @emovereasy.
- [Ademola Adewale, MD](https://epmonthly.com/contributor/ademola-adewale-md/) - Ademola Adewale, MD is an assistant clinical professor of Emergency Medicine at AdventHealth Hospital in Orlando, Florida. He served as the assistant program director, director of research and simulation for the emergency medicine residency program since the inception of the program until June 2020.
- [William Sullivan, DO, JD](https://epmonthly.com/contributor/william-sullivan-do-jd/) - SENIOR EDITOR DR. SULLIVAN, an emergency physician and clinical assistant professor at Midwestern University in Illinois, is EPM’s resident legal expert. As a health law attorney, Dr. Sullivan represents medical providers and has published many articles on legal issues in medicine. He is a past president of the Illinois College of Emergency Physicians and a
- [Murtuza Ghiya, MD, MRCEM](https://epmonthly.com/contributor/murtuza-ghiya-md-mrcem/) - Murtuza Ghiya, MD, MRCEM is an Assistant Professor of Emergency Medicine.
- [Kathryn T Kopec, DO](https://epmonthly.com/contributor/kathryn-t-kopec-do/) - Kathryn T Kopec, DO, is an emergency medicine attending medical toxicologist at Carolinas Medical Center in Charlotte, NC.
- [Elissabeth Hagler, MD](https://epmonthly.com/contributor/elissabeth-hagler-md/) - Elissabeth Hagler, MD, is an emergency medicine resident at Carolinas Medical Center in Charlotte, NC.
- [Sam Mehta, MD](https://epmonthly.com/contributor/sam-mehta-md/) - Dr. Sam Mehta is a partner in Greater San Antonio Emergency Physicians (GSEP) in San Antonio, TX. He is the Director of Resident Education and Academic Liaison. He is an Army Veteran, father of two rambunctious boys and husband to a very patient wife. Twitter: @mehtas_007
- [Sally Hamami](https://epmonthly.com/contributor/sally-hamami/) - Sally Hamami, is a medical student.
- [Leonard Hamera](https://epmonthly.com/contributor/leonard-hamera/) - Leonard Hamera, is a third year resident of IM program at CMH. Inverness, FL.
- [Jeffrey Jordan, MD](https://epmonthly.com/contributor/jeffrey-jordan-md/) - Jeffrey Jordan, MD, is the IM Residency Program Director at CMH.
- [Anwar Hamami, MD](https://epmonthly.com/contributor/anwar-hamami-md/) - Anwar Hamami, MD, is the Associate Medical Director at CMH Emergency Department, Inverness, FL.
- [Spencer Willette, OMS](https://epmonthly.com/contributor/spencer-willette-oms/) - Spencer Willette, OMS is a third year medical student at the Ohio University Heritage College of Osteopathic Medicine. He is also an editor/author for the EM Over Easy Blog.
- [Patricia Capone, OMS](https://epmonthly.com/contributor/patricia-capone-oms/) - Patricia Capone, OMS is a third year medical student at the Ohio University Heritage College of Osteopathic Medicine. She is also an editor/author for the EM Over Easy Blog.
- [Andy Little, DO](https://epmonthly.com/contributor/andy-little-do/) - Andy Little, DO specializes in Emergency Medicine at AdventHealth East in Orlando Florida.
- [Cynthia Santos, MD](https://epmonthly.com/contributor/cynthia-santos-md/) - Cynthia Santos, MD is currently Assistant Professor of Emergency Medicine, Medical Toxicology and Addiction Medicine at Rutgers New Jersey Medical School.
- [Alex Koyfman, MD](https://epmonthly.com/contributor/alex-koyfman-md/) - Alex Koyfman, MD is a Clinical Assistant Professor of Emergency Medicine at UT Southwestern Medical Center and an Attending Physician at Parkland Memorial Hospital. He is also Editor-in-Chief for emDocs.
- [Brit Long, MD](https://epmonthly.com/contributor/brit-long-md/) - Brit Long, MD is an EM Attending Physician at San Antonio Uniformed Services Health Education Consortium.
- [Mallory Keith](https://epmonthly.com/contributor/mallory-keith/) - Mallory Keith is an employee at Collective Medical with a personal and academic interest in Workplace Violence, focusing on the subject as she completes an advanced degree.
- [Ben Zaniello, MD, MPH](https://epmonthly.com/contributor/ben-zaniello-md-mph/) - Ben Zaniello, MD, MPH, is the Chief Medical Officer at Collective Medical, the nation’s most effective network for care collaboration. Dr. Zaniello has worked in care transformation for over a decade, most recently at Providence St. Joseph Health as Chief Medical Information Officer in Population Health.
- [Andrea Austin](https://epmonthly.com/contributor/andrea-austin/) - Andrea Austin is an attending physician at LA County Hospital and Assistant Professor, Keck School of Medicine of USC.
- [Jenny Beck-Esmay, MD](https://epmonthly.com/contributor/jenny-beck-esmay-md/) - Jenny Beck-Esmay, MD is an emergency physician in New York City and the Editor-In-Chief of FemInEM
- [Nathaniel Bonfanti, MD](https://epmonthly.com/contributor/nathaniel-bonfanti-md/) - Nathaniel Bonfanti, MD is an assistant professor and clinical physician at UT Southwestern Medical Center in Dallas, TX, in the Department of Emergency Medicine. He holds a specialization in Trauma and Surgical Critical Care and works clinically in the EDs at Parkland Hospital and WP Clements University Hospital and the Surgical ICU at WP Clements
- [Judith Tintinalli, MD, MS](https://epmonthly.com/contributor/judith-tintinalli-md-ms/) - Dr. Tintinalli is currently a professor and Chair Emeritus of Emergency Medicine at the University of North Carolina. In addition to teaching in the emergency medicine department, she is an adjunct professor at the UNC Gillings School of Global Public, and a frequent lecturer in the School of Journalism and Mass Communication. Dr. Tintinalli is
- [Jonathan Frommelt, MD](https://epmonthly.com/contributor/jonathan-frommelt-md/) - Jonathan Frommelt, MD, is the Attending Physician Department of Emergency Medicine for MetroHealth Medical Center and Clinical Assistant Professor of Emergency Medicine for Case Western Reserve University School of Medicine
- [Elham Pishbin, MD](https://epmonthly.com/contributor/elham-pishbin-md/) - Elham Pishbin, MD, is the assistant professor of emergency medicine at Mashhad University of Medical Sciences.
- [Sandy Keller](https://epmonthly.com/contributor/sandy-keller/) - Sandy Keller is an emergency room nurse at Howard County General Hospital, Columbia, MD.
- [Elizabeth Clayborne](https://epmonthly.com/contributor/elizabeth-clayborne/) - Dr. Elizabeth Clayborne is an Adjunct Assistant Professor at the University of Maryland School of Medicine and works at University of Maryland Prince George’s Hospital Center. You can follow her on twitter at @DrElizPC.
- [Allan S. Vann](https://epmonthly.com/contributor/allan-vann/) - Dr. Vann is a retired public school principal and a former Alzheimer’s spouse caregiver for 10 years. Dr. Vann writes frequently for publication to try to improve the diagnosis and treatment of people with Alzheimer’s.
- [Jennifer Luong](https://epmonthly.com/contributor/jennifer-luong/) - Dr. Jennifer Luong is an emergency medicine resident physician in Ohio. She cares deeply about marginalized populations and health equity.
- [Jonathan Eisenberg](https://epmonthly.com/contributor/jonathan-eisenberg/) - Jonathan Eisenberg is a PEM fellow at Primary Children's Hospital. He is involved in disaster medicine research on local and national levels. He serves as one of the site editors and section officers for ACEP PEM.
- [Matthew Szadkowski](https://epmonthly.com/contributor/matthew-szadkowski/) - Matthew Szadkowski has been an Assistant Professor in PEM for four years and is currently the Assistant Ultrasound Medical Director for the division. Also currently the site PI for an ongoing PECARN C-Spine study. He has been involved in global health research projects in Ethiopia and Ghana.
- [Vincent R. Lee, MD](https://epmonthly.com/contributor/vincent-r-lee-md/) - Vincent R. Lee, MD (@vinleetox) is a Senior Medical Toxicology Fellow in the Department of Emergency Medicine at Northwell Health in Manhasset, New York. He trained in emergency medicine at Morristown Medical Center in Morristown, New Jersey.
- [Joshua N. Nogar, MD](https://epmonthly.com/contributor/joshua-n-nogar-md/) - Joshua N. Nogar, MD is the Medical Toxicology Fellowship Program Director at Northwell Health and is an emergency medicine physician at Long Island Jewish Medical Center and North Shore University Hospital of Northwell Health in Manhasset, New York.
- [Amalia Lehmann, MD](https://epmonthly.com/contributor/amalia-lehmann-md/) - Amalia Lehmann, MD, is a Chief Resident for the department of pediatrics at Indiana University School of Medicine. She is interested the use of POCUS at the bedside as a future pulmonologist both in the inpatient and clinical setting.
- [James M. Williams, MS, DO, FACEP](https://epmonthly.com/contributor/james-m-williams-ms-do-facep/) - James M. Williams, MS, DO, FACEP is a Clinical Associate Professor at Texas Tech University Health Sciences School of Medicine, Associate Professor at UIW School of Osteopathic Medicine, and Attending Emergency Room Physician at Northwest Texas Healthcare System.
- [Andrew Pugh, MD](https://epmonthly.com/contributor/andrew-pugh-md/) - Andrew Pugh is a third year resident at the University of Utah in Salt Lake City. He has interests in Medical Education, FOAM and EMS, and has been accepted to undertake an EMS Fellowship at the University of Utah this coming year.
- [Luis Enrique Jacquez](https://epmonthly.com/contributor/luis-enrique-jacquez/) - Luis Enrique Jacquez is a social worker and graduate of UTEP. He is currently employed by the Hope Border Institute as a border-coordinator in Ciudad Juarez.
- [Paul Stromberg, MD, FAAEM](https://epmonthly.com/contributor/paul-stromberg-md-faaem/) - Dr. Stromberg is an Emergency Physician at Carilion Roanoke Memorial Hospital, a 760-bed Level I trauma center, and Carilion New River Valley Medical Center, a 146-bed community hospital. He is board certified in Medical Toxicology. He is involved in EM residency education at Carilion and serves as Clerkship Director for Emergency Medicine at Virginia Tech
- [Kelly B. McAllister, PharmD, MBA, BCPS](https://epmonthly.com/contributor/kelly-b-mcallister-pharmd-mba-bcps-2/) - Dr. McAllister is an Emergency Medicine pharmacist at Carilion Roanoke Memorial Hospital, a 760-bed Level I trauma center, where she has worked for the last 10 years since completing her critical care residency. She is actively involved in Emergency Medicine education through Carilion's EM and pharmacy residency programs, assists in the development of system-wide protocols,
- [Trisha Anest, MD MPH FACEP](https://epmonthly.com/contributor/trisha-anest-md-mph-facep/) - Dr. Anest is an emergency physician living and practicing in Hampton Roads, Virginia. She is a councilor and board member with the Virginia chapter of ACEP and active in advocacy on behalf of emergency physicians and the communities we serve. She can be reached at trishaanest@gmail.com.
- [Kevin Munjal](https://epmonthly.com/contributor/kevin-munjal/) - Kevin Munjal is an assistant professor of Emergency Medicine, Icahn School of Medicine at Mount Sinai. He is also the medical director for Community Paramedicine, system director of the Division of EMS and chairs the NY Mobile Integrated Healthcare Association.
- [Matt Strain](https://epmonthly.com/contributor/matt-strain/) - Matt Strain is a board member for the National at Home Dad Network.
- [Carla Oska-Gerak, DO](https://epmonthly.com/contributor/carla-oska-gerald-do/) - Carla Oska-Gerak, DO, is pediatrician on staff at Beaumont Hospital, Farmington Hills, MI.
- [Jason P Medler, MD](https://epmonthly.com/contributor/jason-p-medler-md/) - Jason P Medler, MD, is an assistant clinical professor of emergency medicine at Indiana University School of Medicine.
- [Robert P. Doggette, MD](https://epmonthly.com/contributor/robert-p-doggette-md/) - Robert P. Doggette, MD, is an assistant clinical professor of emergency medicine at Indiana University School of Medicine.
- [Nicholena Richardson, MD](https://epmonthly.com/contributor/nicholena-richardson-md/) - Nicholena Richardson, MD is currently a third year EM Resident at Carolinas Medical Center in Charlotte, NC. She will be starting her Pediatric Emergency Medicine Fellowship in July 2020.
- [Kathryn Kopec, DO](https://epmonthly.com/contributor/kathryn-kopec-do/) - Kathryn Kopec, DO is an EM Attending Physician and Medical Toxicologist at Carolinas Medical Center in Charlotte, NC.
- [Kelly B. McAllister, PharmD, MBA, BCPS](https://epmonthly.com/contributor/kelly-b-mcallister-pharmd-mba-bcps/) - Dr. McAllister is an Emergency Medicine pharmacist at Carilion Roanoke Memorial Hospital, a 760-bed Level I trauma center, where she has worked for the last ten years since completing her critical care residency. She is actively involved in Emergency Medicine education through Carilion's EM and pharmacy residency programs, assists in the development of system-wide protocols,
- [Bradford Walters, MD](https://epmonthly.com/contributor/bradford-walters-md/) - Bradford Walters is an emergency physician at William Beaumont Hospital, Royal Oak, Michigan where he is the assistant residency director of emergency medicine program. Among his passions are emergency critical care, particularly airway management, and the historical roots of emergency medicine. He is active in the American College of Emergency Physicians and his state chapter where
- [Paul Stromberg, MD](https://epmonthly.com/contributor/paul-stromberg-md/) - Dr. Stromberg is an Emergency Physician at Carilion Roanoke Memorial Hospital, a 760-bed Level I trauma center, and Carilion New River Valley Medical Center, a 146-bed community hospital. He is board certified in Medical Toxicology. He is involved in EM residency education at Carilion and serves as Clerkship Director for Emergency Medicine at Virginia Tech
- [Faber White, MD](https://epmonthly.com/contributor/faber-white-md/) - Dr. White is the Medical Director of the CHRISTUS Good Shepherd NorthPark Emergency Department in Longview, Texas.
- [Ramón Villaverde-Castañeda](https://epmonthly.com/contributor/ramon-villaverde-castaneda/) - Ramón Villaverde-Castañeda is a first-year medical student originally from the El Paso-Ciudad Juárez area. As a future physician from the US-Mexico border, he cares deeply about promoting patient-centered and humanistic medical care in the region.
- [Zaffer Qasim, MD](https://epmonthly.com/contributor/zaffer-qasim-md/) - Zaffer Qasim, MD is an emergency and critical care physician in Philadelphia. His clinical interests include trauma resuscitation and airway management. Follow him on Twitter at @ResusOne.
- [Mizuho Morrison](https://epmonthly.com/contributor/mizuho-morrison/) - Mizuho Morrison is the assistant professor of Clinical Emergency Medicine, Keck School of Medicine at USC. She is also editor-in-chief of podcasts at Hippo Education, is a community physician at Kaiser Southern California and is the co-founder of 3MD (Three Mommy Doctors).
- [Vanessa Cardy, MD](https://epmonthly.com/contributor/vanessa-cardy-md/) - Vanessa Cardy, MD, is a deputy editor of EM:RAP and the associate managing editor of Right on Prime.
- [Thomas W. Trimarco, MD, FACEP](https://epmonthly.com/contributor/thomas-w-trimarco-md/) - Dr. Trimarco is an emergency and EMS physician at Dartmouth-Hitchcock Medical Center and an assistant professor of medicine at the Geisel School of Medicine at Dartmouth. He is the associate medical director of the Dartmouth-Hitchcock Advanced Response Team (DHART) and is a regional EMS medical director for Vermont and New Hampshire.
- [J. Tyler Schwartz, MD, MPH](https://epmonthly.com/contributor/j-tyler-schwartz-md-mph/) - Dr. Schwartz practices in a community trauma center. With a background in public health policy, he has previously worked in firearm legislation, LGBT rights, employment nondiscrimination, and sex education in schools.
- [Joseph I. Indiano, M.D.](https://epmonthly.com/contributor/joseph-i-indiano-m-d/) - Joseph I. Indiano, M.D., is an Assistant Clinical Professor of Emergency Medicine at Indiana University School of Medicine.
- [Nicholas Saltarelli, MD](https://epmonthly.com/contributor/nicholas-saltarelli-md-2/) - Nicholas Saltarelli, MD is an Emergency Ultrasound Fellow at Indiana University School of Medicine in Indianapolis, IN.
- [Reuben Strayer, MD](https://epmonthly.com/contributor/reuben-strayer-md/) - Reuben Strayer, author of emupdates.com, is an emergency physician based in New York City. His clinical areas of interest include airway management, analgesia, opioid misuse, procedural sedation, agitation, decision-making and error. He is Associate Medical Director at Maimonides Medical Center, in Brooklyn.
- [Nicholas Saltarelli, MD](https://epmonthly.com/contributor/nicholas-saltarelli-md/) - Nicholas Saltarelli, MD is an Emergency Ultrasound Fellow at Indiana University School of Medicine in Indianapolis, IN.
- [Frances Russell, MD, FACEP](https://epmonthly.com/contributor/frances-russell-md-facep/) - Frances Russell, MD, FACEP is an Associate Professor of Emergency Medicine and Co-Director of Clinical Ultrasound at Indiana University School of Medicine in Indianapolis, IN.
- [Andrew H. Erlich, DO](https://epmonthly.com/contributor/andrew-h-erlich-do/) - Andrew H. Erlich, DO is an Emergency Medicine Physician and Core Faculty for the emergency medicine residency at Beaumont Hospital in Farmington Hills, MI.
- [Mary Lanctot-Herbert, NP](https://epmonthly.com/contributor/mary-lanctot-herbert-np/) - Mary Lanctot-Herbert, NP is the CME Director of EM:RAP and also serves on the Board of Directors for EM:RAP Global Outreach and Live Room International.
- [Juli McGown-Boit, NP](https://epmonthly.com/contributor/juli-mcgown-boit-np/) - Juli McGown-Boit, NP is the International Director for Living Room International.
- [Britt Guest, MD](https://epmonthly.com/contributor/britt-guest-md/) - Britt Guest, MD is the UCLA/EM:RAP Access+Innovation Medical Education Fellow.
- [Mel Herbert, MD](https://epmonthly.com/contributor/mel-herbert-md-2/) - Dr. Herbert is the CEO of EM:RAP and EM:RAP Global Outreach.
- [Al Giwa, MD](https://epmonthly.com/contributor/al-giwa-md/) - Al Giwa, MD, is the associate professor at Icahn School of Medicine at Mount Sinai in New York City. Ethics, law, and emergency resuscitation are just a few of his specialties both as a civilian and as an officer in the USARMY Reserve.
- [G. Luke Larkin, MD, MS, MSPH, FACEP FACEM](https://epmonthly.com/contributor/g-luke-larkin-md-ms-msph-facep-facem/) - G. Luke Larkin, MD, MS, MSPH, FACEP FACEM is professor at the Northeast Ohio Medical University, founding professor and Emeritus Lion Chair of EM at the University of Auckland, author of SAEM’s Code of Conduct and ACEPs Principles of Ethics, and serves on the Board of the IFEM Foundation.
- [Molly McGuane](https://epmonthly.com/contributor/molly-mcguane/) - Molly McGuane is a communication specialist and health advocate for the Mesothelioma and Asbestos Awareness Center.
- [Setu Mazumdar, MD](https://epmonthly.com/contributor/setu-mazumdar-md/) - Setu Mazumdar, MD, CFP® is board certified in EM and is the president of Physician Wealth Solutions Inc., a wealth management firm helping physicians with financial planning and investment management.
- [Roody Ménager, MD](https://epmonthly.com/contributor/roody-menager-md/) - Roody Ménager, MD is an emergency physician at the Hôpital Universitaire de Mirebalais. He is also an Alumni association member at the Université Notre Dame d’Haïti and an EM:RAP Global Outreach fellow. Photo Credit: Valery Pierre Louis
- [Philippe Dimitri Henrys, MD](https://epmonthly.com/contributor/philippe-dimitri-henrys-md/) - Philippe Dimitri Henrys, MD is an emergency physician at the Hôpital Universitaire La Paix in Haiti. He is also a professor of Emergency Medicine at the Université Quisqueya in Haiti and an EM:RAP Global Outreach fellow. Photo Credit: Valery Pierre Louis
- [Sam Kim, MD](https://epmonthly.com/contributor/sam-kim-md/) - Dr. Sam Kim is a former chief resident and now faculty at Maimonides Medical Center in Brooklyn, NY. His professional interests include EMS/event medicine, ultrasonography, ED critical care, and medical education.
- [Adam M. Vieder, D.O.](https://epmonthly.com/contributor/adam-m-vieder-d-o/) - Adam M. Vieder, D.O. Emergency Medicine Physician at Beaumont Hospital, Farmington Hills, MI. Teaching Hospital of Michigan State University.
- [2LT Mark Winters](https://epmonthly.com/contributor/2lt-mark-winters/) - 2LT Mark Winters is a second year medical student at USUHS and a Special Forces operator.
- [Joe Ravera, MD](https://epmonthly.com/contributor/joe-ravera-md/) - Joe Ravera, MD is the director of Pediatric Emergency Medicine, assistant professor of surgery, Division of Emergency Medicine at the University of Vermont Medical Center. Follow on Twitter @pemuvm1.
- [Mike Presley, MD, FACEP](https://epmonthly.com/contributor/mike-presley-md-facep/) - Dr. Michael Presley is a board-certified emergency medicine leader with a long history of advancing the performance of emergency departments. As Sound Emergency Medicine’s chief executive officer, Dr. Presley is responsible for driving quality and financial performance of programs, developing physician leaders, and working with hospital leaders on emergency medicine department program design.
- [Rob Bryant, MD](https://epmonthly.com/contributor/rob-bryant-md/) - Dr. Bryant is an Emergency Physician with Utah Emergency Physicians, Salt Lake City, UT.
- [Andrew Merelman, B.S., NRP, FP-C](https://epmonthly.com/contributor/andrew-merelman-b-s-nrp-fp-c/) - Andrew is a critical care paramedic and sceond-year medical student at Rocky Vista University in Colorado. He has interests in cardiology, ECG interpretation, critical care, airway management, and point-of-care ultrasound. He can be reached @amerelman
- [Samuel Brown, MD](https://epmonthly.com/contributor/samuel-brown-md/) - Samuel Brown, MD is a new graduate from USUHS SOM and will begin his EM Residency at SAMMC in San Antonio, TX this June.
- [Caitlin Brumfiel](https://epmonthly.com/contributor/caitlin-brumfiel/) - Caitlin Brumfiel is a 2nd year medical student at Georgetown University School of Medicine and hopes to pursue a career in Dermatology.
- [Sgt. First Class Wayne Hand](https://epmonthly.com/contributor/sgt-first-class-wayne-hand/) - Sgt. First Class Wayne Hand is a recently retired 18D Special Forces combat medic with multiple combat tours. He is beginning PA school at the University of South Florida this fall.
- [Michael Bahntge, MD](https://epmonthly.com/contributor/michael-bahntge-md/) - Michael Bahntge, MD, is assistant professor at Case Western Reserve University and an attending physician in the Department of Neurology at MetroHealth Medical Center in Cleveland, Ohio
- [Kristin L. Baker, DO](https://epmonthly.com/contributor/kristin-l-baker-do/) - Kristin L. Baker, DO, is a third-year resident physician in the Department of Emergency Medicine at MetroHealth Medical Center in Cleveland, Ohio.
- [Stephen Smith, MD](https://epmonthly.com/contributor/stephen-smith-md/) - Dr. Smith is an attending emergency physician at Hennepin County Medical Center in Minnesota. He has interest and expertise in emergent cardiac care and ECG interpretation. He runs “Dr. Smith’s ECG Blog” which houses hundreds of ECG cases covering a wide variety of topics. Tweet him @smithECGBlog
- [Sara Capobianco, BS, MSIV](https://epmonthly.com/contributor/sara-capobianco-bs-msiv/) - Sara is a fourth-year osteopathic medicine student at the University of New England College of Osteopathic Medicine, pursuing a career in emergency medicine.
- [Xiao Chi Zhang, MD, MS](https://epmonthly.com/contributor/xiao-chi-zhang-md-ms-2/) - Xiao Chi (Tony) Zhang, MD, MS, is a medical education fellow at Philadelphia University/Thomas Jefferson University.
- [Tom Ruffin Jr., MD](https://epmonthly.com/contributor/tom-ruffin-jr-md/) - Dr. Ruffin is part of the academic faculty and attending physician in the Pediatric Emergency Department at Arnold Palmer Hospital for Children, Orlando Health.
- [Carolyn Lyon, MD](https://epmonthly.com/contributor/carolyn-lyon-md/) - Dr. Lyon is part of the academic faculty and attending physician in the Pediatric Emergency Department at Arnold Palmer Hospital for Children, Orlando Health.
- [Jeremy A. Lacocque, DO](https://epmonthly.com/contributor/jeremy-a-lacocque-do/) - Dr. Lacocque is an EMS & Disaster Medicine Fellow at UCSF-ZSFG and serves as the EMS Section Editor for EM Resident Magazine, EMRA's official publication.
- [Lori Kullberg](https://epmonthly.com/contributor/lori-kullberg/) - Lori Kullberg is the Social Media Manager for the Advertising & Public Affairs Office (A&PA), U.S. Army 3rd Medical Recruiting Battalion at Fort Knox, KY. She has been a civil service employee for over 20 years with various government/military agencies, to include the U.S. Marine Corps, the U.S. Department of Agriculture, the Army Corps of
- [Darren Morris, MD, MBA](https://epmonthly.com/contributor/darren-morris-md-mba/) - Darren Morris, MD, MBA, FACEP is the director of clinical operations at Virginia Hospital Center Emergency Department, Alteon Health.
- [William Green, MD, FACEP](https://epmonthly.com/contributor/william-green-md-facep/) - Dr. Green is a Fellow of the American College of Emergency and has been a board certified emergency physician for the past 27 years. He is currently an emergency physician at Hoag Hospital in Newport Beach, CA. He is the inventor of the T-RING digit tourniquet, the T-STRIP wound closure strip and the Topical Laceration Closure™ system.
- [Nicholas Genes, MD, PhD](https://epmonthly.com/contributor/nicholas-genes-md-phd/) - SENIOR EDITOR Nicholas Genes is a specialist in emergency medicine informatics in New York City. Dr. Genes is EPM's resident tech guru and can be found sharing his wit and wisdom all over the web.
- [Taylor S. McCorkle, D.O.](https://epmonthly.com/contributor/taylor-s-mccorkle-d-o/) - Taylor S. McCorkle, D.O., is an emergency medicine physician at Beaumont Hospital in Farmington Hills, MI., a teaching hospital of Michigan State University.
- [Ethan R. Saffer, D.O.](https://epmonthly.com/contributor/ethan-r-saffer-d-o/) - Ethan R. Saffer, D.O. is an Emergency Medicine Physician at Beaumont Hospital, Farmington Hills, MI, a teaching hospital of Michigan State University.
- [Robert W. Mathews, D.O.](https://epmonthly.com/contributor/robert-w-mathews-d-o/) - Robert W. Mathews, D.O., is an Assistant Clinical Professor in the Department of Emergency Medicine at Beaumont Hospital.
- [Elizabeth C. Moore, DO](https://epmonthly.com/contributor/elizabeth-c-moore-do/) - Dr. Moore is an Assistant Professor of Clinical Emergency Medicine and a Medical Toxicologist at Los Angeles County Hospital + University of Southern California. She is the course director for the medical toxicology elective at USC Keck School of Medicine, co-founder of Women in Toxicology (WiT), and creator and co-host of the podcast Tox in Ten.
- [Nicole Tidwell](https://epmonthly.com/contributor/nicole-tidwell/) - Nicole Tidwell is the Geriatric Emergency Department Accreditation (GEDA) Program Director. Her background includes 7+ years of program and product development and member marketing for the American College of Emergency Physicians (ACEP.)
- [Mackenzie Esch, MD](https://epmonthly.com/contributor/mackenzie-esch-md-2/) - Mackenzie Esch, MD specializes in Pediatric Emergency Medicine in Chapel Hill, NC and Chapel Hill, NC.
- [Maryam Arshad, MD](https://epmonthly.com/contributor/maryam-arshad/) - Dr. Arshad completed her EM residency at Emory University and is the author of Medical Ethics 101.
- [Sajid Khan, MD](https://epmonthly.com/contributor/sajid-khan-md/) - Sajid Khan is the author of The Ultimate Emergency Medicine Guide and How to Not Kill your Patients and hosts a website at www.myERdoctor.com
- [David Cisewski](https://epmonthly.com/contributor/david-cisewski/) - David Cisewski is an emergency medicine resident at Icahn School of Medicine at Mount Sinai Hospital. He also serves as the education chair on the SAEM RAMS Board of Directors and is the founder of Pain Profiles, a regular series devoted to pain management on EMDocs. Follow on twitter @dhcisewski or @PainProfiles.
- [Maryam Tabrizi, DMD](https://epmonthly.com/contributor/maryam-tabrizi-dmd/) - Maryam Tabrizi, DMD is on faculty at The University of Texas Health Science Center at Houston School of Dentistry, at the Department of General Dentistry & Dental Public Health. She attended dental school at Temple University, Philadelphia, PA and graduated in 1991. She has a Master of Dental Public Health and additional certifications in Geriatric
- [Callasandra L. Rose, D.O.](https://epmonthly.com/contributor/callasandra-l-rose-d-o/) - Callasandra L. Rose, D.O. is completing emergency medicine at Beaumont Hospital, Farmington Hills, MI, a teaching hospital of Michigan State University.
- [Diane M. Paratore, D.O. FACEP](https://epmonthly.com/contributor/diane-m-paratore-d-o-facep/) - Diane M. Paratore, D.O. FACEP, is an Emergency Medicine Physician, program director and core faculty for the emergency medicine residency program at Beaumont Hospital, Farmington Hills, MI.
- [Leah Hatfield, PharmD, BCPS](https://epmonthly.com/contributor/leah-hatfield-md/) - Dr. Hatfield is the System Clinical Pharmacy Director for Sutter Health, where she also maintains an active practice as an emergency medicine pharmacist. She has over fifteen years of practice and faculty experience in emergency medicine, and has particular research interests in trauma, toxicology, anticoagulation reversal and advanced heart failure.
- [Matt Rutz, MD](https://epmonthly.com/contributor/matt-rutz-md/) - Matt Rutz, MD is Co-Fellowship Director for Emergency Ultrasound at Indiana University School of Medicine Department of Emergency Medicine. Follow our division on Twitter @IUEM_Ultrasound.
- [Sanford J. Vieder, D.O., FACOEP, FACEP](https://epmonthly.com/contributor/sanford-j-vieder-d-o-facoep-facep/) - Sanford J. Vieder, D.O., FACOEP, FACEP is chairman and medical director of the Emergency and Trauma Center, Emergency Medicine Core Faculty at Beaumont Hospital, Farmington Hills, MI, a teaching hospital of Michigan State University.
- [Keri Gardner, MD, MPH, FACEP](https://epmonthly.com/contributor/keri-gardner-md-mph-facep/) - Keri Gardner, MD, MPH, FACEP is an emergency physician and Chief Medical Officer of Alaska Regional Hospital.
- [John Kiel DO, MPH](https://epmonthly.com/contributor/john-kiel-do-mph/) - Dr. Kiel is an Assistant Professor of Sports Medicine and Emergency Medicine at the University of Florida College of Medicine - Jacksonville in Jacksonville, FL. He blogs at sportsmedreview.com; Follow on Twitter @sportsmedreview.
- [Andrew Schleihauf, DO, CAQSM](https://epmonthly.com/contributor/andrew-schleihauf-do-caqsm/) - Dr. Andrew Schleihauf is attending physician at Excela Health Orthopedics and Sports Medicine in Greensburg, PA. He blogs at sportsmedreview.com; follow on twitter @DrSchleihauf.
- [Srikanth Nithyanandam, M.B.B.S, MS](https://epmonthly.com/contributor/srikanth-nithyanandam/) - Dr. Srikanth Nithyanandam, is a fellow in faculty development in the Department of Family Medicine at the University of Kentucky College of Medicine in Lexington, KY.
- [Rick Pendykoski](https://epmonthly.com/contributor/rick-pendykoski/) - Rick Pendykoski is the owner of Self Directed Retirement Plans LLC, a retirement planning firm based in Goodyear, AZ. He has over three decades of experience working with investments and retirement planning, and over the last 10 years has turned his focus to self-directed accounts and alternative investments. Rick regularly posts helpful tips and articles
- [Angel F. Chudler, D.O.](https://epmonthly.com/contributor/angel-f-chudler-d-o/) - Angel F. Chudler, D.O. is an attending physician and member of the core faculty for the emergency medicine residency program at Beaumont Hospital in Farmington Hills, MI. She is also a 2004 graduate of Beaumont Hospital.
- [Katlyn Silko](https://epmonthly.com/contributor/katlyn-silko/) - Katlyn Silko is a third year resident in emergency medicine at MetroHealth Medical Center, Cleveland, Ohio
- [Joseph Tagliaferro, DO](https://epmonthly.com/contributor/joseph-tagliaferro-do/) - Joseph Tagliaferro, DO, is an assistant of emergency medicine at Western Reserve University School of Medicine, attending physician in the department of emergency medicine at MetroHealth Medical Center, Cleveland, Ohio.
- [Zachary J. Smith](https://epmonthly.com/contributor/zachary-j-smith/) - Zachary J. Smith is a second-year medical student at The Ohio State University College of Medicine.
- [Jason Bischof, MD](https://epmonthly.com/contributor/jason-bischof-md/) - Dr. Jason Bischof is an Assistant Professor of Emergency Medicine at The Ohio State Wexner Medical Center.
- [Joseph P. Wood, Esq., MD](https://epmonthly.com/contributor/joseph-p-wood-esq-md/) - Joseph P. Wood, Esq., MD is a practicing attorney licensed in Illinois and Arizona. He is the author/editor of “Contract Issues for Emergency Physicians” published by the Emergency Medicine Resident’s Association. He has successfully litigated on behalf of emergency physicians who have been wrongfully terminated by their hospital employer.
- [Xiao Chi Zhang, MD, MS](https://epmonthly.com/contributor/xiao-chi-zhang-md-ms/) - Xiao Chi (Tony) Zhang, MD, MS, is a medical education fellow at Philadelphia University/Thomas Jefferson University.
- [Ayomide Loye, MD](https://epmonthly.com/contributor/ayomide-loye-md/) - Ayomide Loye, MD, is an emergency medicine resident at Philadelphia University/Thomas Jefferson University.
- [William K. Mallon, MD](https://epmonthly.com/contributor/william-k-mallon-md/) - William K. Mallon, MD, is the Director of the Division of International Emergency Medicine and a Professor of Emergency Medicine at Stony Brook University Hospital.
- [Jonathan Kneib, MD](https://epmonthly.com/contributor/jonathan-kneib-md/) - Jonathan Kneib, MD, is a combined International Emergency Medicine and Emergency Ultrasound Fellow at Stony Brook University Hospital.
- [Lindsay Reardon, MD](https://epmonthly.com/contributor/lindsay-reardon-md/) - Lindsay Reardon, MD, is the Emergency Ultrasound Fellowship Director and a Clinical Assistant Professor of Emergency Medicine at Stony Brook University Hospital.
- [Angie Esbenshade, RN, MSN, MBA, NE-BC](https://epmonthly.com/contributor/angie-esbenshade-rn-msn-mba-ne-bc/) - Angie Esbenshade, RN, MSN, MBA, NE-BC, brings more than two years of clinical nursing and administrative experience in emergency, trauma, and critical care to her role as coach leader of the emergency service line at Studer Group.
- [Sachin Shah, MD, MBA, FAAEM](https://epmonthly.com/contributor/sachin-shah-md-mba-faaem/) - Sachin Shah, MD, MBA, FAAEM, has served as an ED physician coach at Studer Group since 2015. A board-certified emergency medicine physician with more than 15 years of experience in the field, he has a track record of achieving operational improvements in the emergency department as well as the hospital.
- [Jesus Martinez](https://epmonthly.com/contributor/jesus-martinez/) - Jesus Martinez is a fourth year medical student at Georgetown University School of Medicine and is applying for residency in EM this year.
- [Skyler Lentz, MD](https://epmonthly.com/contributor/skyler-lentz-md/) - Skyler Lentz, MD is the Assistant Professor of Surgery and Medicine in the Divisions of Emergency Medicine and Pulmonary Critical Care at the University of Vermont Medical Center.
- [Hyunjoo Lee, MD](https://epmonthly.com/contributor/hyunjoo-lee-md/) - Hyunjoo Lee, MD, is a Clinical Assistant Professor in Emergency Medicine at Stony Brook University Hospital. She is also an MDCalc Senior Fellow.
- [Patricia Ruth Atchinson, DO](https://epmonthly.com/contributor/patricia-ruth-atchinson-do/) - Patricia Ruth Atchinson, DO, is a Critical Care Fellow at Dartmouth-Hitchcock Medical Center and an Emergency Medicine physician.
- [David Randall, MD](https://epmonthly.com/contributor/david-randall-md/) - Dr. Randall is a practicing otolaryngologist with the Ferrell Duncan Clinic in Springfield Missouri. After residency training at Naval Medical Center San Diego, he served as otolaryngology chairman at the Naval Hospitals at Millington, Tennesse and Camp Lejeune, North Carolina
- [Ben Mattingly, MD, FAWM](https://epmonthly.com/contributor/ben-mattingly-md-fawm/) - Ben Mattingly, MD, FAWM, the wilderness medicine director for Baystate Medical Center is the owner/lead instructor for Wild Med Adventures. He can be reached at www.wildmedadventures.com.
- [AJ Folsom](https://epmonthly.com/contributor/aj-folsom/) - AJ Folsom is a second year medical student at USUHS SOM and a Special Forces officer in the U.S. Army.
- [Debjeet Sarkar, MD](https://epmonthly.com/contributor/debjeet-sarkar-md/) - Debjeet Sarkar is an attending emergency physician at Howard County General Hospital and Assistant Professor, USUHS SOM, Dept. of Military & Emergency Medicine.
- [Nicholas Schwartz, MD](https://epmonthly.com/contributor/dr-nicholas-schwartz/) - Dr. Nicholas Schwartz is an Attending Emergency Physician at Elmhurst Hospital Center and has a psychiatric private practice in New York City.
- [Jeff Swearingen](https://epmonthly.com/contributor/jeff-swearingen/) - Jeff Swearingen is the co-founder of Edgemont Capital Partners, an independent M&A advisory firm. He has closed 13 hospital–based group transactions, including six in emergency medicine, generating approximately $1.5 billion in cash proceeds.
- [William E. Robertson, DHSc](https://epmonthly.com/contributor/william-e-robertson-dhsc/) - William E. Robertson, DHSc is the Chairman, Emergency Care and Rescue Department, Weber State University, Ogden UT.
- [Jonathan D Apfelbaum, MD, FACEP](https://epmonthly.com/contributor/jonathan-d-apfelbaum-md-facep/) - Jonathan D Apfelbaum, MD, FACEP, is the Medical Director, Emergency Medical Services at Parker Adventist Hospital, Parker, CO.
- [Randy Sorge, MD](https://epmonthly.com/contributor/randy-sorge-md/) - Randy Sorge is a senior resident at Icahn School of Medicine at Mount Sinai Hospital in New York. In July 2018 he will go to Louisiana State University to serve as Assistant Clerkship Director.
- [Stephanie Dabulis, MD](https://epmonthly.com/contributor/stephanie-dabulis-md/) - Dr. Stephanie Dabulis is a partner at Emergency Medicine Associates and is Chair of Emergency Medicine at Calvert Health System in Prince Frederick, MD.
- [Jen Robertson, MD](https://epmonthly.com/contributor/jen-robertson-md/) - Dr Robertson is an emergency physician and Assistant Professor at Emory University, Department of Emergency Medicine. She is an avid dog lover, writer, and enjoys all things wellness.
- [Connor Fitzpatrick, A-EMT](https://epmonthly.com/contributor/connor-fitzpatrick-a-emt/) - Connor B. Fitzpatrick, A-EMT, is the chief operating officer of CrowdRx. He is an Incident Response to Terrorist Bombings instructor, a Tactical EMT, and a Connecticut POSTC Police Instructor.
- [Alison Leung, MD](https://epmonthly.com/contributor/alison-leung-md/) - Alison Leung is a second year emergency medicine resident at Maimonides Medical Center.
- [Max Berger, MD](https://epmonthly.com/contributor/max-berger-md/) - Dr. Max Berger is an MDCalc Senior Fellow, and a PGY-2 at the NYU / Bellevue Emergency Medicine Residency Program.
- [Kenneth Yeager, PhD](https://epmonthly.com/contributor/kenneth-yeager-phd/)
- [Aditi U. Joshi MD, MSc](https://epmonthly.com/contributor/aditi-u-joshi-md-msc/) - Dr. Joshi is the Medical Director of JeffConnect On Demand.
- [Scott Weiner, MD, MPH](https://epmonthly.com/contributor/scott-weiner-md-mph/) - Scott Weiner, MD, MPH is an emergency physician and director of the opioid stewardship program at Brigham and Women's Hospital, Boston, MA.
- [Matthew Roginski, MD, MPH](https://epmonthly.com/contributor/matthew-roginski-md-mph/) - Matthew Roginski, MD, MPH, is an Assistant Professor of Medicine in the Sections of Emergency and Critical Care Medicine and the DHART Assistant Medical Director at Dartmouth-Hitchcock Medical Center.
- [Nidal Moukaddam, MD, PhD](https://epmonthly.com/contributor/nidal-moukaddam-md-phd/) - Assistant Professor ofPsychiatry and Behavioral Sciences, Baylor College of Medicine,Houston, TX
- [Veronica Tucci, MD, JD](https://epmonthly.com/contributor/veronica-tucci-md-jd/) - Professor and EM Residency Director at the William Carey University College of Osteopathic Medicine in Hattiesburg, MS.
- [Susan Derry, MD](https://epmonthly.com/contributor/susan-derry-md/)
- [Garrick Anderson](https://epmonthly.com/contributor/garrick-anderson/) - M.D. Candidate, University of Maryland
- [John Schnabel, MD](https://epmonthly.com/contributor/john-schnabel-md/) - Dr. Schnabel is a practicing emergency physician and the director of patient experience for Alteon Health.
- [Matthew D. Steimle, DO](https://epmonthly.com/contributor/matthew-d-steimle/) - Dr. Steimle practices at Primary Children’s Hospital at the University of Utah School of Medicine in Salt Lake City.
- [Matthew Lyon, MD](https://epmonthly.com/contributor/matthew-lyon-md/) - Dr. Matthew Lyon, MD works at Augusta University Medical Center in Augusta, Georgia.
- [Larry B. Mellick, MD](https://epmonthly.com/contributor/larry-b-mellick-md/) - Dr. Larry B. Mellick, MD works at Augusta University Medical Center in Augusta, Georgia
- [Kimon L.H. Ioannides, M.D.](https://epmonthly.com/contributor/kimon-l-h-ioannides-m-d/) - Kimon L.H. Ioannides, M.D. is a second-year Emergency Medicine resident at Temple University Hospital.
- [MARIAM ASPER, MS](https://epmonthly.com/contributor/mariam-asper-ms/)
- [STACI ENGEL, MSN, RN](https://epmonthly.com/contributor/staci-engel-msn-rn/) - Staci Engel serves as the administrative director of Standardized Patients and Simulation for LUCOM. She enjoys facilitating the student-doctors' education through kinesthetic learning and interacting with the student-doctors and their families, faculty, and staff.
- [Wesley  Eilbert , MD](https://epmonthly.com/contributor/wesley-eilbert-md/) - Dr. Eilbert is an associate professor of emergency medicine at the University of Illinois College of Medicine.
- [Justin Kosirog, MD](https://epmonthly.com/contributor/justin-kosirog-md/) - Dr. Kosirog is a 3rd year resident in the combined Emergency Medicine/Internal Medicine program at the University of Illinois College of Medicine.
- [Alfred Sacchetti, MD](https://epmonthly.com/contributor/alfred-sacchetti-md/) - Alfred Sacchetti, MD, is the Director of Emergency Medicine at Our Lady of Lourdes Medical Center in Camden, New Jersey.
- [Larry Weiss, MD, JD](https://epmonthly.com/contributor/larry-weiss-md-jd/) - Dr. Larry Weiss is a practicing emergency physician, attorney, and a past-president of the American Academy of Emergency Medicine (AAEM).
- [Torree McGowan, MD, FACEP](https://epmonthly.com/contributor/torree-mcgowan-md-facep/) - Dr. McGowan is an Air Force veteran, and has deployed to both Iraq and Afghanistan. She is a practicing emergency physician with St Charles Medical Group in central Oregon.
- [Benjamin Lewin, MD](https://epmonthly.com/contributor/benjamin-lewin-md/)
- [Brady Pregerson, MD](https://epmonthly.com/contributor/brady-pregerson-md/) - EMERGENCY ULTRASOUND SECTION EDITOR Dr. Pregerson manages a free online EM Ultrasound Image Library. He is the author of the Emergency Medicine 1-Minute Consult Pocketbook and the A to Z Pocket Emergency Pharmacopoeia & Antibiotic Guide (available at EMresource.org) and the Tarascon Emergency Department Quick Reference Guide (Tarascon.com).
- [Daniel G. Ostermayer, MD](https://epmonthly.com/contributor/daniel-g-ostermayer-md/)
- [Joseph N. Ponce](https://epmonthly.com/contributor/joseph-n-ponce/)
- [Robyn Hitchcock, MD](https://epmonthly.com/contributor/robyn-hitchcock-md/)
- [Eric Lee, MD](https://epmonthly.com/contributor/eric-lee-md/)
- [Benjamin McVane, MD](https://epmonthly.com/contributor/ben-mcvane-md/) - Dr. McVane is an Emergency Medicine Physician at Elmhurst Hospital in New York City
- [Andrew Pirotte, MD](https://epmonthly.com/contributor/andrew-pirotte-md/)
- [Matthew Pirotte, MD](https://epmonthly.com/contributor/matthew-pirotte-md/)
- [Terry Kowalenko, MD](https://epmonthly.com/contributor/terry-kowalenko-md/) - Dr. Kowalenko is the President of the American Board of Emergency Medicine.
- [Thomas Tobin, MD, MBA](https://epmonthly.com/contributor/thomas-tobin-md-mba/)
- [Manuel Hernandez, MD, MBA](https://epmonthly.com/contributor/manuel-hernandez-md-mba/)
- [Phillip B. Dydynski, MD](https://epmonthly.com/contributor/phillip-dydynski-md/) - Dr. Dydynski is Chief of Pediatric Radiology at Norton Children’s Hospital in Louisville, KY.
- [Eran Rosenberg, MD](https://epmonthly.com/contributor/eran-rosenberg-md/) - Dr. Rosenberg is a Pediatric Urologist affiliated with Norton Children’s Hospital in Louisville, KY
- [Robert A. Bitterman, MD, JD](https://epmonthly.com/contributor/robert-bitterman-md-jd-facep/) - Dr. Bitterman is the President of the Bitterman Health Law Consulting Group.
- [Mackenzie Esch, MD](https://epmonthly.com/contributor/mackenzie-esch-md/) - Dr. Esch is the assistant professor of Pediatric Emergency Medicine at UNC.
- [Drew White, MD, MBA](https://epmonthly.com/contributor/drew-white-md-mba/) - Dr. White is currently president of the Maryland Chapter of ACEP and has been a medical staff president at two different hospitals. He is a partner and regional medical director for Emergency Medicine Associates.
- [Joshua Strommen MD](https://epmonthly.com/contributor/joshua-strommen-md/) - Dr. Strommen is an emergency physician who served six years in the US Army and currently practices in Central Texas.
- [Dan Quan, DO](https://epmonthly.com/contributor/dan-quan-do/) - Dr. Quan is an emergency physician and medical toxicologist at Maricopa Integrated Health System in Phoenix, AZ.
- [Dara Kass, MD](https://epmonthly.com/contributor/dara-kass-md/) - Dr. Kass is the founder and editor-in-chief of FemInEM.
- [Christopher W. Baugh MD, MBA](https://epmonthly.com/contributor/christopher-w-baugh-md-mba/) - Dr. Baugh is a practicing emergency physician and Medical Director of Emergency Department Operations and Observation Medicine in the Department of Emergency Medicine at Brigham and Women's Hospital in Boston, MA.
- [Matt S. Friedman, MD](https://epmonthly.com/contributor/matt-s-friedman-md/) - Matt S. Friedman, MD is a board certified EMS and Emergency Medicine physician. He completed an EMS fellowship with the Fire Department City of New York (FDNY). He is currently the Associate Medical Director of Prehospital Care at Maimonides Medical Center in Brooklyn, NY. He also serves as the Lead House Physician for Yankee Stadium,
- [Nathanael Marsan, MD](https://epmonthly.com/contributor/nathanael-marsan-md/) - Dr. Marsan is an EM resident at Maimonides Medical Center.
- [Gloria Kuhn, DO, PhD](https://epmonthly.com/contributor/gloria-kuhn-phd/) - Dr. Kuhn is the Vice-Chair of Academic Affairs and a Professor of Clinical Medicine at Wayne State University.
- [Leah Hatfield, PharmD, BCPS](https://epmonthly.com/contributor/leah-hatfield-pharmd-bcps/) - Dr. Hatfield is a Lead Clinical Pharmacist Specialist, Emergency Medicine, at UNC Healthcare. She is an assistant professor of clinical education at UNC Eshelman School of Pharmacy.
- [Susan Torrey, MD](https://epmonthly.com/contributor/susan-torrey-md/) - Dr. Torrey is an emergency medicine educator at Baystate Medical Center in Massachusetts.
- [Marc Conterato, MD](https://epmonthly.com/contributor/marc-conterato-md/)
- [Bryarlin Johnson, NREMT-P](https://epmonthly.com/contributor/bryarlin-johnson-nremt-p/)
- [Charlotte DiBartolomeo, M.A.C.T.](https://epmonthly.com/contributor/charlotte-dibartolomeo-m-c-t/) - Charlotte DiBartolomeo, M.A.C.T. is CEO and Cofounder of Red Kite Project. She and her team can be reached at chardibart@redkiteproject.com and www.redkiteproject.com
- [Sean M. Siler, DO, MBA](https://epmonthly.com/contributor/sean-m-siler-mba/) - Dr. Siler has founded three successful startups, advises private equity firms, and is an Executive Coach for the Kenan Flagler Business School at the University of North Carolina at Chapel Hill.
- [Kevin Kohler](https://epmonthly.com/contributor/kevin-kohler/)
- [Raviraj Patel, MD](https://epmonthly.com/contributor/raviraj-patel-md/) - Dr. Patel is Attending Physician of Emergency Medicine at Vassar Brothers Medical Center.
- [Olivia Norrmén-Smith](https://epmonthly.com/contributor/olivia-norrmen-smith/) - Olivia Norrmén-Smith is the Director of Research and Communications at Canopy Innovations, Inc.
- [Justin Myers, DO, MPH](https://epmonthly.com/contributor/justin-myers-mph/)
- [Sarah Leeper, MD](https://epmonthly.com/contributor/sarah-leeper-md/)
- [Kathryn Paul, MS4](https://epmonthly.com/contributor/kathryn-paul-ms4/)
- [Elizabeth Gignac, DO](https://epmonthly.com/contributor/elizabeth-gignac-do/) - Elizabeth Gignac, DO is an EMA/EmCare Emergency Physician and the Emergency Medicine Residency Program Director for Campbell University School of Medicine at Southeastern Regional Medical Center Department of Emergency Medicine.
- [Daniel Castillo, MD, MBA](https://epmonthly.com/contributor/daniel-castillo-md-mba/) - Dr. Castillo is executive vice president, chief quality officer, and chief strategy officer at Evolution Health.
- [Eric Beck, DO, MPH](https://epmonthly.com/contributor/eric-beck-mph/) - Dr. Beck is president and CEO at Evolution Health; assistant professor of emergency medicine at the University of Chicago; and adjunct assistant professor at the University of North Texas Health Sciences Center.
- [Jeff Beeson, DO](https://epmonthly.com/contributor/jeff-beeson-do/) - Dr. Beeson is senior vice president and executive medical director for medical command centers at Evolution Health.
- [Paul Hinchey, MD, MPH](https://epmonthly.com/contributor/paul-hinchey-md-mph/) - Dr. Hinchey is chief operating officer for Medical operations and senior vice president at Evolution Health.
- [Brent Myers, MD, MPH](https://epmonthly.com/contributor/brent-myers-md-mph/) - Dr. Myers is chief medical officer and executive vice president at Evolution Health and associate chief medical officer at American Medical Response. He can be reached at Brent.Myers@evolution.net.
- [Francis X. Guyette, MD, MPH](https://epmonthly.com/contributor/francis-x-guyette-md-mph/) - Dr. Guyette is an associate professor of emergency medicine, both at the University of Pittsburgh.
- [Christian Martin-Gill, MD, MPH](https://epmonthly.com/contributor/christian-martin-gill-md-mph/) - Dr. Martin-Gill is an assistant professor of emergency medicine.
- [Erick E Thronson, BSN](https://epmonthly.com/contributor/erick-e-thronson-bsn/)
- [Jason F Naylor, PA-C](https://epmonthly.com/contributor/jason-f-naylor-pa-c/)
- [Lauren Westafer, DO](https://epmonthly.com/contributor/lauren-westafer-do/) - Dr. Westafer is an emergency physician and research fellow at Baystate Medical Center. She is the author of The Short Coat.
- [Tina Wu, MD](https://epmonthly.com/contributor/tina-wu-md/) - Dr. Wu is the associate chief of service and the director of quality improvement at the Perelman Center for Emergency Services at New York University's Langone Medical Center.
- [Eashwar B. Chandrasekaran MD, MSc](https://epmonthly.com/contributor/eashwar-b-chandrasekaran-md-msc/) - Dr. Chandrasekaran is a clinical assistant professor of emergency medicine and palliative care at Indiana University School of Medicine Methodist Hospital.
- [Esther Choo, MD, MPH](https://epmonthly.com/contributor/esther-choo-md-mph/) - Dr. Choo is an associate professor at the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Sciences University in Portland, OR. She can be reached at chooe@ohsu.edu.
- [Lisa Morena-Walton, MD, MS](https://epmonthly.com/contributor/lisa-morena-walton-md-ms/) - Dr. Morena-Walton is the professor of EM at the Louisiana State University Health Sciences Center.
- [Michael S. Jaffe, MD](https://epmonthly.com/contributor/michael-s-jaffe-md/) - Dr. Jaffe practices emergency medicine in Murphy, NC at Murphy Medical Center.
- [Puja Gopal, MD](https://epmonthly.com/contributor/puja-goba-md/) - Dr. Gopal is a 2nd year EM resident at the University of Illinois at Chicago EM Residency Program.
- [Nuriya Robinson, MD](https://epmonthly.com/contributor/nuriya-robinson-md/) - Dr. Robinson is faculty in the Department of Obstetrics and Gynecology at Harbor-UCLA Medical Center.
- [Valerie Dobiesz, MD, MPH](https://epmonthly.com/contributor/valerie-dobiesz-md-mph/) - Dr. Dobiesz is the Director of External Programs at STRATUS Center for Medical Simulation at Brigham & Women’s Hospital and is faculty at the Harvard Humanitarian Initiative.
- [Earl J. Reisdorff, MD](https://epmonthly.com/contributor/earl-j-reisdorff-md/) - Dr. Reisdorff is the Executive Director of the American Board of Emergency Medicine (ABEM)
- [Patty Cason, FNP](https://epmonthly.com/contributor/patty-cason-fnp/)
- [Jaiva Larsen, MD](https://epmonthly.com/contributor/jaiva-larsen-md/)
- [Taja Whitted](https://epmonthly.com/contributor/taja-whitted/) - Taja Whitted has worked as an editor for Emergency Physicians Monthly and currently works at Harper Collins.
- [Marc Probst, MD, MS](https://epmonthly.com/contributor/marc-probst-md/) - Dr. Probst is an Assistant Professor and K23 Scholar in the Department of Emergency Medicine at the Icahn School of Medicine at Mount Sinai.
- [Gavin Budhram, MD](https://epmonthly.com/contributor/gavin-budhram-md/) - Dr. Budhram is assistant professor of emergency medicine at Baystate Medical Center and is chief and fellowship director in emergency ultrasonography.
- [Nicholas Daniel, DO](https://epmonthly.com/contributor/nicholas-daniel-do/) - Dr. Daniel is assistant professor in emergency medicine at Baystate Medical Center and associate director for the fellowship in wilderness medicine.
- [Sheema Samdani, DO](https://epmonthly.com/contributor/sheema-samdani-do/) - Dr. Samdani is a third-year and chief resident at Baystate Medical Center.
- [Amy Levine, MD](https://epmonthly.com/contributor/amy-levine-md/) - PEDIATRICS SECTION EDITOR Dr. Levine is a professor of pediatrics in the Division of Pediatric Emergency Medicine at the University of North Carolina.
- [Hemal Kanzaria, MD, MS](https://epmonthly.com/contributor/hemal-kanzaria-md/) - Dr. Kanzaria is an emergency physician and Clinical Scholar affiliated with the US Department of Veterans Affairs and the University of California Los Angeles.
- [Creagh Boulger, MD, RDMS](https://epmonthly.com/contributor/creagh-boulger-md/) - Dr. Boulger is the Assistant Ultrasound Director and Assistant Emergency Ultrasound Fellowship Director at Ohio State University.
- [Nikki Waller, MD](https://epmonthly.com/contributor/nikki-waller-md/) - Dr Waller is the Emergency Medicine Residency Program Director at the University of North Carolina in Chapel Hill, NC.
- [Alex Busko](https://epmonthly.com/contributor/alex-busko/)
- [Sonya Swink](https://epmonthly.com/contributor/sonya-swink/)
- [Olivia Morgan PharmD](https://epmonthly.com/contributor/olivia-morgan-pharmd/)
- [Ritu Sahni MD, MPH](https://epmonthly.com/contributor/ritu-sahni-md-mph/) - Dr. Sahni is a practicing EMS and Emergency Physician in Portland, OR. He is Immediate Past-President and Advocacy Chair for the National Association of EMS Physicians.
- [Teresa S. Wu, MD](https://epmonthly.com/contributor/teresa-s-wu-md/) - EMERGENCY ULTRASOUND SECTION EDITOR Dr. Wu is an Associate Professor and the Simulation Curriculum Director at the University of Arizona College of Medicine-Phoenix. She is the Director of the Emergency Ultrasound Program and Fellowships for Banner University Medical Center-Phoenix and the creator of the app SonoSupport. Dr. Wu is the Emergency Ultrasound Section Editor for
- [Seth Trueger, MD](https://epmonthly.com/contributor/seth-trueger-md/) - SOCIAL MEDIA EDITOR Dr. Trueger is an emergency physician at Northwestern University and Assistant Social Media Editor at Annals of Emergency Medicine. He tweets as @MDaware and blogs at mdaware.org
- [Michael Kordecki, DPT, SCS, ATC](https://epmonthly.com/contributor/michael-kordecki-dpt/) - Dr. Kordecki is the owner of Praxis Physical Therapy and Human Performance in Vernon Hills, Illinois.
- [Yuka Kobayashi, DO, MS](https://epmonthly.com/contributor/yuka-kobayashi-do/) - Dr. Kobayashi is a graduate of WesternU and 2nd year resident at MCWAH.
- [Andrew Makowski, MD, MA](https://epmonthly.com/contributor/md-ma/) - Dr. Makowski is an Emergency Medicine attending at St. Joseph's Hospital, Milwaukee, WI.
- [Josh Bettner, DO](https://epmonthly.com/contributor/josh-bettner-do/) - Dr. Bettner is a graduate of WesternU, and a 3rd year resident at the MCW-All Saints Family Medicine Residency.
- [Richard Bukata, MD](https://epmonthly.com/contributor/richard-bukata-md/) - EXECUTIVE EDITOR Dr. Bukata is the Editor of Emergency Medical Abstracts.
- [Joshua Elder, MD, MPH](https://epmonthly.com/contributor/joshua-elder-md-mph/) - Dr. Elder is a practicing emergency physician and a Robert Wood Johnson Clinical Scholar at the Yale University.
- [Joshua Broder, MD](https://epmonthly.com/contributor/joshua-broder-md/) - Dr. Broder is an associate professor and the residency program director in the Division of Emergency Medicine at Duke University Medical Center. His text, Diagnostic Imaging for the Emergency Physician, received the 2011 American Publishers Award for Clinical Medicine.
- [Christie Lech, MD](https://epmonthly.com/contributor/christie-lech-md/) - Dr. Lech is an attending physician at both Bellevue Hospital Center and Tisch Hospital - NYU Langone Medical Center in New York City. She is in the process of com- pleting a Masters in Health Professions Education (MHPE) through NYU.
- [Brennen Beatty, MD](https://epmonthly.com/contributor/brennen-beatty-md/) - Dr. Beatty is a practicing emergency physician in Austin, TX. Special thanks to Britta Barts, MBA and Lawrence Brownstein, PhD psychology, senior lecturer University of Texas.
- [David Zodda, MD](https://epmonthly.com/contributor/david-zodda-md/) - Dr. Zodda is a practicing Emergency Medicine physician, fellowship trained in Knowledge Translation and Evidence Based Medicine, and the Assistant Director of the Emergency Medicine residency program at Hackensack University Medical and Trauma Center in New Jersey.
- [Cedric Dark, MD, MPH](https://epmonthly.com/contributor/cedric-dark-md-mph/) - Dr. Dark is the Founder and Executive Editor of the Policy Prescriptions® blog, where clinicians discuss ways to fix the American healthcare system.
- [Thomas Collins, MD](https://epmonthly.com/contributor/thomas-collins-md/) - Dr. Collins is the medical director for the department of Public Safety for the City of Cleveland
- [John C. Prestosh, DO](https://epmonthly.com/contributor/john-c-prestosh/) - Dr. Prestosh is the president of the American College of Osteopathic Emergency Physicians
- [Arjun Venkatesh, MD](https://epmonthly.com/contributor/arjun-venkatesh-md/) - Dr. Venkatesh is the Director of Quality and Safety Research and Strategy in the Department of Emergency Medicine and Scientist in the Center for Outcomes Research and Evaluation at Yale University. He also chairs the Quality Measures Subcommittee of the ACEP Clinical Registry Committee and co-leads the ACEP Emergency Quality Network (E-QUAL).
- [Louise B. Andrew, MD, JD](https://epmonthly.com/contributor/louise-b-andrew-md-jd/) - EXECUTIVE EDITOR Dr. Andrew is a past chair of the ACEP Wellness Committee. Dr. Andrew founded MDMentor.com
- [Dennis Hughes, MD](https://epmonthly.com/contributor/dennis-hughes-md/)
- [Rita A. Manfredi, MD](https://epmonthly.com/contributor/rita-manfredi-md/) - Dr. Manfredi is an Associate Professor of Clinical Emergency Medicine at the George Washington University and the Chair for the ACEP Well Being Committee.
- [Preeti Jois, MD](https://epmonthly.com/contributor/preeti-jois-md/) - Dr. Jois is an EP who promotes clinical excellence in emergency care and education in cardiovascular emergencies through Jois MD Consulting LLC.
- [William A. Mills, MD](https://epmonthly.com/contributor/william-a-mills-jr-md-mph/) - Dr. Mills is a professor in the Division of Pediatric Emergency Medicine at the University of North Carolina
- [Shakir Katea, MD](https://epmonthly.com/contributor/shakir-katea-md/) - Dr. Katea is the President of Iraqi Society for Emergency Medicine
- [Christian Rose, MD](https://epmonthly.com/contributor/christian-rose-md/)
- [Ben Azan, MD](https://epmonthly.com/contributor/12892/) - Dr. Azan is a PGY-4 in the Department of Emergency Medicine at the Icahn School of Medicine at Mount Sinai.
- [Jesse Pines, MD](https://epmonthly.com/contributor/jesse-pines-md/) - HEALTH POLICY SECTION EDITOR Dr. Pines is a practicing emergency physician and a Professor of Emergency Medicine and Health Policy at the George Washington University.
- [Benjamin M. Krainin, MD, PGY-2](https://epmonthly.com/contributor/benjamin-m-krainin-md-pgy-2/)
- [Vicki Midlow-Porto, PhD](https://epmonthly.com/contributor/vicki-midlow-porto-phd/) - Dr. Mikow-Porto has been a principal of Research and Policy Analytics in Carrboro, NC since 2006. She completed three studies on hospital crime and prisoner hospital treatment issues over the last five years. You can email questions to vmporto@nc.rr.com or call (919) 967-6949.
- [Lauren T. Southerland, MD](https://epmonthly.com/contributor/lauren-t-southerland-md/) - GERIATRICS SECTION EDITOR Dr. Southerland is an Assistant Professor and Director of Geriatric Emergency Care in the Department of Emergency Medicine at the Ohio State University. Her research has focused on older adult injury prevention and management.
- [David Hartnett, MD](https://epmonthly.com/contributor/david-hartnett-md/) - Dr. Hartnett is an Emergency Medicine resident at the Ohio State University Wexner Medical Center.
- [Gillian McCafferty, MD](https://epmonthly.com/contributor/gillian-mccafferty-md/) - Dr. McCafferty a graduating ultrasound fellow and attending at Baystate Medical Center. She will begin working as an emergency physician at Lahey Clinic in Burlington, Massachusetts.
- [Sukhdeep Singh, MD](https://epmonthly.com/contributor/sukhdeep-singh-md/) - Dr. Singh is a graduating Chief Resident and future ultrasound fellow at Baystate Medical Center.
- [Ryan Clark, DO](https://epmonthly.com/contributor/ryan-clark-do/) - Dr. Clark is an Emergency Medicine resident at Baystate Medical Center in Spring field, Massachusetts.
- [John G Knight Jr, MD](https://epmonthly.com/contributor/john-g-knight-jr-md/) - Dr. Knight is an emergency medicine physician at the San Antonio Military Medical Center.
- [Joseph K Maddry, MD](https://epmonthly.com/contributor/joseph-k-maddry-md/) - Dr. Maddry is an emergency medicine physician and toxicologist at the US Air Force En route Care Research Center and the San Antonio Military Medical Center.
- [Mark A Antonacci, MD](https://epmonthly.com/contributor/mark-antonacci-md/) - Dr. Antonacci is the chief of emergency medicine at the San Antonio Military Medical Center.
- [David McLario, DO, MS](https://epmonthly.com/contributor/david-mclario-do-ms/) - Dr. McLario is the Director of Emergency Ultrasound for the University of Louisville Department of Pediatrics. He practices at Kosair Children’s Hospital. He is co-author of Case Studies in Pediatric Emergency and Critical Care Ultrasound, McLario and Kendall, Cambridge University Press, London, UK, 2013.
- [Thomas A. Platts-Mills, MD](https://epmonthly.com/contributor/thomas-platts-mills-md/) - Thomas A. Platts-Mills, MD, PhD, FRS is a Professor of Medicine and Microbiology at the University of Virginia
- [Timothy F. Platts-Mills, MD](https://epmonthly.com/contributor/timothy-f-platts-mills-md/) - Timothy F. Platts-Mills, MD, MSc is an Assistant Professor for the Department of Emergency Medicine at the University of North Carolina at Chapel Hill.
- [Ryan Radecki, MD](https://epmonthly.com/contributor/ryan-radecki-md/) - Dr. Radecki is the author of Emergency Medicine Literature of Note.
- [David Effron, MD](https://epmonthly.com/contributor/david-effron-md/) - Dr. Effron is the assistant professor of emergency medicine at Case Western Reserve University and attending physician in the department of emergency medicine at the MetroHealth Medical Center, in Cleveland, Ohio.
- [Chris Wyatt, MD](https://epmonthly.com/contributor/chris-wyatt-md/) - Dr. Wyatt is an attending physician in the Department of Emergency Medicine at MetroHealth Medical Center and an Assistant Professor of Emergency Medicine at CWRU School of Medicine, Cleveland, Ohio.
- [Jacob Berriochoa, MD](https://epmonthly.com/contributor/jacob-berriochoa-md/) - Dr. Berriochoa is a third-year resident in EM at the MetroHealth Medical Center.
- [Michael J. Breyer, MD](https://epmonthly.com/contributor/michael-breyer-md/) - Dr. Breyer is an associate program director at the Denver Health Emergency Medical Residency Program and an assistant professor of emergency medicine at the University of Colorado.
- [Kerryann B. Broderick, MD](https://epmonthly.com/contributor/kerryann-b-broderick-md/) - Dr. Broderick is an associate professor at Denver Health Medical Center.
- [Marcus Webb](https://epmonthly.com/contributor/marcus-webb/) - Marcus Webb is the Chief Story Telling Officer for Ted Med
- [E. Paul DeKoning, MD, MS](https://epmonthly.com/contributor/e-paul-dekoning-md-ms/) - Dr. DeKoning is an assistant professor of emergency medicine and program director at Dartmouth-Hitchcock Medical Center in New Hampshire.
- [Ryan McKennon, DO](https://epmonthly.com/contributor/ryan-mckennon-do/) - Dr. McKennon is the assistant division head in the emergency department at Henry Ford Fairlane.
- [Jaime Hope, MD](https://epmonthly.com/contributor/jaime-hope-md/) - Dr. Hope is an attending physician at Beaumont Health System, Royal Oak campus and an Clinical Medicine Professor at Oakland University William Beaumont School of Medicine.
- [Jyoti Mahapatra, MD](https://epmonthly.com/contributor/jyoti-mahapatra-md/) - Dr. Mahapatra is an emergency medicine instructor at the University of Nebraska Medical Center.
- [Jennifer Prosser, DO](https://epmonthly.com/contributor/jennifer-prosser-do/) - Jennifer Prosser, DO is the Chief Resident at the Maricopa Medical Center.
- [Kerry Bergman, MD](https://epmonthly.com/contributor/kerry-bergman-md/) - Kerry Bergman, MD is a Pediatric surgeon at Goryeb Children's Hospital in Morristown, NJ.
- [Kamal K. Chavda, MD](https://epmonthly.com/contributor/kamal-k-chavda-md/) - Kamal K. Chavda, MD is a PEM Fellow at Rainbow Babies and Children Hospital, in Cleveland, Ohio.
- [Sean Roth, DO](https://epmonthly.com/contributor/sean-roth-do/) - Sean Roth is Staff Emergency Physician at Cleveland Clinic in Cleveland, Ohio.
- [Theodore Losey, MD](https://epmonthly.com/contributor/theodore-losey-md/) - Theodore Losey, MD is Staff Physician at Silvertip Emergency Physicians in Kalispell, Montana.
- [Jesse Gurm, MD](https://epmonthly.com/contributor/jesse-gurm-md/) - Jesse Gurm, MD is a Staff Emergency Physician at canton Aultman Emergency Physicians (CAEP) in Canton, Ohio.
- [Christina Shenvi, MD, PhD](https://epmonthly.com/contributor/christina-shenvi-md-phd/) - Dr. Shenvi is an assistant professor in the department of emergency medicine at the University of North Carolina. She authors RX Pad each month in EPM.
- [Charles Reese, MD](https://epmonthly.com/contributor/charles-reese-md/) - Dr. Reese is president of the ED Benchmarking Alliance.
- [Jeannette Wolfe, MD](https://epmonthly.com/contributor/jeannette-wolfe-md/) - EXECUTIVE EDITOR Dr. Wolfe is an Associate Professor of Emergency Medicine at Tufts School of Medicine’s Baystate campus.
- [Greg Henry, MD](https://epmonthly.com/contributor/greg-henry-md/) - EXECUTIVE EDITOR Dr. Henry is the founder and CEO of Medical Practice Risk Assessment, Inc.; past president of ACEP.
- [Michael Carius, MD](https://epmonthly.com/contributor/michael-carius-md/) - EXECUTIVE EDITOR Dr. Carius is an alternate delegate to the AMA from Connecticut. He is also a past president of ACEP, and an executive editor for Emergency Physicians Monthly.
- [Ashley Bean, MD](https://epmonthly.com/contributor/ashley-bean-md/) - GLOBAL EM SECTION EDITOR Dr. Bean is an Associate Professor of Emergency Medicine at the University of Arkansas for Medical Sciences. She is a member of the departmental Division of Ultrasound and director of the Global Health an International Emergency Medicine residency track.
- [Mike Levy, MD](https://epmonthly.com/contributor/mike-levy-md/) - EMS SECTION EDITOR Dr. Levy is the medical director areawide of EMS Anchorage, AK and the medical director of the Anchorage Fire Department. He is an affiliate associate professor at UAA College of Health and WWAMI School of Medical Education.
- [Henry Higgins, MD](https://epmonthly.com/contributor/henry-higgins-md/) - Henry Higgins, MD is the CEO and owner of Family Emergency Room in Austin, Texas.
- [K. Michael Duerr Specht, MD, PhD](https://epmonthly.com/contributor/k-michael-duerr-specht-md-phd/) - K. Michael Duerr Specht, MD, PhD is an Assistant Professor in the Department of Emergency Medicine at Campbell University. He practices emergency medicine at Southeastern Regional Medical Center in Lumberton, NC as well as other ED’s in rural North Carolina and has been working as Research Scientist at the Parmenides Center for the Study of
- [Robert Frantz, MD](https://epmonthly.com/contributor/robert-frantz-md/) - Robert Frantz, MD is the president of the TeamHealth Emergency Medicine West Group.
- [Karen Serrano, MD](https://epmonthly.com/contributor/karen-serrano-md/) - Karen Serrano, MD is an assistant professor in the department of emergency medicine at the University of North Carolina.
- [John Williams, MD](https://epmonthly.com/contributor/john-williams-md/) - John Williams, MD is the ED Director of Operations at the University of Illinois Hospital, and has been involved with a number of handoff and consultant initiatives.
- [Keith A. Raymond, MD](https://epmonthly.com/contributor/keith-a-raymond-md/) - Keith A. Raymond, MD has practiced medicine in 8 countries in 4 languages. He currently lives in Austria assisting Asylum seekers with the Red Cross. He has multiple journal publications and is writing his first two novels.
- [Keith Cross, MD](https://epmonthly.com/contributor/keith-cross-md/) - Keith Cross, MD, MS, MSc, is an Associate Professor of Pediatrics in the Division of Emergency Medicine and has authored numerous textbook chapters and articles relevant to Point-of-Care Ultrasound. He developed and oversees the emergency department ultrasound-guided regional anesthesia program at Kosair Children’s Hospital.
- [Adam Patterson, MD](https://epmonthly.com/contributor/adam-patterson-md/) - Adam Patterson, MD is a fellow in the Division of Pediatric Emergency Medicine at the University of Louisville and practices at Kosair Children’s Hospital. Dr. Patterson has assisted in the development of the pediatric emergency medicine ultrasound-guided regional anesthesia program that provides both upper and lower extremity nerve blockade for a variety of injuries and
- [Brian J. Zink, MD](https://epmonthly.com/contributor/brian-j-zink-md/) - Brian J. Zink, MD is a Professor and Chair in the Department of Emergency Medicine at Alpert Medical School of Brown University. Dr. Zink is also the author of Anyone, Anything, Anytime- a History of Emergency Medicine (Mosby Elsevier, 2006)
- [Katie Duke, MSN, RN](https://epmonthly.com/contributor/katie-duke-msn-rn/) - Katie Duke, MSN, RN, CEN, AGACNP-BC, is an ER nurse in New York City. She has been featured on television shows like NY MED, NY ER, and Fox News.
- [Nir J. Harish, MD, MBA](https://epmonthly.com/contributor/nir-j-harish-md-mba/) - Nir J. Harish, MD, MBA is a practicing emergency physician and a Robert Wood Johnson Foundation Clinical Scholar at Yale University School of Medicine.
- [Damian E. Caraballo, MD](https://epmonthly.com/contributor/damian-e-caraballo-md/) - Damian E. Caraballo, MD is the Assistant Emergency Department Director at Florida Hospital North Pinellas. He is also the Chief Quality Officer for USACS Florida.
- [Puneet Chopra, MD](https://epmonthly.com/contributor/puneet-chopra-md/) - Puneet Chopra, MD is chairman of emergency medicine and director of the observation medicine at Doctors Community Hospital in Lanham, MD. He is a partner with Emergency Medicine Associates.
- [Mark Mosley, MD, MPH](https://epmonthly.com/contributor/mark-mosley-md-mph/) - Mark Mosley, MD, MPH is an Emergency Physician practicing in Wichita, Kansas.
- [Edward Bernstein, MD](https://epmonthly.com/contributor/edward-bernstein-md/) - Edward Bernstein is a Professor and Vice Chair for Academic Affairs in Emergency Medicine at the Boston University School of Medicine.
- [April Edwards, MD](https://epmonthly.com/contributor/april-edwards-md/) - April Edwards is a MED-PEDS resident at the University of North Carolina.
- [Opeolu Adeoye, MD, MS](https://epmonthly.com/contributor/opeolu-adeoye-md-ms/) - Opeolu Adeoye, MD, MS, FAHA is an Associate Professor and Co-director, UC Stroke Team at the University of Cincinnati.
- [Evan Schwarz, MD](https://epmonthly.com/contributor/evan-schwarz-md/) - Evan Schwarz, MD is a faculty member in Emergency Medicine at Washington University in St. Louis.
- [Chris Courtney, MD](https://epmonthly.com/contributor/christopher-s-courtney-md/) - Christopher S. Courtney, MD is the Global Health Director of the Nothing to Lose Foundation and Research Fellow at the John Hopkins Bloomberg School of Public Health.
- [Jeremy Brown, MD](https://epmonthly.com/contributor/jeremy-brown-md/) - Jeremy Brown, MD is the Director of the Office of Emergency Care Research at the National Institutes of Health. His opinions do not necessarily represent those of the Office, NIH or any other branch of government.
- [Robert Jones, DO](https://epmonthly.com/contributor/robert-jones-do-2/) - Robert Jones, DO is Associate Professor of Emergency Medicine at MetroHealth Medical Center in Cleveland, Ohio.
- [Diane L. Miller, MD, MS](https://epmonthly.com/contributor/diane-l-miller-md-ms/) - Diane L. Miller, MD, MS is an EMS Fellow of the Department of Emergency Medicine at the University of North Carolina.
- [Cedric W. Lefebvre, MD](https://epmonthly.com/contributor/cedric-w-lefebvre-md/) - Cedric W. Lefebvre, MD is Associate Professor and Program Director of the emergency medicine residency at the Wake Forest School of Medicine.
- [Mel Herbert, MD](https://epmonthly.com/contributor/mel-herbert-md/) - Mel Herbert, MD is a Professor of Emergency Medicine at KECK School of Medicine, and is Founder of EMRAP, HIPPO Education.
- [Laura Dabney, MD](https://epmonthly.com/contributor/laura-dabney-md/) - Laura Dabney, MD, is a psychiatrist who practices psychotherapy in her private practice in Virginia Beach, Virginia. Learn more about her and her practice at DrLDabney.com.
- [Jennifer Prosner](https://epmonthly.com/contributor/jennifer-prosner/) - Jennifer Prosner is the Chief Resident at Maricopa Medical Center.
- [Francesca L. Beaudoin, MD, MS](https://epmonthly.com/contributor/francesca-l-beaudoin-md-ms/) - Francesca L. Beaudoin MD, MS is the Assistant Professor of emergency medicine at The Alpert Medical School of Brown University.
- [Dan Buckland](https://epmonthly.com/contributor/dan-buckland/) - Dan Buckland earned his PhD from MIT in Aeronatuics and Astronautics, and is currently enrolled in Harvard Medical School. He’s also an Associate member of the Center for Space Medicine at Baylor College of Medicine, and an editor for Medgadget.com
- [Paul Jarvis, MD](https://epmonthly.com/contributor/paul-jarvis/) - Paul Jarvis, MD is a Senior Emergency Medicine Physician at Calderdale & Huddersfield NHS Foundation Trust. He is an Honorary Senior Lecturer at the University of Leeds and a Clinical Associate of the Lean Enterprise Academy. In addition, Paul is the Director of P&H Medical, an international management consultancy for the healthcare sector, and Yorkshire
- [Dominic Bagnoli, MD](https://epmonthly.com/contributor/dominic-bagnoli-md/) - Dominic Bagnoli, MD is the CEO of USACS.
- [Mark Reiter, MD, MBA](https://epmonthly.com/contributor/mark-reiter-md-mba/) - Mark Reiter, MD, MBA is President of the American Academy of Emergency Medicine, Residency Director of the University of Tennessee-Murfreesboro/Nashville, and CEO of Emergency Excellence.
- [Rebecca Liggin, MD](https://epmonthly.com/contributor/rebecca-liggin-md/) - Rebecca Liggin, MD is an associate professor of pediatrics, emergency medicine and pediatric emergency medicine at the University of Arkansas for Medical Sciences. She is the director of the global health and service honors track for medical students and the associate director of the emergency medicine honors track at UAMS.
- [Andrew D. Fisher APA-C](https://epmonthly.com/contributor/andrew-d-fisher-apa-c/)
- [Jason Adler, MD](https://epmonthly.com/contributor/jason-adler-md-2/) - Jason Adler, MD is an attending physician at MedStar Montgomery Medical Center and is the physician coding, documentation, and billing expert within Emergency Medicine Associates. In addition to being on the Board of Directors for the Maryland Chapter of ACEP, Dr. Adler currently serves on the National ACEP CNAC (Coding & Nomenclature Advisory Committee) as
- [Mandisa McIver, MD](https://epmonthly.com/contributor/mandisa-mciver-md/) - Mandisa McIver, MD is an assistant professor of PEM at UNC.
- [James Webley, DO](https://epmonthly.com/contributor/james-webley-md/) - James Webley, DO is a Clinical Assistant Professor at the Michigan State University College of Osteopathic Medicine. He is an EM physician at McLaren Oakland Hospital in Pontiac, Michigan.
- [Demetris Yannopoulis, MD](https://epmonthly.com/contributor/demetris-yannopoulis-md/) - Demetris Yannopoulis, MD is the research director for interventional cardiology and an associate professor of medicine at the University of Minnesota.
- [Charles Lick, MD](https://epmonthly.com/contributor/charles-lick-md/) - Charles Lick, MD is an EP with Emergency Physicians P.A. in Minneapolis, Minnesota. He has been EMS medical director for Allina Health since 2000, a researcher in EMS medicine and an active member of the Minnesota Resuscitation Consortium.
- [John Reed, MD](https://epmonthly.com/contributor/john-reed-md/) - John Reed, MD is Chairman and Medical Director for EMA/EmCare at Southeastern Regional Medical Center Department of Emergency Medicine and is a Campbell University School of Medicine Faculty member of the Emergency Medicine Residency Program.
- [Phillip Stephens, DHSc, PA-C](https://epmonthly.com/contributor/phillip-stephens-dhsc-pa-c/) - Phillip Stephens, DHSc, PA-C is the Associate Provider Site Director for EMA/EmCare at Southeastern Regional Medical Center Department of Emergency Medicine and teaches Research Methodology, Population Health & Evidence Based Medicine for A.T. Still University.
- [Annie H. Rominger, MD](https://epmonthly.com/contributor/annie-h-rominger-md/) - Annie H. Rominger, MD, MPH, MsC is Associate Research Director in the Division of Pediatric Emergency Medicine of the University of Louisville and practices at Kosair Children’s Hospital. Dr. Rominger has authored textbook chapters and learning materials advocating ultrasound use for ill or injured children and is a proponent for international ultrasound education; traveling widely
- [Chloe Sidley, MD](https://epmonthly.com/contributor/chloe-sidley-md/) - Chloe Sidley, MD is a resident in the department of emergency medicine at The Ohio State University.
- [Steven G. Schauer, DO](https://epmonthly.com/contributor/steven-g-schauer-do-rdms-faaem/) - Steven G Schauer, DO, RDMS, FAAEM is an emergency physician with the US Army Institute of Surgical Research and San Antonio Military Medial Center, Fort Sam Houston, Texas.
- [Daniel Sessions, MD](https://epmonthly.com/contributor/daniel-sessions-md/) - Daniel Sessions, MD is the assistant program director for research at the San Antonio Uniformed Services Health Education Consortium Emergency Medicine Residency.
- [Adrianna Levesque, MD](https://epmonthly.com/contributor/adrianna-levesque-md/) - Adrianna Levesque, MD is an EM senior resident in the San Antonio Uniformed Services Health Education Consortium Emergency Medicine Residency.
- [Michael Levin-Epstein, JD, M.Ed](https://epmonthly.com/contributor/michael-levin-epstein-j-d-m-ed/) - Michael Levin-Epstein, JD, M.Ed is a Maryland-based freelance writer who contributes to EPM, Telemedicine and other health care and business-related publications.
- [Danielle Turner-Lawrence, MD](https://epmonthly.com/contributor/danielle-turner-lawrence-md/) - Danielle Turner-Lawrence, MD an associate professor at Oakland University William Beaumont School of Medicine, and is the associate emergency medicine residency program director for Beaumont Health System.
- [Brett R. Todd, MD](https://epmonthly.com/contributor/brett-r-todd-md/) - Brett R. Todd, MD is an assistant professor at Oakland University William Beaumont School of Medicine, and is the assistant emergency medicine residency program director for Beaumont Health System.
- [Rosanne Skalicky, MBBS](https://epmonthly.com/contributor/rosanne-skalicky-mbbs/) - Rosanne Skalicky, MBBS, FACEM graduated from University of Tasmania and has worked in emergency medicine in Hobart, Brisbane and Adelaide. During this time she has always been involved in education and was director of EM training at the Royal Adelaide Hospital.
- [James Broselow, MD](https://epmonthly.com/contributor/james-broselow-md/) - James Broselow, MD is the creator of the Broselow Tape and Founder of eBroselow, LLC
- [Joe Lex, MD](https://epmonthly.com/contributor/joe-lex-md/) - Joe Lex, MD, FACEP, MAAEM is a Clinical Professor of Emergency Medicine at Temple University School of Medicine in Philadelphia, Pennsylvania, USA, and a Visiting Professor at Hué University of Medicine and Pharmacy in Hué, Vietnam. He is currently working with organizations in Vietnam, Myanmar, Poland, and Argentina to improve Emergency Medical Education.
- [Lewis Nelson, MD](https://epmonthly.com/contributor/lewis-nelson-md/) - Lewis S. Nelson, MD is a practicing emergency physician and toxicologist and a Professor of Emergency Medicine at NYU School of Medicine.
- [Maryann Mazer-Amirshahi, MD](https://epmonthly.com/contributor/maryann-mazer-amirshahi-md/) - Maryann Mazer-Amirshahi, MD, PharmD, MPH is a practicing emergency medicine physician and medical toxicologist at MedStar Washington Hospital Center and an Assistant Professor of Emergency Medicine at Georgetown University School of Medicine.
- [Michael Tatusov, MD](https://epmonthly.com/contributor/michael-tatusov-md/) - Michael Tatusov, MD is a fellow in Pulmonary and Critical Care at MedStar Washington Hospital Center.
- [Michael Lynch, MD](https://epmonthly.com/contributor/michael-lynch-md/) - Michael Lynch, MD is the Chair of Emergency Medicine at the Concord Hospital in Concord, New Hampshire.
- [Jason Friesen, MPH, EMT-P](https://epmonthly.com/contributor/jason-freisen-mph-emt-p/) - Jason Friesen, MPH, EMT-P is a paramedic who has been working in international development since 2003. He is the Founder of Trekmedics.org
- [Eleanor Silverman, DSc](https://epmonthly.com/contributor/eleanor-silverman-dsc/) - Eleanor Silverman, DSc is a senior executive at NASA where she has direct responsibility for 100 civil servants and hundreds of onsite contractors. The views expressed are her own and not necessarily those of NASA or the U.S. Government.
- [Neel Vibhakar, MD](https://epmonthly.com/contributor/neel-vibhakar-md/) - Neel Vibhakar, MD, FACEP is the Chairman of EM at the University of Maryland Baltimore Washington Medical Center and Co-Chair of the University of Maryland Emergency Medicine Risk Forum.
- [Amal Mattu, MD](https://epmonthly.com/contributor/amal-mattu-md/) - Amal Mattu, MD, FAAEM, FACEP is a Professor and Vice Chair at the University of Maryland School of Medicine’s Department of Emergency Medicine and Co-Director of the Emergency Cardiology Fellowship.
- [Jason Adler, MD](https://epmonthly.com/contributor/jason-adler-md/) - Jason Adler, MD is an attending physician at MedStar Montgomery Medical Center and is the physician coding, documentation, and billing expert within Emergency Medicine Associates.
- [Sonali Ganguly, MD, MA](https://epmonthly.com/contributor/sonali-ganguly-md-ma/) - Sonali Ganguly, MD, MA is a senior EM resident at Maimonides Medical Center. She has staffed multiple EDM festivals and other mass gatherings.
- [Ken V. Iserson, MD, MBA](https://epmonthly.com/contributor/ken-v-isersin-md/) - Ken V. Iserson, MD, MBA is the author of "Improvised Medicine: Providing Care in Extreme Enviroments" 2013, McGraw-Hill and "The Global Healthcare Volunteers' Handbook: What You Need to Know Before You Go" 2014 www.galenpress.com.
- [Susan Musyimi, MD](https://epmonthly.com/contributor/susan-musyimi-md/) - Susan Musyimi, MD is a 3rd year Emergency Medicine resident at Western Michigan University School of Medicine.
- [William Fales, MD](https://epmonthly.com/contributor/william-fales-md/) - William Fales, MD is the EMS Director for Kalamazoo County, Department of Emergency Medicine, Western Michigan University School of Medicine; Professor of Emergency Medicine.
- [Casey Hollensteiner, MD](https://epmonthly.com/contributor/casey-hollensteiner-md/) - Casey Hollensteiner, MD is an Attending physician with the Department of Emergency Medicine, Community Hospital South.
- [Philip Pazderka, MD](https://epmonthly.com/contributor/philip-pazderka-md/) - Philip Pazderka, MD is Associate Residency Director, Department of Emergency Medicine, Western Michigan University School of Medicine; Assistant Professor of Emergency Medicine.
- [Brian J. Holland, MD](https://epmonthly.com/contributor/brian-j-holland-md/) - Brian J. Holland, MD, is an Assistant Professor in the department of Pediatrics at the University of Louisville School of Medicine. He is the Medical Director of the Pediatric Echocardiography Laboratory, Kosair Children’s Hospital, Louisville, KY.
- [Vivek Parwani, MD, FACEP](https://epmonthly.com/contributor/vivek-parwani-md/) - Vivek Parwani, MD, FACEP is an assistant professor of emergency medicine at Yale School of Medicine and the medical director of the Yale-New Haven Adult Emergency Department.
- [Rachel Klockow](https://epmonthly.com/contributor/rachel-klockow-md/) - Rachel Klockow works for EMP. She has been a physician recruiter for 26 years.
- [Jane Hyatt Thorpe, JD](https://epmonthly.com/contributor/jane-hyatt-thorpe-jd/) - Jane Hyatt Thorpe, JD is an Associate Professor at the Milken Institute School of Public Health and Director of the Healthcare Corporate Compliance Program at George Washington University.
- [Elizabeth Gray, JD, MHA](https://epmonthly.com/contributor/elizabeth-gray-jd-mha/) - Elizabeth Gray, JD, MHA is a senior research associate at the Milken Institute School of Public Health at the George Washington University.
- [Terry Mulligan, DO](https://epmonthly.com/contributor/terry-mulligan-md/) - Terry Mulligan, DO is a clinical assistant professor at the University of Maryland.
- [Jason Bryslawskyj](https://epmonthly.com/contributor/jason-bryslawskyj/) - Jason Bryslawskyj is a physicist at the Brookhaven Particle Collider.
- [Paul Rostykus, MD, MPH](https://epmonthly.com/contributor/paul-rostykus-md-mph/) - Paul Rostykus, MD, MPH has been an EMS medical director in Southern Oregon for 25 years and has a subspecialty certification in EMS.
- [Thomas A. Doyle, MD](https://epmonthly.com/contributor/thomas-a-doyle-md/) - Dr. Thomas A. Doyle is an emergency physician who practices in Sewickley, PA. He is the author of the forthcoming book “Suck It Up, America: The Tough Choices Needed for Real Health-Care Reform”
- [Allison Tadros, MD](https://epmonthly.com/contributor/allison-tadros-md/) - Allison Tadros, MD is an Associate Professor at West Virgina University’s Department of Emergency Medicine
- [Fred Wu, PA-C, MHS](https://epmonthly.com/contributor/fred-wu-pa-c-mhs/) - Fred Wu, PA-C, MHS is the Lead PA in the emergency department at Kaweah Delta Medical Center (Visalia, CA) and serves on the Board of Directors for the Society of Emergency Medicine Physician Assistants (SEMPA).
- [Harvey Castro, MD](https://epmonthly.com/contributor/harvey-castro-md/) - Harvey Castro, MD is the Medical Director of Elite Care Emergency.
- [David Tracy, MD](https://epmonthly.com/contributor/david-tracy-md/)
- [William Soares, MD](https://epmonthly.com/contributor/william-soares-md/) - William Soares, MD is an attending physician at Baystate Medical Center/Tufts University SOM.
- [Shivani Mody, DO](https://epmonthly.com/contributor/shivani-mody-do/) - Shivani Mody, DO is a chief resident in emergency medicine at Baystate Medical Center/Tufts University SOM.
- [Debra Baines, MD](https://epmonthly.com/contributor/debra-baines-md/) - Debra Baines, MD is an attending physician at Mercy Hospital in Chicago.
- [Ryan Lown, MD](https://epmonthly.com/contributor/ryan-lown-md/) - Ryan Lown, MD is a Senior EM resident at the University of Illinois.
- [Tim Valeriote, RN](https://epmonthly.com/contributor/tim-valeriote-rn/) - Tim Valeriote, RN, BSN, BSC, CEN is a senior member of the Emergency Department nursing team at UNC Hospitals.
- [Mark A. Merlin, DO, EMT-P](https://epmonthly.com/contributor/mark-a-merlin-do-emt-p/) - Mark A. Merlin, DO, EMT-P is the EMS Fellowship Director at Newark Beth Israel Medical Center/Barnabas Health
- [Ashley Shreves, MD](https://epmonthly.com/contributor/ashley-shreves-md/) - Ashley Shreves, MD is an assistant professor of emergency medicine specializing in geriatrics and palliative medicine at Mount Sinai’s Icahn School of Medicine.
- [Nikita K. Joshi, MD](https://epmonthly.com/contributor/nikita-k-joshi-md/) - Dr. Nikita K. Joshi is an academic fellow at Stanford University
- [Linda Lawrence, MD](https://epmonthly.com/contributor/linda-lawrence-md/) - Linda Lawrence, MD, is the current president of the American College of Emergency Physicians (ACEP)
- [Paul Kivela, MD](https://epmonthly.com/contributor/paul-kivela-md/) - Paul Kivela, MD is managing partner of the Napa Valley Emergency Medical Group in California. He is also medical director of Medic Ambulance and currently serves on the board of the Queen of the Valley Medical Center. He is former president of the Napa County Medical Association.
- [Munish Goyal, MD](https://epmonthly.com/contributor/munish-goyal-md/) - Munish Goyal, MD, is an adjunct assistant professor at the University of Pennsylvania School of Medicine.
- [Jerome Hoffman, MD](https://epmonthly.com/contributor/jerome-hoffman-md/) - Jerome Hoffman, MD is Professor Emeritus of Medicine at the UCLA School of Medicine.
- [Gary M. Gaddis, MD, PhD](https://epmonthly.com/contributor/gary-m-gaddis-md-phd/) - Gary M. Gaddis, MD, PhD is a Missouri Endowed Chair for Emergency Medicine, St. Luke’s Hospital of Kansas City
- [Alan Jon Smally, MD](https://epmonthly.com/contributor/alan-jon-smally-md/) - Alan Jon Smally, MD is the Medical Director at Hartford Hospital, CT
- [Mandy Robar, MD](https://epmonthly.com/contributor/mandy-robar-md/)
- [Kevin Kaucher, PharmD](https://epmonthly.com/contributor/kevin-kaucher-pharmd/) - Kevin Kaucher is a PharmD at Denver Health and Hospital Authority.
- [Deborah Vinton, MD](https://epmonthly.com/contributor/deborah-vinton-md/) - Dr. Deborah Vinton is a 3nd year Emergency Medicine Resident at the Denver Health Emergency Medicine Residency Program.
- [Maxwell S. Kennerly, ESQ.](https://epmonthly.com/contributor/maxwell-s-kennerly-esq/) - Maxwell S. Kennerly, Esq., is a Philadelphia trial lawyer and author of the blog www.LitigationandTrial.com
- [Jonathan E Siff, MD, MBA](https://epmonthly.com/contributor/jonathan-e-siff-md-mba/) - Jonathan E. Siff, MD, MBA is associate professor of emergency medicine at Case Western Reserve University and attending physician in the department of Emergency Medicine at the MetroHealth Medical Center in Cleveland, Ohio.
- [Greg Roslund, MD](https://epmonthly.com/contributor/greg-roslund-md/) - Gregory Roslund, MD is an emergency medicine doctor in Dallas, Texas and is affiliated with multiple hospitals in the area, including Methodist Charlton Medical Center and Texas Health Harris Methodist Hospital Fort Worth.
- [John Dallara, MD](https://epmonthly.com/contributor/john-dallara-md/) - John Dallara, MD, practices emergency medicine in Virginia and North Carolina and directs the EM PREP Course. www.emprepcourse.com
- [Mikhail Elfond, DO](https://epmonthly.com/contributor/mikhail-elfond-do/) - Mikhail Elfond, DO, is the associate director of academic affairs / attending physician, Nassau University Medical Center in East Meadow, New York.
- [Mike Elfond, DO](https://epmonthly.com/contributor/mike-elfond-do/) - Mikhail Elfond, DO, is the associate director of academic affairs / attending physician, Nassau University Medical Center in East Meadow, New York.
- [Christine Ahn, MD](https://epmonthly.com/contributor/christine-ahn-md/) - Christine Ahn, MD, is a PGY-3 and chief resident at SUNY Stony Brook with an appointment as faculty starting July 2010.
- [Eric McLaughlin, MD](https://epmonthly.com/contributor/eric-mclaughlin-md/) - Eric McLaughlin, MD is the medical Director at Elite Care Emergency Center in Houston, Texas.
- [Dr. Maegan Reynolds](https://epmonthly.com/contributor/dr-maegan-reynolds/) - Dr. Maegan Reynolds is a 3rd year EM Resident at the Denver Health Emergency Medicine Residency Program.
- [Dr. Lucia Modesti](https://epmonthly.com/contributor/dr-lucia-modesti/) - Dr. Lucia Modesti is a 4th year resident from University of California at San Diego.
- [Lauren Maeda, MD](https://epmonthly.com/contributor/lauren-maeda-md/)
- [Jonathan Sherbino, MD](https://epmonthly.com/contributor/jonathan-sherbino-md/)
- [Dr. Peter Pryor](https://epmonthly.com/contributor/dr-peter-pryor/) - Dr. Pryor is a faculty member at Denver Health and is an Assistant Professor of EM at the University of Colorado School of Medicine.
- [Dr. John Kendall](https://epmonthly.com/contributor/dr-john-kendall/) - Dr. Kendall is the Director of the Ultrasound Fellowship at Denver Health and Associate Professor at the University of Colorado School of Medicine.
- [Dr. Courtney Smalley](https://epmonthly.com/contributor/dr-courtney-smalley/) - Dr. Smalley is a 3rd-year EM Resident.
- [Joseph Habboushe](https://epmonthly.com/contributor/joseph-habboushe/) - Joseph Habboushe, MD, MBA is an attending at Beth Israel. He is the creator and editor of EMRA's Basics of Emergency /medicine pocket guide and iphoneapp.
- [Taylor McCormick, MD](https://epmonthly.com/contributor/taylor-mccormick-md/) - Taylor McCormick, MD is a fourth year emergency medicine resident at Los Angeles Country and the University of Southern California Medical Center.
- [Mandy Robar](https://epmonthly.com/contributor/mandy-robar/) - Mandy Robar is an Ultrasound Fellow at Denver Health.
- [Mike Miller](https://epmonthly.com/contributor/mike-miller/) - Mike Miller is a 3rd year Resident at Denver Health Emergency Medicine Residency.
- [Jeremiah D. Schuur, MD](https://epmonthly.com/contributor/jeremiah-d-schuur-md/) - Jeremiah D. Schuur, MD is the Co-Chair of ACEP's Cost-Effective Care Taskforce, Chief of the Division of Health Policy Translation in the Department of EM at Brigham and Women's Hospital, and an assistant professor of Emergency Medicine at Harvard Medical School.
- [Rhonda Cadena, MD](https://epmonthly.com/contributor/rhonda-cadena-md/) - Rhonda Cadena, MD is an assistant professor of emergency medicine and neurology at the University of North Carolina.
- [Kevin Klauer, DO, EJD](https://epmonthly.com/contributor/kevin-klauer-do-ejd/) - Kevin Klauer, DO, EJD is the former editor-in-chief of Emergency Physicians Monthly, the CMO of TeamHealth, and the Vice Speaker of the ACEP Council.
- [Justin Hepker, MD](https://epmonthly.com/contributor/justin-hepker-md/) - Justin Hepker, MD is an emergency physician at Franciscan St. Anthony Health in Michigan City, Indiana.
- [Adam Levine, MD](https://epmonthly.com/contributor/adam-levine-md/) - Adam Levine, MD is an assistant professor of emergency medicine and director of the Global Emergency Medicine Fellowship at Brown University.
- [Kerri A. Broderick, MD](https://epmonthly.com/contributor/kerri-a-broderick-md/) - Kerri A. Broderick, MD is an associate professor of emergency medicine at Denver Health Medical Residency Program.
- [Bill Dribben, MD](https://epmonthly.com/contributor/bill-dribben-md/) - Bill Dribben, MD practices emergency medicine and toxicology at Washington University School of Medicine.
- [Joseph Watkins, MD](https://epmonthly.com/contributor/joseph-watkins-md/) - Joseph Watkins, MD is a 4th year resident in emergency medicine at Washington University in St. Louis and is the director of the Washington University EM Journal Club.
- [Anoop Kumar, MD](https://epmonthly.com/contributor/anoop-kumar-md/) - Dr. Kumar is an emergency physicians and the founder of The Story of Health.
- [Richard L. Stennes, MD, MBA](https://epmonthly.com/contributor/richard-l-stennes-md-mba/) - Richard L. Stennes MD, MBA, is the ACEP Delegate to the AMA House of Delegates and was the president of ACEP from 1985-1986.
- [David Mishkin, MD](https://epmonthly.com/contributor/david-mishkin-md/) - David Mishkin, MD is an emergency physician with Sheridan Healthcare. He practices at Baptist Hospital of Miami.
- [Uzma Samadani, MD, PHD, FACS](https://epmonthly.com/contributor/uzma-samadani-md-phd-facs/) - Uzma Samadani, MD, PHD, FACS is the Co-Director at the Steven and Alexandra Cohen Veterans Center for Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone Medical Center; Assistant Professor Departments of Neurosurgery, Psychiatry, Physiology and Neuroscience, New York University School of Medicine, New York; Chief Neurosurgeon New York Harbor Health Care System
- [David Gilinson](https://epmonthly.com/contributor/david-gilinson/) - David Gilinson is a Senior Management Consultant and data scientist at ReefPoint Group, an analytic consulting firm headquartered in Annapolis Maryland.
- [Stephen A. Harper, MD](https://epmonthly.com/contributor/stephen-a-harper-md/) - Stephen A. Harper is a Major in the US Army and current Military EMS and Disaster Medicine Fellow.
- [Robert Simpson, BHSc, Grad Dip ICP](https://epmonthly.com/contributor/robert-simpson-bhsc-grad-dip-icp/) - Robert Simpson is an intensive care paramedic in Australia and the author of AmboFOAM, a medical education blog for paramedics. Read more at ambofoam.blogspot.com
- [Amy Kraft](https://epmonthly.com/contributor/amy-kraft/) - Amy Kraft is a Science reporter based in New York City.
- [Edward Read Jr., MD](https://epmonthly.com/contributor/edward-read-jr-md/) - Edward Read Jr., MD is an Assistant Professor in the Department of Emergency Medicine at Virginia Commonwealth University. He is also an Attending Physician in the Emergency Medicine Department at McGuire VA Medical Center in Richmond, Virginia.
- [Howard Kim, MD](https://epmonthly.com/contributor/howard-kim-md/) - Howard Kim, MD is a PGY-4 resident at the Denver Health Residency in Emergency Medicine.
- [Jesse Loar, MD](https://epmonthly.com/contributor/jesse-loar-md/) - Jesse Loar, MD is a PGY-4 resident at the Denver Health Residency in Emergency Medicine.
- [Jared Marcucci MS, MD](https://epmonthly.com/contributor/jared-marcucci-ms-md/)
- [Alicia Peterson, MD](https://epmonthly.com/contributor/alicia-peterson-md/) - Alicia Peterson, MD is the Chief Resident of Emergency Medicine at the Maricopa Medical Center
- [Jason Grimsman, MD](https://epmonthly.com/contributor/jason-grimsman-md/) - Jason Grimsman, MD is an Emergency Ultrasound Fellow at the Maricopa Medical Center.
- [Chris Crowe, MD](https://epmonthly.com/contributor/chris-crowe-md/) - Chris Crowe, MD is an attending physician at Maricopa Medical Center
- [Michelle Lin, MD](https://epmonthly.com/contributor/michelle-lin-md/) - Michelle Lin, MD is the Editor-in-Chief of Academic Life in Emergency Medicine
- [Chetan U. Kharod, MD, MPH](https://epmonthly.com/contributor/chetan-u-kharod-md-mph/) - Dr. Kharod is a Military EMS and Disaster Medicine Fellow
- [Robert L. Mabry, MD](https://epmonthly.com/contributor/robert-l-mabry-md/) - Dr. Mabry is the Fellowship Director of the Military EMS and Disaster Medicine Fellowship at Fort Sam Houston, San Antonio, Texas.
- [Kerry Ann Broderick, MD](https://epmonthly.com/contributor/kerry-ann-broderick-md/) - Kerry Ann Broderick is an associate professor of emergency medicine at Denver Health Medical Residency Program.
- [Matthew Taecker, MD](https://epmonthly.com/contributor/matthew-taecker-md/) - Matthew Taecker is a fourth year resident at the Denver Health Residency in Emergency Medicine.
- [David Bosch, DO](https://epmonthly.com/contributor/david-bosch-do/) - David Bosch is a fourth year resident at the Denver Health Residency in Emergency Medicine.
- [Joseph Carter, MD](https://epmonthly.com/contributor/joseph-carter-md/)
- [Matthew Roehrs, DO](https://epmonthly.com/contributor/matthew-roehrs-do/) - Dr. Matthew Roehrs is an emergency medicine doctor in Des Moines, Iowa. He received his medical degree from Des Moines University College of Osteopathic Medicine
- [James J. Augustine, MD](https://epmonthly.com/contributor/james-j-augustine-md/) - James J. Augustine, MD is the vice president of the Emergency Department Benchmarking Alliance and is the Director of Clinical Operations for Emergency Medicine Physicians (EMP) in Canton, Ohio.
- [Brian Cohn, MD](https://epmonthly.com/contributor/brian-cohn-md/) - Brian Cohn, MD is an assistant professor of EM at Washington University in St. Louis.
- [Ricardo Martinez, MD](https://epmonthly.com/contributor/ricardo-martinez/) - Ricardo Martinez, MD is the Chief Medical Officer for North Highland and assistant professor of emergency medicine at Emory University School of Medicine.
- [Lynn Massingale](https://epmonthly.com/contributor/lynn-massingale/) - Lynn Massingale is the Executive Chairman and former CEO of TeamHealth.
- [Christopher R. Carpenter, MD, MSc](https://epmonthly.com/contributor/christopher-r-carpenter-md-msc/) - Christopher R. Carpenter, MD, MSc, is an assistant professor of emergency medicine and the director of evidence based medicine at Washington University in St. Louis. He is also on faculty with Best Evidence in Emergency Medicine (BEEM).
- [Joseph Habboushe, MD MBA](https://epmonthly.com/contributor/joseph-habboushe-md-mba/) - Joseph Habboushe, MD MBA is an attending at Beth Israel. Joe is the creator and editor of EMRA’s Basics of Emergency Medicine pocket guide & iPhone app.
- [Eric Steinberg, DO](https://epmonthly.com/contributor/eric-steinberg-do/) - Eric Steinberg, DO is a EM resident at Beth Israel Medical Center of the Albert Einstein College of Medicine.
- [Stuart Swadron, MD](https://epmonthly.com/contributor/stuart-swadron-md/) - Stuart Swadron, MD is currently Vice-Chair for Education in the Dept of EM at the LA County/USC Medical Center. He is an Associate Professor of Clinical Emergency Medicine at the Keck School of Medicine of the University of Southern California. EM:RAP (Emergency Medicine: Reviews and Perspectives) is a monthly audio program that can be found at
- [Mark Rosenberg, DO, MBA](https://epmonthly.com/contributor/mark-rosenberg-do-mba/) - Mark Rosenberg, DO is the chairman of emergency medicine and chief of geriatric emergency medicine and palliative medicine at St Joseph’s Healthcare System in Paterson, New Jersey.
- [Myles Riner, MD](https://epmonthly.com/contributor/myles-riner-md/) - Myles Riner, MD is the 2010 winner of ACEP’s Colin Rorrie Award for Excellence in Health Policy; Author of the blog Ficklefinger.net.
- [Jessica Munoz, RN](https://epmonthly.com/contributor/jessica-munoz-rn/) - Jessica Munoz, RN, BSN, MSN, APRN-RX, FNP-BC is a practicing emergency nurse practitioner in Hawaii. She has spent the past 5 years working in the arena of human trafficking. She is currently the volunteer director for the Courage House Hawaii (tm) project whose goal is to build a long-term residential home for underage victims of
- [Ghazala Q. Sharieff, MD, MBA](https://epmonthly.com/contributor/ghazala-q-sharieff-md-mba/) - Ghazala Sharieff, MD, MBA is the Director of Pediatric Emergency Medicine at the Palomar-Pomerado Health System/California Emergency Physicians
- [Jim Ducharme, MD, CM, FRCP](https://epmonthly.com/contributor/jim-ducharme-md-cm-frcp/) - Jim Ducharme, MD, CM, FRCP, is a clinical professor of medicine, McMaster University. He is the Editor-in-Chief, Canadian Journal of Emergency Medicine, Senior VP and Chief Medical Officer at the AIM Health Group, and the Vice-President, International Federation for Emergency Medicine.
- [Jeffrey P. Feden, MD](https://epmonthly.com/contributor/jeffrey-p-feden-md/) - Jeffrey P. Feden, MD works in the Division of Sports Medicine at The Alpert Medical School of Brown University.
- [Timothy Erickson, MD](https://epmonthly.com/contributor/timothy-erickson-md/) - Timothy B. Erickson, MD is an EM professor at the University of Illinois at Chicago.
- [David Newman, MD](https://epmonthly.com/contributor/david-newman-md/) - David H. Newman, MD is the author of Hippocrates’ Shadow: Secrets From The House Of Medicine
- [Rich Levitan, MD](https://epmonthly.com/contributor/rich-levitan-md/) - Richard Levitan, MD, works at several hospitals in rural New Hampshire, has academic affiliations at the University of Maryland and Dartmouth Medical School, and runs the world’s largest fresh-tissue cadaver airway course every month in Baltimore. More at CEME.org
- [EPM Community](https://epmonthly.com/contributor/admin/)
- [WhiteCoat](https://epmonthly.com/contributor/whitecoat/) - I’m a middle-aged ED physician who likes computers, martial arts, and taking pictures of sunsets. I have an amazing wife who willingly puts up with all of my idiosyncrasies and four great kids who don’t have any choice. My family is my rock. Since I’m an emergency physician, my bias is toward topics that affect
- [Erika Pasciuta, MD](https://epmonthly.com/contributor/erika-pasciuta-md/) - Erika Pasciuta, MD, is a PEM fellow at Kosair Children's Hospital for the Department of Pediatrics at the University of Louisville School of Medicine.

## Blogs

- [Bring 'em All video spotlights frontline medical workers](https://epmonthly.com/blog/bring-em-all-video-spotlights-frontline-medical-workers/) - Eugene Richards, who handled the photography and interviews for the ACEP 50th anniversary book, Bring 'em All, put together a video in honor of the medical workers. Richards said it was hard to see the headlines about frontline workers treating those dealing with COVID-19 without thinking of the people he profiled in the video, which
- [Crash Cart: Why Spending on EDs has Sykrocketed; DNR Tattoo Taboo? Why Wood You Do That?](https://epmonthly.com/blog/crash-cart-spending-eds-sykrocketed-dnr-tattoo-taboo-wood/) - This week: Facility coding and virtual monopoly blamed for extreme ED bills; Should docs trust tattooed medical instructions?; Popping zit with woodworking blade = bad idea. Join in as our editors discuss the week's headlines. ----------------------- In an analysis of over 70 million ED bills, the Health Care Cost Institute (HCCI) and Vox have determined that
- [Crash Cart: Toyota Speeds ER Discharges; Parents of Patients Can Be Present Says More ERs; Why ERs Get a Holiday Surge](https://epmonthly.com/blog/crash-cart-toyota-speeds-er-discharges-parents-patients-can-present-says-ers-ers-get-holiday-surge/) - This week: Toyota tune ups ER discharge process, making it 40% quicker; ERs may stop ushering loved ones into “the other room”; There’s several reasons why ERs get a 5-15% increase around the holidays. Join in as our editors discuss the week's headlines. ----------------------- Toyota likes to help make nonprofits more efficient, so when the company
- [Crash Cart: Nurse Legislator Says ERs Should Be Able to Refuse People; How ERs Saved Hospitals; Most Docs Have Encountered Abusive Remarks](https://epmonthly.com/blog/crash-cart-nurse-legislator-says-ers-able-refuse-people-ers-saved-hospitals-docs-encountered-abusive-remarks/) - This week: GOP lawmaker Diane Black wants EMTALA changed to allow ERs to turn people away to cut costs; People avoided hospitals until ERs revolutionized them; New survey says 59 percent of docs have quietly suffered offensive remarks about their physical characteristics. Join in as our editors discuss the week's headlines. ----------------------- Rep. Diane Black (R-Tenn.),
- [Crash Cart: Anthem Inc Policy Angers ACEP; Follow-Up After ED Missing; CA Nurse House Burns During Evacuation](https://epmonthly.com/blog/crash-cart-anthem-inc-policy-angers-acep-follow-ed-missing-ca-nurse-house-burns-evacuation/) - This week: ACEP says “Prudent Laypersons” at risk with Anthem Inc ED policy, study finds lack of follow-up after ED visits; California nurse's house burns as she evacuates patients in Intensive Care. Join in as our editors discuss the week's headlines. ----------------------- ACEP has stepped up its opposition to Anthem Inc’s policy of rejecting ED claims
- [Crash Cart: Handling the hurricanes in Houston and Florida—and beyond; a safe space for illegal drug users?](https://epmonthly.com/blog/crash-cart-handling-hurricanes-houston-florida-beyond-safe-space-illegal-drug-users/) - This week: NPR on a Houston ER during Harvey; Hospitals preparing for Irma; Health records among Harvey losses; Supervised drug injection in Canada. Join in as our editors discuss the week's headlines. ----------------------- Downtown Houston’s only hospital is just blocks from a convention center where thousands of Harvey evacuees are staying. As NPR reports, 600
- [Crash Cart: The Pain of Electronic Medical Records; Some Patients Still Demand White Docs; iPads Becoming Lifesavers](https://epmonthly.com/blog/crash-cart-pain-electronic-medical-records-patients-still-demand-white-docs-ipads-becoming-lifesavers/) - This week: Digital records need redesign to avoid physician burnout; Asian American ER doc refused by white nationalists in Oregon; Two-way video calling tablets already saving lives in England. Join in as our editors discuss the week's headlines. ----------------------- While Electronic Media Records (EMRs) should make health care better, they are a major cause of
- [Crash Cart: Talking About Near Misses; Death to “Dry Drowning”; Will NaloxBoxes Deliver OD Prevention?](https://epmonthly.com/blog/crash-cart-talking-near-misses-death-dry-drowning-will-naloboxes-deliver-od-prevention/) - This week: Physicians openly discuss mistakes; Why the term “dry drowning” needs to go under; NaloxBox's solution for ODs may be worth a shot. Join in as our editors discuss the week's headlines. ----------------------- A surgical resident at University of North Carolina says physicians need to talk more openly about their mistakes, advocating for debriefings
- [Crash Cart: Trump on Opioid Emergency; Knowledgeable Patients are Helpful; Full Stop Needed After ED Deaths](https://epmonthly.com/blog/crash-cart-trump-opioid-emergency-knowledgeable-patients-helpful-full-stop-needed-ed-deaths/) - This week: Trump may declare opioid epidemic an official emergency; Survey says more nurses appreciate knowledgeable patients than doctors; The common impulse to “move on” after deaths in the ED. Join in as our editors discuss the week’s headlines. Join in as our editors discuss the week's headlines. ----------------------- With 63% of 2015’s 52,000 American
- [Crash Cart: Gig-Style Staffing; Source of Surprise Bills; The Diagnosis of Human Trafficking](https://epmonthly.com/blog/crash-cart-gig-style-staffing-source-surprise-bills-diagnosis-human-trafficking/) - This week: NomadHealth aims to reduce staffing shortages; One company behind many out-of-network charges; Why human trafficking needs an ICD code. Join in as our editors discuss the week's headlines. ----------------------- The Association of American Medical Colleges (AAMC) projects a shortage of 40,800-104,900 physicians relative to need by the year 2030 An offshoot of telemedicine, Nomad
- [Crash Cart: Putting emergency back in ERs; mystic hospitals; call women doctor, too!; medical drones](https://epmonthly.com/blog/crash-cart-putting-emergency-back-ers-mystic-hospitals-call-women-doctor-medical-drones/) - This week: ERs can return to true emergency care; Top hospitals employ unproven treatments; Female docs often get introduced by their first names, look! up in sky! It’s a defibrillator! Join in as our editors discuss the week's headlines. ----------------------- In recent decades, trips to the ER have risen, with care for non-emergent and less
- [Crash Cart: Seniors Going AMA More Often; Red, White, and Black & Blue; Point-of-View Tech](https://epmonthly.com/blog/crash-cart-seniors-going-ama-often-red-white-black-point-view-tech/) - This week: Older patients sometimes have good reason to leave; Ordinary and unusual Fourth of July tales; New tech gives own point-of-view. Join in as our editors discuss the week's headlines. ----------------------- ED physicians working the Fourth of July expect run-of-the-mill summertime incidents and some firework injuries. But sometimes the bombs don’t burst in air
- [Crash Cart: The Drop Out Club, palliative care, and a patient's guide to the ER](https://epmonthly.com/blog/crash-cart-drop-club-palliative-care-patients-guide-er/) - This week: Docs talk about leaving medicine; Does palliative care belong in the ER?; Patients knowing how to properly utilize ER services. Join in as our editors discuss the week's headlines. ----------------------- The first rule of Drop Out Club is talk about doctor burnout with like-minded doctors While one study found that over half of all
- [Crash Cart: EM in space, costly teaching hospitals, and overcharging patients](https://epmonthly.com/blog/crash-cart-em-space-costly-teaching-hospitals-overcharging-patients/) - This week: Dammit Jim, medicine in space ain’t easy!; Learning the benefits and costs of teaching hospitals; Hopkins finds ER patients routinely overcharged. Join in as our editors discuss the week's headlines. ----------------------- Astronauts on long-term missions, like a crew going to Mars, face special medical risks that require ingenuity Weakened bones, radiation poisoning, and
- [Crash Cart: AHCA provisions, lab results via smartphones, and dogs in the ED](https://epmonthly.com/blog/crash-cart-ahca-provisions-lab-results-via-smartphones-dogs-ed/) - This week: The American Health Care Act; smartphones leading to faster discharges; dogs helping patients wag more, bark less. Join in as our editors discuss the week's headlines. ----------------------- The American Health Care Act and the emergency department ABC lists the major provisions of AHCA, explaining the details and highlighting the differences between it and ACA
- [Crash Cart: Boarding in overcrowded hospitals, transgender patients, and police related injuries](https://epmonthly.com/blog/crash-cart-boarding-overcrowded-hospitals-transgender-patients-police-related-injuries/) - This week: Boarding is “as bad as ever” in the ED, #transhealthfail is an unfortunate ER reality, and police-related injury stats. Join in as our editors discuss the week's headlines. ----------------------- In addition to giving a short history on demands on ERs have grown in America, Yale professor, Howard Forman, says that is time ERs
- [Crash Cart: Patient discrimination, nasal delivery, and marathon related deaths from road closures](https://epmonthly.com/blog/crash-cart-patient-discrimination-nasal-delivery-marathon-related-deaths-road-closures/) - This week: Patient choice sometimes includes racism and sexism, ER docs issuing more “up yours”, and marathon detours cause more deaths. Join in as our editors discuss the week's headlines. ----------------------- One study says as many as 15% of pediatric docs experienced discrimination from patients With 1 in 4 U.S. docs being international grads, a
- [Crash Cart: Hospital and insurance bill coder battles, the three emergency treatment options, and Maryland’s longest ER waiting time](https://epmonthly.com/blog/crash-cart-hospital-insurance-bill-coder-battles-emergency-treatment-options-marylands-longest-er-waiting-time/) - This week: Coder battles are major cause of sky-high medical bills, a study examines emergency care facility options and Maryland ER wait is the worst in the nation. Join in as our editors discuss the week's headlines. ----------------------- The battle between hospital and insurance bill coders—not simply medicine itself—is shown to be a major factor
- [Crash Cart: ACEP vs TrumpCare, Joint Commission inspections, and malnutrition](https://epmonthly.com/blog/crash-cart-acep-vs-trumpcare-joint-commission-inspections-malnutrition/) - This week: ACEP speaks out against TrumpCare changes to AHCA. Plus, study shows that watchful eyes (the Joint Commission) equals less patients dying. Join in as our editors discuss the week's headlines. ----------------------- American College of Emergency Physicians found the proposed AHCA changes worth breaking its traditional silence on legislation The Freedom Caucus of The
- [Crash Cart: The return of 24 hour shifts, gender and racial bias, jet-injected lidocaine, and death-predicting algorithms](https://epmonthly.com/blog/crash-cart-return-24-hour-shifts-gender-racial-bias-jet-injected-lidocaine-death-predicting-algorithms/) - This week: Newbies may now doc around the clock, three studies that show women and minorities don’t get a fair shot, increasing the use of jet-injected lidocaine in pediatric EM, and predicting death is now far more than a guessing game. Join in as our editors discuss the week's headlines. ----------------------- Starting July 1, new doctors can
- [Crash Cart: What to do with the "fifth vital sign," truly sick hospital designs, and super bad super bugs](https://epmonthly.com/blog/crash-cart-fifth-vital-sign-truly-sick-hospital-designs-super-bad-super-bugs/) - This week: Half of our colleagues support eliminating pain as the "fifth vital sign." Plus, the WHO announces their list of priority pathogens. Join in as our editors discuss the week's headlines. ----------------------- A Medscape survey says half of doctors and nurses support eliminating pain as the “Fifth Vital Sign.” The majority of docs use
- [Crash Cart: Admission rates, EM apps, antibiotic prescribing, and cockroaches in skulls](https://epmonthly.com/blog/crash-cart-admission-rates-em-apps-antibiotic-prescribing-cockroaches-skulls/) - This week: Is your hospital's admission rate the reason healthy patients die? Plus, more steps are suggested for your antibiotic prescribing. Join in as our editors discuss the week's headlines. ----------------------- A hospital's admission rate is the life and death factor for healthy patients visiting the ED “‘We restricted the sample to people who shouldn't be dying. People
- [Crash Cart: Required burials of miscarriages, stress echoes, and ex-inmates in the ED](https://epmonthly.com/blog/crash-cart-required-burials-miscarriages-stress-echoes-ex-inmates-ed/) - This week: The ethics of requiring women to bury the remains of miscarriages and abortions. Plus, which is better for chest pain: stress echocardiography or coronary CT angiography? Join in as our editors discuss the week's headlines. ----------------------- Texas passes new laws that would require women who have miscarriages or abortions to bury or cremate their
- [Crash Cart: Out-of-network bills, Thanksgiving injuries, and an app for stroke image sharing](https://epmonthly.com/blog/crash-cart-11-30-2016/) - This week: 1 in 5 ED patients may still receive a bill from a doctor out of network. Plus, Thanksgiving's most common injuries. Join in as our editors discuss the week's headlines. ----------------------- Surprise! Here is another medical bill. A new study shows 1 in 5 patients who visit the ER may still receive a bill
- [Crash Cart: Patient discrimination, medicaid coverage, ghost peppers, and Cubs fans in the ED](https://epmonthly.com/blog/crash-cart-patient-discrimination-medicaid-coverage-ghost-peppers-cubs-fans-ed/) - This week: EPs dealing with patient discrimination. Plus, will Chicago ED visits spike during the World Series? Join in as our editors discuss the week's headlines. ----------------------- How do you deal with patient discrimination? One study looks at physicians who have reported discrimination and offers strategies to use in a tense situation. Original Article by Kaiser
- [Crash Cart: 24-hour shifts for first year residents, community paramedic practice, and primary care hours](https://epmonthly.com/blog/crash-cart-24-hour-shifts-first-year-residents-community-paramedic-practice-primary-care-hours/) - This week: First-year residents are bumping up to 24-hour shifts. Plus, paramedics bring emergency geriatric care to patient's doorsteps. Join in as our editors discuss the week's headlines. ----------------------- The 16-hour shift is ending for first-year doctors A proposal by ACGME recommends that first-year residents be allowed to work 24-hour shifts. The ACGME said the goal
- [Crash Cart: ED influx, the FDA's drug watch list, EOL forms, and roller coasters for kidney stones](https://epmonthly.com/blog/crash-cart-emerging-state-medical-care-ed-fdas-drug-watch-list-eol-forms-roller-coasters-kidney-stones/) - This week: Huffington Post describes the emerging state of medical care in the ED. Plus, there is a potential new kidney stone remedy - roller coasters. Join in as our editors discuss the week's headlines. ----------------------- Emergency rooms are becoming busier with the influx of patients coming in for routine checkups Techniques such as "boarding,"
- [Crash Cart: The EpiPen price surge, missed diagnoses, and stroller injuries](https://epmonthly.com/blog/crash-cart-9-30-2016/) - This week: Mylan increases EpiPen prices over 400%. Plus, can you diagnose what's wrong with this child that's had a fever every night for a month? Join in as our editors discuss the week's headlines. ----------------------- EpiPen prices rise 400% The pharmaceutical company behind the allergy medication sees the high demand an an opportune market as
- [Crash Cart: Nurse-driven protocols, autopilot cars, troponin, and FSEDs in high-income areas](https://epmonthly.com/blog/crash-cart-nurse-driven-protocols-autopilot-cars-troponin-fseds-high-income-areas/) - This week: Did this autopilot Tesla save this man's life by taking him to the ER. Plus, the debate on whether FSEDs are chasing the money by being in high-income areas? Join in as our editors discuss the week's headlines. ----------------------- Nurse-driven protocols can decrease ED overcrowding and reduce the length of stay for patients
- [Crash Cart: Pokémon Go, the Dallas shooting, and hypertension patients](https://epmonthly.com/blog/crash-cart-7-21-2016/) - 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. ----------------------- Dallas EPs take care of "extended family" the night of Dallas
- [Crash Cart: The decrease in ED deaths, complicated science papers, and telling patients the bad prognosis](https://epmonthly.com/blog/crash-cart-decrease-ed-deaths-complicated-science-papers-telling-patients-bad-prognosis/) - This week: Studies show there has been a substantial drop in ED deaths since 2011. Plus, when is the right time to tell your patient's family the bad prognosis? Join in as our editors discuss the week's headlines. ----------------------- ED deaths dropped 48% since 2011 The decline in ED mortality may be due to advances in
- [Crash Cart: APPs with full practice authority in the VA, complex scheduling, and adding humanities to med school curriculum](https://epmonthly.com/blog/crash-cart-6-29-2016/) - This week: The VA proposes solving physician shortages with advanced practice providers by giving them full practice authority. Plus, can adding literature study to medical training reduce burnout? Join in as our editors discuss the week's headlines. ----------------------- Is your schedule overflowing? We know why. New research shows emergency physicians schedules are the most complex due
- [Crash Cart: Ending Step-2 CS, reoccurring headaches, opioid alternatives, and the Orlando shootings](https://epmonthly.com/blog/crash-cart-ending-step-2-cs-reoccurring-headaches-opioid-alternatives-orlando-shootings/) - This week: The AMA passes resolution calling for state medical boards to end Step-2 CS. Plus, would you use laughing gas as an alternative to prescribing opioids? Join in as our editors discuss the week's headlines. ----------------------- Step 2 the side: The AMA passes resolution calling for state medical boards to end Step-2 CS The $1,300
- [Crash Cart: A history of opioids, the real cause of medical errors, and the amount of work involved in being a patient](https://epmonthly.com/blog/crash-cart-6-7-2016/) - This week: A history of opioids and government regulations. Plus, are medical errors the results of individual mistakes or the system itself? Join in as our editors discuss the week's headlines. ----------------------- A history of the dangerous drugs that killed Prince The singer's death makes pain management and opioids the topic of conversation. Original Article by
- [Crash Cart: ACEP lawsuit, an EP launched community initiative, and Dr. Heimlich performing the Heimlich manuever](https://epmonthly.com/blog/crash-cart-acep-lawsuit-ep-launched-community-initiative-dr-heimlich-performing-heimlich-manuever/) - This week: ACEP sues the department of Health and Human Services. Plus, Dr. Heimlich saves a choking woman using the technique he invented for the first time. Join in as our editors discuss the week's headlines. ----------------------- ACEP sues the department of Health and Human Services over inadequate emergency payment rules The federal agency reimburses EPs
- [Crash Cart: Steven Stack’s open letter about opioids, code threes, and a study showing EM education costs more than average mortgage](https://epmonthly.com/blog/crash-cart-5-25-2016/) - This week: Steven Stack pens open letter to EPs to stop prescribing opioids. Plus, an EP with a code 3 critical patient questions how much he should do in the absence of a signed affidavit. Join in as our editors discuss the week's headlines. ----------------------- AMA president pens open letter to EPs to stop prescribing opioids Stack
- [Crash Cart: A $629 band-aid, hospital infections, and insurance coverage naivety](https://epmonthly.com/blog/crash-cart-5-17-2016/) - This week: Uproar over a $629 band-aid bill. Plus, do patients and EPs really know what medical insurance covers? Join in as our editors discuss the week's headlines. ----------------------- Patient receives $629 Band-Aid Bill from ED visit The expensive charge questions health care's hospital facility fees. Original Article by Vox. Ryan McKennon, DO: First off, this is
- [Crash Cart: The third leading cause of death, Imodium addictions, and drug shortages](https://epmonthly.com/blog/crash-cart-5-11-2016/) - This week: A new BMJ report says medical errors cause over 25,000 deaths annually making it the third leading cause of death in the US. Plus, Imodium is now being sought after for a euphoric high. Join in as our editors discuss the week's headlines. ----------------------- Diagnostic errors are the third leading cause of death
- [Crash Cart: Prince, Zika, and the top diagnostic errors made by EPs](https://epmonthly.com/blog/crash-cart-5-4-2016/) - This week: Prince's death has many talking about prescription painkiller overdoses and influenza. Plus, a Zika story that brings the hysteria to the forefront. Join in as our editors discuss the week's headlines. ----------------------- Prince's death could be due to an overdose on prescription painkillers or the Flu New reports say Percocet was found on
- [Crash Cart: Penalties for being too careful, satisfied patients, and cognitive loads](https://epmonthly.com/blog/penalties-for-being-too-careful-satisfied-patients-and-cognitive-loads/) - This week: Should EDs get penalized for being too thorough with their tests? Plus, a report on cognitive load just might be what EPs need for a boost in mental health. Join in as our editors discuss the week's headlines. ----------------------- Medicare punishes hospitals for being thorough 758 hospitals across the country will lose funding
- [Crash Cart: Refunds for unsatisfied patients, ACEP vs Excellus, and the ESETT study](https://epmonthly.com/blog/crash-cart-4-20-2016/) - This week: EDs are now passing out refunds for unsatisfied patients. Plus, ACEP calls out Excellus report on ER visits. Join in as our editors discuss the week's headlines. ----------------------- Unhappy patient? Issue a refund Using a smartphone app, Geisinger Health System in Pennsylvania offers refunds to patients unsatisfied with their care. Original Article by
- [Crash Cart: Anesthesiology, fitness trackers, and texting while walking](https://epmonthly.com/blog/12660/) - This week: We have a new certification collab between anesthesiology and EM. Plus, who gets the credit in this lifesaving case: EPs or a fitbit? Join in as our editors discuss the week's headlines. ----------------------- Residents can combine anesthesiology and emergency medicine study in new program The ABA and ABEM teamed up to provide a
- [Crash Cart: New CMS ruling, physician power couples in rural regions, and unlocking a patient's phone](https://epmonthly.com/blog/12571/) - This week: With the rise of the power couple, rural communities are at a disadvantage in hiring EPs. Plus, is it unethical to unlock your patient's phone with their thumb? Join in as our editors discuss the week's headlines. ----------------------- New CMS ruling causes Jay Kaplan, ACEP president, to speak out "Rather than holding insurance
- [Crash Cart: Compensation reports, EMTALA backfire, and the end of the VA](https://epmonthly.com/blog/crash-cart-4-5-2016/) - This week: Medscape reports on EM compensation and costs. Plus, is this the end of VA hospitals? Join in as our editors discuss the week's headlines. ----------------------- EM physicians had a 5% increase in income this year Medscape reports EM physician compensation ranks in the middle among physician specialties. Original Article by Medscape. Nicholas Genes, MD, PhD: It's
- [Crash Cart: A video PSA for the correct use of EDs, e-prescribing, and opioid restriction](https://epmonthly.com/blog/crash-cart-a-video-psa-for-the-correct-use-of-eds-e-prescribing-and-opioid-restriction/) - This week: The Queensland government created a funny and effective video to show the purpose of EDs, but would this work in the US? Plus, what would EPs do if they were forced to switch entirely to e-prescribing. Join in as our editors discuss the week's headlines. ----------------------- The ED Slogan: Keep Emergency for emergencies Queensland government creates an effective
- [Crash Cart: Transparency for medical data and the top items EPs refuse to keep at home](https://epmonthly.com/blog/12557/) - This week: What do trampolines, old pills and ramen noodles have in common—EPs refuse to have them in their homes. Plus, BMJ raises questions about the need for transparency in medical research. Join in as our editors discuss the week's headlines. ----------------------- Why medical data needs transparency BMJ editor, Fiona Godlee tackles medical research and
- [Crash Cart: How the ACA impacted ED volumes, plus new ED patient assessment models](https://epmonthly.com/blog/12528/) - This week: Has there been a change in ED visits since the passing of the Affordable Care Act? Plus, new ED model promises assessment at first sight. Join in as our editors discuss the week's headlines. ----------------------- According to an NHS report, ED visits remain steady after Affordable Care Act was put into effect Aiming
- [Crash Cart: Resident hours, millennials with adderall, and a frustrated patient floods three emergency rooms](https://epmonthly.com/blog/crash-cart-resident-hours-millennials-adderall-frustrated-patient-floods-three-emergency-rooms/) - This week: Are the hours needed to become a doctor akin to human sacrifice? Plus, see what this patient does in her local ED when she decides she wasn't treated fairly. Join in as our editors discuss the week's headlines. ----------------------- Is becoming a doctor akin to human sacrifice? A recent study investigates the effect of
- [Crash Cart: Armed guards in the ED, high deductibles and Valentine's Day](https://epmonthly.com/blog/12472/) - This week: In the wake of NYTimes story on the shooting of Alan Paen, emergency physicians speak out about emergency department violence. Plus, it's time to discuss the rising trend of high deductibles. Join in as our editors discuss the week's headlines. ----------------------- Hospital guards shoot patient in mental distress Houstonian, Alan Pean, was shot
- [Crash Cart: High tech Super Bowl medicine and the 10 highest paying states for EPs](https://epmonthly.com/blog/12458/) - This week: The state of the art technology and medical procedures on the sidelines of Super Bowl 50 were impressive, but what are the implications? Plus, find out which states are paying emergency physicians the most. Join in as our editors discuss the week's headlines. ----------------------- The third team on the sideline at SuperBowl 50: Medical experts
- [Crash Cart: ACEP's wellness week, new chest pain guidelines from ACR/ACC, and the fall of basic science in medical journals](https://epmonthly.com/blog/crash-cart-february-3rd-2016/) - This week: ACEP takes a stand against burnout by launching their 'Emergency Medicine Wellness Week.' Plus, is basic science disappearing from medical journals? Join in as our editors discuss the week's headlines. ----------------------- ACEP launches wellness week and is the first national medical specialty group to do so Wellness videos, daily messages and personal recaps from
- [Crash Cart: Zika, burnout and the NFL teams up with EPs to discuss concussions](https://epmonthly.com/blog/crash-cart-january-20th-2016/) - This week: Medscape singles out EPs in this year's lifestyle report to discuss burnout and bias. Plus, the NFL joins forces with EPs to discuss concussions. Join in as our editors discuss the week's headlines. ----------------------- Medscape reports burnout and bias among ED physicians at an all time high This year's lifestyle report shows with
- [Crash Cart: Dissolvable implants and medical emergencies in space. Plus, are physicians innocent until proven guilty?](https://epmonthly.com/blog/crash-cart-january-20th-2016-t/) - This week: Our editors weigh in on a controversial court case involving a renowned physician. Also, what happens when an astronaut has a medical emergency in space? Join in as our editors discuss the week's headlines. ----------------------- Renowned physician's arrest causes colleagues to express disbelief EPs are surprised to see healthcare advocate David Neman, MD
- [Crash Cart: April 28th, 2015](https://epmonthly.com/blog/crash-cart-april-28th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: Is Google Glass finally making inroads in the ED? Plus, Dr. Oz defends himself against physician critiques. ----------------------- Has the time finally come for Google Glass to make its way into the ED? Original Article: HJ News: Google
- [Crash Cart: January 13th, 2016 – Drug shortages, patient scheduling in the ED, and a study on racial bias](https://epmonthly.com/blog/12359/) - This week: EDs continue to face drug shortages, and it's finally making headlines. Plus, the question of whether or not a patient scheduling application would violate EMTALA. Join in as our editors discuss the week's headlines. ----------------------- Emergency departments continue to face drug shortages The latest report from Academic Emergency Medicine shows american EDs have faced
- [Crash Cart: December 23rd, 2015 - Are the holidays just another day in the office?](https://epmonthly.com/blog/december-23rd-2015/) - This week: Are the holidays just another day in the office? Plus, Martin Shkreli is back in the news. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- The Holidays are just another day in the office Physicians discuss holiday health
- [Crash Cart: January 5th, 2016 – Working on NYE, Overusing CT Scans, and Hoverboards](https://epmonthly.com/blog/12343/) - This week: Researchers accuse EPs of overusing CT scans. Plus, lets talk about these hoverboards. Join in as our editors discuss the week's headlines. ----------------------- Docs share memorable stories from their last NYE shift Drugs, nudity and kissing lips are just a few of the highlights. Original Article by ABC News. William Sullivan, DO, JD: Holiday
- [Crash Cart: December 17th, 2015 – When should our residents sleep?](https://epmonthly.com/blog/crash-cart-december-17th-2015/) - This week: What is more important - a resident's sleep or minimal handoffs during patient's stay? Plus, a modern day Bonnie and Clyde steal patients' payment information from ED for a shopping spree. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. -----------------------
- [Crash Cart: December 8th, 2015 – Research shows minorities receive less pain treatment in ED](https://epmonthly.com/blog/crash-cart-december-8th-2015-research-shows-minorities-receive-less-pain-treatment-in-ed/) - This week: Research shows minorities receive less pain treatment in the ED. Plus, learn how to improve the handoff. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- Minorities get less access to analgesics, research says A nationwide examination reports white patients
- [Crash Cart: November 24th, 2015 - What we can learn from France's 'White Plan'](https://epmonthly.com/blog/crash-cart-november-24th-2015-what-we-can-learn-from-frances-white-plan/) - This week: What can we learn from the White Plan that saved so many in Paris? Plus, FDA approves nasal spray that treats heroin drug overdoses. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- Paris Terror Attacks: The “White Plan”
- [Crash Cart: November 17th, 2015 - The links between high-spending doctors and malpractice claims](https://epmonthly.com/blog/crash-cart-november-17th-2015-the-links-between-high-spending-doctors-and-malpractice-claims/) - This week: The links between high-spending doctors and malpractice claims. Plus, emergency medicine drones are cool, but are they necessary? Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- Higher-spending physicians face fewer malpractice claims A Harvard Medical School Study finds
- [Crash Cart: November 11th, 2015 - Trevor Noah's Appendectomy is a Laughing Matter](https://epmonthly.com/blog/crash-cart-november-11th-2015-trevor-noahs-appendectomy-is-a-laughing-matter/) - This week: The Daily Show's Trevor Noah has some things to say about American emergency departments. Plus, an injured deer seeks treatment at a NY ED. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- The Daily Show pokes fun at
- [Crash Cart: November 3rd, 2015 -  Why did this EMT get suspended for stopping to help a choking child?](https://epmonthly.com/blog/crash-cart-november-3rd-2015-why-did-this-emt-get-suspended-for-stopping-to-help-a-choking-child/) - This week: An EP gets sued for prematurely announcing a man dead, and an EMT gets suspended for stopping to save a choking child. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- Sanofi US Recalls the AUVI-Q Epinephrine Injector The company
- [Crash Cart: October 22, 2015 - Gun control, weight loss supplements and burnout](https://epmonthly.com/blog/crash-cart-october-22-2015-gun-control-weight-loss-supplements-and-burnout/) - This week: Should EPs worry about the number of ED visits caused by weight loss supplements? Plus, your coping mechanism may lead to increased burnout. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- Weight loss supplements cause 20,000 ED visits each year
- [Crash Cart: October 14th, 2015 – Utah hospital asks radical questions about hospital costs](https://epmonthly.com/blog/crash-cart-october-14th-2015-utah-hospital-asks-radical-questions-about-hospital-costs/) - This week: Utah Hospital asks a radical question - what do the services provided actually cost the hospital? Plus, EpiPens are life-saving, but what about the lacerations? Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- What is the cost of running a
- [Crash Cart: September 30th, 2015 - Do med students need simulation suits to learn empathy?](https://epmonthly.com/blog/crash-cart-september-30th-2015-do-med-students-need-simulation-suits-to-learn-empathy/) - This week: Do med students need simulation suits to learn empathy? Plus, observations on why software advances haven't impacted the healthcare industry. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- For the last two years over 400,000 visited the ED with
- [Crash Cart: October 6th, 2015 - Let the ICD-10 backlash begin](https://epmonthly.com/blog/crash-cart-october-6th-2015-let-the-icd-10-backlash-begin/) - This week: Let the ICD-10 backlash begin. Plus, emergency medicine is back on prime time, but can Code Black carry the "ER" torch? Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- The WSJ says Non-Emergencies will continue to plague the
- [Crash Cart: September 23rd, 2015 - Controversy arises over the exorbitant price increase of the drug Daraprim](https://epmonthly.com/blog/crash-cart-september-23rd-2015-controversy-arises-over-the-exorbitant-price-increase-of-the-drug-daraprim/) - This week: Controversy arises over the exorbitant price increase of the drug Daraprim. Plus, how will mobile ultrasounds affect your practice? Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- Daraprim’s price rises and protests begin. The drug’s cost rose from $13.50
- [Crash Cart: September 15th, 2015 - Are hospital consolidations a threat to hospital quality?](https://epmonthly.com/blog/crash-cart-september-15th-2015-are-hospital-consolidations-a-threat-to-hospital-quality/) - This week: Is the wave of hospital consolidations a threat to hospital quality? Plus, Shazam invests in a stethoscope add-on. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- Children ER visits for medicine overdoses drop The number of visits peaked in 2010
- [Crash Cart: September 1st, 2015 - Can a new handheld device replace the hospital monitor?](https://epmonthly.com/blog/crash-cart-september-1st-2015-can-a-new-handheld-device-replace-the-hospital-monitor/) - This week: Can a new handheld device replace the standard hospital monitor? Plus, a Dallas hospital makes all its single-patient rooms bariatric rooms. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- Tyto Care develops diagnostic physical exam device for consumers
- [Crash Cart: August 25th, 2015 - Want to succeed in medicine? Get an MBA](https://epmonthly.com/blog/crash-cart-august-25th-2015-want-to-succeed-in-medicine-get-an-mba/) - This week: Annals of IM on "heavy overtones of sexual assault" in the OR. Plus, Forbes says that modern doctors need to study business. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- Annals of Internal Medicine article describes ‘heavy overtones’
- [Crash Cart: August 18th, 2015 - Yelp gets involved in the healthcare rating system](https://epmonthly.com/blog/crash-cart-august-18th-2015-yelp-gets-involved-in-the-healthcare-rating-system/) - This week: Yelp gets involved in the healthcare rating system. Plus, CNN discusses the doctor's attitude towards one's death. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- Yelp’s new initiative allows patients to review hospitals With the help of Yelp
- [Crash Cart: August 12th, 2015 - Get ready for 3-D printed pills](https://epmonthly.com/blog/crash-cart-august-12th-2015-get-ready-for-3-d-printed-pills/) - Can counseling in the ED reduce domestic violence and drinking problems? Plus, 3-D printed pills are coming. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- Can motivational intervention in the ED reduce domestic violence? A clinical trial tests counseling in the
- [Crash Cart: August 5th, 2015 - Study pushes CCTA to rule out Coronary Artery Disease](https://epmonthly.com/blog/crash-cart-august-5th-2015/) - Study pushes CCTA to rule out Coronary Artery Disease. Plus, The AMA may issue disciplinary guidelines for media medicine. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- New study emphasizes the value of Coronary CT Angiography to rule out Coronary Artery
- [Crash Cart: July 14th, 2015 - The Twittersphere thinks ESPN violated HIPAA](https://epmonthly.com/blog/crash-cart-july-14th-2015/) - Are more people dying in EDs over the weekend? Plus, the Twittersphere thinks ESPN violated HIPAA over release of NFL athletes July 4th injury. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- Heroin Epidemic Rises Ohio EDs see 2-3 heroin
- [Crash Cart: June 16th, 2015 - An unlikely partnership forms to address the needs of ED super-users](https://epmonthly.com/blog/crash-cart-june-16th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. This week: Can an app connect CPR responders to nearby heart attack victims? Plus, an unlikely partnership forms to address the needs of ED super-users. ----------------------- Mobile app connects CPR volunteers with nearby heart
- [Crash Cart: July 30th, 2015 - Is #FOAMed good for EM?](https://epmonthly.com/blog/crash-cart-july-30th-2015/) - Is #FOAMed good for EM? Plus, a new startup aims to quicken emergency response time with an app for first responders. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- Free Open-Access Medical Education in Emergency Medicine receives tremendous social media
- [Crash Cart: July 21st, 2015 - Are your nurses dealing with "death anxiety"?](https://epmonthly.com/blog/crash-cart-july-21st-2015/) - Are your nurses dealing with "death anxiety"? Plus, UCLA study shows the patients with familiar primary care doctors end up in the ED less. Catch up on the week's critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. ----------------------- Patients who routinely visit their primary care doctor
- [Crash Cart: May 27th, 2015](https://epmonthly.com/blog/crash-cart-may-27th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: West Virginia is paving the way for patients to sue doctors for their addictions. Plus, the NY Times asks: are you responsible for documenting next-of-kin? ----------------------- In West Virginia, drug addicts can now sue physicians
- [Crash Cart: Critical Reads from Around the Web](https://epmonthly.com/blog/crash-cart-critical-reads-from-around-the-web/) - In this new weekly series, EPM will curate a must-read list of medical links from around the web, along with the comments and analysis of our executive editorial team. In this new weekly series, EPM will curate a must-read list of medical links from around the web, along with the comments and analysis of our
- [Crash Cart: August 5, 2014](https://epmonthly.com/blog/crash-cart-critical-reads-from-around-the-web-august-5-2014/) - EPM presents a weekly rundown of critical reads from around the web, along with commentary by EPM senior editors. This week, we look at stories from the New York Times, the BBC, and CNN about the consequences of making rushed diagnoses, the ebola outbreak in West Africa, and an ebola vaccine that's about to enter
- [Crash Cart: August 12, 2014](https://epmonthly.com/blog/crash-cart-august-12-2014/) - EPM presents a weekly rundown of critical reads from around the web, along with commentary by EPM senior editors. This week, we look at stories from Pacific Standard, Fortune, and Vox about football-related brain injuries, Walmart's latest foray into medical marketing, and quality-based pay for healthcare providers. EPM presents a weekly rundown of critical reads
- [Crash Cart: August 19, 2014](https://epmonthly.com/blog/crash-cart-august-19-2014/) - EPM presents a weekly rundown of critical reads from around the web, along with commentary by EPM senior editors. This week, we look at stories from the New York Times Well blog, Kaiser Health News, and the CBC about the learning curve for doctors, wide variations in hospital charges for blood tests, and the ALS
- [Crash Cart: August 26th, 2014](https://epmonthly.com/blog/crash-cart-august-26th-2014/) - EPM presents a weekly rundown of critical reads from around the web, along with commentary by EPM senior editors. This week, we look at stories from the New York Times, ABC, and Pacific Standard about redesigned hospitals, medically ill-informed celebrity rants, and handling the night shift. EPM presents a weekly rundown of critical reads from
- [Crash Cart: March 24th, 2015](https://epmonthly.com/blog/crash-cart-march-24th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: What is causing rural hospitals to close? Plus, an emotional photo of an ED doc goes viral. This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: What
- [Crash Cart: March 31st, 2015](https://epmonthly.com/blog/crash-cart-march-31th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: Will the SGR get repealed? Plus, Google's next endeavor: surgery performed by robots. This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: Will the SGR get repealed?
- [Crash Cart: April 7th, 2015](https://epmonthly.com/blog/crash-cart-april-7th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: A journalist and a celebrity battle on Twitter about frequent health screenings. Plus, the accountable care experiment in NY. This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This
- [Crash Cart: April 14th, 2015](https://epmonthly.com/blog/crash-cart-april-14th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week, two new threats entering the ED: the tick-born Powassan Virus and a street drug called "Flakka." This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week, two new
- [Crash Cart: April 21st, 2015](https://epmonthly.com/blog/crash-cart-april-21st-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: Medicare is giving star ratings for hospitals based on patient satisfaction. Plus, Candy Crush is rupturing tendons. This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: Medicare
- [Crash Cart: May 20th, 2015](https://epmonthly.com/blog/crash-cart-may-5th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: Palliative care principles in the ED. Plus, a Canadian Children's hosptial will rate visits to educate parents on the definition of "emergency." This week's crop of critical reads from around the web, along with commentary by EPM
- [Crash Cart: June 4th, 2015](https://epmonthly.com/blog/crash-cart-june-4th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: University comes up with decoder for the transition to ICD-10. Plus, are tech companies slowing down the open sharing of EMRs? ----------------------- Will the transition to ICD-10 create particular complications for ED physicians? Starting October 1,
- [Crash Cart: June 9th, 2015](https://epmonthly.com/blog/crash-cart-june-9th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. This week: Did Texas just kill telemedicine? Plus: What if emergency vehicles could turn every red light to green? ----------------------- Fear of the MERS Virus is expanding and causing increased travel difficulties Hong Kong
- [Crash Cart: June 23rd, 2015](https://epmonthly.com/blog/crash-cart-june-23rd-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. This week: Telemedicine may change how doctor's respond to medical emergencies on planes. Plus, antiobiotics over appendectomy for appendicitis? This week's crop of critical reads from around the web, along with commentary by EPM senior
- [Crash Cart: July 1st, 2015](https://epmonthly.com/blog/crash-cart-july-1st-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. This week: Is this new medication the answer to anticoagulation? Plus, pacemakers have a new enemy - smartphones. This week's crop of critical reads from around the web, along with commentary by EPM senior
- [Crash Cart: July 7th, 2015](https://epmonthly.com/blog/crash-cart-july-7th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors and practicing physician guests. This week: The aftermath of Independence Day in the ED. Plus, simulation trainings are on the rise. This week's crop of critical reads from around the web, along with commentary by EPM senior editors and
- [Crash Cart: September 9th, 2014](https://epmonthly.com/blog/william-sullivan-md-and-mark-plaster-md/) - EPM presents a weekly rundown of critical reads from around the web, along with commentary by EPM senior editors. This week, we look at stories from EDs blocking their doors to potential cures for heart failure. EPM presents a weekly rundown of critical reads from around the web, along with commentary by EPM
- [Crash Cart: September 16th, 2014](https://epmonthly.com/blog/crash-cart-september-16th-2014/) - EPM presents a weekly rundown of critical reads from around the web, along with commentary by EPM senior editors. This week, we look at stories from the recent increase in ED visits to the question of whether to screen for malnutrition in the ED. EPM presents a weekly rundown of critical reads
- [Crash Cart: September 23rd, 2014](https://epmonthly.com/blog/crash-cart-september-23rd-2014/) - EPM presents a weekly rundown of critical reads from around the web, along with commentary by EPM senior editors. This week, we look at stories comparing CT to ultrasound for finding kidney stones to the problems of overdiagnosis and overtreatment. EPM presents a weekly rundown of critical reads from around the web, along with commentary
- [Crash Cart: September 30th, 2014](https://epmonthly.com/blog/crash-cart-september-30th-2014/) - EPM presents a weekly rundown of critical reads from around the web, along with commentary by EPM senior editors. This week, we look at stories covering the boarding of psychiatric patients to the issues involved in treating VIP syndrome. EPM presents a weekly rundown of critical reads from around the web, along with commentary by
- [Crash Cart: October 7th, 2014](https://epmonthly.com/blog/crash-cart-october-7th-2014/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week we talk about children overusing the ED, scribes taking bad notes . . . and we find out which editor nearly died of caffeine overdose in high school. This week's crop of critical reads from around
- [Crash Cart: October 14th, 2014](https://epmonthly.com/blog/crash-cart-october-14th-2014/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week we talk about how Ebola has infected the media circus, whether we should worry about decision fatigue, and a potential new use for propofol. This week's crop of critical reads from around the web, along
- [Crash Cart: October 21st, 2014](https://epmonthly.com/blog/crash-cart-october-21st-2014/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week we talk about the potential for subspeciality emergency departments, the effect of malpractice immunity on defensive medicine, and the treatment of health care workers who have handled Ebola patients. This week's crop of critical reads from around
- [Crash Cart: October 28th, 2014](https://epmonthly.com/blog/crash-cart-october-28th-2014/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week we talk about the effect of charge awareness, whether Texas Health Presbyterian Hospital was qualified for the challenge of Ebola, and the difference between syncope and near syncope. This week's crop of critical reads from around the web,
- [Crash Cart: November 11th, 2014](https://epmonthly.com/blog/crash-cart-november-11th-2014/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week we talk about computers that recognize tumors, doctor rating systems, and why we don't take selfies with patients. This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This
- [Crash Cart: November 18th, 2014](https://epmonthly.com/blog/crash-cart-november-18th-2014/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week we talk about the potential negligence in the Texas Ebola case, the skyrocketing generic drug costs, the medical issues and safety of inmates, and a drug-resistant bacteria found in the trenches of WWI. This week's crop of
- [Crash Cart: November 25th, 2014](https://epmonthly.com/blog/crash-cart-november-25th-2014/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week we talk about the prescription opioid overdose epidemic, a virus that makes people stupid, overcrowding in Belfast EDs, and what to do with a pregnant man's drug test. This week's crop of critical reads from around the
- [Crash Cart: December 9th, 2014](https://epmonthly.com/blog/crash-cart-december-9th-2014/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week we talk about the new guidelines for severe allergies, a fatal mistake in an Oregon ED, and the effectiveness of the flu shot. This week's crop of critical reads from around the web, along with commentary by
- [Crash Cart: December 16th, 2014](https://epmonthly.com/blog/crash-cart-december-16th-2014/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week we talk about forecasting ED visits using internet data, the impact of supervised visits, the increase of drunks in the ED, and the connotations behind the term "drop-off centers." This week's crop of critical reads from around
- [Crash Cart: December 23rd, 2014](https://epmonthly.com/blog/crash-cart-december-23rd-2014/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week we talk about using google translate in the ED, robot doctors of the future, employee doctor notes, and exaggerated health care journalism. This week's crop of critical reads from around the web, along with commentary by EPM
- [Crash Cart: January 6th, 2015](https://epmonthly.com/blog/crash-cart-january-6th-2014/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week we talk about cancer's causes, telemedicine for the flu and how cartoons are killing our children. This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week we
- [Crash Cart: January 13th, 2015](https://epmonthly.com/blog/crash-cart-january-13th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: Dubious telemonitoring technology, "Blockbuster" urgent care clinics, readmission penalties, and whether a minor should be allowed to refuse cancer treatments. This week's crop of critical reads from around the web, along with commentary by EPM senior
- [Crash Cart: January 20th, 2015](https://epmonthly.com/blog/crash-cart-january-20th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: saline shortages, telling patients that they're dying, apps that propose hospital reservations, and the arrival of robots in the hospital. This week's crop of critical reads from around the web, along with commentary by EPM senior
- [Crash Cart: January 28th, 2015](https://epmonthly.com/blog/crash-cart-january-28th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: can Twitter predict heart disease? Plus, how many degrees of seperation are needed between doctors and their patients for effective medical care? This week's crop of critical reads from around the web, along with commentary by
- [Crash Cart: February 3rd, 2015](https://epmonthly.com/blog/crash-cart-february-3rd-2015/) - This week: Will a new "Death Test" check-list be required when taking care of elderly patients? Plus, how to crowdfund your next hospital bill. This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: Will a new "Death Test" check-list be required when taking care of elderly
- [Crash Cart: February 10th, 2015](https://epmonthly.com/blog/crash-cart-february-10th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: This week: The influenza policy discussion continues as the verdict is out on the death of swine flu victim Chela Butler. Plus, is Apple going to expand their empire into the medical market? This week's crop of critical
- [Crash Cart: February 17th, 2015](https://epmonthly.com/blog/crash-cart-february-17th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: Forbes' top ten deadliest hazards for your hospital. Plus, a cute dog treks across town to find her owner in a hospital. This week's crop of critical reads from around the web, along with commentary by
- [Crash Cart: February 24th, 2015](https://epmonthly.com/blog/crash-cart-february-24th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: Are those hard-to-clean endoscopes behind the CRE superbug? Plus, an interesting idea: donating blood in the ER wait room. This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This
- [14 Ways To Know Whether You Are Failing As A Hospital Administrator](https://epmonthly.com/blog/14-ways-to-know-whether-you-are-failing-as-a-hospital-administrator/) - I've been an administrator. I've seen hospitals in which a strong leadership team has improved the hospital's market share and I've seen hospitals that have closed and that are struggling to stay open due to a failed administrative team. Here are some common traits I've seen in the failures: 1. You don't know the names of the people
- [Healthcare Update Satellite - 07-13-2015](https://epmonthly.com/blog/healthcare-update-satellite-07-13-2015/) - Boy bitten by a mouse, mother brings boy and mouse to emergency department, wants rabies testing done. Nurse brings the mouse outside and lets it go. Mom fumes because no one recommended that her son go through rabies shots and that because the animal was released, now she'll never know if the animal had rabies.
- [Crash Cart: March 17th, 2015](https://epmonthly.com/blog/crash-cart-march-10th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: Are your patients recording your dialogue without your consent? Plus, why making a machine that can analyze flatulence is most definitely a good idea. This week's crop of critical reads from around the web, along with commentary
- [Crash Cart: March 4th, 2015](https://epmonthly.com/blog/crash-cart-march-4th-2015/) - This week's crop of critical reads from around the web, along with commentary by EPM senior editors. This week: Smart syringes that break after one use are being adopted into practice worldwide. Plus, a survey on whether facility renovation affects patient satisfaction. This week's crop of critical reads from around the web, along with commentary
- [Healthcare Update Satellite - 06-08-2015](https://epmonthly.com/blog/healthcare-update-satellite-06-08-2015/) - To increase access to medical for our nation's veterans, the Veteran's Choice Act authorized the VA to pay for more medical provided to veterans from community health providers. How did the VA save money in that scenario? It either "lost" claims in which providers had proof of submission or it just delayed paying the claims
- [Survey](https://epmonthly.com/blog/survey/) - Quick request ... If you haven't taken this short survey, it would be much appreciated. Looking to publish the results in a future journal article. Many thanks for your help. http://www.esurveyspro.com/Survey.aspx?id=8ee4bd68-04a7-4b43-b07b-652af4088ddd
- [Rodent Control](https://epmonthly.com/blog/rodent-control/) - A crotchety old fellow from the nursing home gets brought in for trouble breathing. After looking at the swelling in his legs and listening to the crackles in his lungs, it’s pretty obvious that he’s in congestive heart failure. We started an IV, drew labs, and performed a chest x-ray. Then he got some nitroglycerin,
- [Memories ...](https://epmonthly.com/blog/memories-2/) - A sweet little lady was brought to the emergency department by her caregiver after having difficulty breathing at home. She got a few breathing treatments and some steroids and was doing much better an hour or so later. When I went back in the room to evaluate her, several family members were present. “Oooh. You
- [Healthcare Update Satellite -- 05-14-2015](https://epmonthly.com/blog/healthcare-update-satellite-05-14-2015/) - Morally corrupt and illegal at any other hospital, but the VA system will sweep it under the rug and absolutely nothing will happen about it. Patient in car just a few feet outside the emergency department calls emergency department for help getting out of car so that he could come in for treatment of his broken
- [Healthcare Update Satellite -- 04-26-2015](https://epmonthly.com/blog/healthcare-update-satellite-04-26-2015/) - Both an unusual case and a great attitude. Woman with cerebral palsy for 33 years seeks care for a physician who questions the diagnosis. Considers that the patient may have rare type of dystonia and starts patient on L-dopamine. Within 2 days, the woman's symptoms are nearly gone. She has been living a life without
- [Healthcare Update Satellite - 04-15-2015](https://epmonthly.com/blog/healthcare-update-satellite-04-15-2015/) - You've heard of a CAT scan? Get ready for the dog sniff. Dogs can identify bladder and prostate cancer with a 98% accuracy rate when smelling male urine samples. Not into the whole dog sniffing thing as a screen for prostate cancer? A $1 screening test using gold nanoparticles 10,000 times smaller than a freckle
- [Semantics and the $28 Million Unnecessary Test](https://epmonthly.com/blog/semantics-and-the-28-million-unnecessary-test/) - There’s been an awful lot of Internet hullabaloo about “unnecessary testing” lately. The Choosing Wisely program keeps trying to assert that we should not perform any “unnecessary” tests. Recently, a paper was published in the Journal Academic Emergency Medicine alleging that “overordering of advanced imaging may be a systemic problem” since many emergency physicians believe that such
- [Healthcare Update Satellite -- 03-04-2015](https://epmonthly.com/blog/healthcare-update-satellite-03-04-2015/) - Homeless North Carolina VA patient comes into the ED to be evaluated for the sores on his feet. His shoes are falling apart. Nurse Chuck Maulden bandages up the patient's feet and then gives the patient the brand new Nike sneakers off of his own feet. Chuck then works the rest of his shift in
- [Healthcare Update Satellite -- 02-10-2015](https://epmonthly.com/blog/healthcare-update-satellite-02-10-2015/) - Home remedy for lice kills a 1 year old child. Headline is a little misleading, though. Family members put mayonnaise all over the child's scalp to suffocate the lice. No the child didn't die from mayonnaise poisoning. The child died because the family members put a plastic bag over the child's head and the bag
- [Healthcare Update Satellite -- 02-03-2015](https://epmonthly.com/blog/healthcare-update-satellite-02-03-2015/) - Thanks for the patience in putting up with my lack of regular posting. Life has been challenging lately. Still working on it. When government pays for your care, government may try to force its values on you. Learning-disabled mother of six children in England deemed at "grave" risk if she has any more children. Now
- [Healthcare Update Satellite -- 01-19-2015](https://epmonthly.com/blog/healthcare-update-satellite-01-19-2015/) - Penicillin allergy? It's associated with increased bad outcomes, but not for the reasons you think. The allergies themselves are mostly not allergies. And no, "my mother said I had a rash when I was a baby" isn't an allergy. However, when compared with patients who don't have penicillin "allergies", patients with penicillin allergies have longer
- [How Can You Be Sure?](https://epmonthly.com/blog/how-can-you-be-sure/) - "How can you be sure?" That question stopped our discussion for a second. During some down time, several nurses and I were talking about childhood coughs. Her 6 month old child had just started daycare 2 weeks ago and has been coughing ever since. The child was put on amoxicillin and then Zithromax by her
- [Healthcare Update Satellite -- 12-16-2014](https://epmonthly.com/blog/healthcare-update-satellite-12-16-2014/) - Answering the important questions ... why does the flu vaccine suck this year? Keep a lookout for next month's issue of EP Monthly which will tell you everything you need to know about influenza diagnosis and treatment. Of course, if you had read the backboard article in EP Monthly's November issue, you'd already be doing
- [Healthcare Update Satellite -- 12-01-2014](https://epmonthly.com/blog/healthcare-update-satellite-12-01-2014/) - More health related news from around the web on my other blog at DrWhitecoat.com. This edition begins with another installment of the Ebola Chronicles ... perhaps the last in the short-lived series now that the media has stopped whipping the public into a panic. New York City actively monitoring 357 people for symptoms of Ebola
- [An Argument With No Clear Winner](https://epmonthly.com/blog/an-argument-with-no-clear-winner/) - “You’re going to the hospital.” “I’m NOT going to the hospital. There’s nothing they’d do and it would cost us thousands of dollars for nothing. Besides … we have to leave. We’re already late.” A husband was attempting to attach the family’s camper onto the trailer hitch of the family’s truck when the trailer slipped.
- [Healthcare Update Satellite -- 11-04-2014](https://epmonthly.com/blog/healthcare-update-satellite-11-04-2014/) - Back with more of the Ebola Chronicles ... Ebola fears causing discrimination problems all over the US. Thomas Duncan died from Ebola. Now his fiancee is having difficulty finding a place to live as landlords are refusing to rent to her. People of African descent are facing discrimination just because they are from Africa. Mothers
- [Healthcare Update Satellite -- 10-21-2014](https://epmonthly.com/blog/healthcare-update-satellite-10-21-2014/) - More medical news from around the web on my other blog over at DrWhitecoat.com Study from University of Maryland proves that emergency physicians are idiots ... at least when treating pediatric extremity injuries. Splints were placed improperly in 93% of suspected pediatric fractures treated in emergency departments. "The researchers found that the most common reason for
- [Healthcare Update Satellite -- 10-13-2014](https://epmonthly.com/blog/healthcare-update-satellite-10-13-2014/) - More medical news from around the web on my other blog over at DrWhitecoat.com So what are medical providers supposed to do if they are faced with a potential or actual Ebola victim? Who knows? Here's a case you don't see every day ... Patient transferred to University of Alabama Medical Center after having what was
- [Healthcare Update Satellite -- 09-30-2014](https://epmonthly.com/blog/healthcare-update-satellite-09-30-2014/) - Pittsburgh police taser a reverend who was praying over his dead stepson in the emergency department. His stepson had been shot and was dead. The hospital stated that the reverend was interfering with attempts to revive the patient, but the video shows no such attempts taking place. Now the reverend has filed a lawsuit against
- [How To Discourage A Doctor](https://epmonthly.com/blog/how-to-discourage-a-doctor/) - This post should be required reading for every physician in this country. A physician finds a document on a chair in his hospital executive's waiting room and reads through it, then realizes it is a manifesto on how to disempower physicians and put hospital administrators in control of patient care. The document's title: How to
- [Healthcare Update Satellite -- 09-22-2014](https://epmonthly.com/blog/healthcare-update-satellite-09-22-2014/) - More updated from around the web at my other blog at DrWhiteCoat.com Study in the journal Pediatrics shows that about 10,000 children are hospitalized each year for accidental medication ingestions. Three quarters of those hospitalizations involved 1 or 2 year olds. Twelve medications were responsible for 45% of all pediatric emergency hospitalizations for accidental drug
- [Another Example of Defensive Medicine](https://epmonthly.com/blog/another-example-of-defensive-medicine/) - The ultrasound images above show a circular clot in the superficial femoral vein. The image on the left is without compression and the image on the right is with compression. Normally blood vessels flatten out when compressed. Since the vessel did not flatten with compression it confirmed the presence of a blood clot. While discussing
- [Healthcare Update Satellite -- 09-15-2014](https://epmonthly.com/blog/healthcare-update-satellite-09-15-2014/) - Don't have as much time to do it as I used to, but I still post additional updates over at DrWhiteCoat.com if you're looking for more medical news from around the web. Enterovirus 68 is confirmed in seven states. Worried parents bring children to emergency departments with "even mild symptoms" to make sure that the
- [Healthcare Update Satellite -- 09-08-2014](https://epmonthly.com/blog/healthcare-update-satellite-09-08-2014/) - Think a patient is faking alcohol withdrawal tremors? Yeah. There's an app for that. Canadian researchers develop app that uses iPod's built-in accelerometer to determine whether or not tremors are more than seven cycles per second. 75% of true alcohol withdrawal tremors have rates faster than that. Only one in six volunteers could fake tremors
- [Healthcare Update Satellite -- 08-28-2014](https://epmonthly.com/blog/healthcare-update-satellite-08-28-2014/) - Good news is that the number of medical malpractice cases in Pennsylvania is decreasing. Bad news is that if you practice medicine in the Philadelphia area, you've got a big target painted on your back. Philadelphia accounts for only 12 percent of the state's population yet in 2013, 40 percent of medical malpractice trials resulting
- [Driving With A Foot Out The Window](https://epmonthly.com/blog/driving-with-a-foot-out-the-window/) - I saw this while driving down the road recently. A person just tooling down a major road with their foot hanging out the window. What possesses people do drive with their feet out the window? I see it every once in a while from both drivers and passengers. This time my daughter just happened to be
- [Healthcare Update Satellite -- 08-12-2014](https://epmonthly.com/blog/healthcare-update-satellite-08-12-2014/) - ** CLEAR! ** Not dead yet. Having withdrawal symptoms from lack of blogging and actually violating a cardinal rule of blogging by posting from work. Now that travel is done and life is getting back to normal, will hopefully have more time to write. Sabrina Kropp had damaged the cartilage in her nose from all
- [Healthcare Update -- 07-24-2014](https://epmonthly.com/blog/healthcare-update-07-24-2014/) - Busier may be better* ... at least for for patients with life-threatening medical emergencies. When comparing very high volume emergency departments with very low volume emergency departments, a study in Annals of Emergency Medicine shows that patients with medical emergencies were about 0.4% less likely to die when they were treated at the nation's busiest
- [Healthcare Update Satellite -- 07-14-2014](https://epmonthly.com/blog/healthcare-update-satellite-07-14-2014/) - Practicing telemedicine may just get a whole lot easier. Federation of State Medical Boards creating an interstate "compact" that would reduce barriers by providing an "expedited license" to physicians who wish to practice medicine in multiple states. The physician has to establish a state of "principal license" and then may apply to the "Interstate Commission"
- [Quick Visit](https://epmonthly.com/blog/quick-visit/) - A mother brought her son to the emergency department with a rather non-emergent complaint ... chapped lips. The registration clerk started taking the registration information. "Can I get the patient's name and date of birth please?" "Yes, it's Johnny ..." The clerk got distracted by the patient who first licked his lips, then smacked his lips,
- [Healthcare Update Satellite -- 07-2-2014](https://epmonthly.com/blog/healthcare-update-satellite-07-2-2014/) - Ve have vays of keeping you qviet. Halt den mund! Government-contracted security force who actually call themselves the "Brown Shirts" ... threatens to arrest medical providers if they leak any information to media about all of the medical illnesses that are being seen at an illegal alien refugee camp in Lackland Air Force Base. By
- [One Way to Cure a Drug Seeker's Back Pain](https://epmonthly.com/blog/one-way-to-cure-a-drug-seekers-back-pain/) - A gentleman in his 40s limped into the emergency department for evaluation of severe back pain. He had a chronic history of back pain, but had decided to forgo recommended surgeries because he was told that there was a chance his pain could worsen. He reportedly had multiple MRIs in the past ... all of
- [Hemoptysis Pearls](https://epmonthly.com/blog/hemoptysis-pearls/) - There was a nice article over at Consultant360.com by Drs. Laren Tan and Samuel Louie on hemoptysis pearls. Learned quite a few things. 200 mls of blood (about a cupful) is enough to fill the dead space in the lungs and is therefore generally considered the minimum amount of blood to make the diagnosis of
- [Healthcare Update Satellite -- 06-23-2014](https://epmonthly.com/blog/healthcare-update-satellite-06-23-2014/) - The right to carry a concealed weapon only exists if your doctor says so. Many states are requiring that physicians certify whether patients are competent to carry a concealed weapon. Some states require mandatory reporting of those deemed not competent to carry a concealed weapon. Of course, the natural extension of such laws is that
- [Assistant Physicians Coming to Missouri](https://epmonthly.com/blog/assistant-physicians-coming-to-missouri/) - Missouri is planning to allow medical school graduates who have not completed residency to treat patients in underserved parts of the state. Bills that would allow medical school graduates to provide medical care have passed the General Assembly and are awaiting Governor Jay Nixon's signature. The newly-minted physicians would receive "assistant physician" licenses and would be able
- [Insecticide Poisoning From Aluminum Phosphide and Phosphine](https://epmonthly.com/blog/insecticide-poisoning-from-aluminum-phosphide-and-phosphine/) - There was a sad story about a woman who died from insecticide poisoning inside her home after family member sprayed agricultural insecticide inside the house earlier in the day. While the story was sad, the back story was quite interesting to me. The poisoning was from aluminum phosphide. When exposed to atmospheric moisture or stomach
- [Healthcare Update Satellite -- 06-17-2014](https://epmonthly.com/blog/healthcare-update-satellite-06-17-2014/) - Read more healthcare-related news from around the web on my other blog at DrWhitecoat.com Oklahoma University Medical Center joins the growing ranks of hospitals that are requiring patients to pay a fee of $200 to be treated for non-emergency complaints. That amounts to an estimated 40% of OU's emergency department visits. If patients do not
- [14.5 Million Reasons Physicians Practice Defensive Medicine](https://epmonthly.com/blog/14-5-million-reasons-physicians-practice-defensive-medicine/) - Cleveland's MetroHealth Medical Center and a staff physician were recently found liable for a $14.5 million medical malpractice verdict in what is commonly termed a "bad baby" case. The case as described in the article involved 36 year old Stephanie Stewart who was pregnant with her second child. She went to MetroHealth several times for premature labor when
- [BMI Measurements Inaccurate But Still A Government Gold Standard](https://epmonthly.com/blog/bmi-measurements-inaccurate-but-still-a-government-gold-standard/) - Everyone needs to read this NY Times article and then think about how inane the concept has become. The Body Mass Index or "BMI" is used as a measure of a person's body weight. If your BMI is between 18.5 and 25, you're normal. More than 25 and you're overweight. More than 30 and you're obese.
- [The Effectiveness of Advertising](https://epmonthly.com/blog/the-effectiveness-of-advertising/) - A cute little 6 year old boy was brought from home. He had autism and didn't communicate much. His mother stated that he would occasionally just stop eating and drinking. Then he would get dehydrated. Then he'd get constipated. Then it would be a big problem to attempt to get him un-constipated. He had to
- [Healthcare Update Satellite -- 06-10-2014](https://epmonthly.com/blog/healthcare-update-satellite-06-10-2014/) - See more health-related stories from around the web on my other blog at DrWhitecoat.com. The doctor will call you now ... Rural health clinics increasingly turning to telemedicine. The story gives an example of a South Dakota clinic physician who used a video feed to get advice on how to insert a chest tube -
- [Michael Kirsch, MD Redux](https://epmonthly.com/blog/michael-kirsch-md-redux/) - For the past 30 minutes, my cell phone has buzzed repeatedly, urging me not to climb out of this rabbit hole. “Come back,” it beckons, “we’re not finished yet.” When KevinMD deleted my first comment about Dr. Kirsch, I decided to keep further comments on my own blogs so they don’t mysteriously disappear again. Now I've learned that
- [Michael Kirsch, MD - An Emergency Physician Basher Without A Clue](https://epmonthly.com/blog/michael-kirsch-md-an-emergency-physician-basher-without-a-clue/) - The nice thing about the internet, about having a blog, and about having a Twitter account is that even us peons have the ability to combat censorship. Here's a good example. Self-described "insider" and "whistleblower" Michael Kirsch, MD, who blogs at "MD Whistleblower," has a penchant for bashing emergency physicians even though his commentary shows
- [Healthcare Update Satellite - 06-04-2014](https://epmonthly.com/blog/healthcare-update-satellite-06-04-2014/) - See more medical news from around the web at my other blog ... DrWhiteCoat.com Car crashes into VA Hospital emergency department in Boston. Elderly driver taken to emergency department ... then put on a secret waiting list and will be seen within 2 weeks ... if he's lucky. What happens when someone calls an ambulance
- [Diagnosis by Retrospectoscope](https://epmonthly.com/blog/diagnosis-by-retrospectoscope/) - The patient was crying and shaking her hands when she rolled through the doors on the ambulance stretcher. She had been sitting at work and developed severe chest pain. There was also a little shortness of breath thrown in because she felt as if someone was sitting on her chest. She said she had been upset
- [Healthcare Update Satellite -- 05-21-2014](https://epmonthly.com/blog/healthcare-update-satellite-05-21-2014/) - See more healthcare related stories from around the web at my other blog: DrWhiteCoat.com 19 year old Baltimore teen dies in hospital after involved in altercation where 5 security guards were unable to control him, police were called to hospital and used Taser on patient, then left once he had been subdued. Now State's Attorney
- [Healthcare Update Satellite -- 05-13-2014](https://epmonthly.com/blog/healthcare-update-satellite-05-13-2014/) - Interesting story on how an Indiana hospital discovered the first case of MERS in this country. Patient came in with influenza like symptoms and was placed in negative pressure room immediately. By the time he was admitted to the floor and was interviewed by an ID specialist, everyone coming into contact with him was required
- [Healthcare Update Satellite -- 05-07-2014](https://epmonthly.com/blog/healthcare-update-satellite-05-07-2014/) - They've got "insurance" but they still can't find anyone to provide them with dental care. In Oregon, dental problems are the second most common emergency department discharge diagnosis in patients 20 to 40 years of age and have a 25% repeat visit rate, costing the State more than $8 million annually -- just in hospital costs.
- [Acute Incarceritis Revisited](https://epmonthly.com/blog/acute-incarceritis-revisited/) - It has happened a few times recently. Just had another case of acute incarceritis. A man was brought in by police after drinking a little too much and then beating the heck out of his girlfriend. Police were called to the scene and the man was arrested for domestic battery. While riding handcuffed in the
- [Healthcare Update Satellite 04-24-2014](https://epmonthly.com/blog/healthcare-update-satellite-04-24-2014/) - Kudos to staff at Blessing Hospital in Quincy, IL for its excellent management of a rollover bus accident with 27 kids. You all do us proud! Stock up on your Norco pills now, folks. This study shows there's no difference in pain relief when compared with codeine, and when the DEA changes hydrocodone to a
- [Healthcare Update Satellite -- 04-16-2014](https://epmonthly.com/blog/healthcare-update-satellite-04-16-2014/) - Ouch. Tree trimmer using chainsaw mistakes his neck for a branch and shows up in the ED with the chainsaw embedded into his neck and shoulder. Trauma surgeons removed the saw and the patient is expected to make a full recovery. You think eating all of that nasty salad and tofu is doing you any
- [Income Comparisons - Teacher vs. Physician](https://epmonthly.com/blog/income-comparisons-teacher-vs-physician/) - Who makes more money over the course of their career - a high school teacher or a doctor? Doctors are obviously paid more. However, when you also consider that doctors work 1.5 times more each week than other Americans, that doctors spend an average of 42,000 to 50,000 hours (20-24 years of full time work
- [Healthcare Update Satellite - 04-08-2014](https://epmonthly.com/blog/healthcare-update-satellite-04-08-2014/) - See more healthcare-related news from around the web on my other blog at DrWhitecoat.com Emergency physicians more likely to miss signs of strokes in young patients - often headaches with dizziness. Those misdisgnoses may account for 40,000 to 80,000 preventable deaths each year. Of course, the answer to save lives is to perform MRIs/MRAs on
- [We've Been Facebooked -- Part 1](https://epmonthly.com/blog/weve-been-facebooked-part-1/) - I'm developing an increasing dislike for certain forms of social media. Fortunately, this first incident didn't happen to me, but the nurses who endured the onslaught were still twitching the following day when I came into work. The day before started out as a pleasant day, or so they said. Even pace. Good flow of
- [Healthcare Update Satellite -- 04-02-2014](https://epmonthly.com/blog/healthcare-update-satellite-04-02-2014/) - See other medical news on my other blog at DrWhiteCoat.com Liberal use of blood transfusions may increase the incidence of serious infections. I don't have access to the entire article, but wonder if the study also looked at overall mortality. In other words, is the increased risk of developing a serious infection outweighed by preventing
- [Happy Doctors' Day](https://epmonthly.com/blog/happy-doctors-day/) - According to the Southern Medical Association, Doctors' Day was first observed in 1933 as a way to honor the profession. Initially, it involved mailing cards to physicians and their wives and placing flowers on the graves of deceased physicians. It wasn't until 1958 that the US House of Representatives adopted a resolution commemorating Doctors' Day.
- [Excuses](https://epmonthly.com/blog/excuses/) - I recently got into a rather ... shall we say "colorful" ... discussion with another doctor about lawsuits. I'm involved in another one. This one is even more screwy than the one I wrote about before. But this lawsuit isn't finished yet. I expect that it will be over with in the next few months,
- [Healthcare Update Satellite -- 03-25-2014](https://epmonthly.com/blog/healthcare-update-satellite-03-25-2014/) - Patients gone wild. Really wild. 70 year old Brookdale Hospital nurse Evelyn Lynch gets knocked to the ground by patient Kwincii Jones and has her head stomped. She was knocked unconscious and suffered severe facial fractures. Also underwent brain surgery, so it is likely she suffered a brain bleed or has brain swelling as well.
- [The "Punch" Line](https://epmonthly.com/blog/the-punch-line/) - Q: How do you get a room full of little old ladies to all use obscene language at the same time? A: Yell “BINGO!” When elderly patients blurt out obscenities, most of the time it takes everything I can do not to laugh out loud. No offense intended. I just get flashbacks of my mom
- [Healthcare Update Satellite -- 03-04-2014](https://epmonthly.com/blog/healthcare-update-satellite-03-04-2014/) - Science reporter Miles O'Brien suffers a freak accident while packing equipment after a reporting trip. Case falls onto his arm and causes bruise/injury. The following day, pain and swelling in his arm got worse. The day after that, he was being rushed to the operating room for compartment syndrome. His blood pressure dropped during surgery
- [Unprofessional Act or Political Mudslinging?](https://epmonthly.com/blog/unprofessional-act-or-political-mudslinging/) - US Senate candidate Milton Wolf (@miltonwolfmd), who also happens to be a radiologist, is catching heat because he had previously posted patient x-rays on his Facebook account ... and then made what some people would consider as inappropriate comments about the patients who were depicted in the x-rays. Articles in the Topeka Capital Journal are
- [Healthcare Update Satellite -- 02-24-2014](https://epmonthly.com/blog/healthcare-update-satellite-02-24-2014/) - More medical posts from around the web over on my other blog at DrWhiteCoat.com Another Pennsylvania hospital closes its obstetrics department, citing clinical and financial viability of the department with only one obstetrician on staff. Interesting point in the article is that in 14 years, more than 40 obstetrics units have closed in Pennsylvania. One
- [Just Checking](https://epmonthly.com/blog/just-checking/) - In one of the hospitals where I work, when we order certain tests in the computer, we have to write the indications for the test on the order sheet. I suppose this isn't a bad idea in some cases. For example, if an ultrasound might be better than a CT scan to look for the
- [Problem Found](https://epmonthly.com/blog/problem-found/) - An 8 year old girl was brought in for a psychiatric evaluation. The child's mother had a laundry list of abnormal behavior in which the child was engaging. The child allegedly scratched the eyes out of all her dolls - except her stuffed cat, of course. The patient breaks glass on the bathroom floor so
- [Healthcare Update Satellite -- 02-13-2014](https://epmonthly.com/blog/healthcare-update-satellite-02-13-2014/) - More medical news from around the web on my other blog at DrWhiteCoat.com. No more "putting it on my account." Due to cuts in payments from Medicare and Medicaid and expenses for treating uninsured patients, Hutchinson Hospital in Kansas will require payment for emergency department services, radiology, and outpatient surgery services before services are rendered.
- [What's the Diagnosis #18](https://epmonthly.com/blog/whats-the-diagnosis-18/) - An elderly patient with hypertension, hypothyroidism, and dementia is sent from the nursing home by ambulance for evaluation of a rash to her scalp. The patient's nurse had noted the rash that afternoon while putting the beret in the patient's hair and is sure that the rash wasn't there two days ago when she last
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-20/) - It's been a year since I last did this and I've had a couple of people send me questions about medical issues. Interest has varied in previous Open Mics, so we'll see how this one turns out. Like Reddit, you can "Ask Me Anything" in the comments section and I'll give you the best non-binding
- [Healthcare Update Satellite -- 02-06-2014](https://epmonthly.com/blog/healthcare-update-satellite-02-06-2014/) - More medical news from around the web over at my other blog at DrWhiteCoat.com Holy feces, Batman! How bad of a marriage do you have to be in for your wife to inject "fecal matter" into your IV line while you're recovering from a heart procedure in the hospital? Whacked out wifey is a former
- [Guaranteed Referral](https://epmonthly.com/blog/guaranteed-referral/) - Emergency physicians are generally a good group of people. Most of the time we will go out of our way to try to help you. Sometimes, things just won't work out, though. For example, if you bring your child in with a bead stuck in her ear and the first words out of your mouth
- [Healthcare Update Satellite - 01-30-2014](https://epmonthly.com/blog/healthcare-update-satellite-01-30-2014/) - More medical news from around the web over on my other blog at DrWhitecoat.com St. Barnabas Hospital in Bronx, NY registers a patient in emergency department to be seen for a rash. Told to go sit in the emergency department. Was called several times over the loudspeaker but didn't answer. Found "stiff, cold, and blue"
- [Thrombolytic Use in Ischemic Stroke](https://epmonthly.com/blog/thrombolytic-use-in-ischemic-stroke/) - Use of thrombolytic therapy in ischemic stroke is a perennial hot topic. Chances are that you will have as many people swearing AT the idea as you have swearing BY the idea of using thrombolytics for acute strokes. That fact alone should demonstrate that there is no "standard of care" for thrombolytic use in ischemic
- [CMS One Way Data Transparency](https://epmonthly.com/blog/cms-one-way-data-transparency/) - According to an article on the CMS Blog, in 60 days the government plans to begin disclosing information regarding payments it has made to individual physicians. In order to receive the information, there has to be a FOIA request and each request will be evaluated on a "case by case basis" which means it is
- [Name That Rhythm](https://epmonthly.com/blog/name-that-rhythm/) - I'm posting this here today because I really don't know the answer to the question and I wanted to get some opinions from the couple of you who still read this blog. A patient in his 70's comes in by ambulance with a complaint of dizziness. As part of his workup, we get an EKG
- [Healthcare Update Satellite -- 01-19-2014](https://epmonthly.com/blog/healthcare-update-satellite-01-19-2014/) - Hospital administrators may be sabotaging their own satisfaction scores by boarding patients in the emergency department. New study in Journal of Emergency Medicine shows that 6 out of 7 patients prefer inpatient boarding to boarding in the emergency department because inpatient hallways are deemed safer, more confidential, more comfortable, quieter, more private, and as having
- [Healthcare Update Satellite -- 01-07-2014](https://epmonthly.com/blog/healthcare-update-satellite-01-07-2014/) - In Great Britain, the emergency departments are having problems with “superusers” as well. According to a survey of about 60% of the hospital trusts and boards in the UK, almost 12,000 people used the emergency department an average of once a month in 2012 while 150 patients used the emergency department an average of about
- [Unconventional Sign Language](https://epmonthly.com/blog/unconventional-sign-language/) - The patient coming through the door was having trouble breathing. No doubt. You could hear the hiss of the nebulizer as the cart whisked by the nurse's station into a room. Most people knew the patient from prior emergency department visits. Bad asthma Steroid dependent Several previous intubations Last ED visit a couple of months
- [Healthcare Update Satellite -- 12-30-2013](https://epmonthly.com/blog/healthcare-update-satellite-12-30-2013/) - More updates on my other blog at DrWhiteCoat.com North Las Vegas VA Hospital emergency department repeatedly “disrespected and mistreated” a 78 year old diabetic volunteer with more than 5,000 hours of service at local VA facilities. A few weeks after two visits for a colon problem, the patient died in a hospice. When the patient’s
- [Amusing Nonsequitur](https://epmonthly.com/blog/amusing-nonsequitur/) - A patient gets brought in by ambulance for knee pain. The story goes that the patient was at a gas station and finished filling up his truck. He walked inside to pay for his gas and when he turned around to leave, he said that "his leg gave out on him" and he fell to
- [Healthcare Update Satellite -- 12-13-2013](https://epmonthly.com/blog/healthcare-update-satellite-12-13-2013/) - More healthcare news from around the web can also be found on my other blog at DrWhiteCoat.com Vacancy rate for physicians at hospitals nearly doubles in four years and vacancy rate for nurses at hospitals triples in four years. NPs and PAs also in short supply. Even though I’m no Obamacare fan, I don’t think
- [Anchors Aweigh!](https://epmonthly.com/blog/anchors-aweigh/) - An otherwise healthy 38 year old patient was brought in by her family with vomiting and mental status changes from her pain medications. She had repair of a tibial plateau fracture performed four days earlier and was having a lot of pain. She didn’t like taking the Percocets that she was prescribed because they made
- [Healthcare Update Satellite -- 12-04-2013](https://epmonthly.com/blog/healthcare-update-satellite-12-04-2013/) - What are the busiest hospital emergency departments? An American Hospital Association survey from 2011 published earlier this year is surprising (link to .pdf file). The 25 busiest hospitals in the US see more than 5 million patients per year. Florida Hospital in Orlando is the busiest in the US and sees 407,000 patients per year
- [The Most Common Thanksgiving ED Complaints](https://epmonthly.com/blog/the-most-common-thanksgiving-ed-complaints/) - When I first saw this article in Live Science about the strangest holiday ED complaints, I was interested in what other doctors' perceptions were, but I first sat back and thought about what types of complaints I usually see more often on Thanksgiving than during other times of the year. I've given up on trying
- [Healthcare Update Satellite -- 11-25-2013](https://epmonthly.com/blog/healthcare-update-satellite-11-25-2013/) - See many more medical news stories from around the web over at my other blog at DrWhitecoat.com Nice synopsis by an Ohio State University emergency physician on how sinusitis can be mistaken for a primary dental problem … and how to use physical examination to help tell the difference between the two. Just don’t expect
- [What's The Diagnosis #17](https://epmonthly.com/blog/whats-the-diagnosis-17/) - A 26-year old female seeks your care for a bee sting to her thumb that occurred just prior to her arrival. She states that she reached into her purse looking for her car keys and felt a sting to the pad of her thumb. She came directly to the emergency department after the incident because
- [Healthcare Update Satellite -- 11-20-2013](https://epmonthly.com/blog/healthcare-update-satellite-11-20-2013/) - How do patients choose their physicians? New survey by the American Osteopathic Association shows that 65% use word of mouth. 50% use their insurance provider directories. 10% use hospital web sites. 9% use consumer review websites such as Yelp. Then 19% who want to gamble with their lives use physician rating sites such as Healthgrades.com. The
- [Healthcare Update Satellite -- 11-14-2013](https://epmonthly.com/blog/healthcare-update-satellite-11-14-2013/) - See more news from around the web over at my other blog at DrWhitecoat.com An example of the downside to government-run health care. Patients in Venezuela can’t get proper medical care. 300 cancer patients were just sent home when supply shortages and “overtaxed equipment” made it “impossible … to perform non-emergency surgeries.” 70% of the
- [Dragonisms - Voice Misrecognition Contest](https://epmonthly.com/blog/dragonisms-voice-misrecognition-contest/) - I like the Dragon NaturallySpeaking program. I like tequila, too. But I try to use both with caution. Dragon's speech recognition is good in that it saves a lot of time and costs in transcribing medical records, especially in complicated patients where it would take a long time to type out the patient's history and
- [Healthcare Update Satellite -- 11-04-2013](https://epmonthly.com/blog/healthcare-update-satellite-11-04-2013/) - See more medical news from around the web on my other blog at DrWhiteCoat.com 72 year old Connecticut patient awarded $9.3 million after being hospitalized for UTI, then given overdose of Lovenox. She developed intra-abdominal bleeding and required several surgeries and blood transfusions to correct the problem. She also developed a large abscess at the
- [Some Joke](https://epmonthly.com/blog/some-joke/) - If you haven’t been threatened by a patient, you haven’t been working in an emergency department very long. It’s a common occurrence that shouldn’t be so common. You can read about “patients gone wild” on this blog almost every week – and those are just the incidences that make the news. Little threats come even
- [Healthcare Update Satellite 10-28-2013](https://epmonthly.com/blog/healthcare-update-satellite-10-28-2013/) - Check out more updates on my newly refurbished blog at DrWhiteCoat.com! Does homelessness affect use of emergency departments and hospitals? Absolutely. According to this study of 1165 homeless Canadian patients in the American Journal of Public Health, when compared with a control population, homeless patients used the emergency department 8.5 times more often, were hospitalized
- [Healthcare Update Satellite - 10-21-2013](https://epmonthly.com/blog/healthcare-update-satellite-10-21-2013/) - Setting the record straight about EMS myths. Well … really one myth … going to an emergency department by ambulance doesn’t mean you’ll go to the front of the line. The places that I work will frequently have patients who come by ambulance go directly to the waiting room. Other times when it isn’t as
- [Acute Incarceropathy](https://epmonthly.com/blog/acute-incarceropathy/) - The chest pain patient was escorted back to a treatment room by not only the triage nurse, but also by a police officer. The patient was crying in pain. Agonizing pain. As the officer removed the handcuffs, the patient slowly and deliberately climbed onto the cot. “I’m doctor WhiteCoat. What brings you to the emergency
- [ACEP 2013 WhiteCoat Recap](https://epmonthly.com/blog/acep-2013-whitecoat-recap/) - I arrived at ACEP's 2013 Scientific Assembly a day early to attend the Council Meeting and to meet up with some old friends. The venue for the gathering was good. Transportation, hotels, dining, and shopping all within easy walking distance from the Convention Center. The Convention Center itself was rather oddly situated. Had to take
- [Healthcare Update Satellite -- 10-09-2013](https://epmonthly.com/blog/healthcare-update-satellite-10-09-2013/) - Government getting pissed because providers are beating it at its own game? When feds started pushing electronic medical records and threatening to penalize patient, a funny thing happened … the amount of money the feds spent on healthcare increased by billions of dollars. Now Kathleen Sebelius and Eric “Fast N Furious” Holder are warning that
- [Still Don't Use These Abbreviations](https://epmonthly.com/blog/still-dont-use-these-abbreviations/) - Remember all of those "do not use" abbreviations? I wrote a post about them a loooong time ago, but since then things have changed. We went from written medical charting to almost exclusively computer [hack hack] generated medical records. So the whole Joint Commission issue about a ">" looking like the number "7" or the
- [Healthcare Update Satellite -- 10-03-2013](https://epmonthly.com/blog/healthcare-update-satellite-10-03-2013/) - Via @mdaware … ever wonder whether you need to prescribe two antibiotics for patients with uncomplicated cellulitis? EM Literature of Note’s Ryan Radecki pulls an article showing that there isn’t much difference in outcome/cure rates between treatment of uncomplicated cellulitis with only cephalexin versus combination treatment with cephalexin and Bactrim. This is important. And it’s
- [More Unique Chief Complaints](https://epmonthly.com/blog/more-unique-chief-complaints/) - The unique chief complaints keep coming. Maybe this should be a monthly topic ... The top and bottom half of my body are mismatched. No stroke. No weakness. No pain. Just "mismatched." Patient was discharged from hospital 12 hours ago for alcohol intoxication, unable to get into mother’s house because she has key and she’s
- [Healthcare Update Satellite - 09-25-2013](https://epmonthly.com/blog/healthcare-update-satellite-09-25-2013/) - See more health care news from around the web on my other blog at DrWhiteCoat.com Man found dead in parking lot of Detroit’s Grand Valley State University had just used the university computers to query Dr. Google on “pain and tightness of the chest and sweating.” Wonder what happens if the web site he landed
- [Medical Tourism Downsides](https://epmonthly.com/blog/medical-tourism-downsides/) - A patient comes into the hospital with dizziness and trouble breathing. The story about how he developed those symptoms was a little more involved. The patient needed some major work done on his teeth. He was having a lot of pain and couldn’t take it any longer. So he sold his favorite Harley Davidson motorcycle
- [Healthcare Update Sattelite Edition - 09-18-2013](https://epmonthly.com/blog/healthcare-update-sattelite-edition-09-18-2013/) - Copeptin levels may revolutionize chest pain evaluations in the ED. When standard treatment was compared with early discharge after normal copeptin levels were obtained, there was no significant difference in major adverse cardiac events at 30 days. Need to review the study data, but this is a promising new test. Marco Rubio calls federal government’s
- [Anatomy of a Tragedy and Healthgrades.com](https://epmonthly.com/blog/anatomy-of-a-tragedy-and-healthgrades-com/) - Saul Elbein deserves a shout out for the article he wrote in the Texas Observer titled Anatomy of a Tragedy. If you haven't read the article, you need to go get a cup of coffee, sit down and take it all in. I disagree with his suggestion that the problems raised in the article may
- [Healthcare Update Satellite -- 09-04-2013](https://epmonthly.com/blog/healthcare-update-satellite-09-04-2013/) - Look for more updates on my other blog at DrWhitecoat.com American Medical News ceasing publication due to decreasing ad sales. Now focusing on online and e-mail publications. Too fat to rescue? Some patients weighing more than 350 pounds (and even some weighing more than 250 pounds) are being denied air transport due to their weight.
- [Unique Chief Complaints](https://epmonthly.com/blog/unique-chief-complaints/) - I've had a few interesting chief complaints lately. Here is a small sampling ... from different patients, of course. Someone broke into the patient’s house while he was sleeping and stole only his schizophrenia medications so that he would act up and then get arrested by police and have to be admitted to the hospital.
- [Healthcare Update Sattelite -- 08-28-2013](https://epmonthly.com/blog/healthcare-update-sattelite-08-28-2013/) - Find more updates on my other blog at DrWhitecoat.com British National Health Service now gives physical therapists and podiatrists the authority to prescribe medications to patients without physician supervision. Good for them. I still believe that all drugs aside from antibiotics and perhaps narcotics should be over the counter anyway. Not only the King of
- [Head trauma workup](https://epmonthly.com/blog/head-trauma-workup/) - Patient’s chief complaint: "I was slapped on the back of my head with a file folder by a co-worker. I have a headache and I want a CT scan to make sure there’s nothing wrong on the inside. In other words, "I really want to get my co-worker in trouble." Fortunately, it wasn't one of
- [Healthcare Update Satellite -- 8-21-2013](https://epmonthly.com/blog/healthcare-update-satellite-8-21-2013/) - Look for more updates on my other blog at DrWhitecoat.com Judge orders Colorado family to pay $340,000 in legal fees after losing the medical malpractice suit it brought against a hospital. The family plans to declare bankruptcy. The family’s attorney, Stacy Warden, alleges that the hospital lacked compassion for “going after a family with a
- [Proper Workup in Young Hypertensive Tachycardia Patient](https://epmonthly.com/blog/proper-workup-in-young-hypertensive-tachycardia-patient/) - There were a couple of comments to the last post on Semantics that made me question whether or not it was proper to do a large workup on a young patient with tachycardia. So I decided to create a poll to get everyone else's opinion. Assume that the patient's use of K2 was disclosed. In
- [Semantics](https://epmonthly.com/blog/semantics/) - A 17 year old patient comes in by ambulance for chest pain and tachycardia. His heart rate was in the 130s. He was hypertensive. He was sweating. He had a history of ADHD and was on Adderall. No other medications. No alcohol or drugs. His exam was unimpressive and all the testing came back negative,
- [Healthcare Update Satellite - 08-06-2013](https://epmonthly.com/blog/healthcare-update-satellite-08-06-2013/) - Look for more updates at my other blog at Dr.Whitecoat.com Naked West Virginia patient steals ambulance from emergency department parking lot, goes on joy ride and then crashes into three vehicles - requiring more ambulances to take injured patients to the hospital. Hopefully this time they locked the ambulance doors. And I’m not sure I’d
- [Pain Predicament](https://epmonthly.com/blog/pain-predicament/) - A family doctor calls to give us a heads up about a patient coming to the emergency department. He was obviously upset and sounded frustrated. He started in with the story … I used some lidocaine a pair of tweezers, and some small scissors to remove a small lesion from a patient’s tongue. There was
- [Healthcare Update Satellite 07-29-2013](https://epmonthly.com/blog/healthcare-update-satellite-07-29-2013/) - Look for more health care stories from around the web at my other blog at DrWhitecoat.com InQuickER has some competition for violating EMTALA in the “reserve a spot for my emergency department visit” market. Massachusetts hospital using service called “ResERved” and another company called ER Express is also filling this niche … at least until
- [CLEAR!](https://epmonthly.com/blog/clear/) - I got a few e-mails asking whether I'm still blogging. Short answer is "yes." The number of posts has been a lot less than usual, which sometimes is a sign of a blog on life support. Have had several things that have required my time over the past couple of months but now most of
- [Thanks For Watching](https://epmonthly.com/blog/thanks-for-watching/) - Its been a rough few weeks. The stories keep piling up on my desk. This one keeps coming to mind, so I figured I'd try to post it from my phone.* An elderly patient came in by ambulance after tripping over a curb. She fell and hit her face, causing a nasal fracture and a
- [Healthcare Update Satellite -- 07-09-2013](https://epmonthly.com/blog/healthcare-update-satellite-07-09-2013/) - More updates available tomorrow on my other blog at DrWhitecoat.com Why does an $11,596 emergency department visit cost $1,100? A spokesperson for the California Hospital Association says that it is because of government regulation. I want to know what doctor ever gets paid $4,242 for a Level 4 emergency department visit. California attorneys are trying
- [Dragonisms](https://epmonthly.com/blog/dragonisms/) - I'm not sure if I've had a stroke and am slurring my speech or if the Dragon NaturallySpeaking voice recognition engine is just messing with me, but lately I've had to triple check my charts to make sure some bad transcriptions don't get finalized into the record. Earlier this month, I tweeted about one case
- [Healthcare Update Satellite -- 06-26-2013](https://epmonthly.com/blog/healthcare-update-satellite-06-26-2013/) - See more HealthCare Updates at my other blog at http://drwhitecoat.com. UK Accident and Emergency Department criticized for multiple failures after going into “crisis” mode from January through March due to a surge in patient volumes. Of course, all the investigators go and pick through the hospital’s policies four times in April after things have calmed down,
- [The Orthopedist's Favorite Footwear](https://epmonthly.com/blog/the-orthopedists-favorite-footwear/) - "Come ON! You've gotta be KIDDING me!" the orthopedist yelled into the phone when I called him for the third fracture of the morning. Meh. Wasn't the phone calls. He's always in a bad mood. First, it was a patella fracture. Then, it was a hip fracture. Now, it was an open ankle fracture. What
- [The Last Doctor is Always the Smartest](https://epmonthly.com/blog/the-last-doctor-is-always-the-smartest/) - Twice recently, I've been privy to patient complaints about emergency department "misdiagnoses" when patients have gone to follow up appointments with their physicians. One case involved a young girl who had a rash. The rash was preceded by a low grade fever in the days prior, began on the chest and spread outward, and had
- [Healthcare Update Satellite -- 06-15-2013](https://epmonthly.com/blog/healthcare-update-satellite-06-15-2013/) - More HealthCare Updates from around the web are at my other blog at http://drwhitecoat.com. What’s the highest sodium level you’ve seen? These docs saved a patient with a corrected sodium level of 196 which is the highest I’ve ever heard of. Lower 170s is the highest I can remember. The patient drank a quart of soy
- [Healthcare Update Satellite -- 06-06-2013](https://epmonthly.com/blog/healthcare-update-satellite-06-06-2013/) - More HealthCare Updates from around the web are at my other blog at http://drwhitecoat.com. Remember the case where hospital administrator Bruce Mogel allegedly planted a gun in a doctor’s car then called the police to frame him because the administrator didn’t like the doctor’s criticisms of the way the hospitals were being managed? The doctor sued
- [I Can Hear You ...](https://epmonthly.com/blog/i-can-hear-you/) - I think I've discovered what elderly patients feel like when everyone thinks that they're too senile to understand the conversations around them and just talk about them as if they aren't there. Like this ... In one emergency department, the nurses regularly talk about me in loud voices as if I'm either deaf or unable
- [Press Ganey's Invalid Statistics](https://epmonthly.com/blog/press-ganeys-invalid-statistics/) - Remember that whole line about how Press Ganey won't create reports or analyze statistics based on fewer than 7 surveys? Yeah. That's not true. This report which was sent to me by a reader shows that the involved doctor was in Press Ganey's 99th percentile! Oh. Too bad that the rankings were based on a
- [Healthcare Update Satellite -- 05-29-2013](https://epmonthly.com/blog/healthcare-update-satellite-05-29-2013/) - More HealthCare Updates from around the web are at my other blog at http://drwhitecoat.com. Next on the FDA hit list … sleeping pills. Number of ED visits related to Ambien prescriptions triples between 2005 and 2010. Connecticut emergency department declares influx of intoxicated patients from nearby concert venue a “scheduled mass-casualty situation" and a public health
- [Facebook use in the Emergency Department](https://epmonthly.com/blog/facebook-use-in-the-emergency-department/) - New study shows that emergency department workers are on Facebook quite a bit. They spend an average of 4.3 minutes per hour on Facebook during day hours, which is just under an hour out of every 12 hour shift. However, during night shifts when the study hospital was busier, the staff spent an average of
- [Healthcare Update Satellite -- 05-15-2013](https://epmonthly.com/blog/healthcare-update-satellite-05-15-2013/) - More HealthCare Updates from around the web are at my new digs at http://drwhitecoat.com. “Dear ER staff. Our friend is drunk. Fix him.” Unconscious Arizona college student who was “turning blue” left in hospital lobby with Post-It note stuck to his body after losing “drinking contest” at frat house. Nice friends. If you decide to follow
- [Healthcare Update Satellite -- 05-07-2013](https://epmonthly.com/blog/healthcare-update-satellite-05-07-2013/) - More HealthCare Updates from around the web are at my new digs at www.drwhitecoat.com. Annals study shows clinical signs that necessitate admission in patients with ALTE (when newborns appear to stop breathing): “obvious need for hospitalization (they used persistent hypoxia as one example of this), significant medical history, and more than one ALTE in 24 hours. Dual
- [Alarm Fatigue](https://epmonthly.com/blog/alarm-fatigue/) - For those of you who don't know what alarm fatigue is, think of a car alarm. The first time you hear it going off, you run to your window to see who's breaking into a car. Maybe you run to the window the second time and the third time, too. By the tenth time the
- [Healthcare Update -- 04-23-2013](https://epmonthly.com/blog/healthcare-update-04-23-2013/) - More HealthCare Updates from around the web are at my new digs at www.drwhitecoat.com. Diagnostic errors account for most paid claims in medical malpractice cases. Errors in diagnosis were the most common type of claim and also amounted to the highest proportion of total payments. The total inflation-adjusted amount of diagnosis-related payouts was $38.8 billion over 25
- [Do Hospital Policies to Deter Potential Drug Seekers Violate EMTALA?](https://epmonthly.com/blog/do-hospital-policies-to-deter-potential-drug-seekers-violate-emtala/) - Interesting issue brought to my attention by a reader in South Carolina. One of the hospitals in South Carolina wanted to post a sign in its emergency department waiting room stating the following: Prescribing Pain Medication in the Emergency Department Our Emergency Department staff understands that pain relief is important when one is hurt or
- [Healthcare Updates -- 04-15-2013](https://epmonthly.com/blog/healthcare-updates-04-15-2013/) - See more HealthCare Updates from around the web at my new digs at www.drwhitecoat.com. More of a free market approach to medical care. Australian private hospitals noting a large uptick in emergency department patients as patients opt to pay for emergency services rather than wait for care at the public hospitals. Some emergency departments are
- [Dear Diary](https://epmonthly.com/blog/dear-diary-17/) - So much to rant about today. The girls are doing a dance competition this weekend. I'm trapped in my own little version of Dance Moms. Aaaaauuuuuggghhh. Somebody help me. One daughter complains because she's in the back of one dance the whole time. Another daughter is upset because people are mad at her because she's
- [Proving a Negative](https://epmonthly.com/blog/proving-a-negative/) - A young lady comes to the emergency department and wants to be evaluated for a ... somewhat nonurgent ... problem. Chief complaint: "I've lost 50 lbs in the past month." She felt a little weak as well, but she had just lost too much weight. No other symptoms. The patient weighed 132 pounds. Her skin
- [Time for a New Roommate](https://epmonthly.com/blog/time-for-a-new-roommate/) - Second time in a week. The first episode, the patient from the assisted living facility came in with sharp anterior chest pain. She said that she was sleeping and woke up with sudden onset of pain. When she opened her eyes, her roommate was standing over her with a crazed look in her eye. Sticking
- [Healthcare Update -- 04-08-2013](https://epmonthly.com/blog/healthcare-update-04-08-2013/) - Columbus, OH paper compares hospital wait times from 15 different hospitals throughout central Ohio. Metrics include minutes until diagnostic evaluation, minutes until pain medication, minutes until admission decision, and minutes from admission to room placement. I just wonder how accurate the metrics are. It isn’t like self-reported data like this can’t be manipulated. Evanston Northwestern
- [Unnecessary Testing?](https://epmonthly.com/blog/unnecessary-testing-3/) - A patient was sent to the emergency department to have an ultrasound of her uterus performed. She had been having abnormal bleeding which coincided with about the time her period was due - only it was a little heavier and lasted a little longer than usual. She decided the best course of action would be
- [My Secret Addiction](https://epmonthly.com/blog/my-secret-addiction/) - By an Anonymous Emergency Physician Hi. I'm Anon. I'm a 44 year old emergency physician. And I'm an addict. My addiction came to light when my Press Ganey scores plummeted after I started to stand up to the chronic pain and frequent ER patients. The fact that I have an addiction was reaffirmed when I
- [What's the Diagnosis #16](https://epmonthly.com/blog/whats-the-diagnosis-16/) - A nursing home patient is brought by ambulance with a cough. Nursing home staff believe the patient may have aspirated lunch 30 minutes ago. The patient's workup is normal except for his EKG which is shown below (you can click on it for a much larger/printable version). What's the diagnosis? What needs to be done
- [Healthcare Update -- 04-01-2013](https://epmonthly.com/blog/healthcare-update-04-01-2013/) - This case report is entirely bizarre. Patient gets awarded more than $800,000 after visit to doctor resulted in incorrect diagnosis of cancer when the patient really had pneumonia and caused patient to have amputation of her foot. A trial was held on the case four years ago with a verdict in favor of the doctor,
- [Dear Diary](https://epmonthly.com/blog/dear-diary-16/) - My gosh. I actually get angst when I haven't posted for a few days. Actually, I have angst for other reasons, but not posting just adds to the angst. So what's been happening lately? First, the poor WhiteCoat children are having trying times in their love lives. Oldest daughter WhiteCoat found out from a member
- [Healthcare Update -- 03-25-2013](https://epmonthly.com/blog/healthcare-update-03-25-2013/) - Another medical issue with overweight patients: Intramuscular injections. An Epi-Pen may not work in patients who are obese since the distance through the subcutaneous fat to the muscle is greater than the length of the needle. This study showed that in more than 4 of 5 obese children, the subcutaneous fat layer was too thick
- [Grand Rounds Snoop Dog Style](https://epmonthly.com/blog/grand-rounds-snoop-dog-style/) - I happened to catch on Twitter a web site where people could search up their Twitter names and get their tweets translated into gangsta talk. Probably not something you should read at work or in church, tho ... yo. So I tried it with some other sites. I can't decide which is more amusing. A
- [I Made A Drug Seeker Cry Today](https://epmonthly.com/blog/i-made-a-drug-seeker-cry-today/) - I made a chronic back pain patient who was out of his pain medications cry in my emergency department today. Actually, he was already crying when he came in. The nurse said that he hobbled in from the waiting room bent over like an old man and using his wife's shoulder for support. He couldn't
- [Legislative Comparison](https://epmonthly.com/blog/legislative-comparison/) - Another factoid about the UnAffordable Care Act sparked by an e-mail link from DefendUSA (thanks!). Number of pages in the document that formed the basis for creating our nation: FOUR. Well, five if you include the Bill of Rights Number of pages in the document that purports to provide affordable "care" for everyone by requiring
- [Cavity Pain](https://epmonthly.com/blog/cavity-pain/) - You'll probably consider this post non-medical, but I consider it a discussion of anatomy which IS medical. A New York newspaper article caught my eye. Two New York City miscreants were arrested for drug trafficking. Big deal, right? The thing that caught my eye was how police found the drugs, the amount of drugs, and
- [Healthcare Update -- 03-18-2013](https://epmonthly.com/blog/healthcare-update-03-18-2013/) - The Veteran’s Administration intentionally changed and hid data to avoid providing costly yet critical medical care to soldiers from the Gulf War? A head VA epidemiologist alleges that more than two thousand veterans responding to a study felt like they would be “better off dead”. In 95% of those cases, the VA did nothing to
- [WTF Moment #1071](https://epmonthly.com/blog/wtf-moment-1071/) - What is it with some people and rashes? The patient waits 3 hours to be seen. When I enter the room, the patient says "I had a rash on the back of my leg 2 months ago. Can you tell me what it was?" Out of the 4 or 5 things running through my mind
- [Useless Workups](https://epmonthly.com/blog/useless-workups/) - A patient calls his family doctor and gives a history of having chest pain on and off for the past few days. Pain worse with activity. Not having any now. Of course, you know that the family doc is going to send the patient to the Emergency Department. You just know it. So the patient
- [Comic Relief](https://epmonthly.com/blog/comic-relief-4/) - Courtesy of mednificentcomics.com Not quite a case medical student's disease, but close. Have to love it. The thing is that when I was a medical student, there wasn't an internet and there definitely wasn't a Dr. Google. So we were a lot more stressed out because we had to rely on the advice of our
- [Healthcare Update -- 03-11-2013](https://epmonthly.com/blog/healthcare-update-03-11-2013/) - Doctor treats child born to HIV positive mother with full three-drug regimen of HIV drugs one day after birth instead of one or two drug regimen typically used until an HIV infection can be confirmed. Treatment continued for 18 months, then the patient’s mother stopped bringing the patient to appointments. The child is now 30
- [Should Refusing Medical Care Be A Crime?](https://epmonthly.com/blog/should-refusing-medical-care-be-a-crime/) - Doctor threatens to call police on patient if she does not consent to immediate Caesarian section. The mother was a high-risk pregnancy (due to VBAC), was post-dates and had gestational diabetes. The fetus wasn’t in a good position to facilitate vaginal delivery, and an ultrasound showed the fetus in possible distress. The patient was sent
- [Suing Doctors For Patient Addictions](https://epmonthly.com/blog/suing-doctors-for-patient-addictions/) - Nevada Senator Tick Segerblom proposes bill that would allow patients addicted to prescription drugs to sue doctors for prescribing the addictive medications and manufacturers for creating the medications. Patients can already sue doctors for prescribing medications if they can prove that writing the prescriptions violated the standard of care and that they have suffered damages
- [The Nurse Who Denied CPR](https://epmonthly.com/blog/the-nurse-who-denied-cpr/) - I'm in shock about the case where a nurse refused to give CPR to 87 year old Lorraine Bayless in a California senior living facility - a housing setup akin to an apartment complex. Ms. Bayless fell unconscious in the dining room of a senior living facility. Facility members called 911. Ms. Bayless wasn't breathing
- [High School Science Class Fail](https://epmonthly.com/blog/high-school-science-class-fail/) - Daughter WhiteCoat doesn't have the stomach for her science class. They were dissecting a sheep heart in her class not too long ago and she was becoming increasingly queasy. Apparently the sheep had been recently slaughtered because she said that there was still blood in the heart. She was more skeeved because the science teacher
- [Healthcare Update - 03-04-2013](https://epmonthly.com/blog/healthcare-update-03-04-2013/) - Drunks caught on security camera beating each other in a Turkish emergency department waiting room. Best part of the video is when one dope pulls off his belt to start hitting people and his pants fall down. Then he waddles about swinging his belt like a little kid with a load in his diapers. Another
- [Dear Diary](https://epmonthly.com/blog/dear-diary-15/) - Lets see. What's new recently? Wrestling is officially over for the year. I happened to be the "trainer" for junior's regional wrestling meet. Was busy most of the day. It seems as if the coaches give kids Coumadin before the meets. I haven't seen so many nosebleeds in a long time ... except maybe last
- [Increased Workload = Increased Medical Errors?](https://epmonthly.com/blog/increased-workload-increased-medical-errors/) - They throw around that lame 98,000 preventable deaths per year statistic, but the survey is still quite telling. More than one third of 890 hospitalists surveyed stated that their workload exceeded safe levels on at least a weekly basis. As a result of this increased workload, 22% of doctors stated that they had delayed admissions
- [Who Should Sign Death Certificates?](https://epmonthly.com/blog/who-should-sign-death-certificates/) - I happened to read an article in the Columbus (Ohio) Dispatch where Ohio coroners are complaining because some doctors, including emergency physicians, are refusing to sign death certificates listing a patient's cause of death. The coroners are concerned because they are being "burdened" with hundreds of extra cases every year that they must handle. And
- [Healthcare Update -- 02-27-2013](https://epmonthly.com/blog/healthcare-update-02-27-2013/) - Knowledgeable and honest. Yeah, that’s me. Study shows that doctors wearing white coats were most likely to be judged by patients as being the “best” physicians. Doctors wearing scrubs were also more likely to be highly rated. Of course my widespread appeal could also come from my stunning good looks or my debonaire personality …
- [Reader Poll](https://epmonthly.com/blog/reader-poll/) - So I had a problem with a patient and family recently and I'm looking for solutions from everyone who reads this blog. An elderly patient who lives at home with his wife, his son, and his son's family was brought by the ambulance to the emergency department for "not feeling well." As I attempted to
- [Dear Diary](https://epmonthly.com/blog/dear-diary-14/) - I hate the movie Pitch Perfect. Actually I like the movie itself, but my kids won't stop singing the frigging songs. I have heard the songs from that movie in my sleep for months now. The latest thing that my kids have taken to doing is re-enacting the "cup" scene where Anna Kendrick sings You're
- [The Book and its Cover](https://epmonthly.com/blog/the-book-and-its-cover/) - When you work in an urban hospital, sometimes it's difficult not to become jaded. There are certain neighborhoods that generate a disproportionate number of patients for some emergency departments. Meth is rampant. Marriage pretty much nonexistent. More bars than there are restaurants. Domestic abuse frequent, but prosecutions rare. Police know people more by their street
- [Healthcare Update 02-18-2013](https://epmonthly.com/blog/healthcare-update-02-18-2013/) - Some hospital CEOs just don’t like being questioned. When one hospital chief of staff led some other physicians in questioning the manner in which a hospital was being run, hospital CEO Bruce Mogel allegedly had black gloves and a gun planted in the doctor’s car. Then someone called 911 and reported that someone was driving
- [The Last Patient of a Long Night Shift](https://epmonthly.com/blog/the-last-patient-of-a-long-night-shift/) - By Birdstrike M.D. My first night shift in a stretch of 7 was almost over. It was 6:15 a.m. and I had to keep moving otherwise the minute I would stop, my eyelids would drop like two ton shades and I’d fall asleep. That never makes for a good drive home after a night
- [It Didn't Feel Like A "Win"](https://epmonthly.com/blog/it-didnt-feel-like-a-win/) - By Birdstrike M.D. My kid and I are outside in the front yard blowing bubbles, enjoying the blue skies and 70 degree weather when she says, “Cool Daddy! Look, there’s a police car coming down the street. Oh, cool! I think he’s coming to see us!” Uh, oh, I think to myself. Despite my
- [Are You Better Than 83% of Radiologists?](https://epmonthly.com/blog/are-you-better-than-83-of-radiologists/) - Fascinating study about missing obvious findings on CT studies, based on another study about selective attention. In the cited study, 83% of radiologists missed the abnormal findings on the first CT image. Don't ruin it for anyone else, but how many of you caught all the abnormalities on the CT scan below? For those who
- [Mending](https://epmonthly.com/blog/mending/) - Surgery went uneventfully, I think. Don't remember much of it because of the dang Versed. While walking back to the outpatient surgery room, I never thought what big business surgeries are for hospitals. The outpatient surgery floor had a long curving hallway of identical rooms, one after another, all with freshly-made beds, blankets folded neatly
- [Healthcare insurance but no healthcare access](https://epmonthly.com/blog/healthcare-insurance-but-no-healthcare-access/) - California doesn’t have enough doctors to provide healthcare to newly “insured” patients under the UnAffordable Care Act. California state senator Ed Hernandez asks “"What good is it if they [state citizens] are going to have a health insurance card but no access to doctors?" Wait. Health care insurance doesn’t mean that patients will have access to
- [Healthcare Update -- 02-11-2013](https://epmonthly.com/blog/healthcare-update-02-11-2013/) - Patients gone wild. Also, a perfect example of why doctors shouldn’t play security guard. Iowa man attempts to leave emergency department, doctor doesn’t allow him to do so. Patient then slams doctor against wall and puts doctor into a choke hold before being pulled off and restrained. Who gets paid to study this stuff? “Researchers”
- [Spaghetti and Impaction](https://epmonthly.com/blog/spaghetti-and-impaction/) - Stool impactions probably aren't what most people would consider an "emergency" ... until they actually have a stool impaction. Personally, I wouldn't wish a stool impaction on someone. In chronic constipation, more and more stool collects in the colon until size of the ball of stool is too big to pass through the opening to
- [Dear Diary](https://epmonthly.com/blog/dear-diary-13/) - Well, I thought we escaped it, but we didn't. The past week has been full of emesis, diarrhea, and disinfectant spray. Just when we think that things are on the mend, someone else in the family starts having a stomach ache. The vomiting is the worst. When it starts out, it sounds like a loud
- [Social Media Fair Play](https://epmonthly.com/blog/social-media-fair-play/) - JustADoc commented about a Yahoo News story concerning an obstetrician who posted a mini-rant on Facebook about one of her patients always being late. The obstetrician's post said "I have a patient who has chosen to either no-show or be late (sometimes hours) for all of her prenatal visits, ultrasounds, and NSTs. She is now
- [Healthcare Update -- 02-04-2013](https://epmonthly.com/blog/healthcare-update-02-04-2013/) - Chinese man runs out of money to pay for dialysis. Government “insurance” only pays half the costs of treatment (keep that in mind, Affordable Care Act supporters). Then human ingenuity kicks in. The man builds himself a dialysis machine out of used and discarded medical equipment, mixes his own dialysis fluid, and has been dialyzing
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-19/) - Just in case anyone was wondering what happened to Open Mic Weekends ... If you're bored with the Super Bowl, you can post any medically-related comments, questions, or observations in the comments section. I’ll try to answer any questions on Monday or Tuesday. As usual, the only rules for comments are that there are no
- [Paybacks](https://epmonthly.com/blog/paybacks-2/) - One of our registration clerks thinks she's pretty slick. We play little practical jokes on each other every once in a while. One day she'll unplug the keyboard to my computer when I'm in a room with a patient. I'll come out to try to enter orders and start pounding the keyboard. Another day I'll
- [Post Online, Get Investigated By State Medical Board](https://epmonthly.com/blog/post-online-get-investigated-by-state-medical-board/) - Earlier this month, a survey of state medical boards published in the Annals of Internal Medicine showed that many state medical boards were willing to investigate physicians for lack of online "professionalism." The authors of this study created 10 vignettes regarding online physician behavior and then queried state medical boards regarding their likelihood of "investigating"
- [Healthcare Update -- 01-28-2013](https://epmonthly.com/blog/healthcare-update-01-28-2013/) - You can keep your doctor and your insurance … if you can afford it. Some insurance brokers expect health insurance premiums to triple in the fall prior to full implementation of Obamacare. Oh, and if you can’t afford that insurance, plan to pay a punitive tax. But don’t worry, Mississippi Gov. Phil Bryant thinks that
- [Art Kellermann Rand Rant](https://epmonthly.com/blog/art-kellerman-rand-rant/) - One of the posts in my Twitter feed was a re-tweet of something asserted by Dr. Art Kellermann (@ArtKellermannMD). Dr. Kellermann is a distinguished physician. He is the Director and VP of Rand Health. At one point he was a professor at Emory University, but apparently does not practice emergency medicine any more. Dr. Kellermann's
- [What's the Diagnosis #16 -- Mmmmm, Eggs](https://epmonthly.com/blog/whats-the-diagnosis-16-mmmmm-eggs/) - This is an interesting case for a number of reasons. First, it shows how a little testing can turn into a lot of testing to "rule out" diseases in the emergency department. Second, it hopefully provides some good teaching points. Third, the comment from the attending physician gave me the giggles. That will explain the
- [More Joys of Electronic Medical Records](https://epmonthly.com/blog/more-joys-of-electronic-medical-records/) - Go up to your favorite emergency department staff member and ask them what they think of "twofers." Depending on that person's mood, chances are that you'll get anything from a scowl to a punch in the gut in response. Two patients from the same family both needing emergent medical care at the exact same time?
- [Comic Relief](https://epmonthly.com/blog/comic-relief-3/) - Another cartoon courtesy of Mednificent Comics. The answer to the question at the end ... "absolutely"
- [Healthcare Update 01-21-2013](https://epmonthly.com/blog/healthcare-update-01-21-2013/) - Amount of medical malpractice in the military is “shockingly underreported”. To add insult to injury, the Supreme Court continues to deny injured patients the ability to sue the government for damages from medical malpractice in military hospitals under the Feres Doctrine. Oh, and do you think that you’ll be able to compare hospital “quality” between
- [Not Heart Failure](https://epmonthly.com/blog/not-heart-failure/) - I wasn’t giving in to the patient who wanted a prescription for Levaquin after the standard ZeePack didn’t cure his cough. He had a normal chest x-ray and labs the day before but was convinced that he had pneumonia. I tried explaining the difference between bacteria and viruses. I used the “RAID doesn’t work on
- [Ancient Shaman Ritual](https://epmonthly.com/blog/ancient-shaman-ritual/) - On the way into my shift, I walked by a room and noticed that there was iodoform gauze packing hanging on the sign outside the room. Why was it there? Someone found it on the floor and put it there so no one would trip? Ancient Shaman ritual to ward off evil spirits? Secret code
- [What's the Diagnosis #15](https://epmonthly.com/blog/whats-the-diagnosis-15/) - An elderly patient presents with leg weakness over the prior two days. The day of presentation he also notices pain in his upper back which seems to be fairly persistent. His medical history includes diabetes and renal failure. He was dialyzed the afternoon prior to his presentation and his glucose was 264. The patient's daughter
- [Healthcare Update 01-14-2013](https://epmonthly.com/blog/healthcare-update-01-14-2013/) - Interesting facts about the human body. Did you know that your stomach acid can melt zinc? Your femur is 4 times stronger than concrete? In your life you make enough saliva to fill two swimming pools? More strange facts at the link. If your stomach acid can’t dissolve it, then try some Coca-Cola. Study shows
- [Sappy Dog Pictures](https://epmonthly.com/blog/sappy-dog-pictures/) - Just a couple recent pictures of our dogs that made me smile (post title from the late great William the Coroner - he's been gone for more than a year now) . . . . . . .
- [Unnecessary Care?](https://epmonthly.com/blog/unnecessary-care/) - It isn't much of a case, but it created questions in my mind. A mom brings her 8 year old daughter to the hospital for a nonproductive cough. No fever. No runny nose. Just a cough. The patient had started school again this week, and so the microbiome in her nasal passages had thus begun
- [Sage Advice](https://epmonthly.com/blog/sage-advice/) - Some sage advice to my loyal readers ... When you're cleaning up an old house, you move the stove, and you happen to a find a small metal pipe with an unknown substance inside of it, it's probably not the best idea to take a break, pull up a chair, and smoke whatever is in
- [Healthcare Update -- 01-07-2013](https://epmonthly.com/blog/healthcare-update-01-07-2013/) - Colorado Medical Society files suit to prevent chiropractors from administering medications. The Chiropractic Board of Examiners created a rule permitting such actions after chiropractors complete 24 hours of study and a certification exam. I go against the grain on this one. Let chiropractors prescribe medications. After patients start experiencing bad outcomes because the 24 hour
- [Comic Relief](https://epmonthly.com/blog/comic-relief-2/) - Another cartoon courtesy of Mednificent Comics. Winter break ... yeah I think I remember those days. . . . . . . . . . . . .
- [Picture my vocal cords](https://epmonthly.com/blog/picture-my-vocal-cords/) - Dammit Shadowfax. You had to re-tweet the whole "taking pictures of your larynx with an iPhone" meme, didn't you? Started with tweet by @traumagasdoc. Then @Shadowfax retweeted it. Then @maggiemay419 got involved. I don't have an iPhone. I upgraded to a Samsung Galaxy which is larger, so it's a little more of a chore to jam
- [WTF Moment #1036](https://epmonthly.com/blog/wtf-moment-1036/) - While performing CPR on a patient for the third time in the four hours that the patient was waiting in the ED for an ICU bed, a family member shows up. The family member was invited into the room to watch us perform CPR on his grandmother. A nursing supervisor asked him whether or not
- [The WhiteCoat Year in Review](https://epmonthly.com/blog/the-whitecoat-year-in-review/) - I was going to post this yesterday but I got all fired up over the whole Press Ganey thing. Sorry about that. What has happened in the past year? My humble little blog has quite a few visitors over the past year. Depending on the source, last year I had between 700,000 and 780,000 unique
- [Press Ganey Mantra: Suck It Up](https://epmonthly.com/blog/press-ganey-mantra-suck-it-up/) - "It’s a case of good intentions gone badly awry – and it’s only getting worse." Prophetic words in a Forbes Magazine article by Kai Falkenberg titled "Why Rating Your Doctor Is Bad For Your Health." According to the article, Survey “response rates have been dramatically declining over the past decade,” says Paul Alexander Clark, founder
- [That's Some Serious Constipation](https://epmonthly.com/blog/thats-some-serious-constipation/) - By Birdstrike M.D. “Help. Help! I need something for the pain!” I hear a woman wailing from Emergency Department room 4. “What’s that all about?” I ask Veronica the nurse. “I guess I need to see that one first, don’t I?” “No. She says she’s got constipation and no other problems. You need to
- [Healthcare Update -- 12-31-2012](https://epmonthly.com/blog/healthcare-update-12-31-2012/) - A brief interview with an emergency physician who is also a health care attorney … defense only. On the right track about the Affordable Care Act, though - it’s all about access, not insurance. How often have you heard this claim before: Alcohol saved my life! For a man from the UK, the claim was
- [Dear Diary](https://epmonthly.com/blog/dear-diary-12/) - The holidays have been eventful so far. In the "I wish I had my camera ready" department: Driving down the main drag in town where all the stores are located. A man in Clifford the Big Red Dog outfit is walking up and down the street with a sign saying that puppies in the pet
- [NOW You Tell Me](https://epmonthly.com/blog/now-you-tell-me/) - Paramedics bring in a three year old girl who was hit in the head by a television that had fallen off some shelves. It appeared to be a glancing blow - with some bruises to the side of the face and a bump to the back of the head. The only problem was that she
- [Healthcare Update -- 12-24-2012](https://epmonthly.com/blog/healthcare-update-12-24-2012/) - Didn’t take long for that “harmless” drug to kill someone after being legalized in Washington. Vancouver, WA man charged with driving under the influence of marijuana after running down a pedestrian. Just like guns, we should ban it before more people are killed. If it saves one life, it is worth it. It has affected
- [Comic Relief](https://epmonthly.com/blog/comic-relief/) - Courtesy of Mednificent Comics. Lots of funny comics about med school over there. Of course now that I've linked to the site, I won't be able to re-post any of her other comics. Well ... maybe a few. P.S. For those of you who don't know what "medical" clubbing is, click here.
- [Blaming doctors for prescription drug abuse](https://epmonthly.com/blog/blaming-doctors-for-prescription-drug-abuse/) - An article written by two physicians in Time magazine questions whether we should blame doctors for the large number of chronic pain patients and the abuse of prescription pain medications. There are two frames of reference to this article. First, no one can argue that prescriptions for pain medications in this country are excessive. The
- [Should AEDs be required?](https://epmonthly.com/blog/should-aeds-be-required/) - Interesting question posed in a California court case. There's that state acting up again. In Verdugo v. Target Corp (.pdf file) a 49 year old woman collapsed in a Target store. Paramedics were called, but it took them several minutes to arrive and several more minutes for them to find the patient. They were unable
- [A Physician Tries to Make Sense of Sandy Hook](https://epmonthly.com/blog/a-physician-tries-to-make-sense-of-sandy-hook/) - By Birdstrike M.D. Since the massacre of innocent school children and those that gave their lives educating and trying to protect them this past Friday at Newtown Connecticut’s Sandy Hook Elementary School, I've struggled to make sense of this calamity as much as much as anyone. As a Physician who has worked to save the
- [Chronic Hip Pain](https://epmonthly.com/blog/chronic-hip-pain/) - "Careful, he's been in here like six times in the past month and a half. Always looking for his narcs. Check the state database." That was the report I got from the triage nurse as I picked up the chart. I humored her and checked the state database. She was right. The patient had received
- [Healthcare Update -- 12-17-2012](https://epmonthly.com/blog/healthcare-update-12-17-2012/) - Man faces 6 to 30 years in prison after being convicted of aggravated battery for stabbing emergency physician in chest with steak knife. During trial, patient stated “If they’d followed emergency room protocol, we wouldn’t be here right now.” We do it to the heart … why not to the brain? Stents may help certain
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-18/) - OK, so I didn't get home until late yesterday, so it's only a half-weekend. So between shopping trips, you can still post any medically-related comments, questions, or observations in the comments section. I’ll try to answer any questions on Monday or Tuesday. As usual, the only rules for comments are that there are no personal
- [The Boxer](https://epmonthly.com/blog/the-boxer-2/) - He used to be a boxer. Those days were long-gone, though. Now he was a shell of his former self. The hands that formerly knocked opponents to the mat were now contracted and full of arthritis. Dementia had taken away his ability to tell the stories about his career. Metastatic lung cancer ravaged his body.
- [Ah-HA!](https://epmonthly.com/blog/ah-ha/) - I had to go back in time, but I found the post I was looking for. We were joking about patients who come to the emergency department for our help and then won't talk to us. I remembered this story from a previous post on a blog long ago and far far away ... A
- [Does ED overcrowding affect outcomes or costs?](https://epmonthly.com/blog/does-ed-overcrowding-affect-outcomes-or-costs/) - Does ED overcrowding affect patient outcomes or costs? This study from Annals Emergency Medicine (.pdf) suggests so. However, the study used times that hospital was on ambulance diversion as a measurement of overcrowding. When a hospital diverts ambulances, that action may demonstrate overcrowding or may also be due to CT scanner being down or other
- [Healthcare Update -- 12-10-2012](https://epmonthly.com/blog/healthcare-update-12-10-2012/) - You know the ED? No. The OTHER ED. Yeah. That. The one that you get, not the one that you go to. Well it turns out that researchers did a study comparing men with chronic periodontitis to men without chronic periodontitis and they found that men who had chronic periodontitis were more than 3 times
- [CMS Offering Us Some Rope](https://epmonthly.com/blog/cms-offering-us-some-rope/) - Our beloved government is now seeking comments on how it can deny payments to hospitals through patient assessment of the emergency department experience. According to this entry in the Federal Register, the "Consumer Assessment of Healthcare Providers and Systems" ("CAHPS" for short) doesn't address patients' experiences with emergency department services. So the Centers for Medicare
- [How Long Before Zofran Gets Black Boxed?](https://epmonthly.com/blog/how-long-before-zofran-gets-black-boxed/) - It has been a few years, but the FDA's war on antiemetics (medications for vomiting) continues. To review ... Bendectin was the first antiemetic to be taken off the market after famous plaintiff attorney Melvin Belli sued Merrell Dow Pharmaceuticals. No credible evidence was ever found that Bendectin caused birth defects as the plaintiff attorneys
- [Healthcare Update -- 12-03-2102](https://epmonthly.com/blog/healthcare-update-12-03-2102/) - Can a total mattress ban be far behind? Pediatricians publish paper noting that an average of 31 children each day are treated for inflatable bounce house-related injuries and urging that policy makers either “recommend against pediatric bouncer usage” or “formulate recommendations for safer bouncer usage and design.” Because regulation is the key to everyone’s safety.
- [Pressure to Admit](https://epmonthly.com/blog/pressure-to-admit/) - We were away for the weekend, but in a restaurant, I caught glimpses of this segment on 60 Minutes called "The Cost of Admission." Couldn't hear the conversations in the restaurant, but luckily CBS posted the entire report online. If you didn't see it, you really need to watch the video and/or read the transcript.
- [Oddest Patient Complaints of the Night](https://epmonthly.com/blog/oddest-patient-complaints-of-the-night/) - Daughter brings in elderly parent saying "her voice doesn't sound as strong when she talks." Patient then proceeds to scream at daughter telling her that there's nothing wrong with her voice. Daughter says "Well, I guess she's better now, but how do you know she didn't have a TIA?" Simple answer was that I don't
- [Dear Diary](https://epmonthly.com/blog/dear-diary-11/) - Dear Diary Some things just don't make sense to me. Why do dogs just like to eat random objects? Lately, it's been a case of "guess what the dog ate today" around our house. Eraser. Hairbrush. Tube of toothpaste (she loves toothpaste). Martial arts training knife. Our other dog just walks around with his tail
- [Too Heavy to Fly](https://epmonthly.com/blog/too-heavy-to-fly/) - Photo credit and further story at http://www.inquisitr.com Medical care for the morbidly obese is back on the radar. Today this blog got several inbound clicks from a site where a bunch of apparent doctor haters have used one of my blog posts and the comments to the post as an example of how much the
- [Healthcare Update -- 11-26-2012](https://epmonthly.com/blog/healthcare-update-11-26-2012/) - Whatever the hospital is paying this person … it’s not enough. After Hurricane Sandy hit, ED tech Marsha Hedgepeth swam down the flooded road from her apartment to a major highway and then hitchhiked ride with out-of-state utility truck to get to work so she could help other hurricane victims. Amazing dedication. Note to criminals,
- [Accepting Our New Normal and Finding New Opportunities](https://epmonthly.com/blog/accepting-our-new-normal-and-finding-new-opportunities/) - by Birdstrike M.D. It Is Here To Stay The 2012 Presidential election is over. Obamacare is the law of the land and is certain to remain so. There was tremendous uncertainty not knowing whether the law would be repealed, revised or remain. Many of us opposed the bill, and there certainly are negatives. Like it or not,
- [Happy Thanksgiving](https://epmonthly.com/blog/happy-thanksgiving/) - Just finished dinner and going to play a few games of Pictionary with the family, then have a few glasses of wine while watching a movie. To get you in the Thanksgiving spirit, here's a special Thanksgiving video from the great WKRP in Cincinnati: http://www.kewego.com/video/iLyROoafYtDe.html And, for some discussion around the dinner table, did you
- [The Not-So-Free Lunch](https://epmonthly.com/blog/the-not-so-free-lunch/) - A report comes from a nurse on the general medical floor about a patient who is being wheeled down to the emergency department in a wheelchair: The patient was visiting her mother in the hospital when her mother was served lunch. The visitor asked if she could have a tray as well and asked to
- [Healthcare Update -- 11-19-2012](https://epmonthly.com/blog/healthcare-update-11-19-2012/) - Can you imagine your kids on this stuff? Two ounces of Cracker Jack’d will have 70 mg of caffeine - as much caffeine as a cup of coffee. Frito-Lay reports that the snack won’t be marketed to children and will be labeled different from the traditional Cracker Jack boxes. Not sure how I feel about
- [WTF Moment #1012](https://epmonthly.com/blog/wtf-moment-1012/) - A patient and his wife wait patiently in the room for evaluation of the patient's bilateral leg pain ... which has been present for two weeks. Mostly in the back of his calves. Could it be a blood clot? I go in the room and took a look at the patient's legs. There are two
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-17/) - It's time for another episode of Open Mic Weekend and our special guest is ... you. All weekend everyone is welcome to post any medically-related comments, questions, or observations in the comments section. I'll try to answer any questions on Monday. As usual, the only rules for comments are that there are no personal attacks
- [Flu Alert](https://epmonthly.com/blog/flu-alert/) - Influenza has arrived. Some Georgia emergency departments are seeing a 25-30% increase in volumes due to people seeking care for influenza or influenza-like illness. According to the CDC web site, there is good match between vaccines and the circulating virus strains this year. H1N1 virus strain not being seen much. H3N2 is the predominant Influenza
- [The Sneaky "Drunk"](https://epmonthly.com/blog/the-sneaky-drunk/) - A man is brought in by police for blood draw after being arrested for suspicion of DUI. It was very busy, so the patient and officer waited in the waiting room for an hour or so before being brought back to a room. Typically a serum alcohol level decreases by 20-25 mg/dl (.20 to .25)
- [What About MEN?](https://epmonthly.com/blog/what-about-men/) - Retired emergency physician/family physician writes letter to editor of Minnesota newspaper stating that insurance should pay for birth control for all women because otherwise rich women could afford to pay for birth control and poor women would be forced to have unwanted children or “back-alley abortions.” I’m not really sure how someone too poor to
- [Healthcare Update -- 11-12-2012](https://epmonthly.com/blog/healthcare-update-11-12-2012/) - What does President Obama’s victory mean for your future prospects of health care? Here’s one doctor's opinion: Rising insurance premiums, restricted choices for patients, more visits to nurse practitioners or physician assistants, doctors cherry-picking healthy patients for their practice, extra taxes to fund mandates, fewer employment opportunities so that employers can avoid the ACA mandates,
- [Spidey Senses](https://epmonthly.com/blog/spidey-senses/) - This was one of the patients I submitted for Nurse K's Dr. No BS contest. By my calculations, I was the unofficial winner in said contest, but I don't want to brag. The case involves what one of my old mentors used to call his "Spidey Senses". Something just doesn't seem quite right. You can't
- [The Case of the Purple Urine](https://epmonthly.com/blog/the-case-of-the-purple-urine/) - Here's a medical conundrum for all of you faithful viewers of "House" out there. I'm throwing this out there because I have never seen it before. I did some internet searching and think that I came up with the answer (.pdf file) but I'm not positive. The basic history is that the patient is a
- [Greedy or Necessary?](https://epmonthly.com/blog/greedy-or-necessary/) - Mrs. WhiteCoat had a patient issue and doesn't know how to proceed, so she asked me to post the case for other people to comment upon. A patient came to her practice 2 years ago with thyroid problems. She had been seeing an endocrinologist for several years before seeing Mrs. WhiteCoat and even the endocrinologist
- [Healthcare Update - 11-05-2012](https://epmonthly.com/blog/healthcare-update-11-05-2012/) - What will the form for paying your new health care tax look like once 2014 rolls around? Americans for Tax Reform creates one possibility. If you are looking for a list of legislators who voted in favor of the Affordable Care Act on this day before election day, one list broken down by state is
- [Double Bad Idea](https://epmonthly.com/blog/double-bad-idea/) - Throwing gasoline on a lit barbecue is never a good idea. It is an especially bad idea when wearing baggy clothing upon which the gasoline may splash because when the gasoline suddenly explodes, your clothes may catch on fire as well, causing significant burns to your chest, arms, hands, and face. Strange, though, usually when
- [Dear Diary](https://epmonthly.com/blog/dear-diary-10/) - The Hurricane Sandy coverage has me absolutely captivated. Hard to believe how much destruction occurred. Reading about all the hardships that people on the East Coast are going through right now makes me wish I could help somehow. My brother lives in Hoboken and we weren't able to get in touch with him until today.
- [Do Electronic Medical Records Affect Productivity - Part 2](https://epmonthly.com/blog/do-electronic-medical-records-affect-productivity-part-2/) - In case you didn't catch the earlier version of this experiment that I posted, you can find that one here. I work at several hospitals and each uses a different electronic medical record system. When I switch from hospital one to another, I obviously have my favorite EMR systems and my not so favorite EMR
- [Healthcare Update -- 10-29-2012](https://epmonthly.com/blog/healthcare-update-10-29-2012/) - Electronic medical records causing significant delays in medical care and less face time with patients. In the “that’s why they call it dope” department: Man high on PCP undresses at intersection, runs street naked, randomly pounding on hoods of cars. Tries to pull driver out of car and is arrested by police. Taken to ED
- [Criminal Charges for Taking Newborn Outside](https://epmonthly.com/blog/criminal-charges-for-taking-newborn-outside/) - This story came across my news feed this morning. The father of a 2 day old infant is being criminally charged by New York prosecutors with child endangerment and harassment because he attempted to take his son outside for "fresh air" and to "look at the moon." The story only showed up on my news feed
- [Stretching the Definition of "Quality"](https://epmonthly.com/blog/stretching-the-definition-of-quality/) - Attribution: http://www.everystockphoto.com/photographer.php?photographer_id=12419 It seems as if some members of the American Academy of Pediatrics have determined that emergency physicians aren't performing enough useless tests on teenage girls. According to a study presented at this year's AAP conference, only 19 percent of the 77 million girls between ages 14 and 21 that were examined in emergency
- [Criminalizing Society](https://epmonthly.com/blog/criminalizing-society/) - Attribution: http://www.everystockphoto.com/photographer.php?photographer_id=14097 The criminalization of society continues. Regular readers know that I strongly disagree with state efforts to criminalize the practice of medicine. See previous posts here, here, and here for a few. Two days ago I posted an article about a doctor who was criminally charged with providing excessive pain medications to patients who
- [Healthcare Update -- 10-22-2012](https://epmonthly.com/blog/healthcare-update-10-22-2012/) - We wipe our buttocks on your hospital food? Study of 100 food samples from a university hospital in Houston showed that one quarter of them were contaminated with Clostridium difficile - the organism that causes severe diarrhea and colitis in infected individuals and that causes 14,000 deaths per year. Safest bets (at least for this
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-16/) - Welcome back for another edition of the Open Mic Weekend What’s been on your mind since last month? All weekend everyone is welcome to post any medically-related comments, questions, or observations in the comments section. I'll try to answer any questions on Monday. As usual, the only rules for comments are that there are no
- [[Shudder]](https://epmonthly.com/blog/shudder/) - We went to see the movie "Sinister" last night. Cheap scares - like all of a sudden the villain's head pops in front of the camera. Disturbing story line. Several themes in the movie went underdeveloped or were just out of place. WhiteCoats had high hopes, but give it two thumbs down. Then it got
- [Healthcare Update -- 10-17-2012](https://epmonthly.com/blog/healthcare-update-10-17-2012/) - Patient in VA hospital has groin packed in ice for 19 straight hours. Later develops frostbite and gangrene on his penis requiring 5 inches of his penis to be amputated. Man files claim under the Federal Tort Claims Act seeking compensation. Attorney for the Department of Veteran’s Affairs reviews case and writes letter to patient
- [Homeless Elvis](https://epmonthly.com/blog/homeless-elvis/) - By Birdstrike M.D. I think every Emergency Department has a patient like this. Homeless Elvis came in to our ED at least once per day, for many years. Sometimes he’d see each doctor, on each shift in an entire day. By sheer numbers the amount of uninsured ED visits he accumulated over time was
- [Undertreatment](https://epmonthly.com/blog/undertreatment/) - I was surprised by the tenacity of a mother whose 12-year-old child had twisted her ankle while running in gym class. The exam showed minor pain and no soft tissue swelling. Perhaps a little point tenderness over the distal fibular growth plate. X-rays showed open growth plates (see orange arrows), but no other injuries. I
- [Healthcare Update -- 10-11-2012](https://epmonthly.com/blog/helathcare-update-10-11-2012/) - Fascinating four-part series about how Dr. Larry Gentilello helped to bring safety measures to Dallas’ Parkland Memorial Hospital and UT Southwestern. In the end he filed a whistleblower lawsuit against the hospital. Then his career suddenly crashed. On the day that the series was published, the managing editor for the series, Claire St. Amant, received
- [Dear Diary](https://epmonthly.com/blog/dear-diary-9/) - Did you ever have one of those months where you had about a hundred things to write about, but you had no time to write about them? Yeah, that's been me lately. So where do I begin? Just got back from the ACEP Scientific Assembly in Denver. Have another post about that later. So I'll
- [Healthcare Update 10-04-2012](https://epmonthly.com/blog/healthcare-update-10-04-2012/) - Violating EMTALA to get “a lot of positive press”? More hospitals using the InQuickER service that preferentially triages patients who register for their emergency department visits online. Florida businessman reportedly had a seizure while driving, rolled his car, and crashed through a fence. When paramedics arrived, the patient was suspended upside down in his car.
- [Medically Cleared](https://epmonthly.com/blog/medically-cleared/) - Chief Complaint: Claustrophobia HPI: Arrested after beating girlfriend with a wooden table leg. Put in jail cell. Began shaking uncontrollably, flopped about on the floor of jail cell, and screamed repeatedly that the cell was closing in on him and he has terrible fear of enclosed spaces. PE: Wiry multiply tattooed patient sitting in room
- [Lighterman](https://epmonthly.com/blog/lighterman/) - By Birdstrike M.D. I was driving home from a night shift and the scorching sound of Texas guitars flamed out of my car speakers. The group ZZ Top was old, but the song was new. It went like this, “25 lighters on my dresser, yessir. You know I gotsta get paid.” Mostly, I was
- [Is It A Full Moon?](https://epmonthly.com/blog/is-it-a-full-moon/) - [Rrrring ... rrrring] "Hello, Metro General Emergency Department, how may I help you?" [Man with voice kind of like Steve Harvey] "Yeah, do you all do DNA paternity testing down there?" "Ummm, no. No emergency department does paternity testing that I know of. You'd have to get that done through your doctor's office." "I don't
- [Healthcare Update -- 09-26-2012](https://epmonthly.com/blog/healthcare-update-09-26-2012/) - Macabre Monty Python plot? Organ donor network allegedly pressures hospitals to declare severely ill patients as being brain dead - even when the patients showed signs of life. If these allegations are true, should criminal charges be filed? Against whom? Lindsay Lohan goes to the emergency department for an asthma attack … or a “bad
- [When You Don't Know What You Don't Know](https://epmonthly.com/blog/when-you-dont-know-what-you-dont-know/) - This has happened twice to me, but I'm learning ... The first patient was several years ago. She came in with headaches. Her blood pressure was 220/110. The headache wasn't an issue. The patient hadn't taken her blood pressure medications that day and had a history of headaches. There was no change from prior headaches.
- [Healthcare Update -- 09-24-2012](https://epmonthly.com/blog/healthcare-update-09-24-2012/) - Which is exactly why they’re going to cut reimbursement even more … Medicare requires providers to use electronic medical records to avoid being “penalized”. Now they discover that computerized medical records are better at billing and that Medicare had to pay $1 billion more in reimbursements in 2010 than it did five years earlier. Goodbye
- [Dr. Owth](https://epmonthly.com/blog/dr-owth/) - An irate patient comes to the registration window. "I need to find the doctor that treated me last night." "What's the problem?" the registration clerk asked. "How am I supposed to function when this Dr. Owth only gave me EIGHT Vicodin tablets? I'm already out!" "Dr. Owth? There's no Dr. Owth that works here." "I
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-15/) - It's been about a month since the last open-mic weekend. What's on your mind? All weekend everyone is welcome to post any medically-related comments, questions, observations in the comments section. Will try to answer any questions through the weekend. Only rules are that there are no personal attacks and that the comments/questions are medically-related. Have
- [Those Shoes](https://epmonthly.com/blog/those-shoes/) - By BirdStrike M.D. Some cases burn into your brain like a hot branding iron, for whatever reason, and never really leave. This was one of those cases. One hectic morning before my shift, my wife and I rushed around the house trying to get our kids ready for school. On this day, my daughter was
- [Growth of Emergency Medicine Contractor Groups](https://epmonthly.com/blog/growth-of-emergency-medicine-contractor-groups/) - Interesting statistics from a September 2012 Modern Healthcare magazine survey regarding the number of contracts held by major emergency medicine contract management groups and the rate of growth in their contracts from 2010 to 2011. Firm / Percent Change in contracts 2010 to 2011 / Contracts in 2011 EmCare / +8.9% / 428 TeamHealth /
- [Healthcare Update -- 09-13-2012](https://epmonthly.com/blog/healthcare-update-09-13-2012/) - Kentucky man goes into surgery for a circumcision, leaves surgery without a penis. The urologist stated that the patient’s genitals were “cancer ridden”, that no living tissue was present, and the patient consented to additional procedures at the doctor’s discretion. The patient claims the doctor should have delayed the procedure and allowed the patient to
- [Dr. No BS](https://epmonthly.com/blog/dr-no-bs/) - Can you or an emergency physician that you work with win Nurse K's coveted "Dr. No BS" award? Check her blog to get rules and post your scores in the comments section or on her twitter account. She includes science behind some of the scoring, as well. Interesting in that some people in the comments
- [My Three Patients](https://epmonthly.com/blog/my-three-patients/) - I'm not going to tag anyone else for this meme, but I liked the idea that Ramona Bates (Sutured for a Living and @rlbates) put out on her Twitter feed from Wing of Zock. Play along if you want and drop a comment in the comments section if you do. I'd like to read them.
- [Obama vs. Romney vs. Honey Boo Boo](https://epmonthly.com/blog/obama-vs-romney-vs-honey-boo-boo/) - By Birdstrike M.D. Once again, our upcoming election will have great impact on future health care policy. Obamacare will either be kept intact, repealed or altered. This will have great impact on patients, physicians in general, and especially Emergency Physicians. By whom they choose to lead us, the electorate will decide whether treatments are
- [Choosing Wisely - Good Medical Practice or Prelude to Rationing?](https://epmonthly.com/blog/choosing-wisely-good-medical-practice-or-prelude-to-rationing/) - EP Monthly has an important Pro-Con debate between ACEP President David Seaberg and EP Monthly founder Mark Plaster about the "Choosing Wisely" program. Choosing Wisely is being pushed by the ABIM Foundation as a way to get specialty societies to label certain tests as "unnecessary" or of questionable benefit. I side with Dr. Seaberg in
- [Good medical reads](https://epmonthly.com/blog/good-medical-reads/) - For those medical practitioners that don't usually read EP Monthly, there are always good articles from some of the top names in emergency medicine. Lately, there have been several articles published that are exceptionally good. Rick Bukata has a thought-provoking article about management of simple abscesses. Definitely worth a read. The bottom line is that
- [Dear Diary](https://epmonthly.com/blog/dear-diary-8/) - Not to interrupt the interesting discussion going about BirdStrike's post regarding what a life is worth, but ... Kids are all back to school. It was funny watching three of them enter new schools this year. The video of Junior WhiteCoat trying five times to open his locker then getting mad when dad did it
- [What Is Your Life Worth?](https://epmonthly.com/blog/what-is-your-life-worth/) - By BirdStrike M.D. “Good, it’s about time that these greedy doctors get smacked down for being the financial rapists that they are. Medicine in this country is the biggest, most destructive SCAM going on today. Doctors think they are entitled to RIDICULOUS amounts of money for simple routine procedures.”- Johnathan Blaze August 27, 2012 at
- [Healthcare Update -- 09-02-2012](https://epmonthly.com/blog/healthcare-update-09-02-2012/) - Deadly amoeba found in home drinking water. Initially, two patients who died from Naegleria fowleri meningoencephalitis were thought to have contracted the disease from using Neti pots. Now investigations show that the amoeba was found in the patients’ home plumbing systems. JCAHO soon will require only bottled JCAHO-approved spring water in all hospital plumbing systems.
- [It's an MVA, dammit](https://epmonthly.com/blog/its-an-mva-dammit/) - If you're an EMT, don't start lecturing me in front of the patient you just brought in about how she was involved in a "motor vehicle collision" and not a "motor vehicle accident." I was half joking when I asked you if you meant that she was in a motor vehicle "accident" when she rolled
- [Why You Shouldn't Wash Cats](https://epmonthly.com/blog/why-you-shouldnt-wash-cats/) - It was 2 AM and kind of slow. Then a "twofer" comes up to the registration desk. Mother and son both need to be seen. Emergency medicine lore has it that when more than one patient from the same household registers to be seen at the same time in the emergency department, the likelihood of
- [Healthcare Update -- 08-27-2012](https://epmonthly.com/blog/healthcare-update-08-27-2012/) - And we think doctors have it bad ... Woman sues Santa Monica City Hall for $1.7 BILLION because the town’s newly-installed parking meters and their wireless signals have caused her tinnitus, ear infections, and muscle tightness. Hat tip to Walter Olson at Overlawyeredfor the link. New Orleans jury awards plaintiff $24 million after infusion pump
- [Unnecessary Testing](https://epmonthly.com/blog/unnecessary-testing-2/) - Real patient encounter ... A 22 year old guy comes to the registration grabbing his chest. He's having palpitations and chest pain. He's a pack a day smoker, has no family history of heart disease, and was out late the prior evening partying. So when he woke up, he was dragging a little. He had
- [Fair Payment?](https://epmonthly.com/blog/fair-payment/) - This story is making the rounds on the internet recently. A plastic surgeon is being sued by California State because she charges patients fees in excess of what insurance pays for her services. California's lawsuit alleges that the doctor poses a "substantial, irreparable, and unjustified threat to the financial livelihood" of her patients. In addition,
- [Healthcare Update -- 08-20-2012](https://epmonthly.com/blog/healthcare-update-08-20-2012/) - Sharks beginning to smell blood in the water. Pradaxa lawsuits piling up and likely will result in giant class action suit. One law firm has 70 employees dedicated to Pradaxa litigation alone and the attorney can’t even remember the name of the client the reporter called to ask him about. Looks like the yolk’s on
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-14/) - Back for another open-mic weekend. All weekend everyone is welcome to post any medically-related comments, questions, observations in the comments section. Only rules are that there are no personal attacks and that the comments are medically-related. Have a safe and enjoyable weekend.
- [Healthcare Update -- 08-17-2012](https://epmonthly.com/blog/healthcare-update-08-17-2012/) - Jury … in Florida … awards family of child $28.4 million after defendant physicians reportedly ignored the lumbar puncture results of a “fever wracked” infant and failed to give the infant antibiotics for meningitis. The doctors allegedly “robbed the … youngster of a normal life” since he later had a stroke and will have the
- [FDA's Latest Deadly Drug: Codeine](https://epmonthly.com/blog/fdas-latest-deadly-drug-codeine/) - Get ready for more governmental regulation of opioids and maybe even some black box warnings added to the prescribing information for c0deine-containing drugs ... just for everyone's safety, of course. According to this FDA Special Bulletin on Safety Information, three pediatric deaths and one case of respiratory depression were documented in the medical literature after
- [Hacker Labeling](https://epmonthly.com/blog/hacker-labeling/) - I've got a question for all you pharmacists and other experts out there. Is there some scientific basis why we laBEL mEDIcatION BoTtLeS liKE We'RE COMPuter HACKers? The practice appears to me to be more commonplace, so I tried to find some scientific studies demonstrating its effectiveness. While several articles show "tall man" lettering may
- [Do Something!](https://epmonthly.com/blog/do-something/) - They waited patiently while the emergency department staff was stabilizing several patients who had been involved in a motor vehicle accident. "We'll be with you as soon as we can." They waited patiently while the emergency department staff tended to the hypotensive nursing home patient, but were loudly telling everyone how the nursing home patient
- [Tony the Doorman](https://epmonthly.com/blog/tony-the-doorman/) - By BirdStrike M.D. I’m sitting in my apartment on the West Coast starving, listening to my stomach growl, waiting for my pizza to be delivered. It is taking unacceptably long. I’m going back and forth on how little I can tip the pizza delivery man without feeling too guilty to actually enjoy the pizza if
- [Healthcare Update 08-10-2012](https://epmonthly.com/blog/healthcare-update-08-10-2012/) - Good thing the government is going to make sure everyone has INSURANCE. Now good luck finding care. Nearly one third of doctors won't take government's Medicaid insurance. If you live in New Jersey, only 40% of doctors accept Medicaid. This same issue was raised years ago and no one paid attention. Now we're all getting
- [Healthcare Update -- 08-06-2012](https://epmonthly.com/blog/healthcare-update-08-06-2012/) - Finally some proof! We CAN’T sue our way to better health care. Choke on that, American Association for Justice. Largest medical malpractice verdict in Colorado history handed down last month. $15 million awarded to 36 year old man who came to the emergency department with neck pain, numbness, and tingling in his arms and legs,
- [No Fingers Allowed](https://epmonthly.com/blog/no-fingers-allowed/) - Sent from a reader ... Because stool obviously transmogrifies as it exits the rectum. Stool contained on the end of one's finger after performing a rectal exam and then transferred to a hemoccult card causes hemoccult cards to give wrong readings and therefore the results "may not be accurate." However, stool that is plopped in
- [A Nameless Faceless Killer](https://epmonthly.com/blog/a-nameless-faceless-killer/) - By BirdStrike M.D. 1) A 40-year-old female sees her family physician for burning chest pain after she eats hot peppers. She had it only once while exercising. Her family physician sends her to the emergency department and she gets admitted for chest pain. Rather than going home with treatment for her GERD, she ends up dead.
- [A Great MasterCard Commercial](https://epmonthly.com/blog/a-great-mastercard-commercial/) - Cost to replace the door that you knocked off the hinges when you fell and hit your head: $127 Cost of bandages your dad used to wrap the laceration to your head when he came home from work: $6.50 Cost of food from the vending machine in the emergency department waiting room: $7 Cost of
- [Healthcare Update -- 08-01-2012](https://epmonthly.com/blog/healthcare-update-08-01-2012/) - Bank robber gets shot in hand while trying to run over state troopers. Brought to emergency department and prescribed pain medication. When he returned to jail, the nurse gave him Tylenol #3 instead. Inmate then sued everyone for $2 million. Fortunately, a judge dismissed the case. Something wrong with this picture? Woman has “mommy makeover”
- [GNYHA STOP Sepsis Collaborative Guidelines Revealed](https://epmonthly.com/blog/gnyha-stop-sepsis-collaborative-guidelines-revealed/) - The Greater New York Hospital Association guidelines Jim Dwyer cited in his Rory Staunton articles about physicians who "missed obvious signs" of sepsis were hidden in his article. Fortunately, Alissa D'Amelio who is the Senior Project Manager for Regulatory and Professional Affairs at the GNYHA was kind enough to forward me a copy of the
- [We Need Those Meds!](https://epmonthly.com/blog/we-need-those-meds/) - A patient comes in with dyspnea. He has a history of CHF and a history of COPD, so determining the etiology of his shortness of breath would prove to be a little tricky. His wife, trying to be helpful, repeatedly interrupts the patient during his history. "How long have you been having trouble breathing, sir?"
- [The Importance of Emergency Medical Services](https://epmonthly.com/blog/the-importance-of-emergency-medical-services/) - There has been a lot of "spinning" of the tragic shooting that occurred in Colorado last week. More guns. Less guns. Democratic policy issues. Republican policy issues. I'm going to try not to add my spin to the mix, but I do want to raise one issue for everyone to consider. As this event unfolded,
- [Skeevalicious](https://epmonthly.com/blog/skeevalicious/) - You know how when people talk about lice in the emergency department everyone starts itching? The entire itching thing just evolved to a whole new level for me. Usually I leave my backpack under the desk and I have books, medical equipment, some electronics, snacks and drinks inside. Usually snacks include powerbars, dried fruit, almonds,
- [Political Quote of the Day](https://epmonthly.com/blog/political-quote-of-the-day/) - “Maybe we should have started with you at the very beginning, talked to the physicians before they started writing a 2,000-plus-page bill that many of them [politicans] didn’t read, yet passed.” - Republican Rep. Scott Tipton, commenting about the Affordable Care Act during a House Small Business Committee meeting last week which showed how “physicians
- [Why Some People Just Will Never Get It](https://epmonthly.com/blog/why-some-people-just-wont-be-able-to-ever-get-it/) - By BirdStrike M.D. This post was inspired by a brilliant response by Lior to WhiteCoat’s excellent article “Jim Dwyer New York Times Pediatric Fever Article Debate” on this very blog. First, what should not be lost in this back and forth debate are Rory Staunton and his family. I give my deepest condolences to the
- [Healthcare Update -- 07-25-2012](https://epmonthly.com/blog/healthcare-update-07-25-2012/) - Stop calling it a tax, dammit! Under the Affordable Care Act, business owners will pay $4 billion more in taxes. Now the Congressional Budget Office is calling it a “penalty tax.” NY Times journalist Jim Dwyer dislocates shoulder patting himself on back for getting NYU hospital to change policies after writing poorly-researched article on sepsis
- [Chief Violetté and the Headless Trauma](https://epmonthly.com/blog/chief-violette-and-the-headless-trauma/) - By Birdstrike M.D. It was intern year of my Emergency Medicine residency. I was on my trauma surgery rotation and working at least 100 hours per week (pre-ACGME regulations). To say that I was burned out and sleep deprived would be an understatement. It was three weeks into residency and I had done nothing but
- [Jim Dwyer New York Times Pediatric Fever Article Debate](https://epmonthly.com/blog/jim-dwyer-new-york-times-pediatric-fever-article-debate/) - This is probably a record length post for me, but I thought it was important to respond to Mr. Dwyer's comments to a post written on this blog regarding the article he wrote that appears in the NY Times. I had planned to leave my comments after his, but they became too long and involved
- [Five Long Years](https://epmonthly.com/blog/five-long-years/) - Today marks the end of the fifth year that I've been posting drivel on the Internet. It all started when some lady kept fretching in our emergency department and I had enough. I created a blog called WhiteCoat Rants, posted a little story about fretching, and since then, it has been a rollercoaster of a
- [Get Your Own X-ray](https://epmonthly.com/blog/get-your-own-x-ray/) - GruntDoc had a post that illustrates a point I have been trying to make for quite some time. The post is simple enough. It starts out with a Twitter post by a physician named Brett (@EMDocBrett) noting "Ottawa Ankle Rules? People follow them? I try to explain to pts but really, they [just] want an
- [Dear Diary](https://epmonthly.com/blog/dear-diary-7/) - I've had an interesting couple of weeks. My trusty Palm Pre died on me after a good few years. When I brought it to the customer service center, the whippersnapper working there said "Whoa! That's an old phone!" Thanks. Amazing how something that was so "cutting edge" a few years ago is now pretty much
- [Jim Dwyer New York Times Article - Irresponsible Journalism?](https://epmonthly.com/blog/jim-dwyer-new-york-times-article-irresponsible-journalism/) - By an Anonymous Emergency Physician The opinion piece below was written by an emergency physician regarding a New York Times article by Jim Dwyer (picture at right). The author did not want to be identified due to fears of retribution from either the NY Times or from the hospital at which the physician is employed.
- [Healthcare Update 07-16-2012](https://epmonthly.com/blog/healthcare-update-07-16-2012/) - Some inner-city New York hospitals have figured out how to save money in malpractice premiums … they “go bare.” Interfaith, Kingsbrook Jewish, and Wyckoff Heights all insure themselves for lawsuits and two of them have set aside no money for judgments. Lawyers call it “irresponsible.” Feeling suicidal? Text me about how you feel. Patients with
- [The Individual Mandate For Dummies](https://epmonthly.com/blog/the-individual-mandate-for-dummies/) - This cartoon was sent to me in an e-mail. Overly simplistic, but illustrates the issue. Credit here.
- [Healthcare Update -- 07-13-2012](https://epmonthly.com/blog/healthcare-update-07-13-2012/) - Difficult ethical dilemma. With limited resources, what should be done about the 10% of Medicare patients who use nearly two thirds of the Medicare’s hospital spending? End of life care also accounts for a large amount of spending - rough estimates show that about 22% of Medicare spending is for end of life care. And
- [New Public Health Hazard](https://epmonthly.com/blog/new-public-health-hazard/) - I took my daughter to her pediatrician's office for her immunizations and it never ceases to amuse me how little logic is contained within the agencies that are supposed to be protecting our health. To prevent the spread of infection, the Medical Marijuana Advocates (a.k.a. the Joint Commission) have apparently made it a "standard" to
- [Buffy the Lifeguard](https://epmonthly.com/blog/buffy-the-lifeguard/) - By BirdStrike, MD Taking a break from my main job at the trauma center, I was covering an odd night shift at the “Little ER”, an 8 bed glorified “urgent care” type ED that actually takes ambulances, but probably shouldn’t. Susie the nurse walks calmly out of room 4 and says, “We’ve got a heroin
- [Advice for New Medical Students](https://epmonthly.com/blog/advice-for-new-medical-students/) - Whether you're starting medical school or beginning your second year, this post is for you. Will probably work just as well for PAs, NPs and any other health professional student who hasn't started clinical rotations. Our former babysitter just graduated from medical school and the WhiteCoats are just as proud as her parents are. Then
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-13/) - Back by popular request … All weekend everyone is welcome to post any medically-related comments, questions, observations in the comments section. Only rules are that there are no personal attacks and that the comments are medically-related. Will try to respond Monday or Tuesday with answers. Stay cool over the weekend.
- [Healthcare Update -- 07-06-2012](https://epmonthly.com/blog/healthcare-update-07-06-2012/) - Hmmmm. Sunburns and skin cancer versus loss of libido and shrunken male genitals. Which to choose? According to this expert, the oxybenzone contained in most sunscreen causes smaller penis size in children, loss of libido in adult males, and fibroids/endometriosis in females. There may be a scientific basis behind the Crazy Cat Lady Action Figure
- [The Supreme Curve Ball](https://epmonthly.com/blog/the-supreme-curve-ball/) - The Supreme Court decision on the Affordable Healthcare Act threw us a curve ball. Many people who predicted the outcome of the ruling swung and missed - including me. The Court agreed with the government's argument that the individual mandate contained in the Affordable Care Act was not a tax ... for purposes of the
- [Obamacare Is Wrong, But The Chief Justice Is Right](https://epmonthly.com/blog/chief-justice-birdstrike/) - By Birdstrike M.D. Yesterday, my 2 year old asked me, “Daddy, do clouds make rain by forming condensing nuclei of water vapor which act to form droplets which fall to the ground?” I said, “No, son. No. You’ve got it all wrong. Actually, those drops of rain are the tears of our founding fathers crying
- [Happy July 4](https://epmonthly.com/blog/happy-july-4/) - While celebrating this great day, remember that the holiday wasn't created for picnics, it wasn't created as an excuse to shoot off fireworks, and it wasn't created so that most of us could get another day off of work. Always remember the ordinary people who became extraordinary by leaving their families to travel far away
- [WTF Moment #1007](https://epmonthly.com/blog/wtf-moment-1007/) - Mom busts through the doors with her young son. "He's having an allergic reaction. Someone help!" Everyone drops what they are doing, rushes over, and brings the child into a room. Young child looks up at all the people and gives a big grin. "I was feeding him his bottle and some of it spilled
- [Healthcare Update -- 06-27-2012](https://epmonthly.com/blog/healthcare-update-06-27-2012/) - Supreme Court prediction: Individual mandate unconstitutional. Remainder of law stands. Both parties declare victory. Then we have to put up with talking heads putting their spin on the decision for the next two weeks. Beware what you write online … they’re watching. Study published in Emergency Medicine Journal analyzes the Twitter accounts of emergency physicians
- [Pain Transference](https://epmonthly.com/blog/pain-transference/) - It took a while, but I now have five things on my list of rantable offenses occurring in the emergency department. To recap ... Don't call it the "emergency room" or the "ER" to my face, in the comments, or anywhere else. Period. It is the emergency department. "ER" is a TV show that was
- [Bullying a Bus Monitor](https://epmonthly.com/blog/bullying-a-bus-monitor/) - If you haven't seen the video of the elderly school bus monitor being taunted and bullied by several upstate New York boys riding the bus, you should watch it. When I watched that video, my heart sank for the poor woman, but the video also made me wonder where society's morals have gone. While it
- [You Can Tie, You Can Lose, But You Can Never Win](https://epmonthly.com/blog/you-can-tie-you-can-lose-but-you-can-never-win/) - The article below was forwarded to me by a reader. It was originally published on the Student Doctor Network by an anonymous poster who goes by the handle "BirdStrike" and was made free to republish. For those of you who want further insight into how patient satisfaction rankings adversely affect medical care in the emergency
- [The Expense of Saving Money](https://epmonthly.com/blog/the-expense-of-saving-money/) - Our state government, just like every state government, is trying to save money. One of the largest targets for this attempt at savings is the health care system, since health care is one of the largest expenses in any state budget. In order to save money, the state government has several options: It can raise
- [Healthcare Update -- 06-20-2012](https://epmonthly.com/blog/healthcare-update-06-20-2012/) - Lots of propaganda ahead of Supreme Court’s decision on constitutionality of health care reform. 3 patients an hour die because they don’t have health insurance. A group called “Families USA” states that “only the Affordable Care offers the promise of access to affordable coverage and to a longer and healthier life.” The group cites a
- [Opportunities](https://epmonthly.com/blog/opportunities/) - I was away all weekend at another lacrosse tournament with the family. That was fun, but a little stressful. Plus, we were sitting out in the sun from 8AM to 6PM. Even SPF 70 sunscreen doesn't block all the sun for those with hypomelanosis. My forehead and nose are now a deep rouge color. On
- [Healthcare Update 06-18-2012](https://epmonthly.com/blog/healthcare-update-06-18-2012/) - That won’t get you back any quicker. 18 year old Utah man arrested for making terroristic threats after writing threatening messages on the back of ED comment cards while waiting to see his aunt. One note allegedly said “put the money in a bag or I’ll blow up the hospital.” Hospital personnel found the notes while
- [Bye Bye Generic Vicodin](https://epmonthly.com/blog/bye-bye-generic-vicodin/) - Let the wailing and gnashing of teeth begin. Vicodin pills are about to get a lot more expensive. You see, according to this Abbott Vicodin Announcement (.pdf file), Abbott Labs is very concerned about the Tylenol content in its combination pain medications. After all, too much acetaminophen per dose in prescription medications may cause "severe
- [You Can Have Our Flowers When We're Done](https://epmonthly.com/blog/you-can-have-our-flowers-when-were-done/) - A little old lady is brought to the emergency department by ambulance after she called 911 because she was having chest pains. She woke up that morning and felt fine, but after eating breakfast, she began having more difficulty breathing than usual, and had substernal chest pressure which radiated to her left arm. The pain
- [Dear Diary](https://epmonthly.com/blog/dear-diary-6/) - [Exhale] The last few weeks have really been ... busy. We're down a doc at work, so I had to pick up a few shifts and my schedule was already overloaded to begin with. But that's just the beginning. Had two graduations - oldest daughter from middle school and youngest daughter from kindergarten. Family was
- [Healthcare Update -- 06-11-2012](https://epmonthly.com/blog/healthcare-update-06-11-2012/) - Good news is that you and your children are less likely to die in a fire. Bad news is that you and your children may be more likely to gain weight, become anxious, experience premature puberty, and have abnormal reproductive cycles. To blame: the flame retardant chemical named Firemaster 550. Jury awards family $6.4 million
- [Healthcare Update -- 06-04-2012](https://epmonthly.com/blog/healthcare-update-06-04-2012/) - Lawmakers want to Nix the Kwell. Am I witty or what? I’ll post a leader board if it ever makes it onto AddictingGames.com. Northwestern University finalizing video game to show doctors how to address drug seekers. And until uninformed administrators stop relying on Press Ganey scores where unhappy drug seekers can knock down a physician’s
- [Healthcare Update -- 06-01-2012](https://epmonthly.com/blog/healthcare-update-06-01-2012/) - Sorry I've been "off the grid" this week. Upcoming diary post about why ... The drip that keeps dripping. Cases of gonorrhea up 25% in England in the past year - up 61% among homosexual males and young heterosexuals. New cases totaled just under 21,000 last year. Many of those cases were drug resistant. According
- [I'm Getting Old](https://epmonthly.com/blog/im-getting-old/) - Congratulations on your graduation, kiddo. We're all proud of you and your straight A average, even if your friends make fun of you for being a "try-hard." Doesn't seem like it was that long ago when I was giving you piggy back rides and helping you fix the disarticulated joints on your Barbie dolls. You've
- [Healthcare Update -- 05-25-2012](https://epmonthly.com/blog/healthcare-update-05-25-2012/) - Simulated training improves skills in real life cardiac resuscitations. Not sure that I believe sim training should be a replacement for real-life resuscitations, though, which is were I see this headed. To heck with medical malpractice cases - this is a whole lot easier. Plaintiff attorneys begin gravitating toward cases in which there have been
- [Healthcare Update -- 05-24-2012](https://epmonthly.com/blog/healthcare-update-05-24-2012/) - Another reason that I like sushi. Man goes to hospital for abdominal pain. Doctors believe he has appendicitis. Surgery shows that he swallowed a 1.5” bristle from the brush he used to clean his barbecue and the bristle had perforated his colon. Six Indiana emergency physicians resign after hospital outsources contract to national emergency medicine
- [Best States in Which to Practice Medicine -- UPDATE](https://epmonthly.com/blog/best-states-in-which-to-practice-medicine-update/) - This blog gets a lot search engines hits from people (presumably physicians) who are looking for the best states in which to practice medicine. Many of the hits go to a previous post on this topic here. Medscape recently came out with a new set of recommendations based on research done by Shelly Reese, a
- [Crazy Rabid Squirrels -- Part Deux](https://epmonthly.com/blog/crazy-rabid-squirrels-part-deux/) - And I thought that there was only going to be one case of a crazy rabid squirrel. Boy was I wrong. A previous post on the subject a year ago had a lively discussion. This visit started by a mother bringing in her six-year-old son because her son got bitten by a squirrel. Actually, the
- [Antibiotics Kill, Probiotics Heal](https://epmonthly.com/blog/antibiotics-kill-probiotics-heal/) - Two interesting studies were published recently. First was a study in NEJM showing that the beloved ZeePack that so many people think will clear their boogers and resolve their cough instead increases the risk of death. During the 5 days that they took Zithromax (azithromycin), patients had almost a threefold increase in risk of cardiovascular
- [Healthcare Update -- 05-19-2012](https://epmonthly.com/blog/healthcare-update-05-19-2012/) - Very poignant story about how a daughter is dealing with the health problems of her elderly father. Not Watching My Goldfish Die. Read it. Gatorade and Powerade are going to hate this study. Bananas are just as good as energy drinks as a source of energy during exercise. Bonus: They're a frick of a lot
- [Press Ganey Flunks Own Rating Scale](https://epmonthly.com/blog/press-ganey-flunks-own-rating-scale/) - So I happened to be looking through my blog stats to see which posts are most interesting to you all lately. One of the stats on the blog is search terms that cause people to end up on my blog. Some of them are amusing, such as "How do I disimpact myself" [ANSWER: You don't]
- [Format Change](https://epmonthly.com/blog/format-change/) - I decided to stop posting Healthcare Updates every Monday. For one, if I get overwhelmed on a Monday (like what has happened a couple of times in the past month) and can't get everything out into a post, then it doesn't get published. Plus, there's a delay in getting the stories out there and I
- [Healthcare Update -- 05-17-2012](https://epmonthly.com/blog/healthcare-update-05-17-2012/) - Going green may make you feel blue. Reusable grocery bag cited as cause for norovirus outbreak. Member of girls soccer team became sick in bathroom where bag was sitting, later passed bag around to other players who ate cookies contained in the bag. The following day, six teammates developed vomiting and diarrhea. Testing showed norovirus
- [Dear Diary](https://epmonthly.com/blog/dear-diary-5/) - Two days later than I planned on posting. First of all, you all crack me up about the unemployment post. You can't imagine all the e-mails I got about this. I'm not going anywhere. But it is nice to know that my ramblings are modestly interesting to more than a couple of people. The weekend
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-12/) - Back by popular request ... All weekend everyone is welcome to post any medically-related comments, questions, observations in the comments section. Only rules are that there are no personal attacks and that the comments are medically related. I don't want to hear anything about politics, canines, or politics and canines. Will try to respond Monday
- [Soon To Be Unemployed](https://epmonthly.com/blog/soon-to-be-unemployed/) - It is with a heavy heart that I tell you all that someone else is going to be taking over my duties in the emergency department and on this blog from this point forward. Below is the story why. --------- Something didn't look right when the very large patient was wheeled into the emergency department.
- [Microbial Armageddon](https://epmonthly.com/blog/microbial-armageddon/) - Any patient who demands a ZeePack for a runny nose, who wants amoxicillin for sinus congestion, or who wants Levaquin to "keep this bronchitis from developing into pneumonia" needs to read this Bloomberg article. We are heading toward a situation where people die from infections that no antibiotics can treat. The article discussed one infant
- [Dr. Google, meet Pharmacist Bing](https://epmonthly.com/blog/dr-google-meet-pharmacist-bing/) - FDA decides whether to allow patients to purchase prescription medications over the counter for many common ailments. This idea is controversial. On one hand, deregulation would remove one of the largest barriers to receiving treatment for some conditions - the doctor's visit. If no doctor's visit is necessary to receive necessary blood pressure medications or
- [Healthcare Update -- 05-07-2012](https://epmonthly.com/blog/healthcare-update-05-07-2012/) - Want to score some narcotics and some inappropriate antibiotics? Go to an emergency department complaining of a toothache. 75% of patients complaining of toothaches are prescribed Vicodin. The article also notes how patient satisfaction ratings contribute to the problem. Australian hospital threatens a “zero tolerance” policy for violence in the emergency department. Police will be
- [Why Bother?](https://epmonthly.com/blog/why-bother/) - Doctor: "No, I'm not giving you a prescription for Levaquin for your 'sinus infection' of the past 12 hours. You don't have a sinus infection and even if you did, antibiotics aren't effective in treating sinus infections." Patient's husband: "Come on, honey. We'll just go to the walk-in clinic at the pharmacy. They'll give us
- [Speaking from Experience](https://epmonthly.com/blog/speaking-from-experience/) - I was having difficulty with a back pain patient who was being rather antisocial. He wouldn't answer my questions about his history. He flopped forward on the bed and wouldn't let me examine him. He couldn't sit up because he was in too much pain. Then his next door neighbor adds to the problems. "You
- [Healthcare Update 04-30-2012](https://epmonthly.com/blog/healthcare-update-04-30-2012/) - Back from a rough week. Satellite Editions of this week's update at ER Stories and at Medbloggers.org. As always, if you're interested in posting here or at Medbloggers, drop me an e-mail. Not a laughing matter. Not even a smiling matter … especially for the patient. Man goes to see dentist for a toothache. Dentist
- [Diet Blogging is a Crime in North Carolina](https://epmonthly.com/blog/diet-blogging-is-a-crime-in-north-carolina/) - North Carolina Board of Dietetics and Nutrition threatens to sue a diabetes blogger and potentially subject him to 120 days in jail for recommending the "Paleo diet", alleging that the blogger is practicing “nutrition” without a license (which is a misdemeanor [.pdf file]). The NC Dietetics Nutrition Practice Act really doesn't state what is permissible,
- [Life vs. Blogging](https://epmonthly.com/blog/life-vs-blogging/) - The past week has been extraordinarily busy, but I just wanted to drop a quick post to let everyone know that I haven't quit the blogging scene. Let's see ... I've worked 36 hours, lectured, accompanied a sick friend to the doctor's office (got a post in my head about that already), attended a two
- [Know these people](https://epmonthly.com/blog/know-these-people/) - Someone sent me this link and it's amusing enough to pass on while I attend Daughter WhiteCoat's dance competition. http://www.buzzfeed.com/daves4/people-you-wish-you-knew-in-real-life Smile
- [The Squeeze](https://epmonthly.com/blog/the-squeeze/) - Work in emergency medicine long enough and you get good at figuring out what patient’s medical problems are just by their appearance. He had a pasty color as he was wheeled through the door. Anemic for sure. His abdomen was swollen. Liver failure is my guess. Probably GI bleeding. But he also had the blank
- [Healthcare Update -- 04-17-2012](https://epmonthly.com/blog/healthcare-update-04-17-2012/) - Sorry about the delay. Had a few "rock" issues to take care of over the weekend. The number of uninsured patients in North Carolina increased by 22% in five years - more than double the rate of rise in population. The article touted the Affordable Care Act as a way to decrease the number of
- [Poo Quote of the Night](https://epmonthly.com/blog/poo-quote-of-the-night/) - Poo issues tend to be interesting. Still haven't had one that matches up with this poo issue, but nevertheless ... poo issues are interesting. A young woman stated that she had a worm that kept sticking its head out of her "butthole," wiggling around, and retreating back inside before she could get her pants down and
- [Mail Order Prescriptions Just Went From Bad to Worse](https://epmonthly.com/blog/mail-order-prescriptions-just-went-from-bad-to-worse/) - As if drug shortages aren't enough. Remember the post about Medco patients "accidentally" running out of their prescriptions because Medco "didn't receive" faxes, because Medco was trying to pitch your doctor to prescribe other medications, and because of "delays" from the mail? Well you don't have to worry about Medco anymore. The Federal Trade Commission
- [Anna Brown And Appropriate Emergency Medical Care](https://epmonthly.com/blog/anna-brown-and-appropriate-emergency-medical-care/) - I'm surprised that this case hasn't gotten more press. A patient named Anna Brown was unhappy with the care she received at several hospital emergency departments. When she was discharged from the last emergency department, she refused to leave. Police were called and the patient was carried to a police car. She said that she
- [Healthcare Update 04-09-2012](https://epmonthly.com/blog/healthcare-update-04-09-2012/) - Lots more news at the Satellite Editions of this week's update at ER Stories and at Medbloggers.org. If you're interested in posting at Medbloggers, drop me an e-mail. Stinky urine in children linked to urinary tract infections. Really. I'll bet that runny noses in children are linked to head colds, too. C’mon. Are pediatricians that
- [Power of Words ... and Production](https://epmonthly.com/blog/power-of-words-and-production/) - Happy Easter to everyone. Hopefully everyone is enjoying spending time with their families. My daughter showed me a video about how words can have a tremendous effect on the message being delivered. Applies not only to blind people, but to everyone else - including doctors. When I researched the movie a bit further, the idea
- [WTF Moment #998](https://epmonthly.com/blog/wtf-moment-998/) - A 17 year old African American girl comes in by ambulance after being involved in a fight at school. Shortly after the ambulance leaves, her parents arrive. Both of her parents are white. After examining the patient and determining that she isn't severely injured I walked from the room to go write up her chart.
- [Healthcare Update 04-02-2012](https://epmonthly.com/blog/healthcare-update-04-02-2012/) - Lots more news at the Satellite Editions of this week's update at ER Stories and at Medbloggers.org. If you're interested in posting at Medbloggers, drop me an e-mail. Washington State loses this game of chicken. Governor enacts a last-minute delay in enforcing policy to refuse payments to hospitals for Medicaid patients who present with non-emergencies.
- [The Loof Lirpa Bird](https://epmonthly.com/blog/the-loof-lirpa-bird/) - Friday night, my kids decided to watch the movie Insidious. If you haven't seen it, it's a pretty scary movie. Of course, that meant my middle daughter was up all Friday night with nightmares. Today we were out of the house most of the day. We returned home tonight and then my middle daughter remembered
- [Smurf That!](https://epmonthly.com/blog/smurf-that/) - I have come to grips with the fact that I am a mischievous 11 year old kid trapped in an adult's body and there is nothing I can do about it. I walk out of a patient's room and grab the next chart. Eight year old girl. Chemical exposure. Several people are already giggling, but
- [Drug Shortages](https://epmonthly.com/blog/drug-shortages/) - Just got word that several additional medications have been added to the national list of "drug shortages". Doctors better start learning more about wilderness medicine at this rate. I can see the management of our next unstable patient now ... [Call comes in on telemetry line] "We're coming to you with a 44 year old
- [Healthcare Update -- 03-26-2012](https://epmonthly.com/blog/healthcare-update-03-26-2012/) - Also see more medical news from around the web at ER Stories.net and at medbloggers.org. Woman awarded $22 million at trial after suing hospital when she was rendered a quadriplegic after “unnecessary” procedure was performed to evaluate her migraine headaches. Number of head CT scans ordered by emergency physicians varies up to two fold between
- [Sappy Dog Blogging](https://epmonthly.com/blog/sappy-dog-blogging-4/) - Title borrowed from the late great William the Coroner. Haven't had a picture of the dogs up in a while. Here, they're in line at the McD's drive through jockeying for position to get a doggie treat that the cashier hands out. Wish I had a better camera than my daughter's iPod to snap the
- [A Good Bet](https://epmonthly.com/blog/a-good-bet/) - A patient comes in from the nursing home for evaluation of a choking episode ... that occurred 6 hours prior to his arrival while he was drinking water. Because the patient was sent in by a staff attending, I usually call the staff docs to let them know that there is nothing wrong with the
- ["Safer" Conscious Sedation](https://epmonthly.com/blog/safer-conscious-sedation/) - I've performed conscious sedation dozens of times. Never had a problem. Not once. Until now. For some unforeseen reason, our hospital has now decided that there are multiple additional hoops through which physicians must jump in order to be credentialed to perform conscious sedation. We have to be certified in ACLS. We have to sit
- [Joanne Doroshow At It Again](https://epmonthly.com/blog/joanne-doroshow-at-it-again/) - Why does the Huffington Post allow Joanne Doroshow to keep posting misinformation? For those of you who didn't know, Ms. Doroshow is an attorney who is the executive director for New York Law School's Center for Justice and Democracy. Attorney Doroshow's latest blog post on HuffPo alleges that medical malpractice caps are an "attack on
- [Healthcare Update -- 03-19-2012](https://epmonthly.com/blog/healthcare-update-03-19-2012/) - Also see the Satellite Edition of this week's Update over at Medbloggers.org. “Super losses” - malpractice verdicts totaling $50 million or more - are increasing. Verdicts from just seven cases in the past two years totaled more than $1 billion and the number of cases with verdicts of $5 million or more will quadruple between
- [Medicaid Recipients Twice as Likely to be ED Patients](https://epmonthly.com/blog/medicaid-recipients-twice-as-likely-to-be-ed-patients/) - A study just published in the Annals of Emergency Medicine shows something that many people suspected: Patients with Medicaid (i.e. government "insurance") tend to use the emergency department much more often than patients with private insurance. After studying 230,000 participants in the National Health Interview Survey, the researchers found that Medicaid patients were more than
- [Flat WhiteCoat](https://epmonthly.com/blog/flat-whitecoat/) - Dear readers, I have a favor to ask. My youngest daughter developed on obsession after seeing a project from my middle daughter's class. Remember "Flat Stanley"? Well middle daughter's class was doing a "Flat Stanley" project and youngest daughter wanted to be involved. So youngest daughter made her own version of a "Flat Stanley" drawing
- [Dear Diary](https://epmonthly.com/blog/dear-diary-4/) - It's been a long few weeks since I last wrote. I'm going to file this one under "serentipity." My son's wrestling season is over. He didn't make the cutoff to qualify for states, but he still had a great season. There was something strange that happened as he prepared for the tournaments, though. In our
- [The Minion](https://epmonthly.com/blog/the-minion/) - There are some times where you can't help messing around with patients ... just a little. A patient got brought into the emergency department by police in a "hog tied" position. According to police and to the patient's brother, the patient had smoked some "K2" and then began drinking. He then listened to some unidentified
- [Healthcare Update -- 03/12/2012](https://epmonthly.com/blog/healthcare-update-03122012/) - See more news stories from around the web at ER Stories.net and at Medbloggers.org. Hopefully this is the beginning of a trend … California OSHA officials fine two hospitals nearly $100,000 in part for failing to protect from patient assaults and for inadequate staffing. If hospitals can’t be made safe, then staff needs to make
- [More on Perfect Medicine](https://epmonthly.com/blog/more-on-perfect-medicine/) - Someone forwarded my the link to this story about a Connecticut woman who filed a multi-million-dollar lawsuit against a hospital and emergency physician for failing to diagnose pulmonary emboli which ultimately killed her husband. According to the article, the patient went to Stamford's Tully Hospital emergency department complaining of flank pain. The emergency physician performed
- [Literature Pearls](https://epmonthly.com/blog/literature-pearls/) - A few interesting topics caught my eye in the literature lately. From the Journal of Emergency Medicine (full article on Medscape): Tessalon Perles can be dangerous in an overdose. This case report shows how a teenager who took 10 pills in a suicide attempt presented in cardiac arrest, was successfully resusciatated, then ended up losing
- [How Time is Spent During an Emergency Department Shift](https://epmonthly.com/blog/how-time-is-spent-during-an-emergency-department-shift/) - During one shift last week, I felt as if I was spending too much time doing computerized charting, computerized order entry, and computerized admit orders [contractually required to write them - don't ask] and not enough time with patients and their families. This week, I decided to account for every minute of my time during
- [Healthcare Update -- 03-05-2012](https://epmonthly.com/blog/healthcare-update-03-05-2012/) - Also see the Satellite Edition of this week's update at ER Stories. What’s it like to try to save a child’s life and then fail? This trauma surgeon tells the sad story. Patients gone wild. Pennsylvania woman beats on emergency department staff and is charged with aggravated assault and harassment. $4.3 million settlement in case
- [Vaccinate Now?](https://epmonthly.com/blog/vaccinate-now/) - Flu season is late, but it is upon us. Is it only my experience, or does it seem to be the following: 1. Those patients and parents who most vehemently refuse influenza vaccines are the same ones who complain the loudest about their symptoms and their childrens' symptoms when they actually come down with the
- [Nonemergent Complaints and Refusal of Care](https://epmonthly.com/blog/nonemergent-complaints-and-refusal-of-care/) - A few recent emergency department complaints: 1. "My husband is snoring too loud when he sleeps." Husband shrugs his shoulders. 2. Nonverbal patient sent from nursing home for evaluation of "irregular heart rate." History on the transfer papers includes chronic atrial fibrillation ... which causes an irregular heart rate. 3. Patient sent by another physician
- [Healthcare Update -- 02-27-2012](https://epmonthly.com/blog/healthcare-update-02-27-2012/) - See the Satellite edition of this week's update over at the new and improved MedBloggers.org site. $15 million judgment against radiologist that misses early breast cancer on a mammogram despite palpable lump. 16 months later when patient returns for follow-up mammogram, the mass is “as big as a golf ball” and has spread to the
- [Pay Up or Leave](https://epmonthly.com/blog/pay-up-or-leave/) - Want non-emergency care in the emergency department? Pay up first. After performing a federally-mandated screening exam, many hospitals are now charging an up-front fee of $100 to $150 to be treated for non-urgent complaints. Don’t want to pay? You’ll get a list of other health care resources and can leave. And it is happening …
- [Healthcare Update -- 02-20-2012](https://epmonthly.com/blog/healthcare-update-02-20-2012/) - Also see the Satellite Edition of this week's update over at ER Stories. Woman allegedly comes close to dying because on call doctor won’t perform a necessary abortion. Nurse calls a doctor who is not on call to come in and rescue patient. Lucky this didn’t happen in Arizona or else another nurse would be
- [Amanda Trujillo Update](https://epmonthly.com/blog/amanda-trujillo-update/) - I haven't dropped the mission with Amanda. There have been a few technical problems, though. Amanda is in the process of creating a timeline of events that have occurred since the incident. I have been piecing together responses from organizations that have responded to the issue and will add those to the timeline. Thus far,
- [We Now Return to Our Regularly Scheduled Program ...](https://epmonthly.com/blog/we-now-return-to-our-regularly-scheduled-program/) - The web site went down for some reason last evening. Had to restore everything from a backup copy, but lost the past few days' worth of posts and comments. Posts were saved to computer, so I just restored them, but the comments are permanently lost. And just when things were getting good. :-/
- [The Angry Mime](https://epmonthly.com/blog/the-angry-mime/) - An older gentleman comes in because he has a “sinus infection” for the past couple of days. As soon as the triage nurse brings him back, she’s already whispering to the other nurses. Later, I learned that she told them to make sure that I get the patient. She’ll get her paybacks later. The man
- [Legislative Fixes](https://epmonthly.com/blog/legislative-fixes/) - Washington State drops its plans to limit Medicaid patients to three emergency department visits per year. Instead, Washington plans to institute a policy of refusing to pay for any emergency department visits by Medicaid patients that are deemed “unnecessary.” What effect will this policy have? Medicaid patients can’t/won’t be charged for the “unnecessary” visits. Washington
- [A Death Knell for Press Ganey?](https://epmonthly.com/blog/a-death-knell-for-press-ganey/) - For those of you who believe that patient satisfaction ratings are a detriment to health care and to our patients, a study published yesterday in the Archives of Internal Medicine titled “The Cost of Satisfaction” is a must-read. Not only does “satisfaction [have] little or no correlation with Health Plan Employer Data and Information Set
- [Healthcare Update -- 02-13-2012](https://epmonthly.com/blog/healthcare-update-02-13-2012/) - See more medical news from around the web over at the Satellite Edition of this week's update on ER Stories. The eternal drip. Multi-drug resistant gonorrhea is developing growing resistance to the last antibiotic we have to treat it. What happens when the "love darts" don’t work? Maybe a "ZeePack"? As we move toward a
- [Video Backups](https://epmonthly.com/blog/video-backups/) - Haven't done a computer post in a long time, but thought that you all could benefit from some research and testing that I recently had to perform. My old computer burned out and started smoking (literally) not too long ago. After the smoking incident, it wouldn't even boot up. So I removed everything salvageable and
- [RIP - Weird Nursing Tales](https://epmonthly.com/blog/rip-weird-nursing-tales/) - From Tex ... After nearly 20 years on the internet, Weird Nursing Tales passed away. Weird Nursing Tales died on February 7, 2012 after it was reported to Administration that the true author was an employee of the Hospital. Yesterday, February 7, "The Author" sat in a conference room in the Human Resources department with
- [You Know You've Been Admitted Too Many Times When ...](https://epmonthly.com/blog/you-know-youve-been-admitted-too-many-times-when/) - ... your conversation with the admitting clerk goes like this: "You're going to be admitted to Room 201B." "I don't want to go to 201B." "Why?" "The faucet in the bathroom drips and cold air leaks around the window. Can't I have like 216 or 217 instead?" "Those are private rooms. There's an extra charge
- [Gender Equality in Unnecessary Testing](https://epmonthly.com/blog/gender-equality-in-unnecessary-testing/) - I admire this lady’s chutzpah. If Virginia wants to make an unnecessary ultrasound necessary before a woman can have an abortion, Virginia Senator Janet Howell wants to make unnecessary rectal exams and stress tests a prerequisite before men can receive Viagra prescriptions. I bookmarked this link from Instapundit which is one of my favorite news
- [Amanda Trujillo](https://epmonthly.com/blog/amanda-trujillo/) - I finally took the time to read some other blogs today. One of the issues that I found disturbing was the case of Amanda Trujillo. There are a lot of bits and pieces out there about what actually happened in this case. This blog post was reportedly an e-mail from Amanda describing the events. A
- [Healthcare Update -- 02-06-2012](https://epmonthly.com/blog/healthcare-update-02-06-2012/) - See more news stories at this week's Satellite Edition over at ER Stories.net. Pfizer may be in legal trouble after some lots of its oral contraceptives had the wrong medications. Now women who took the mislabeled medications have an increased chance of becoming pregnant. Plaintiff attorneys wonder whether there will be class action lawsuits with
- [Healthcare Update -- 01-30-2012](https://epmonthly.com/blog/healthcare-update-01-30-2012/) - See more medical news from around the web at the Satellite Edition of this week's update on ER Stories.net Meth heads do the “shake and bake” … on their face. New process for making methamphetamines in a 2 liter soda bottle often backfires, causing explosion and burns to the junior chemist. Because most people suffering
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-11/) - Haven't had an Open Mic in a couple of months. Leave questions, opinions, and any other medically-related comments below and I will try to get to them Monday night. Remember, no personal attacks.
- [I'm Glad I'm A Doctor](https://epmonthly.com/blog/im-glad-im-a-doctor/) - I made the statement that "I'm glad I'm a doctor" in one of my posts, but when I went back to link to the story behind the statement, I couldn't find it anywhere. So I pulled up the story from the archives and have posted it below. Still holds true today. When I was a
- [The House Abuser](https://epmonthly.com/blog/the-house-abuser/) - Never finished describing what happened when we got back from our vacation ... three weeks ago. Dang does time fly. When we walked in the house, the first thing we noticed was that it smelled like cleaning products. There were a mop and a bucket sitting in the wet room by the garage. The fishtank
- [Demanding Perfection?](https://epmonthly.com/blog/demanding-perfection/) - Want more evidence about how many people expect perfect outcomes in medical practice? Look no further than the Wall Street Journal: "What if the Doctor is Wrong?" by Laura Landro. As a substantive basis for the conclusion that initial treating physicians are "wrong" when they haven't yet reached a diagnosis, Ms. Landro interviewed two patients
- [More Adventures of Dick](https://epmonthly.com/blog/more-adventures-of-dick/) - Daughter WhiteCoat's reading is going well. In keeping with the previous posts on the topic, she continues to learn about the adventures of Dick and his family and she still can't understand why mom and dad laugh at her as she reads her workbook. I bet the teacher sits in her class every morning just
- [Healthcare Update -- 01-23-2012](https://epmonthly.com/blog/healthcare-update-01-23-2012/) - See more medical news from around the web over at the Satellite Edition of this week's Update at ER Stories. The story of “Dr. Douchebag” and why morale is declining in many of this country’s emergency departments. Even if you say “thank you, sir” for the abuse, your job may still be threatened because of
- [Too Many CT Scans ... or Not Enough?](https://epmonthly.com/blog/too-many-ct-scans-or-not-enough/) - Scary findings. Patients using Coumadin who have any head injury need repeat CT scans. The study looked at 116 patients who were taking Coumadin and who had any head injury with a GCS of 14 or 15 - regardless of loss of consciousness (patients with lower GCS were presumably at higher risk of intracranial bleeding).
- [Certificates of Medical Necessity](https://epmonthly.com/blog/certificates-of-medical-necessity/) - Not too long ago I got a letter labeled "URGENT" in my mailbox at work. The letter was from Walgreens regarding a patient I had seen several weeks earlier. I cut and pasted parts of the letter to make it fit on one page above. As the prescribing physician, in order for our government
- [Timing is Everything](https://epmonthly.com/blog/timing-is-everything/) - I almost had an ironic picture to post from this week's wrestling meets. Almost. There was a parent in the stands several rows in front of me. She was cheering on her son, which we all do. Her son was 13 years old and weighed 229 pounds. I know because wrestlers have their weights written
- [Healthcare Update -- 01-16-2012](https://epmonthly.com/blog/healthcare-update-01-16-2012/) - Also check out the Satellite Edition of this week's update over at ER Stories. Florida teen wins a $12.6 million medical malpractice award after being given an expired vaccination and then contracting an infection which developed into sepsis, DIC, and gangrene resulting in amputations of all four limbs. I’m sure the antivax crowd are having
- [Wrestlemania](https://epmonthly.com/blog/wrestlemania/) - So Jr. WhiteCoat is back to wrestling. During one match, he is winning 11-0 and the kid he is wrestling flings his head back and hits Jr. WhiteCoat in the mouth. He gets a little cut on the corner of his lip and his lip started bleeding. Referee stopped the match. It took about 45
- [Presidential Voting and Press Ganey Part 2](https://epmonthly.com/blog/presidential-voting-and-press-ganey-part-2/) - If you haven't read the first part of this two-part series, which was published before the primary results were known, please go here to review it. The final results in the New Hampshire Republican presidential primaries have been published and I'm confused. Based upon the sample from Dixville Notch, each candidate should have received one
- [Historical Nuggets](https://epmonthly.com/blog/historical-nuggets/) - Parents bring their child to the emergency department for evaluation of nausea and vomiting. Well, mostly nausea. He vomited once. When I entered the room, the 7 year old child was underneath the bed trying to squeeze himself into the area where they usually put the patient belongings. He was rocking the bed back and
- [Presidential Voting and Press Ganey](https://epmonthly.com/blog/presidential-voting-and-press-ganey/) - Well, the results are in. Based on a survey of New Hampshire voters, Rick Perry and Rick Santorum will receive NO votes in the New Hampshire primaries. Jon Huntsman and Mitt Romney will receive the exact same number of votes and will be tied for first place. Ron Paul and Newt Gingrich will receive the
- [Healthcare Update -- 01-09-2012](https://epmonthly.com/blog/healthcare-update-01-09-2012/) - Welcome to the New Year! I had a couple hundred e-mails with health care news sitting in my e-mail box and don't have time to read all the articles, so I decided to declare health care news "bankruptcy," delete all the messages and start fresh. So ... back to the regularly scheduled updates, and the
- [Most Dangerous Items in the House](https://epmonthly.com/blog/most-dangerous-items-in-the-house/) - There was a good article posted on My Health News Daily about the five most dangerous things around the house. They interviewed several experts (I must have been out of reach during my vacation, so I wasn't quoted - although one of my friends was quoted) and came up with a pretty useful list of
- [Update](https://epmonthly.com/blog/update-4/) - First, thanks for all the e-mails. I'm fine. Family is good. I haven't quit blogging yet. Remember the story about the Rock? My rock still sits on the corner of my desk every day to remind me of its importance. Well, the rocks in life just keep falling out of the glass. We got home
- [Reasonable Conclusion?](https://epmonthly.com/blog/reasonable-conclusion/) - When, over the period of 10 minutes, medical personnel hear the following statements from an elderly patient: 1. "You come any closer to me, I'm going to stick my boot up your a** so far, I'll come out with a bare foot," 2. "Up your a** with a meat cleaver," and 3. [While making sure
- [Why Bundling Payments Won't Reduce Costs -- Part 3](https://epmonthly.com/blog/why-bundling-payments-wont-reduce-costs-part-3/) - If you haven't read parts 1 and 2 of this manifesto, please do so here and here before reading further. How will bundled payments affect the incentives for each of the players in the medical market? For patients, a change to bundled payments will probably have little effect upon monetary issues or fears. Demand for
- [Dear Diary](https://epmonthly.com/blog/dear-diary-3/) - Dear Diary Well, it's been over a week since I posted anything online. I think that's a record for me. In fact, I haven't been online that much at all since well before Christmas. First, there was a miserable work week before Christmas. Almost 70 hours of work in 5 days. A lot of people
- [Didn't See That One Coming ...](https://epmonthly.com/blog/didnt-see-that-one-coming/) - When a young male patient has a urinary tract infection and difficulty urinating, usually a check for prostatitis is in order. Add prostate checks to the list of things where you can "expect it." When checking a patient for prostatitis, I will usually say something to the patient along the lines of "When I press
- [Healthcare Update -- 12-19-2011](https://epmonthly.com/blog/7483/) - VA hospital settles claim for $275,000 after leaving two “SmamWow” 14x11 sized towels in patient’s abdomen after surgery. Isn’t that some kind of “never event” according to … the agency that runs the VA hospitals? In 2010, dental problems caused 115,000 emergency department visits in Florida alone. That’s about 0.1% of all the emergency department
- [Christmas Light Police](https://epmonthly.com/blog/christmas-light-police/) - One of our neighbors with nothing better to do left a note taped to our front door chastising us because the lights on our trees lining the road we live on weren't lit when he happened to walk by our house. The thing is that we usually have the trees lit, but we just happened
- [Why Bundling Payments Won't Reduce Costs - Part 2](https://epmonthly.com/blog/why-bundling-payments-wont-reduce-costs-part-2/) - If you haven't read Part 1 of this post, please do so. In that part, I try to explain the main drivers of cost in our health care system. Now that everyone has a basic grasp of the drivers of cost in our health care system, I want to try to show how the proposed
- [Addressing Transgender Patients](https://epmonthly.com/blog/addressing-transgender-patients/) - I read this story about how transgender patients are upset because they are addressed incorrectly when they seek medical care. Because of this, some people are demanding sensitivity training for medical personnel and are alleging that "transphobia" must be occurring. “Transphobia”? Sorry, but I think that the whole transgender rights thing is going a little
- [WhiteCoat the Grinch](https://epmonthly.com/blog/whitecoat-the-grinch/) - Based on your feedback, at least a couple of you like hearing about my dysfunctional family more than I thought. If you're not in that group, prepare yourselves for a boring read. Last year, I had a story about Christmas Eve that I never published. Here it is. Around every Christmas, I get letters to
- [Duty Calls](https://epmonthly.com/blog/duty-calls/) - Had intended to finish the second half of the bundled payment post, but in my other job, I had a somewhat unexpected ... umm ... need that had to be filled Friday through tomorrow. Because of that, I haven't been online very much. Got a posts lined up to auto-publish, but may not be online
- [Why Bundling Payments Won't Reduce Costs - Part 1](https://epmonthly.com/blog/why-bundling-payments-wont-reduce-costs-part-1/) - Probably one of the largest pending changes in health care is payment reform. Right now, payment for medical services is essentially a fee for service model. Patients (or their insurers) are generally charged for the services utilized. If a patient goes to hospital for chest pain, and a physician evaluates the patient, either the patient
- [Akismet Rocks](https://epmonthly.com/blog/akismet-rocks/) - Are any of you other bloggers getting blasted with spam comments lately? Last month, I had an uptick toward the middle of the month. November ended with 84,000 spam comments. This month, I'm on track to have well more than 100,000 spam comments. I can guarantee that without Akismet, I wouldn't allow comments on the
- [Miscellaneous Pain Histories](https://epmonthly.com/blog/miscellaneous-pain-histories/) - Had several notable histories from patients in pain lately. One patient with chronic back pain hobbled into a room and said "I better not be waiting here 8 hours like I did last time." We looked through her old chart out of curiosity to find out what caused the extended eight hour wait on her
- [Healthcare Update -- 12-05-2011](https://epmonthly.com/blog/healthcare-update-12-05-2011/) - Also see more medical news from around the web over at the Satellite Edition of this week's update at ER Stories. Whooping cough resurgence in New York. More than double the number of cases than occurred in the next-largest outbreak in 2006. I renew my assertion that vaccinations should not be mandatory, but that parents
- [Dear Diary](https://epmonthly.com/blog/dear-diary-2/) - This week was rather rough. Things in the ol' emergency department have been busy lately. Lots of people seem to have minor problems that don't need "emergency" care, but they have nowhere else to turn. I've had several patients come in just asking for medicine refills or asking to have their medications switched to something
- [Revenge Best Served with Hot Lead](https://epmonthly.com/blog/revenge-best-served-with-hot-lead/) - A young guy gets brought in with a non-life-threatening gunshot wound to his arm. The police were called and the patient had no idea who shot him. After the police left, the patient admitted that his own friend shot him. He was sent home that night. Not 45 minutes after my shift started the next
- [Meet Babs Bunny](https://epmonthly.com/blog/meet-babs-bunny/) - A dad brought his 15 year old daughter in because she had missed her menstrual period the past week. He kept her home from school for three days because he wanted to see if the period had just decided to show up late. Alas, after 5 extra days, no period was forthcoming. The young girl's
- [Diagnostic conundrum](https://epmonthly.com/blog/diagnostic-conundrum/) - A man in his 5os drives himself to the emergency department with 10/10 crushing chest pain, nausea, and shortness of breath. He was clearly uncomfortable when he arrived. Why did he drive himself there? Well, he was going to call an ambulance, but he happened to be only a couple of blocks from the hospital
- [Healthcare Update – 11-28-2011](https://epmonthly.com/blog/healthcare-update-satellite-edition-11-28-2011/) - That’s why they call it dope, sister. Upset woman searching for boyfriend’s missing finger draws attention of police. Boyfriend was inside emergency department having a laceration repaired on his intact finger. Police find syringe full of methamphetamine in seat where boyfriend was sitting. Woman and boyfriend both arrested. Emergency department haiku. This guy is good.
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-10/) - If you're bored of shopping, leave a note in the comments section and let everyone know what’s on your mind. Leave questions, comments, opinions, and any other medically-related comments below and I will get to them on Monday. Remember, no personal attacks. And no shoving in line to get those last Kindle Fires, either.
- [Unnecessary Testing](https://epmonthly.com/blog/unnecessary-testing/) - An 89 year old little old lady is brought in because she is weak and doesn't want to eat. She hasn't eaten in about a week and she hasn't been out of her home in longer than that. Finally a friend visiting her convinces her to come to the hospital for some IV fluids. When
- [Thanksgiving in the ED](https://epmonthly.com/blog/thanksgiving-in-the-ed/) - You want to know the worst thing about working Thanksgiving in the emergency department - aside from not being able to spend time with the family? All the little old ladies and men that show up with their families. It's not the patients, either. It's the families. You see, the families drag mom or dad
- [Healthcare Update -- 11-21-2011](https://epmonthly.com/blog/healthcare-update-11-21-2011/) - Late start today after some family issues and working a shift. For more medical news from around the web, see the Satellite Edition of this week's update over at ER Stories. He swallowed WHAT? New book publishes pictures about foreign bodies in patients’ bodies -- that have found their way into many orifices. Some picture
- [Huh?](https://epmonthly.com/blog/huh-2/) - A patient comes in for evaluation of left flank pain. In her urine sample, the nurse finds a small brown pebble. Nurse, holding small plastic cup with stone inside: "Looks like I found what was causing your pain! That looks like a kidney stone!" Patient: "Well, maybe ... but I do have a cat, you
- [Cake Cures Pain?](https://epmonthly.com/blog/cake-cures-pain/) - When you come limping into the emergency department bent over and moaning because your back pain is "definitely 10 out of 10" and is "so bad you can barely move your arms," then 20 minutes later when the doctor comes to see you in the room, you are sitting on the bed laughing with your
- [Healthcare Update -- 11-13-2011](https://epmonthly.com/blog/healthcare-update-11-13-2011/) - See more medical stories from around the web over at the Satellite Edition of this week's update at ER Stories.net Remember how the Congressional Budget Office predicted that so many more people would have health care “insurance” after health care reform was enacted? A recent Gallup poll shows that the CBO is inept at making
- [Sappy Dog Blogging](https://epmonthly.com/blog/sappy-dog-blogging-3/) - Seventy two degrees on November 13? Who would have thought? What a perfect day to go to the park with the dogs (with post title credit to William the Coroner). Don't worry, I'm not going to turn into Happy Hospitalist. I love my dogs, but this is a medical blog.
- [WTF Moments #995 and #996](https://epmonthly.com/blog/wtf-moments-995-and-996/) - Psychiatric patients can be either frustrating or enjoyable, depending on their demeanor. With six of the first ten patients I saw having psychiatric issues, I got to see both sides of the spectrum today. First was a woman who was having dizziness. She also made it clear that she was "bipolar and a little schizo."
- [Dear Diary ...](https://epmonthly.com/blog/dear-diary/) - One of the weenies that knows my identity made fun of me for having an "online diary." To you, I say "bite me." Now you get stuck reading all of my inner secrets. Well, diary, the last week has been busy. Had a time-sensitive project in my other job that I finally got finished on
- [What's The Diagnosis #14](https://epmonthly.com/blog/whats-the-diagnosis-14/) - A patient in her late 60's comes in with vomiting and some vague abdominal pain over the previous 24 hours. Her husband states that her stomach looks swollen. It does. X-rays below can be clicked upon to give you a higher resolution image if you want one. What is wrong with the patient? What's the
- [Healthcare Update -- 11-07-2011](https://epmonthly.com/blog/healthcare-update-11-07-2011/) - Also see the Satellite Edition of this week's update at ER Stories.net (I hope) $9 million verdict against Wyoming hospital and emergency physician after patient with neck pain was discharged from emergency department after accident with no neck imaging. Later, he was diagnosed with multiple cervical fractures and has chronic pain. $2 million of the patient’s verdict
- [Healthcare Update -- 10-31-2011](https://epmonthly.com/blog/healthcare-update-10-31-2011/) - Also see the Satellite Edition of this week's update over at ER Stories.net. Many good Halloween safety recommendations from emergency department staff at UC San Diego Health System. Take a look before you go trick or treating. Interesting infographic regarding emergency department visits, including the most common reasons for visits to the emergency department (not
- [Government Safety](https://epmonthly.com/blog/government-safety/) - Remember how the government health care wonks at the CDC thought random HIV testing in the emergency department would be such a great idea? Things didn't quite turn out that way in France. A study in France published in the Archives of Internal Medicine showed that out of 138,000 emergency department visits, 21,000 patients were
- [Man Cuts Arm Off with Guillotine](https://epmonthly.com/blog/man-cuts-arm-off-with-guillotine/) - "I tried to think of a witty comment to this story ... but I was stumped." So begins the comments section to the story about a Washington man who was rushed to the emergency department after cutting off his arm with a homemade guillotine. While the story is sad, many of the comments are amusing
- [Worst States For Medical Malpractice Risk](https://epmonthly.com/blog/worst-states-for-medical-malpractice-risk/) - I just read an article in American Medical News about medical malpractice insurance costs. Included in the article was a small graphic about how much internists pay for medical malpractice insurance. Internists in Dade County, Florida paid medical malpractice insurance premiums that were 1400% higher than internists in the state of Minnesota. Illinois internists in Chicago
- [Dr. Nurse](https://epmonthly.com/blog/dr-nurse/) - I really don't like it when people call me "doctor." The only time that I ever refer to myself as "Dr. WhiteCoat" is when I first enter a room and introduce myself to a patient. That way they know that I'm not some schmuck off of the street who wandered into the wrong room. Patients
- [More Thoughts for the Day](https://epmonthly.com/blog/more-thoughts-for-the-day/) - After finishing a shift today, I had several pertinent thoughts that came to mind while driving home. First, when a helicopter is coming in to land on the hospital helipad, standing on the helipad to take pictures with your camera phone and refusing to move will likely end up in you being tackled by a
- [Healthcare Update -- 10-23-2011](https://epmonthly.com/blog/healthcare-update-10-23-2011/) - Jury awards 15 year old patient $144 million judgment against William Beaumont Hospital in Michigan after she was born with cerebral palsy and hypoxic-ischemic encephalopathy -- which her attorney described as “the worst [injuries] that have negligently been inflicted on an innocent child in the history of Michigan, perhaps the United States." Tsk tsk tsk. A
- [Got emphysema, asthma, arthritis, or inflammatory bowel disease? Eat broccoli.](https://epmonthly.com/blog/got-emphysema-asthma-arthritis-or-inflammatory-bowel-disease-eat-broccoli/) - I was forwarded an article that seems boring, but had an interesting catch to it. You may not have known this, but denitrosylation of HDAC2 by targeting Nrf2 restores glucocorticosteroid sensitivity in macrophages from COPD patients. The study showed that in some forms of chronic inflammatory diseases, such as COPD/emphysema, acute respiratory distress syndrome, asthma, rheumatoid
- [Great Door to Balloon Time](https://epmonthly.com/blog/great-door-to-balloon-time/) - Interesting but sad case that bypassed the ED but about which we later heard. An elderly female with previous coronary artery disease, diabetes, and hypertension called EMS for chest pain. Then she has a syncopal event in front of her husband. Medics arrived and found the patient in ventricular tachycardia. They cardioverted her back to
- [Events at Scientific Assembly](https://epmonthly.com/blog/events-at-scientific-assembly/) - GruntDoc, ShadowFax, Nick Genes, Graham Walker and others are all tweeting highlights from ACEP's Scientific Assembly. If you're interested, read the tweets here - or meet them at the bar tonight.
- [Healthcare Update -- 10-17-2011](https://epmonthly.com/blog/healthcare-update-10-17-2011/) - Also see the Satellite Edition of this week's Update at ER Stories.net. How are these two people related? Actually, they are pictures of the same person taken 5 years apart. The woman started itching after having a “bad reaction to seafood.” Afterwards, she aged 50 years “in a matter of days” and she keeps getting
- [Chinese Pager Torture - REPOST](https://epmonthly.com/blog/chinese-pager-torture-repost/) - Do I know what on-call docs go through? Let me know your thoughts after reading this post - one of my first posts ever more than 4 years ago. ------------------------------------- OK, while I’m at it, I have to add one of the terms I created. No offense to the Chinese on this one. Even Wikipedia
- [Curriculum Change](https://epmonthly.com/blog/curriculum-change/) - My 5 year old daughter came home from kindergarten with more of her schoolwork. Included in her papers was this fine coloring job. "So you colored very well. You stayed in the lines and everything." "I know." "What else did you do today." "We actually didn't read Dick." She knew something was up when I
- [Lighten Up a Little](https://epmonthly.com/blog/lighten-up-a-little/) - So there's a patient that needs to be admitted to the hospital. I ask the secretary to call the patient's attending physician. Said attending physician woke up on the wrong side of the bed or forgot his coffee or something. According to the secretary's account, the conversation went something like this: "Hi, this is the
- [Entomology Clinic](https://epmonthly.com/blog/entomology-clinic/) - Two different patients came in with strange "bug" complaints. The frustrating thing for doctors is that the patients with "bug bite" complaints are absolutely convinced that the bugs are present and are causing all kind of physical maladies. Many times they are not. The frustrating thing for the patient is that the doctors are sometimes
- [Healthcare Update -- 10-10-2011](https://epmonthly.com/blog/healthcare-update-10-10-2011/) - More news at the Satellite Edition of this week's update over at ER Stories.net. Admitted drug dealer (who is currently in prison) sues physician (also in prison) for $43 million because the physician prescribed patient the drugs he sold and "caused" patient's addiction. Australian patient with shortness of breath and who was “vomiting black stuff”
- [Time To Join The Debate Team?](https://epmonthly.com/blog/time-to-join-the-debate-team/) - I'm getting to dread Friday evenings in the emergency department. This past Friday, I saw six patients who had assorted injuries from football games. Six. Two of them had concussions, which goes along with a recent study published by the CDC showing that concussions are on the rise. See articles here, here, and here. CDC
- [No Deal](https://epmonthly.com/blog/no-deal/) - There are a few times in emergency medicine when you know that a patient is either very sick or very injured. When you see a car screech to a halt in the ambulance bay and then see people get out of the car and start running about haphazardly, it is generally a good bet that
- [Wear Your Seat Belt](https://epmonthly.com/blog/wear-your-seat-belt/) - Quite a powerful ad about seat belt use that was forwarded to me. I haven't heard of many paramedics who have had to unbuckle dead people. httpv://www.youtube.com/watch?v=p916yeFa2Xk
- [Hot Blooded](https://epmonthly.com/blog/hot-blooded/) - "I've had a fever," said the 50-something year old lady who wasn't feeling well. "My muscles ache and I don't feel well." OK, not much to go on. "Well, how high was your fever?" I asked. "Just under 207 degrees." "You mean 102.7?" "No, 207." "As in 2-0-7?" "Yes, as in '2-0-7.'" She was starting
- [Healthcare Update -- 10-03-2011](https://epmonthly.com/blog/healthcare-update-10-03-2011/) - More medical news from around the web at the Satellite Edition of this week's update on ER Stories ... Australian emergency physician punches and slaps restrained patient who spat in his face. He was terminated from his position. A court held that the termination was unfair. Australian doctors considered going on strike after learning how
- [Sappy Dog Blogging](https://epmonthly.com/blog/sappy-dog-blogging-2/) - Back by popular demand (with attribution to William the Coroner for the post title) ... more pictures of our pets. Our two dogs are doing well. However, during a check up, we found that our puppy has demodectic mange. Of course, that freaked everyone in the family out until we learned that it wasn't contagious.
- [Big and Little](https://epmonthly.com/blog/big-and-little/) - Our youngest daughter couldn't understand why her parents, both medical professionals, were laughing uncontrollably when she read the workbook page that she had colored so well. While you read the short passage, look at the face of the sitting baby and look where the dad's hands are. Who writes this stuff? . . . .
- [True Love](https://epmonthly.com/blog/true-love-2/) - A nice 89 year old man was brought to the emergency department by ambulance complaining of chest pain. While I was talking to him, he mentioned that he and his wife would be celebrating their 65th wedding anniversary in a few days. So I asked him "What's the key to your long marriage" He rubbed
- [Healthcare Update -- 09-26-2011](https://epmonthly.com/blog/healthcare-update-09-26-2011/) - See more health care stories from around the web over at the satellite edition of this week's update at ER Stories.net. Innovative ideas for tort reform. If states don’t establish malpractice caps, doctors can contract with patients directly “to establish pre-determined rules for compensation in the case of injury due to physician negligence.” Just like
- [Foley Catheter Greeting Card](https://epmonthly.com/blog/foley-catheter-greeting-card/) - When we opened up our hospital's new Foley insertion kits, we found that they contained the card below. What's next? Dinner mints with Hemoccult cards? I don't even want to know what colonoscopy patients have in store. . . . . . . . . . . . . . . .
- [Emergency Department Complaints](https://epmonthly.com/blog/emergency-department-complaints/) - Recent patient complaints requiring emergency department evaluation: 1. "Belly button problem". White and blue stuff keeps growing in belly button and thinks that there may be fungal infection there. Brought some in a plastic bag for analysis. Diagnosis: Umbilical Lint 2. Ambulance transport for rectal itching. The patient was having difficulty reaching his bottom to
- [Pennsylvania Medicaid's Cost "Savings"](https://epmonthly.com/blog/pennsylvania-medicaids-cost-savings/) - While scanning the news this morning, I laughed out loud at Pennsylvania's newest proposal to cut Medicaid costs. According to this Kaiser Health News report, Pennsylvania plans to pay Medicaid recipients up to $200 to visit "higher quality and lower cost hospitals and doctors." Gary D. Alexander, the Pennsylvania secretary of public welfare, compared the
- [Healthcare Update -- 09-19-2011](https://epmonthly.com/blog/healthcare-update-09-19-2011/) - More health-related news from the past week over at the Satellite Edition at ERStories.net. ---------------- Chinese patients take different approach when they believe that medical care has been substandard … they hire professional protesters. Protesters then attack hospitals with pitchforks and clubs with hopes that the hospitals will pay the patients to make the protesters
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-9/) - I got the message. OK, everyone, what's on your mind? Leave questions, comments, opinions, and any other medically-related comments below and I will get to them on Monday or Tuesday. Remember, no personal attacks.
- [Who Was That Guy?](https://epmonthly.com/blog/who-was-that-guy/) - An elderly patient with Alzheimer's Disease was brought by concerned family members after reportedly having blood in his stool. I introduced myself to everyone in the room and to the patient. When I tried to obtain a history from the patient, it was clear that he didn't recall what happened. So I began obtaining the
- [FDA: Zofran May Be DEADLY](https://epmonthly.com/blog/fda-zofran-may-be-deadly/) - Get ready for a "black box" warning on Zofran. The FDA has just issued a "safety alert" stating that Zofran may now be potentially deadly. The FDA is now recommending ECG monitoring in patients who receive Zofran who have potential "electrolyte abnormalities (e.g., hypokalemia or hypomagnesemia), congestive heart failure, bradyarrhythmias, or in patients taking other
- [Tylenol, Anyone?](https://epmonthly.com/blog/tylenol-anyone/) - A patient comes into the emergency department holding his jaw. He has had a chronic toothache for the past two weeks. We looked up his old records and he had been coming to the emergency department with toothaches and back pain for the past four years. He has a dentist appointment scheduled at an out
- [Healthcare Update -- 09-12-2011](https://epmonthly.com/blog/healthcare-update-09-12-2011/) - See much more health-related news from around the web at the Satellite Edition of this week's update at ER Stories.net. Plaintiffs prepare to seize Ohio obstetrician’s assets to collect $9.7 million judgment against her. Personal vehicle and other personal property are all being targeted. Court hearing set to determine how much of doctors wages will
- [Walgreens Blows It](https://epmonthly.com/blog/walgreens-blows-it/) - Scanning the news this morning and found a story that really bothered me. Walgreens fired one of its Benton Harbor, Michigan pharmacists. No big news there. However, the reason the pharmacist was fired was more of a story. Walgreens fired the pharmacist for thwarting a robbery. Video posted on the mlive.com site shows two hooded
- [Sappy Dog Blogging](https://epmonthly.com/blog/sappy-dog-blogging/) - I'm appropriating the title of this post from William the Coroner who likes to post pictures of his cats on Fridays. This isn't going to turn into a blog about my animals, I promise. However ... when I got home from running errands this afternoon, I walked into our basement to find something that I
- [EMR Survey](https://epmonthly.com/blog/emr-survey/) - I was asked to post a short survey for those of you who use electronic medical records. How does EMR use affect quality and delivery of health care that you provide? There are a total of about 20 questions and it should take you 2-3 minutes to answer them. The results will be published in
- [Healthcare Update -- 09-05-2011](https://epmonthly.com/blog/healthcare-update-09-05-2011/) - See more news stories at the Satellite Edition of this week's update over at ER Stories.net. Patients gone wild CAUGHT ON VIDEO. It’s like a Jerry Springer show in the hospital waiting room. Check out the one guy stabbing the other with what appears to be a hair pick beginning at the 1:05 mark. Another
- [Pearls of Wisdom](https://epmonthly.com/blog/pearls-of-wisdom/) - I found these on my computer while looking for a medical article. PEARLS OF WISDOM •The only time you run out of chances is when you stop taking them. •Making a living is not the same thing as making a life. •Every exit is an entrance to someplace else. •Your self-worth is more important than
- [More Florida Medical Follies](https://epmonthly.com/blog/more-florida-medical-follies/) - Yet another reason to stay away from Florida if you are a physician. The inspectors and health care agencies down there leave quite a bit to be desired. The Florida Agency for Healthcare Administration cited an emergency department's staff for failing to give “adequate care” to 13 week pregnant patient before she had miscarriage of
- [WTF Moments #989 and #990](https://epmonthly.com/blog/wtf-moments-989-and-990/) - A man hurriedly walks into the emergency department, comes up to the triage window, bangs on the bell several times even though the nurse is sitting right there and says in a loud voice "Ma'am! I need a denture cup real quick!" I'm still having difficulty figuring out the emergency that requires a stat denture
- [Personal Update](https://epmonthly.com/blog/personal-update/) - Have so many posts lined up, but unfortunately little time to write them. In the past week, I have worked 36 hours, taught for a day at one school, given a lecture at another school, been the official videographer for my son's football team, ran around helping a friend get his ice cream shoppe ready
- [Healthcare Update -- 08-29-2011](https://epmonthly.com/blog/healthcare-update-08-29-2011/) - Also see the Satellite Edition of this week's update over at ER Stories' resurrected blog. Patients gone wild goes international. High patient volumes and lack of adequate staffing cause patients to become “aggressive over lack of service” in Australia. "Five or six" nurses assaulted in one week. Note to patients: Assaulting nurses won’t get you
- [Hurricane Safety, Part Deux](https://epmonthly.com/blog/hurricane-safety-part-deux/) - Hurricane Irene is beginning its trek up the East Coast. The damage from the storm is predicted to be horrific. Any of you self-righteous attorneys from New Orleans want to post a comment prospectively telling all the hospitals everything that they need to do in order to avoid being sued for an "inadequate response" to
- [My Kind of Town ...](https://epmonthly.com/blog/my-kind-of-town/) - While traveling to Chicago for a class that one of our daughters took earlier in the week, my wife was in the city for a total of about 15 minutes, was stopped at a light using the GPS function on her phone to find an address, was pulled over by a police officer, and was
- [Choose "C"](https://epmonthly.com/blog/choose-c/) - In case anyone was wondering, I am a rude racist doctor who discriminates against poor people and who has no idea how to provide medical care for children. This message was transmitted to the emergency department nurse, the nursing supervisor, the Director of Patient Affairs, and the secretary to the hospital CEO. Want to know
- [Strangest Complaint of the Night](https://epmonthly.com/blog/strangest-complaint-of-the-night/) - A patient came in with the following chief complaint: The FBI told me to come in for evaluation The patient's wife followed behind him, telling the nurse that the patient had "lost it." OK. Paranoid delusions about the FBI calling him. No problem. "No," the wife stated, "the FBI really did tell him to come
- [How I Caused A Pneumothorax With A Laser Pointer](https://epmonthly.com/blog/how-i-caused-a-pneumothorax-with-a-laser-pointer/) - While we were playing with a laser light with our dogs, I was reminded of a story about how I was accused of causing a patient's pneumothorax with a laser light while I was a resident. During our internal medicine training, senior residents had to run the intensive care unit for several months out of
- [Healthcare Updates -- 08-22-2011](https://epmonthly.com/blog/healthcare-updates-08-22-2011/) - Florida is back in the news again. After creating legislation to criminalize medicine, creating a three strikes law where doctors lose their license if they lose three malpractice suits, and having some of the highest malpractice premiums in the country, a funny thing seems to be happening. Florida doesn’t have enough doctors. Now Senator Bill
- [We're From The Government, We're Here To Help ...](https://epmonthly.com/blog/6993/) - The clock is ticking for Parkland Memorial Hospital in Dallas. Last week, Parkland was cited by the Centers for Medicare & Medicaid Services for several "serious threats" to patient safety. As a result, the hospital is now in jeopardy of losing its ability to participate in the Medicare program unless it submits "correction plans" to
- [The Forgotten Candidate?](https://epmonthly.com/blog/the-forgotten-candidate/) - I'm not going to start political debates on this blog, but I had to post a couple of things relating to how the Republican race is shaping up. First, is John Stewart's rant about how the mainstream media is treating Ron Paul like the "13th floor on a hotel". Paul came in second in the
- [Healthcare Update -- 08-16-2011](https://epmonthly.com/blog/healthcare-update-08-16-2011/) - Hey - ERP started posting again on his ER Stories blog. Go take a look for more posts from him and for the satellite edition to this week's update. Deadly fungus infection adds insult to injury in Missouri tornado survivors. Thirteen patients were confirmed to have a cutaneous mucormycosis infection, ten required admission to ICUs
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-8/) - Away for the weekend and into Monday (actually posting this from my phone). Take over the comments section with any medically-related questions or comments you have. Just remember -- no personal attacks. Will try to answer any questions on Monday. Have a great weekend!
- [Differences in Opinion](https://epmonthly.com/blog/differences-in-opinion/) - There's a relatively new radiologist on staff at our hospital. He and I just don't seem to see eye-to-eye. The radiologists like to do real-time readings of xray studies from the emergency department during business hours. Then the radiology tech brings us a report. I tend to look at most of the radiology studies I
- [How Betadine Almost Got Me Arrested](https://epmonthly.com/blog/how-betadine-almost-got-me-arrested/) - I often joke around with my co-workers. I just find that it makes the day go quicker and messing around every once in a while sometimes makes it seem, well, not so much like work. Wouldn't you know it ... some people just can't take a joke. One of the administrators at a clinic where
- [Commotio Cordis - Literally Heartbreaking](https://epmonthly.com/blog/commotio-cordis-literally-heartbreaking/) - Another story of a probable case of commotio cordis - this one occurring during a softball game. Sad situation, especially since patients often die when the injury occurs. When CPR is started by trained professionals within 3 minutes, only about 25% of patients survive. If resuscitation is delayed more than 3 minutes, more than 97%
- [Healthcare Update -- 08-08-2011](https://epmonthly.com/blog/healthcare-update-08-08-2011/) - You didn’t cure my kid’s vomiting over the phone and I had to take him to the emergency department two days later when the vomiting came back. Now give me my co-payments back. If services provided don’t perfectly meet expectations, those services should be free? Sorry, but life doesn’t work that way, ma’am. You didn’t
- [Where Are Force Fields When You Need Them?](https://epmonthly.com/blog/where-are-force-fields-when-you-need-them/) - When I first heard about the lawsuit in which Louisiana attorneys sued a hospital system because it didn't prepare well enough for Hurricane Katrina, I thought they were kidding. Really? Hospitals have to be built to withstand hurricanes and flooding from one of the deadliest and costliest storms in American history? Now I see the
- [The Boxer](https://epmonthly.com/blog/the-boxer/) - Paramedics had a difficult time with the patient. Call went out for a patient named Joanne Doroshow that was reportedly "man down" on the city bus. By the time the paramedics arrived, the patient was laying on the sidewalk with a crowd of bystanders around him. He had shallow breathing. His pupils were constricted. Ahhhhh.
- [Google Plus](https://epmonthly.com/blog/google-plus/) - The Happy Hospitalist was kind enough to invite me to join Google Plus. I haven't done much with it yet. but I now have a bunch of invites to give out. If you don't have one and you want an invite to Google Plus, drop me an e-mail. whitecoat at epmonthly dot com.
- [Liam Donaldson a Trial Lawyer Shill?](https://epmonthly.com/blog/liam-donaldson-a-trial-lawyer-shill/) - I wrote about this topic in February. In fact, Overlawyered.com just linked to the story today. The American Association for Justice really cares about "justice" and not about money ... The United States is debt free ... Vice President Biden was a second runner up in the Miss World pageant ... The World Health Organization
- [Healthcare Update -- 08-01-2011](https://epmonthly.com/blog/healthcare-update-08-01-2011/) - Study on patients gone wild shows that 40% of emergency department employees in California had been physically assaulted in the previous year. More than 10% had been attacked in the prior week. What do hospitals administrators do? Tell employees things such as "If you are going to work for this hospital, you are not going to
- [Take The Train](https://epmonthly.com/blog/take-the-train/) - A medical student from a suburban medical school in another state was doing rotation in our emergency department. He asked me what he should do about issues with riding public transportation to the hospital. On the way here, some guy two seats in front of me puked on the empty seat next to him. Everyone
- [Huh?](https://epmonthly.com/blog/huh/) - Possibly submitted from a reader e-mail A patient comes in complaining of swelling to her right foot. No pain. No injury. Just swelling. A quick glance at the patient's foot showed that there was no swelling whatsoever. Examination ... nothing. Range of motion ... normal. However, the patient insisted that her foot was swollen. "Where
- [Where's the Love?](https://epmonthly.com/blog/wheres-the-love/) - Apparently it isn't just disgruntled docs who used to take board call and misguided gastroenterologists that have animus toward the emergency department. Hey - it's not like we sit down here and plan when to send patients upstairs. When a tech brings the fifth OB patient in labor to the maternity ward in the past
- [Healthcare Update 07-25-2011](https://epmonthly.com/blog/healthcare-update-07-25-2011/) - What? MRSA infection? Get that patient a super mocha latte … STAT! That morning cup of Joe may decrease your risk of getting a “superbug” infection - by up to 50%. Prescription abuse kills. In 2010, more than 80 percent of the drug-related deaths in Oklahoma involved prescription medicines. Yet they’re still on the market
- [To Admit or Not to Admit? That is the Question.](https://epmonthly.com/blog/to-admit-or-not-to-admit-that-is-the-question/) - Gastroenterologist Michael Kirsch put up a post on his blog that was then reposted over at ACP Hospitalist asking where the threshold for admitting a patient to the hospital should be. He asserts that there should be more collaboration between medical colleagues to determine whether or not a patient needs to be hospitalized. He also
- [The Scarlet Ear](https://epmonthly.com/blog/the-scarlet-ear/) - Another page to the "that's why they call it dope" chronicles. ScienceDaily reports that several people are suffering from skin necrosis related to adultered cocaine. Updated ScienceDaily story here. Good Morning America report about topic here. January 2010 article in Time magazine about the same phenomenon here. It seems that the dealers are cutting cocaine
- [Maneurysms](https://epmonthly.com/blog/maneurysms/) - During a lull in the day, the nurses were talking about ... other nurses ... and one nurse commented that a particular nurse's mannerisms were annoying. Only she didn't call them "mannerisms," she kept calling them "maneurysms." I was only half listening while working on the computer, but the word "maneurysm" kept catching my ear.
- [Medical Malpractice Hedge Funds](https://epmonthly.com/blog/medical-malpractice-hedge-funds/) - I was forwarded a Forbes Magazine article from an outraged physician. The article explains how hedge funds in some states are financing medical malpractice lawsuits in exchange for a percentage of any judgment. The firm reviews the case, and, if it believes the case has merit, will provide money to finance litigation and expenses to
- [Healthcare Update 07-18-2011](https://epmonthly.com/blog/healthcare-update-07-18-2011/) - More patients gone wild. Texas man becomes disruptive in emergency department, rips IV out, flings blood everywhere, shoves police officers who happened to be in the ED at the time, then gets a throwdown. Now faces up to 20 years in prison. Of course if he beat the emergency department personnel senseless, he might get
- [Two Views of the Day](https://epmonthly.com/blog/two-views-of-the-day/) - Most frustrating part of the day ... Working 60 hours in last 4 days, after being called an "idiot" by a patient because the hospital won't dispense OTC antifungal cream for her foot fungus, running a code on a child who didn't make it, telling a patient that she has metastatic lung cancer, getting threatened
- [Independence (from fingers) Day](https://epmonthly.com/blog/independence-from-fingers-day/) - I was going to write about the worst July 4th accident I had seen in the ED prior to July 4, but I got bogged down in other things and then had to take an unexpected road trip out of state. The story is below. If you're wondering why I'm telling the story after July
- [King v. St. Barnabas](https://epmonthly.com/blog/king-v-st-barnabas/) - Walter Olson at Overlawyered.com forwarded me a case to comment upon. The opinion was King v. St. Barnabas Hospital. The facts of the case are that a 38 year old off-duty prison guard was playing basketball in the prison gym when he collapsed. Seven minutes later, medical clinic staff arrived to find the patient unresponsive
- [Healthcare Update 07-11-2011](https://epmonthly.com/blog/healthcare-update-07-11-2011/) - Wicky sticks making a comeback? Kids ingesting enbalming fluid with marijuana to enhance their “high.” Bad news is that formaldehyde can cause headaches and psychosis and who knows what the hell other symptoms. Remember: The only controlled studies on the effects of formaldehyde on human beings have been on DEAD PEOPLE. Ten Texas patients called
- [Happy 4th of July!](https://epmonthly.com/blog/happy-4th-of-july/) - We're celebrating the July 4th holiday, but how many of you actually know what we're celebrating? What event occurred on July 4, 1776? A. The United States declared independence from Great Britain B. The wording of the Declaration of Independence was adopted C. The Declaration of Independence was signed Click this link to Wikipedia for
- [Healthcare Update -- 07-04-2011](https://epmonthly.com/blog/healthcare-update-07-04-2011/) - Billing your doctor for making you wait. Some doctors are giving patients money if the patients have to wait longer than 15 minutes for an appointment. This practice definitely falls into the category of “be careful what you wish for.” Would it still be a good idea if patients had to pay the doctor out
- [WhiteCoat Challenge #7 Winners](https://epmonthly.com/blog/whitecoat-challenge-7-winners/) - The competition was tough, the voting was close, and half of you have your minds in the gutter. After careful consideration, EP Monthly's editors have chosen the following comments as winners of WhiteCoat Challenge #7: #3 Ed's observation that "they have the 'sickness and health' clause covered." #13 joebob's morning after question - “Have you
- [Greet and Street](https://epmonthly.com/blog/greet-and-street/) - Another article that I was going to put in a Healthcare Update that just irked me enough that I had to make it into its own post. First, the news ... In order to cut down on unpaid health care bills while also complying with federal EMTALA laws, hospitals emergency departments are increasingly engaging in
- [Healthcare Update -- 06-27-2011](https://epmonthly.com/blog/healthcare-update-06-27-2011/) - A different kind of deadly epidemic. Armed robberies at pharmacies rose 81% between 2006 and 2010. Then number of pills stolen now tops 1.3 million. Not surprisingly, the criminals are taking opiates such as oxycontin and Norco. One New York robber walked into a pharmacy and shot without warning - killing the pharmacists and two
- [Help Wanted](https://epmonthly.com/blog/help-wanted/) - For the first time in many months, I updated my list of medical blog links. I added a few and removed a bunch of blogs that have either gone dormant or that have gone offline. I need more. Do you have a medically-related blog that you read regularly? Do you write a medically-related blog? If
- [Real Life Limon](https://epmonthly.com/blog/real-life-limon/) - I just discovered how all those lemon-lime drinks came up with their unique flavor. On Tuesday, we purchased ingredients to make some Orange Roughy fillets tonight. We left them out on the counter. This morning, we discovered that one of the lemons had combined with one of the limes to form a "limon." In other
- [WhiteCoat Challenge #7](https://epmonthly.com/blog/whitecoat-challenge-7/) - I was going to add this story to next week's Health Care Update, but as I was thinking about it, there were too many smart-alec comments that can be made about this scenario. See what you can come up with ... Bride gets married in hospital when appendix ruptures on her wedding day. Here are
- [My Father's Day Present](https://epmonthly.com/blog/my-fathers-day-present/) - Is keeping me a little busy ... Another shelter save. Mom and 7 puppies were dropped off there a couple of weeks ago. This one needed some medical care before being able to be adopted. She's 9 weeks old. Hopefully things will turn out better this time.
- [Healthcare Updates -- 06-20-2011](https://epmonthly.com/blog/healthcare-updates-06-20-2011/) - Debunking myths about the emergency department ... or perpetuating them? Guest blogger at HuffPo asserts that emergency medicine is NOT the most expensive type of health care (accounting for only 2% of all healthcare spending), that 92% of emergency department visits require some type of treatment within 2 hours, and that most patients who visit
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-7/) - Leaving for a two day lacrosse tournament, so won't be online this weekend. May add a couple of tweets from my phone. The comments section is hereby open for anyone to post any medically-related questions, comments, or other esoterica. Just remember, no personal attacks. I'll try to answer posted questions/comments on Monday. Have a safe and
- [They're Watching You](https://epmonthly.com/blog/theyre-watching-you/) - If you are prescribed any type of controlled substances from a physician, your name is on a database somewhere - pharmacy, insurance company, possibly a state database. When you start filling more prescriptions for controlled substances than average, your name may just have a little asterisk at the end of it. Even insurance companies are
- [Unusual Coincidence](https://epmonthly.com/blog/unusual-coincidence/) - Any time that I discuss patients on this blog, I randomly change around the gender, the age, the complaints, and any names involved - both to protect the patients' privacy and to comply with privacy laws. As I have stated in my "About" link: "If you think there is any similarity between you and a
- [Emergency Physicians International](https://epmonthly.com/blog/emergency-physicians-international/) - A quick shout out to a new venture from Emergency Physicians Monthly Logan Plaster and company have started a new magazine called Emergency Physicians International. They just put out Issue #3 and there are a lot of good articles inside, including articles about laryngoscopy and emergency medicine in Croatia, Japan, and South America, to name
- [The Case of the Crazy Rabid Squirrel](https://epmonthly.com/blog/the-case-of-the-crazy-rabid-squirrel/) - Who (if anyone) is to blame? Man and squirrel fight it out in man's driveway. Squirrel scratches him twice, man runs inside grabs BB gun and plugs squirrel ala Elmer J Fudd. Man then calls health department for advice about what to do. Health department tells him to go to ED for rabies shots. After
- [Healthcare Update -- 06-13-2011](https://epmonthly.com/blog/healthcare-update-06-13-2011/) - More medical news over at the Satellite Edition at ERStories.net. Another emergency department closes its doors. Kenneth Hall Regional Hospital in East St. Louis stopped seeing patients on June 7, Visitors gone wild. Gang of people tried to push their way into the emergency department at Nassau University Medical Center and were threatening hospital staff
- [Dr. Perfect](https://epmonthly.com/blog/dr-perfect/) - I occasionally get asked to review charts from other emergency departments in order to determine whether the care provided was appropriate. One of the cases from a visit to a competitor emergency department is below. A patient with a longstanding history of migraine headaches comes to the hospital for another one of her typical migraine
- [More Quotes From The ED](https://epmonthly.com/blog/more-quotes-from-the-ed/) - I was taking a history on a patient, and, in order to receive appropriate compensation from the government, one of the things that doctors are required to ask about (regardless of whether it has any impact on the patient's condition or care) is a patient's social history. "Do you smoke?" "Nope. Never." "Do you drink
- [Healthcare Update -- 06-06-2011](https://epmonthly.com/blog/healthcare-update-06-06-2011/) - More news stories from around the web at this week's Satellite Edition over at ER Stories.net. Cell phones will really kill ya. If they don't cause brain cancer from the radiation, those used in the hospitals are twice as likely to be full of deadly bacteria. $7 million verdict against surgeons when patient develops sepsis
- [B...R...B...](https://epmonthly.com/blog/b-r-b/) - A teenager is brought in by her mother after falling while skateboarding. She was whisked off to xray shortly after arriving - and before I had gotten into the room to evaluate her. I walked into room and was talking with her mother when a cell phone buzzed on the bed under pillow. "Is this
- [Correlations](https://epmonthly.com/blog/correlations/) - Has anyone else noticed the following correlation? The more narcotics that a patient has received in a given month, the less likely that a patient is to be able to pronounce the names of those medications. For example, a patient with chronic abdominal pain and multiple negative workups came into the emergency department for a
- [Refusing to Treat Obese Patients](https://epmonthly.com/blog/refusing-to-treat-obese-patients/) - I discussed whether or not ambulances should be required to add equipment costing $12,000 in order to be able to transport 850 pound patients in a previous post, so I won't belabor the point here. Providing medical care to morbidly obese patients presents multiple challenges. Then I read an article in the Florida Sun Sentinel about
- [Healthcare Update -- 05-30-2011](https://epmonthly.com/blog/6646/) - Happy Memorial Day! Please take a few moments to remember all of our servicemen and servicewomen who have sacrificed for us and our country. More medical news stories from around the web on the Satellite Edition of this week's update over at ER Stories.net. -------------------------- Amazing story from one of the emergency physicians working when
- [Unique Medical Allergies](https://epmonthly.com/blog/unique-medical-allergies/) - Had a rather heated discussion a couple of years ago about the difference between allergies and adverse medication reactions, so when patients tell me about strange allergies to medications, most of the time I just smile and move on. But ... while reading through a patient's typewritten two page list of allergies in a recent
- [Death of a Family Member](https://epmonthly.com/blog/death-of-a-family-member/) - I had worked the previous evening and got home late. As I laid down in bed, I looked forward to sleeping in the following morning. At 7:38 AM my daughter screamed "HELP! DADDY! HELP!" Our two dogs were barking, and by the tone of the barking, it was easy to tell that they were attacking
- [Free Market Medicine and Lab Tests](https://epmonthly.com/blog/free-market-medicine-and-lab-tests/) - As my surgical experiences come to a close, I have now begun to receive all the bills for services that were provided to me. One bill shows what one national health care provider considers "fair payment" for laboratory testing performed prior to my surgery. I matched that bill up with my insurance explanation of benefits
- [Update](https://epmonthly.com/blog/update-3/) - I'm still around. Unfortunately, the past couple of weeks have been very busy at work and filled with some not so nice things. Dealing with a lot of death - both at work and at home. Death is part of life, but sometimes circumstances make it a little harder to accept. Have a lot to
- [Healthcare Update -- 05-23-2011](https://epmonthly.com/blog/healthcare-update-05-23-2011/) - See also the Satellite Edition of this week's update at ERStories.net. -------------------------------------------- How should we manage elderly patients with dementia when they become violent and nursing homes or families can no longer handle them? We better make a plan quickly - the number of elderly patients with mental illness jumped 30% in one year and is
- [The Diesel Fitter](https://epmonthly.com/blog/the-diesel-fitter/) - I took care of a patient who was a pipefitter and which reminded me of another patient I had long long ago. I looked back through the blog and never mentioned this story before, so here it is. The patient was rather intoxicated and he said that he had hurt his leg at work. So
- [Healthcare Update -- 05-16-2011](https://epmonthly.com/blog/healthcare-update-05-16-2011/) - Also see more updates at the Satellite Edition of this week's update at ERStories.net --------------------------- The devil chased one patient off the roof of a two story building. The devil also possessed a 7 year old girl, so her brother pushed her down the stairs. Two patients were so uncontrollable that they had to be
- [Trial of a Commenter - Final Order](https://epmonthly.com/blog/trial-of-a-commenter-final-order/) - In the State of EP Monthly ) County of WhiteCoat’s Call Room ) --FINAL ORDER-- This cause having come to trial before this court and a jury of the defendant's peers having considered all evidence presented by the parties, the jury has hereby found Matt the Commenter GUILTY of Disorderly Commenting Conduct in the Second
- [Happiness is ...](https://epmonthly.com/blog/happiness-is/) - Two portraits drawn for me during and after a tough day. . . . . . . . . . . .
- [What Goes Inside?](https://epmonthly.com/blog/what-goes-inside/) - After my hospitalization, I got a letter from a patient satisfaction survey company. It contained a envelope addressed back to the same patient satisfaction survey company and the envelope stated that "POSTAGE WILL BE PAID BY ADDRESSEE." I wasn't sure what I was supposed to put inside of the envelope, though. Can you all give
- [Things NOT to say in a Hospital](https://epmonthly.com/blog/things-not-to-say-in-a-hospital/) - In one of the hospitals were I work, there is a policy that security has to escort all newborns and their families to their vehicles once the babies have been discharged. While security was in the emergency department observing another patient, over his radio came the following statement: "Hello! This is Susan in OB. I
- [Healthcare Update -- 05-09-2011](https://epmonthly.com/blog/healthcare-update-05-09-2011/) - Also see the satellite edition of this week's update over at ER Stories. -------- Kudos to Tuscaloosa, Alabama hospital and medical staff for treating more than 650 patients in the 6 hours after a devastating tornado hit the town (and also took out part of the hospital). Much of the time, the hospital was running
- [Under the Knife - Part 6](https://epmonthly.com/blog/under-the-knife-part-6/) - I turned around, shuffled backward, and eased myself back onto the clean bedsheets. Mrs. WhiteCoat removed the lines from the IV pole and moved the pole to the other side of the bed so it was on the same side as the arm where the IV was placed. Then she gently hung the Foley catheter
- [The Trial of a Commenter](https://epmonthly.com/blog/the-trial-of-a-commenter/) - Because several people have asked me to address Matt's comments, I have decided to take action. I will preface the text below by saying that I believe everyone has a right to speak their mind, within reason [no shouting "fire" in a crowded theater and all that stuff]. I also find value in the opinions
- [Now About That Nasal Congestion ...](https://epmonthly.com/blog/now-about-that-nasal-congestion/) - I'm still a little skeeved out by this. An adult patient comes to the hospital for evaluation of wrist pain she has had for three months. I get a little history and then start to examine her hand. I turn over her wrist so I can tap on it to check for Tinel's sign ...
- [Healthcare Update -- 05-02-2011](https://epmonthly.com/blog/healthcare-update-05-02-2011/) - First year medical student writes about what it is like to dissect cadavers in the anatomy lab. Abuse-resistant form of oxycodone on the horizon? I give it a month before someone has figured out how to abuse it. Emergency department access not the same as health care access. Here's why. I disagree with some of
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-6/) - Daughters WhiteCoat are competing in two dance competitions and performing in two plays this weekend, so will be busy videotaping and taking pictures. Ergo, no posting. However ... I finally made a few tweets [?] on my Twitter account. If you are exceedingly bored, you can follow me at "WCintheED". If I can figure out
- [Cracking the Top 100](https://epmonthly.com/blog/cracking-the-top-100/) - I hate Top 100 rankings. In my e-mail box there was another Top 100 solicitation. This one was for the Top 100 most influential people in healthcare. I deleted it. Then I thought a moment and pulled it out of the trash bin. What if *I*, humble and pure WhiteCoat the blogger, could be voted
- [Pictures in ED Legally Permissible?](https://epmonthly.com/blog/pictures-in-ed-legally-permissible/) - The news feed that I read each day came up with a link to an interesting legal opinion in a Georgia district court relating to care in the emergency department. The case involved federal agents who went to a trauma center to question a patient in the emergency department who was being treated for a gunshot
- [WTF Moment #916](https://epmonthly.com/blog/wtf-moment-916/) - And it didn't even happen in the emergency department. A staff member's husband stops by Subway sandwich shop to get his wife some lunch. A couple people ahead of him in line is an elderly man in a John Deere baseball cap and overalls. When he gets up to the counter, the conversation goes something
- [Under the Knife - Part 5](https://epmonthly.com/blog/under-the-knife-part-5/) - Getting out of bed was much more difficult than I expected. The pain of sitting up was one thing. I was able to help myself up to the side of the bed by pulling at the top of the bed railings, sitting the back of the bed as high up as it would go, and
- [Healthcare Update -- 04-25-2011](https://epmonthly.com/blog/healthcare-update-04-25-2011/) - Pennsylvania hospital gets hit with $21 million verdict after woman comes to hospital with twin gestation and has "difficult delivery." One of the twin children was born with cerebral palsy. New Jersey hospital pays $8.5 million to settle birth-related lawsuit. Family awarded $2 million after surgeon fails to remove both ovaries in a patient who
- [Glad I Could Help](https://epmonthly.com/blog/glad-i-could-help/) - A mother brings her 9 year old son into emergency department. The chief complaint on the chart was "red lips." The young man sitting on the bed did indeed have red lips. Nothing else appeared wrong. The mother stated "He has chapped lips." Yes. Yes he does. Petroleum jelly works great. Just ask Suzy Chapstik.
- [Healthcare Update -- 04-19-2011](https://epmonthly.com/blog/healthcare-update-04-19-2011/) - US health care providers aren't the only ones who are concerned about patients gone wild. 89% of emergency physicians in China have been threatened with violence and 37% of Chinese emergency physicians have been physically attacked. US agencies aren't the only ones failing to address the issue, either. Chinese emergency physicians and nurses are studying
- [Under the Knife - Part 4](https://epmonthly.com/blog/under-the-knife-part-4/) - After actually spending almost a week as a patient in the hospital, I can't figure out why people want to be patients in the hospital. Some people come to the emergency department with their suitcases in tow and are actually disappointed -- if not downright mad -- if the emergency physician has the audacity to
- [More on Criminalizing Medicine](https://epmonthly.com/blog/more-on-criminalizing-medicine-2/) - A Florida lawmaker is attempting to criminalize many aspects of medical care of pain patients, making some Florida pain management specialists and pharmacists at risk of ending up in jail. Rep. Rob Schenck of Spring Hill, Florida created House Bill 7095. According to this article in the Miami Herald, Rep. Schenck is proposing stiff penalties
- [New Flavor of Dog Biscuit](https://epmonthly.com/blog/new-flavor-of-dog-biscuit/) - All you dog food manufacturers listen up. Based upon extensive testing in the WhiteCoat household, I have come up with a new flavor of dog biscuit that dogs will absolutely love. It's called "Bloody Human Wound Dressings." One of our dogs actively digs through the garbage in our bathroom to find the damn dressings from
- [Under the Knife - Part 3](https://epmonthly.com/blog/under-the-knife-part-3/) - People began talking. I heard someone say something about a room number. I could feel the cart that I was laying in being rolled on the floor. Bump-bump. I heard doors open. I opened my eyes to see the bed being pushed through automatic doors. The hallway lights flitted by my eyes like road signs
- [Healthcare Update -- 04-11-2011](https://epmonthly.com/blog/healthcare-update-04-11-2011/) - Scranton attorney "scores" $10 million medical malpractice verdict after client with spinal cord compression is misdiagnosed as having Lou Gehrig's Disease. Man gets brought to emergency department after going to bathroom in WalMart and being unable to get up from toilet. Seems that someone lathered the toilet seat up with glue the night before. They
- [How to Assure Your Norco Prescription Isn't Filled](https://epmonthly.com/blog/how-to-assure-your-norco-prescription-isnt-filled/) - 1. Go to your primary care physician's office and refuse to take a random drug test when you entered into a contract to do so in order to get your pain medications refilled. 2. When the doctor threatens to terminate you from his practice, go into the bathroom, urinate in a cup, and then throw
- [Under The Knife - Part 2](https://epmonthly.com/blog/under-the-knife-part-2/) - By the time we reached the hospital, the parking garage was nearly full. How damn many surgeries do they do at 6:00 in the morning? We ended up getting to the registration desk 15 minutes late. The presurgical waiting room was dark and kind of musty. There were many antique chairs situated in a maze
- [Under the Knife - Part 1](https://epmonthly.com/blog/the-cutting-of-a-whitecoat-part-1/) - "You can't keep popping antibiotics to cure your diverticulitis," Mrs. WhiteCoat told me. Yeah, yeah. I know. That's why I grudgingly went to see a surgeon. Then I started wondering to myself. Aside from those neurologic complications and the increased incidence of tendon ruptures, why can’t I just take Cipro and Flagyl every few months?
- [Update #2](https://epmonthly.com/blog/update-2/) - Thanks for sticking with me and for all the good wishes. I'm clinging to life. Not back to fighting weight, but getting there. Lost 10 pounds, but don't recommend this as a weight loss method. My surgical wound popped open and is slowly leaching essential fluids from my body. In other words, the wound won't
- [Healthcare Update -- 04-04-2011](https://epmonthly.com/blog/healthcare-update-04-04-2011/) - Lots of health care-related news this week. Read more on the satellite edition of this week's update over at ERStories.net. Yeah, um, I'm calling in sick today because I had to go to the emergency department for treatment. You just nevermind what the treatment was for. I can't be seen in public until I soak
- [Medical Malpractice Firms Get Taste of Their Own Medcine](https://epmonthly.com/blog/medical-malpractice-firms-get-taste-of-their-own-medcine/) - Remember Charles Cullen? The Angel of Death nurse who killed at least 29 patients in various hospitals throughout New Jersey and Pennsylvania? He admitted sneaking into the patients' rooms at night and injecting them with overdoses of medications - usually either insulin, digoxin, or epinephrine. Many law firms sued Cullen and the hospitals at which
- [My Rules of the ER](https://epmonthly.com/blog/my-rules-of-the-er/) - A guest post by Hueydoc After almost 30 years in the ER, I have found that many of the Rules from "The House of God" are oh so accurate. But let me add a few new ones, based on my own experiences: 1) The correct answer to any problem is "Whatever screws the ER the
- [Update](https://epmonthly.com/blog/update/) - Just so that everyone doesn't think I've bitten the dust ... Surgery went fairly well. First couple of days post-op were a blur. Developed a post op ileus which resolved by Day 4. At home now and trying to get my body to heal. Had a little setback when part of the surgical wound popped
- [REPOST - Fix the Problem, Doc!](https://epmonthly.com/blog/repost-fix-the-problem-doc/) - One of my favorite stories. Originally posted October 2007 An old fellow got brought in by ambulance. His wife was waiting for him as he rolled into the room. A tire fell off of his bicycle, he fell, hit the curb, and got banged up. Ripped his shirt, ripped his pants, knocked the lens out
- [Healthcare Update -- 03-28-2011](https://epmonthly.com/blog/healthcare-update-03-28-2011/) - Johnny Stickyfingers. Patient in Chicago suburbs arrested after breaking into a code cart and attempting to steal an I.V. catheter syringe, tourniquet band, roll of clear medical tape, several electronic monitoring pads, assorted bandages, and 25 thermometer probe covers. What was he going to do with these things? Montana is the latest state to consider
- [Most Funny Moment - REPOST](https://epmonthly.com/blog/most-funny-moment-repost/) - [Originally posted September 2007] WARNING: THIS IS GROSS In keeping with the “Most” theme, this is probably one of the most funny moments I have had at work. I have one other one that I’ll use on another day off when I’m bored and don’t have much to write about. You’ve been warned that this
- [REPOST - Yee-HAW!](https://epmonthly.com/blog/repost-yee-haw/) - [Originally posted February 2008] When someone kicks at the locked door between the waiting room and the triage room, it usually isn’t a good thing. Most often it is someone who has been shot, someone who is being dragged in by any available body appendage as a drug overdose, or someone with a bad asthma
- [Dangerous Medications for Kids](https://epmonthly.com/blog/dangerous-medications-for-kids/) - From an eMedHome.com "Clinical Pearl" Medications which, when taken even in small amounts, can have significant adverse effects on young children. Camphor, which is contained in many OTC products such as vapor rubs and Tiger Balm Quinine, such as in some cardiac medications and in Placquenil which is used to treat lupus. TriCyclic Antidepressants such
- [Karma Victim](https://epmonthly.com/blog/karma-victim/) - Sometimes karma works in strange ways. Parents bring their child in for evaluation of the child's cough and runny nose. About the tenth such case of the day and no one wants to get their kids flu shots. The child's dad is standing next to the bed holding the child's hands and talking baby talk
- [Break](https://epmonthly.com/blog/break-3/) - By the time you read this, I'll be having a gas ... literally. As in Sandman, Great Z's, and Anesthesioboist kind of gas. I'm having surgery done to fix some issues that have been giving me trouble for quite some time. According to the surgeons, I'm expected to be in the hospital for about a
- [Healthcare Update -- 03-21-2011](https://epmonthly.com/blog/healthcare-update-03-21-2011/) - See more medical related news stories from around the web at the Satellite Edition of this week's update over at ER Stories.net. More patients gone wild. Florida woman being abusive to staff in emergency department, then punches and kicks several nurses and technicians. After getting a nice matching sets of leather bracelets, then then bit
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-5/) - I'm going to be away at a wrestling tournament with the family for the weekend. Hopefully Junior WhiteCoat will do well and we won't be back until Sunday evening. So this weekend will be devoted to your questions, comments, rants about anything medically-related that interests you. Just leave a post in the comments section. Other readers
- [What's the Diagnosis #13](https://epmonthly.com/blog/whats-the-diagnosis-13/) - A breast cancer patient presents with painful rash to her hands and feet for the past 24 hours. The palms and soles were warm and she had a horrible "burning" sensation that didn't improve with pain medications. Putting ice on her hands and feet seemed to provide her with temporary relief. She started several new
- [Let GO - Answer](https://epmonthly.com/blog/let-go-answer/) - Remember the post last month about the snapping turtle stuck on the patient's lip? EP Monthly updated the story this month to tell everyone how the emergency department staff got the snapping turtle off the patient's lip. See the answer at this link.
- [Healthcare Update -- 03-14-2011](https://epmonthly.com/blog/healthcare-update-03-14-2011/) - Patients gone wild. Patient gets upset at wait and goes "berserk" on emergency department physician, breaking ribs and giving the doc a concussion. I told you it was cold in here. More patients gone wild. Las Vegas woman sets fire to a trash can in emergency department restroom. Burning plastic from the garbage can filled
- [Stroke Victim](https://epmonthly.com/blog/stroke-victim/) - A 27 year old woman is brought in by ambulance. The call comes in as "patient having a stroke." When the patient arrives, she is dressed up with nice clothing, makeup, and high-heel shoes. She looks like she was out at the clubs. In fact, she was drinking at home with her boyfriend and was
- [Voice Recognition Not Quite There](https://epmonthly.com/blog/voice-recognition-not-quite-there/) - Our emergency department switched over to a voice recognition program and got rid of the transcriptionists (and the expenses) for dictating patient charts. Problem is that transcriptionists pick out errors in dictation that Dragon NaturallySpeaking doesn't. The computer program has no idea bad certain transcription errors can look in the chart. If you're dictating and not
- [Healthcare Update -- 03-07-2011](https://epmonthly.com/blog/healthcare-update-03-07-2011/) - Absolutely amazing story. Man falls to ground inside of a rural Minnesota grocery store. Unconscious and no pulse. One customer inside begins CPR. Store clerk calls 911. Other people start to gather. For 96 minutes, more than 20 bystanders rotate turns doing CPR until a helicopter arrives. Airamedics shock the patient 12 times and get
- [Provider Attitude and Patient Violence](https://epmonthly.com/blog/provider-attitude-and-patient-violence/) - Kevin MD published an op-ed in USA Today titled "Violence is a symptom of health care dysfunction" which discusses patient frustrations as one source of violence against health care workers. I've been busy this week and the comments section is apparently closed on Kevin's post, so I didn't get the chance to put my 2
- [Chief Complaint: Insomnia](https://epmonthly.com/blog/chief-complaint-insomnia/) - Me: Hi. I'm Dr. WhiteCoat. What brings you here this evening? Patient: I'm stressed and I haven't slept in 5 days because those bitches at work don't keep up with their work and so I have to do their work AND my work so finally I had it the other day and started punching one
- [The Vein of WhiteCoat](https://epmonthly.com/blog/the-vein-of-whitecoat/) - We have had a run on very sick children in our emergency department lately. One 2 year old patient had a seizure and just didn't look good. Blood glucose good. Blood pressure good. Temperature 101.2 degrees. Not super high, but is this meningitis or is the temperature up from the constant seizing? I ordered antibiotics
- [Healthcare Update -- 02-28-2011](https://epmonthly.com/blog/healthcare-update-02-28-2011/) - Also see the satellite edition of this week's update over at ER Stories. Its about time. California hospitals fined by California OSHA for failing to protect workers from violence in the emergency department. The hospitals claim that the California Nursing Association is "sensationalizing" the fines in order to "apply pressure at the bargaining table.” Have
- [St. Baldricks](https://epmonthly.com/blog/st-baldricks/) - Shadowfax is graciously donating his bounding locks of hair to a good cause. Again this year he is raising money for children's cancer research through the St. Baldricks Foundation. Please consider donating to St. Baldricks through Shadowfax's donor page and help the cause. He's about 2/3 of his way to his goal of $15,000. Maybe
- [Doctor's Work Notes and Medical Ethics](https://epmonthly.com/blog/doctors-work-notes-and-medical-ethics/) - I wrote the story below before all of the Wisconsin issues popped up, but the "doctor fraud" scandal segues nicely with the issues in the patient encounter I wrote about. Kevin, MD had a post yesterday linking to an article in The Atlantic about how physicians in Wisconsin were standing on street corners and writing
- [What's the Diagnosis #12](https://epmonthly.com/blog/whats-the-diagnosis-12/) - A 15 year old girl goes to a pharmacy chain's walk in clinic with a nonproductive cough and nasal congestion. She is diagnosed with "bronchitis" and is of course given antibiotics. Two days later, she presents with joint pains and the rash below. What's the diagnosis? What is/are the likely cause(s)? What is the treatment?
- [Sign of The Times](https://epmonthly.com/blog/sign-of-the-times/) - The comment thread just died down on the post about filming the birth of babies. Then a real-life example occurs in our emergency department. Tell me that the following scenario would have even taken place five years ago: A patient's mother completely freaked out on one of our nurses because her child wasn't getting Demerol
- [Healthcare Update - 02-21-2011](https://epmonthly.com/blog/healthcare-update-02-21-2011/) - See more health news from around the web on the Satellite Edition of this week's update over at ER Stories.net. The "Valentine's Day Massacre" - healthcare budget style. Cook County Hospital system in Chicago slashes nursing staff in its hospitals. Oak Forest hospital will fire more than 100 nurses, leaving it with only 27 nurses.
- [Cup Check x 2](https://epmonthly.com/blog/cup-check-x-2/) - Today just wasn't my day in the emergency department. First, I'm taking care of a patient with shortness of breath. I'm standing at the side of the cart. He leans forward and I listen to his lungs with my stethoscope. Sound good. Then I lean the bed back a little so that I can listen
- [Should JCAHO Regulate Family Visitation?](https://epmonthly.com/blog/should-jcaho-regulate-family-visitation/) - I had a whole story ready to post about another very sick child that we treated, but decided to leave a more general issue instead. When there are critically ill patients, the staff has to think quickly and act quickly. Interruptions are counterproductive to our job during those times. Think about trying to concentrate on
- [Healthcare Update -- 02-14-2011](https://epmonthly.com/blog/healthcare-update-02-14-2011/) - See more health care news from around the web on the Satellite Edition of this week's update over at ER Stories.net. A new study in the Annals of Emergency Medicine shows how much time emergency physicians spend performing direct patient care versus indirect patient care. Also see a news article on the study here. In
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-4/) - Time for more input from you ... the readers. Comment, rant, or ask about anything medically-related that interests you in the comments section. Other readers feel free to chime in and answer, comment more or rant more. Just remember - be nice and no personal attacks.
- [Blast Your Boss on Facebook - You're Protected](https://epmonthly.com/blog/blast-your-boss-on-facebook-youre-protected/) - The National Labor Relations Board sued a Connecticut ambulance company after the ambulance company fired an employee for posting negative comments about her boss on Facebook. The EMT made an "expletive-filled posting" on Facebook about her boss after a patient had complained about her at work. The NLRB argued that the negative comments were "free
- [Safety of Medical Care in US](https://epmonthly.com/blog/safety-of-medical-care-in-us/) - Remember that statistic from the 1999 Institute of Medicine report that trial lawyers like to throw in everyone's face about how "up to 98,000 people in the US die each year due to medical mistakes"? It's like TWO 737 jetliners crashing every day ... and we're doing nothing about it. So today a news story
- [Let GO!](https://epmonthly.com/blog/let-go/) - Interesting case just published on EP Monthly's site regarding a snapping turtle. Patient comes in via ambulance with a 25 pound snapping turtle firmly attached to his upper lip. The turtle isn't letting go. See the link for a picture. https://epmonthly.wpengine.com/clinical-skills/visual-dx/when-turtles-attack/ How do you get the turtle off of his lip?
- [Healthcare Update -- 02-07-2011](https://epmonthly.com/blog/healthcare-update-02-07-2011/) - See also the Satellite Edition of this week's update over at ER Stories. Hey ... she had great Press Ganey scores, so who cares? Spanish woman with no medical training masquerades as emergency department physician for 5 months before being caught. See also a Google Translation of the Spanish newspaper article covering the story. Drug
- [A Birthright?](https://epmonthly.com/blog/a-birthright/) - Do parents have a "right" to videotape doctors and hospital staff while they deliver their babies in the hospital? Many hospital delivery rooms are banning cameras or recording devices due to threat of medical malpractice and "litigious atmosphere." Judges do it. Try walking into a courtroom with a video camera and videotaping a judge doing
- [Question for the Day](https://epmonthly.com/blog/question-for-the-day/) - Question: Why was the patient not complaining of any pain from this injury? Answer: She was highly intoxicated ... and she was driving a motorcycle at a high rate of speed ... without a helmet ... when she crashed ... and broke her neck. Such a sad case. She has kids that she will now
- [Healthcare Update -- 02-02-2011](https://epmonthly.com/blog/healthcare-update-02-02-2011/) - Welcome to the belated edition of this week's update and the first post that I have ever made from work -- because I have been snowed in at the hospital for the past 2 days. Shameless plug for songs involving me by name - The ER Blitz. Tex now has over 100 songs in his
- [Cross Post](https://epmonthly.com/blog/cross-post/) - For those interested, I also just posted a story on ER Stories about a patient encounter that frustrated me a little bit.
- [Daughter WhiteCoat and Sex Ed](https://epmonthly.com/blog/daughter-whitecoat-and-sex-ed/) - My wife and I don't watch TV that much. Maybe the news in the evening and that's about it. Our kids, on the other hand, not only watch TV, but they download video clips on their iPods. Daughter WhiteCoat showed us this excerpt from Family Guy where Peter gets all buzzed up on Red Bull.
- [Gaming ObamaCare](https://epmonthly.com/blog/gaming-obamacare/) - Remember my post a few months back about how some large companies were getting waivers so they didn't have to pay into the new health care system? Things are getting worse. According to this article on The Hill, the feds just granted new insurance waivers to more than 500 groups, bringing the total number of
- [It's About Time](https://epmonthly.com/blog/its-about-time/) - It was a busy night in the emergency department as many nights are. All of the rooms were full and there were 6 to 8 patients waiting just to get back to the emergency department. I hadn't taken a break in several hours, and though I was hungry I just drank sips of Gatorade and
- [Healthcare Update -- 01-24-2011](https://epmonthly.com/blog/healthcare-update-01-24-2011/) - Also see the satellite edition of this week's update over at ER Stories. While ERP is on vacation, I'll try to do double duty and post on both blogs this week. They're already starting to itch. Drug seeking patients will soon have a new medication to add to their list of allergies ... and/or medications
- [Unfulfilled Expectations](https://epmonthly.com/blog/unfulfilled-expectations/) - A patient came into the emergency department at 3:00 in the morning with broken peritoneal dialysis catheter. Actually, the catheter wasn't broken, there was a small leak in the catheter at the distal end of the tubing. She had clamped the shunt off as she was instructed to do in the past and she came
- [Birth Control Factoids](https://epmonthly.com/blog/birth-control-factoids/) - From MMWR January 14, 2010 (.pdf file)(hat tip to emedhome.com): 50% of all pregnancies in the US are "unintended." The failure rate for condoms in preventing pregnancy during "typical use" is 15% The failure rate for oral contraceptives ("the pill") in preventing pregnancy during "typical use" is 8% The failure rate for intrauterine devices (IUDs)
- [Healthcare Update -- 01-17-2011](https://epmonthly.com/blog/healthcare-update-01-17-2011/) - Despite medical malpractice damage caps, number of Ohio closed cases and damage awards rise in 2009. Average payouts were $322,000 and the average cost to defend a case was $39,000. Only 24% of the malpractice claims were successful, meaning that the plaintiff attorneys committed legal malpractice 76% of the time. Many chronic pain patients become
- [Open Mic Weekend 01-15-2011](https://epmonthly.com/blog/open-mic-weekend-01-15-2011/) - I'm leaving on a trip with the family for the weekend. Feel free to ask questions, vent, rant, or otherwise post in the comments section. Remember the only rules: Be nice, no personal attacks, and try to keep things medically-related. I'll be back to try to answer questions on Monday. Everyone enjoy your weekend!
- [Caring for Morbidly Obese Patients](https://epmonthly.com/blog/caring-for-morbidly-obese-patients/) - Not sure how I feel about this. Boston Emergency Medical Services debuts an ambulance with a mini-crane and reinforced stretcher to transport patients weighing up to 850 pounds. It cost $12,000 to retrofit the ambulance. My problem is this: I think we need to do our best to provide medical care to all patients. But
- [Healthcare Update -- 01-10-2011](https://epmonthly.com/blog/healthcare-update-01-10-2011/) - See many additional news stories over at the Satellite Edition of this week's update at ER Stories. Two year old child loses both feet and one hand to rapidly-progressing infection. Newspapers suggest that 5 hour wait in emergency department waiting room may have played part in the patient's injuries. Keep in mind that Group A
- [Is Protecting Yourself a Joint Commission Violation?](https://epmonthly.com/blog/is-protecting-yourself-a-joint-commission-violation/) - There are a lot of bonehead stories about the Joint Commission in the news lately. I just had to post this one. CMS and JCAHO are now investigating Lehigh Valley Hospital in Pennsylvania for using stun guns on unruly patients. In one instance, a patient was using an IV pole as a pugil stick before
- [Do they Have Gastroenteritis or Antimony Poisoning?!](https://epmonthly.com/blog/do-they-have-gastroenteritis-or-antimony-poisoning/) - Hey all, it's ERP from erstories.net. Haven't done a guest post in a while but here ya go. Recently there has been a huge uptick of visitors to my ER violently ill with vomiting and diarrhoea. They (the CDC) thinks it is Norovirus, but that got me thinking. We see episodes of this sort of
- [The Case of the Cyanotic Hands](https://epmonthly.com/blog/the-case-of-the-cyanotic-hands/) - I went in to see a patient whose hands suddenly turned blue at work. She stated that she couldn't feel any of her fingertips once they started turning blue and said that she was "cleaning" before the symptoms occurred. As I walked into the room, all of the fingers on both her hands were definitely
- [Memories](https://epmonthly.com/blog/memories/) - I picked up the chart of a very nice little old lady who fell on the ice and broke her arm. When I walked in the room, her husband said "Oh good! He's the best doctor here." I thanked him for his compliment and went about treating her injury. All three of us joked back
- [Johnny Floppy Shoulder](https://epmonthly.com/blog/johnny-floppy-shoulder/) - My son wrestles. We were at a wrestling tournament most of the day today. At the tournament, one of the other members of his team was losing a match and then suddenly complained of shoulder pain. Immediately, several people said that his shoulder looked deformed and then assumed that he had dislocated his shoulder. Another
- [Reader Satisfaction Survey](https://epmonthly.com/blog/feedback-request/) - It's been almost two years and more than 2.5 million hits since I switched my blog to the EP Monthly site. It still continues to amaze me that so many people have an interest in what I write about. The number of posts I've been making has decreased over the last 6 months due to
- [Now See Here](https://epmonthly.com/blog/now-see-here/) - I'm hoping that everyone enjoyed the evening last night. We went out for dinner and, under the influence of sake, I bet each of my kids $10 that they wouldn't be awake past midnight. I lost $40. Was also getting text messages from several people working in the emergency departments describing how crazy things were
- [Healthcare Updates -- 12-31-2010](https://epmonthly.com/blog/healthcare-updates-12-31-2010/) - See more health care news at the satellite edition of this update over at ER Stories.net. Providing free medical care when a mistake occurs. The hospital doesn't just compensate the patient for his injuries - it writes off the entire hospitalization. I think we ought to do this for every industry. Restaurant screws up my
- [Joint Commission - Anti-Safety in Action](https://epmonthly.com/blog/joint-commission-anti-safety-in-action/) - "Severe pain can trigger suicide in hospital ERs" the headline reads. If they're still calling it an "ER" you already know they're clueless. The article at the National Library of Medicine cites a new "Sentinel Event Alert" from the Joint Commission (.pdf download) urging emergency departments to be on the lookout for patients who may
- [The Gift 2010](https://epmonthly.com/blog/the-gift-2010/) - Some people really hate those photocopied updates inserted into the Christmas cards that show up in your mailbox each year. You don't hear from people for a whole year, what makes them think that you want to know what they did instead of writing you an e-mail once in a while, right? I happen to
- [An Early Christmas Present](https://epmonthly.com/blog/an-early-christmas-present/) - For those of you who are starved for snark and who miss Nurse K ... She's baaaaaack. And posting with a vengeance, I might add.
- [Healthcare Update -- 12-24-2010](https://epmonthly.com/blog/healthcare-update-12-24-2010/) - Has the pendulum swung too far in the other direction? Texas tort reform is allegedly making it hard for injured patients to find lawyers to represent them. In addition, once they do find representation, it is more difficult to prove a malpractice case against an emergency physician due to heightened pleading standards. One side argues
- [Akismet Shout Out](https://epmonthly.com/blog/akismet-shout-out/) - I don't know about the other bloggers out there, but I'm noticing that comment spam is becoming more and more prevalent. When running through comments flagged for approval last week, my spam folder totaled 7,994 spam comments. That prompted me to do a little digging, and I found that the amount of spam comments I
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-3/) - Back with another weekend where you can let everyone else know what is on your mind. Ask questions, make statements, vent. Just try to keep it medically-related and don't engage in ad-hominem attacks. I'll be back Tuesday to try to answer any questions posted. Have a good weekend.
- [Healthcare Update -- 12-17-2010](https://epmonthly.com/blog/5858/) - See more medical news stories on the Satellite Edition over at ERP's blog - ER Stories. More violence against emergency department staff. Illinois nurse gets punched in the gut by an intoxicated patient. At least the police and hospital are prosecuting the schmuck. Because health care employees are a protected class of individuals, the criminal
- [Great Stocking Stuffer](https://epmonthly.com/blog/great-stocking-stuffer/) - During my last shift, seven of the first eight patients that I treated had injuries from falls on the ice. Elbow fracture, elbow dislocation, two hip fractures, coccyx (tailbone) fracture, depressed skull fracture, a few back pains ... and a partridge in a pear tree. When it snows out, the snow is slippery. When you
- [One-Liners](https://epmonthly.com/blog/one-liners/) - As more and more state databases come on line, those "patients" who feign pain seeking narcotic pain medications are finding it more and more difficult to find prescribers willing to oblige them. As a result, the patients are adapting by suffering acute injuries for which they need immediate narcotic pain medications to relieve their suffering.
- [Too Much Information About AICD Function](https://epmonthly.com/blog/too-much-information-about-aicd-function/) - A 350+ pound man comes in for evaluation after his cardiac defibrillator discharged. When defibrillators discharge once, there isn't a lot to do with the patients. The defibrillator did what it was designed to do - sense and terminate an abnormal cardiac rhythm. When there are multiple shocks, that is a different story. Multiple things
- [Healthcare Update -- 12-10-2010](https://epmonthly.com/blog/5832/) - Did I tell you how much Google sucks ... BLAM! Droid phone explodes in man's head while he is talking on phone. Emergency department overcrowding takes another life. Short of breath 41 year old Ontario patient dies while sitting in emergency department waiting room for more than 90 minutes. Waits for patients with serious conditions
- [Stomach Flu](https://epmonthly.com/blog/stomach-flu/) - There is a run on gastroenteritis in our area. Lately, it seems as if about half of the patients coming into the emergency department have some combination of nausea, vomiting, diarrhea, and abdominal cramps. School attendance has dropped by 15%. I cringe when people call gastroenteritis the "stomach flu." You can call it whatever you
- [Inevitable Malpractice](https://epmonthly.com/blog/inevitable-malpractice/) - I'll preface this post by saying that, as I usually do when discussing specific patient presentations, I made multiple factual changes in the factual information regarding the patient. An 87 year old lady who is in excellent health comes into the department because she couldn't move her leg. When she woke up and was fine.
- [Death Panels and Access to Care](https://epmonthly.com/blog/death-panels-and-access-to-care/) - I read an article in the New York Times that underscores my argument that health care insurance does not and never will equal health care access. Our federal and state governments are being crushed by debt. There are many reasons for that debt, and addressing the reasons for the debt are a necessary aspect of
- [Healthcare Update -- 12-02-2010](https://epmonthly.com/blog/healthcare-update-12-02-2010/) - Also see the satellite edition of this week's update over at ER Stories. Problems with Canadian health systems getting worse. "We’re trying to get a Size 13 foot into a Size 8 shoe." Emergency department overcrowding increasing due to lack of available beds. The president of the Edmonton Emergency Physicians Association described the situation as
- [New CPR and ACLS Guidelines Published](https://epmonthly.com/blog/new-cpr-and-acls-guidelines-published/) - The "ABCs" that emergency medical providers have come to know and love has now been changed to "CAB" - as in Circulation first then Airway then Breathing. Gordon Ewy finally gets well-deserved recognition for his compression-only model of CPR and its significant improvement in patient outcomes. Compress first, compress hard, ask questions later. These are
- [Thanksgiving Thoughts](https://epmonthly.com/blog/thanksgiving-thoughts/) - Since the kids had this week off from school, we decided to take a mini-vacation in a hotel/indoor water park - just to spend some time together and to relax. It was fun to watch the kids forget about all of the other things going on in their lives and focus on having fun. I
- [The Giggles](https://epmonthly.com/blog/the-giggles/) - Sometimes there is just something that strikes you as funny, even though it may not be appropriate and it probably wouldn't be funny to someone else. And you can't stop laughing about it. Kind of like this Dutch comedy show spoof. Well, our dog BrownCoat has this habit. When he hears car keys jingle, he's
- [New Defensive Medicine Survey](https://epmonthly.com/blog/new-defensive-medicine-survey/) - "Every word that I write on every form is crafted with the idea that a malpractice attorney will challenge me to defend my practice." Just one of the quotes in the survey about defensive medicine published by Jackson Healthcare. The survey of more than 3000 physicians showed that 92% admitted practicing defensive medicine and that,
- [Healthcare Update -- 11-19-2010](https://epmonthly.com/blog/healthcare-update-11-19-2010/) - Malpractice environment in Texas improves, doctors flock to state. In the three years after tort reform took place in Texas, 7000 doctors applied for Texas medical licenses. Malpractice environment in Illinois stays bad, doctors leave. According to a recent Northwestern University study (.pdf file, see story here), 70% of medical students who planned to leave
- [Keeping Patients Safe](https://epmonthly.com/blog/keeping-patients-safe/) - A friend's hospital recently underwent a visit from the Joint Commission. I was told that JCAHO cited them for the following infractions: Surgilube in the patient's rooms was expired. After expiration, I'm sure that the Surgilube turns into napalm or some other dangerous chemical so this is a valid concern. There was too much Surgilube
- [Cloud Computing](https://epmonthly.com/blog/cloud-computing/) - Cloud computing has a lot of benefits. By having your information stored on someone else's servers and accessible online, you have access to that information anywhere that you have an internet connection. We are currently using Google Calendar for the scheduling of our group. It comes in handy because putting information onto the calendar is
- [Healthcare Update -- 11-11-2010](https://epmonthly.com/blog/healthcare-update-11-11-2010/) - Some people think that there is a trick to getting seen in emergency departments more quickly by arriving in an ambulance. Not necessarily so. When the emergency department is full, ambulance runs are routinely triaged to the waiting room if the patients do not have an urgent complaint. In Canada, paramedics share the pain. They
- [The Freebie](https://epmonthly.com/blog/the-freebie/) - If you're eating, if you like lollipops, if you are a member of the clergy, if you are under age 18, or if you frequent gentlemen's clubs, you may not want to read this post. You have been warned. While out at dinner of all places, one of my friends asked me about the weirdest
- [Are Vaccines Effective?](https://epmonthly.com/blog/are-vaccines-effective/) - In one of my other posts, I cited an article showing that the incidence of pertussis in California has skyrocketed and at the same time the incidence of vaccine refusals in California has quadrupled over the past four years. Mama on a Budget raised a question as to whether the pertussis vaccine was effective, citing
- [Fall Back](https://epmonthly.com/blog/fall-back/) - It is that time of year when most of the country sets its clocks back one hour in order to provide more daylight for itself during working hours. It is also that time of the year when those who with clipboards who audit hospitals are on heightened alert for those practicing clinicians who dare not
- [Healthcare Update -- 11-03-2010](https://epmonthly.com/blog/healthcare-update-11-03-2010/) - Because men like getting a Q-Tip shoved up their woo-hoo when they go to the emergency department for nasal congestion. The American Society for Clinical Pathology recommends that men be screened for sexually transmitted diseases in the emergency department. Just what we need - longer waits due to "mission creep." We screen for tuberculosis, domestic
- [Happy November](https://epmonthly.com/blog/happy-november/) - My schedule is starting to wind down to its normal chaos instead of its chaotic chaos. I'll sure be glad when tomorrow is over for a lot of reasons. The sugar level in my kids' collective bloodstreams will be near normal. It's great that they enjoyed Halloween. They each came home with a half pillowcase
- [Healthcare Update -- 10-27-2010](https://epmonthly.com/blog/healthcare-update-10-27-2010/) - For more news from around the web, see the Satellite Edition of this week's Update over at ER Stories. Canadian man dies after waiting seven hours in a Montreal emergency department waiting room. Those little hits to the head on the football field ... aren't so little. Check out this new Sports Illustrated article on how minor
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend-2/) - I have several posts half-finished and needing some polishing, but just haven't had the time to get to them lately. That being said, I also haven't had an open microphone in over a month. So what medically-related is on your collective minds? Spout off in the comments section. Remember to be civil. No ad hominem
- [Unpleasable](https://epmonthly.com/blog/unpleasable/) - “So how is your pain doing after the morphine shot?” I asked the 87 year old little old lady who had fallen at home. “I don’t have pain any more,” she replied. “That’s great! Well I have some good news. The x-rays show a lot of arthritis, but no fractures.” I thought that the patient
- [Miscellaneous Quotes](https://epmonthly.com/blog/miscellaneous-quotes/) - Two quotes overheard recently in the department. Quote #1: Nurse talking on the phone said "Don't worry, sometimes anal can be a good thing." Quote #2: Female tech in room with male patient said "You just put it in the hole and I'll do the rest. Don't worry, I'll hold it there." Get your minds
- [Healthcare Update -- 10-15-2010](https://epmonthly.com/blog/healthcare-update-10-15-2010/) - Also check out the Satellite Edition of this week's update at ER Stories. Added bonus: No virus alerts! ------------- "You'd be nuts to drink this." Growing craze drink "Four Loko," a mix between an energy drink with caffeine and a high-alcohol content liquor, is sending many victims to emergency departments. Problem is that the concoction
- [Web Site Blocking](https://epmonthly.com/blog/web-site-blocking/) - Some time yesterday morning, EP Monthly was labeled by Google as a site that could be spreading malicious software to its visitors. Those who visit this site may get a message something like that contained below. From what I can tell, it seems to happen more often with Mozilla Firefox than it does with Internet
- [Don't TAZE Me, Bro!](https://epmonthly.com/blog/dont-taze-me-bro/) - I thought this post might be of interest because it isn't something that is seen every day, but it is something that ED physicians will likely have to deal with sooner or later. There is one police officer in our area who has the "Golden TASER Award." If you look at him crosseyed, you'll be down on
- [Destitute Companies Get Health Insurance Pass From Feds](https://epmonthly.com/blog/destitute-companies-get-health-insurance-pass-from-feds/) - Why repeal the new health care law? Just get a waiver so you don't have to comply. When companies are required to pony up money for the new health care reform law that is going to give everyone in the country insurance, guess what happens. The companies balk. Multiple companies have applied for and received
- [Second Press Ganey Article](https://epmonthly.com/blog/second-press-ganey-article/) - For those of you interested in patient satisfaction statistics, EP Monthly editors have published a second article about Press Ganey in this month's edition. Are Press Ganey Statistics Reliable? Small Samples Create Questionable Results. If you haven't read the first article, it is here: 2+2=7? Seven things you may not know about Press Ganey Statistics
- [Caremark frustrations](https://epmonthly.com/blog/caremark-frustrations/) - Below is a link to a recent phone message from one of Mrs. WhiteCoat's patients who was "begging" Mrs. WhiteCoat to help her because she was "going crazy with that Caremark." Blue Cross Blue Shield Caremark Message This poor lady is 89 years old, is legally blind, and needs multiple medications. She can't get her
- [Death by Wallpaper, Medical Malpractice, or Both?](https://epmonthly.com/blog/death-by-wallpaper-medical-malpractise-or-both/) - Hello all, it's ERP from Erstories.net. Haven't done a post here in a while so I thought I'd put up one on a subject I find pretty fascinating. Having read Dr Grumpy's fascinating historical posts and being an avid history buff myself, I thought I would give one a try. I don't have his encyclopaedic
- [Healthcare Update -- 10-06-2010](https://epmonthly.com/blog/healthcare-update-10-06-2010/) - The self-service emergency department. If they have a vending machine for Percocets, they may be on to something. Hospital staff fails to realize umbilical cord wrapped around newborn's neck during labor, allegedly causing oxygen deprivation and severe brain damage. Mother and father each awarded $5 million by federal court after child's death. Crime or no
- [Scientific Assembly Day 2](https://epmonthly.com/blog/scientific-assembly-day-2/) - Still can't get the pictures to post correctly from my portable netbook. Will have to wait until I get home and then add pictures to the post. The Wellness Center is probably worth the cost of conference registration by itself. Screening blood tests, burnout assessment, flu shot and dTAP booster all for $20. I'm not
- [Scientific Assembly Day 1](https://epmonthly.com/blog/scientific-assembly-day-1/) - At the ACEP Scientific Assembly for day 1 of the event in Las Vegas. It is the most attended Scientific Assembly in the history of the College. Lots of good lectures. The faculty here is top-notch. I kept a pad with me and took notes as the day progressed. Things I jotted down are below.
- [Thank God](https://epmonthly.com/blog/thank-god/) - As I walked into the ED for my shift, the nursing supervisor was fumbling with a syringe attempting to get medication out of a small vial. “Ummmm. Looks like you need to adjust your bifocals,” I quipped. We have a running joke about who is older and bust on each other about our ages every
- [Press Ganey Article](https://epmonthly.com/blog/press-ganey-article/) - Remember that survey that we did last fall about Patient SatisFICTION? Two of the editors at EP Monthly finally used some of the survey results to create an article about Press Ganey. Interesting reading ... 2+2=7? Seven things you may not know about Press Ganey Statistics
- [Healthcare Update -- 09-23-2010](https://epmonthly.com/blog/healthcare-update-09-23-2010/) - Bitten, shot, spat on. A day in the life of a health care worker. Hospitals would be wise to start taking the safety of their employees more seriously. I guarantee that this issue will come to a head in the near future - probably literally and figuratively. Speaking of health care workers being shot ...
- [The IRS May Owe You Money](https://epmonthly.com/blog/the-irs-may-owe-you-money/) - Several medical schools and universities sued the IRS for taking FICA taxes out of resident paychecks. The theory was that a "student exception" to tax laws also applied to residents and interns. As of 2005, the IRS changed the tax laws to close this loophole. The IRS recently accepted the position that FICA taxes should
- [Best States to Practice Medicine](https://epmonthly.com/blog/best-states-to-practice-medicine/) - Physicians Practice Magazine just came out with a list of the Best States to Practice for 2010. The article looked at things such as cost of living, state income tax, malpractice premiums, number of physicians per capita and number of disciplinary actions per 1000 physicians, then graded each state in each category as a "green,"
- [What's The Standard of Care for Strokes?](https://epmonthly.com/blog/whats-the-standard-of-care-for-strokes/) - EP Monthly has taken a new twist on its Standard of Care Project. This month, the editors published a statement regarding whether use of thrombolytics is the standard of care for a stroke. They're asking emergency physicians who agree with the statement to log in and cast their vote. The theory behind the project is
- [Medications and Side Effects](https://epmonthly.com/blog/medications-and-side-effects/) - I went to visit a friend in our hospital after he had abdominal surgery. He was having pain, so his doctors put him on a morphine pump. The way that a morphine pump works is that the doctor determines the dose of medicine and the lockout period. For example, typical pump settings may be a
- [The Power of Suggestion](https://epmonthly.com/blog/the-power-of-suggestion/) - A couple of weeks ago, I got to work and the first three patients in the rack waiting to be seen were a child with a rash, a young lady with a toothache, and a patient who had been to our emergency department many times in the past for chronic low back pain. I did
- [Healthcare Update 09-16-2010](https://epmonthly.com/blog/healthcare-update-09-16-2010/) - Looking for more medical news from around the web? See the satellite edition of this week's Update over at ER Stories. Want to get rid of that nasty MRSA infection or that nasty E. coli infection? Try sucking on some cockroach brains. Seriously. You might get a cameo on Fear Factor while you're at it.
- [Damienne](https://epmonthly.com/blog/damienne/) - When I got to work this morning, I had several people tell me that they wished that I was working the day before. A little five year old girl was brought to the emergency department for suicidal and homicidal ideations - at least according to the social worker who accompanied the patient to the emergency
- [You Don't Own Your Software](https://epmonthly.com/blog/you-dont-own-your-software/) - An article I read in Wired Magazine kind of ticked me off, although technically I should be ticked at myself for not reading the fine print of the software I purchase. A recent ruling by the 9th Circuit Federal Court of Appeals says that software you purchase is subject to the license agreements contained with
- [Healthcare Update -- 09-09-2010](https://epmonthly.com/blog/healthcare-update-09-09-2010/) - Plaintiff's law firm gets hit with a $1.8 million judgment for screwing up medical malpractice case. Plaintiff was forced to settle for $1 million when she was actually awarded $2.5 million. AMA gets on Timothy Geithner about tax breaks for plaintiff lawyers. 1 in 4 people can misread a pregnancy test. Who did they poll
- [Random ED Weirdness](https://epmonthly.com/blog/random-ed-weirdness/) - Three strange things overheard in the ED during my last shift ... Over the police scanner: "I need an available unit to respond to the corner of 5th Avenue and Clark for report of a black male walking down the street with his pants too low. The complainant says that it looks like something dangerous
- [Low Grade Fevers](https://epmonthly.com/blog/low-grade-fevers/) - Just found another thing to add to my list of pet peeves. First, I'll recap. There are three things that get on my nerves to the point that I have had to rant about them: Cell phones, using the term "emergency room," and anyone who engages in "baby talk." Introducing #4: The "low grade fever".
- [Primary Care Cartoon](https://epmonthly.com/blog/primary-care-cartoon/) - After I've read through my EP Monthly issue a good dozen or so times, there are a couple of other medical magazines I enjoy. Medical Economics is one of them. I especially like the creativeness of the cartoons. This cartoon about lack of primary care physicians made me laugh - in an ironic kind of
- [Healthcare Update - 09-02-2010](https://epmonthly.com/blog/healthcare-update-09-02-2010/) - Also see the satellite edition of this week's update over at ER Stories. ------- Work in a health care facility? Get a flu shot or lose your job. That's the policy that a couple of national health organizations are pushing. We already do it for tuberculosis, measles, mumps, and rubella. Why should influenza be any
- [Serious Injuries](https://epmonthly.com/blog/serious-injuries/) - We receive this transfer from an outlying hospital for a neurology evaluation. The patient is in his 30s and was out at the bars when he was hit in head with beer bottle during an altercation. Since that event, he has complained of dizziness, headache, loss of vision in one eye, pain all over his
- [Another Worrisome Phone Call](https://epmonthly.com/blog/another-worrisome-phone-call/) - I'm getting worried about going to work lately. First it's this phone call. Now, it's the following: Mrs. WhiteCoat happened to be at the hospital seeing a patient and I get a call from Daughter WhiteCoat in the ED. "Ummm ... Dad? Yeah. Um Junior WhiteCoat got stung by a bee and I think he's
- [Open Mic Weekend](https://epmonthly.com/blog/open-mic-weekend/) - Haven't had an open mic in a while. Go ahead and rant about anything health-related that piques your interest in the comments section to this post. Only rule is that there are no ad hominem attacks. Flames get deleted and I'm Smokey the Bear. Argue away, but be nice. Matt, behave yourself. Taking the weekend
- [No LOL Matter](https://epmonthly.com/blog/no-lol-matter/) - It's sad when you hear about deaths due to texting while driving. Dr. Frank Ryan recently drove off a California cliff while reportedly making a Twitter post about his dog. We recently had a 22 year old patient come in from a bad motorcycle accident. Road rash all over the place. Wasn't wearing a helmet.
- [APB](https://epmonthly.com/blog/apb/) - Over the police/EMS scanner in the ED we hear the following 911 call: "I need an available unit to respond to 359 Main Street ... 359 Main Street ... for a report of a black and white raccoon that won't come out from beneath a bed." I thought the same thing that you're thinking. Black
- [Healthcare Update - 08-25-2010](https://epmonthly.com/blog/healthcare-update-08-25-2010/) - See the satellite edition with more news briefs from around the web over at ERP's blog - ER Stories. --- When states cut funding for mental health, where do all the patients go? You guessed it. Sacramento emergency departments are getting "swamped" by mental health patients. Visits for mental health illnesses are up 30% in
- [Bad Idea](https://epmonthly.com/blog/bad-idea/) - A patient came into the hospital after being bitten several times on the hand by a squirrel. What caused the squirrel to bite her, you ask? Well it seems that the patient was in the park and saw the squirrel "limping." So the patient scooped it up in her handbag and brought it home with
- [What's The Diagnosis #11](https://epmonthly.com/blog/whats-the-diagnosis-11/) - A 55 year old patient comes in with itching to her scalp - so bad that it is setting off her migraine headaches. She's been to her family physician twice already and was first prescribed antibiotics for a scalp infection, then was prescribed steroid lotion for the inflammation. She was feeling worse. When I examined
- [Urine Toxicology Pearls](https://epmonthly.com/blog/urine-toxicology-pearls/) - Drug seekers will love this post. EMedHome.com recently published a set of pearls about urine drug testing that included several things I wasn't aware of. Did you know that ... Urine levels of "ecstasy" (MDMA) need to be quite high before they will be picked up by the urine drug screen since the tests have
- [Attack of the Superbugs](https://epmonthly.com/blog/attack-of-the-superbugs/) - Antibiotics for viral infections are a big pet peeve of mine. No. Make that a huge pet peeve. Some doctors prescribe antibiotics for coughs and stuffy noses because the patients want them. If you're one of those patients who think that antibiotics make your coughs go away, or clear up your stuffy noses, or somehow
- [Healthcare Update -- 08-16-2010](https://epmonthly.com/blog/healthcare-update-08-16-2010/) - . . . The newest national epidemic: Medical malpractice lawyers. Hey - they said it, I didn't. Bwaaaahahahahahaha. Getting groped is part of the job. "Violence against nurses and other medical professionals appears to be increasing around the country as the number of drug addicts, alcoholics and psychiatric patients showing up at emergency rooms climbs."
- [More Visits, Less Availability](https://epmonthly.com/blog/more-visits-less-availability/) - A new study released in JAMA shows that the number of annual emergency department visits between 1997 and 2007 increased from 94.9 million to 116.8 million -- nearly twice as much as would be expected for population growth. Also published recently was the Department of Health and Human Services' 2007 Emergency Department Summary (.pdf file
- [What Will They Find?](https://epmonthly.com/blog/what-will-they-find/) - Catching up on the news and saw an article about a construction crew in Flint, Michigan that was expanding the hospital emergency department when they came upon two time capsules buried deep within Hurley Hospital. At least one of the time capsules is more than 100 years old. I had a bunch of humorous ideas
- [I Don't Want To Know](https://epmonthly.com/blog/i-dont-want-to-know/) - Just finished a string of shifts and finally have a few days to breathe and put all the posts I have in my head into writing. One short thing that happened to me last night ... I was busy writing admission orders when I saw my phone light up. A call from home. Eight year
- [Healthcare Update -- 08-06-2010](https://epmonthly.com/blog/healthcare-update-08-06-2010/) - More stories from around the web at the Satellite Edition of this week's update over at ER Stories. Hmmmm. I've already fulfilled my life's dream to jump on someone's car at a gas station while waving a gun. What to do next? I know! I'll run to the hospital and hold a nurse hostage in
- [Double Gotcha](https://epmonthly.com/blog/double-gotcha/) - For a few hours, our emergency department was Octogenarian Central. It seemed like every patient that registered to be seen was in their 80's. Weakness. Dizziness. Constipation. Chest pain. More weakness. Hip pain. Eight out of ten patients were octogenarians. Family members accompanied all of the patients and helped us piece together the multiple medical
- [Stay Away From That Oxygen Stuff - It'll Kill Ya](https://epmonthly.com/blog/stay-away-from-that-oxygen-stuff-itll-kill-ya/) - A recent publication in the Journal of the American Medical Association is right up there with the study on how thrombolytics improve outcomes in patients with hemorrhagic strokes. Researchers found that patients who were admitted to the intensive care unit after suffering a cardiac arrest were almost twice as likely to die if they had
- [iPhone SpyPhone](https://epmonthly.com/blog/iphone-spyphone/) - I don't use the iPhone and don't want one, but for those who do use them ... look at how much data it stores about you. This guy even teaches people how to recover information from the iPhone - including keystrokes, pictures, address book entries, call history, image maps, browser cache, and deleted voicemails. Moral
- [Healthcare Update -- 07-30-2010](https://epmonthly.com/blog/healthcare-update-07-30-2010/) - When the Alaska governor vetoed a bill aimed to expand access to children's health care, State Senator Bettye Davis wrote an article showing all the services that are not available in the emergency department - including well child care, dental care, physical therapy and neonatal care. Her article is insightful and she raises the very
- [Sending Home the LOL who DFO](https://epmonthly.com/blog/sending-home-the-lol-who-dfo/) - The Journal of the American College of Cardiology presented the ROSE study for triaging patients with syncope in the emergency department. No, ROSE isn't some LOL that the study was named after. ROSE is an acronym standing for "Risk Stratification of Syncope in the Emergency Department." They just left out a few letters because an
- [Away](https://epmonthly.com/blog/away/) - Had a few things come up that are going to keep me away from the blog - probably for the rest of the week. May publish a quick post, but don't expect much for the week. In the meantime, enjoy the heat and check out some of the other great blogs in my "Blog Links"
- [Deconstructing Socialized Medicine?](https://epmonthly.com/blog/deconstructing-socialized-medicine/) - Socialized health care is great, and it's a money saver, too. That's why England is looking to decentralize it. The health care budget in Great Britain has tripled in the past 13 years and the budget needs to stabilize. According to the manifesto titled "Equity and excellence: Liberating the NHS" which was presented to the
- [Why Harriet's Hemorrhoids Weren't Getting Better](https://epmonthly.com/blog/why-harriets-hemorrhoids-werent-getting-better/) - This order was found in her chart. Probably explains why the white paste in her mouth didn't grow out fungus, either ... . . . . . . . . . P.S. For those non-medical readers that don't get it, Anusol is a suppository that is supposed to be inserted in the rectum. This order
- [Healthcare Update -- 07-23-2010](https://epmonthly.com/blog/healthcare-update-07-23-2010/) - Also see more news tidbits from around the web on the Satellite Edition over at ER Stories. Rome, GA woman is arrested after police find her on top of another patient in a dark emergency department room ... throwing punches. After being seen yelling profanities at the patient, the perpetrator told law enforcement that she
- [What's Fair?](https://epmonthly.com/blog/whats-fair/) - The parent of a patient that we saw in our ED last night upset staff members. One of her three children was out riding a bicycle without shoes and her foot got cut on the pedal of the bicycle. As we were cleansing and sewing up the laceration, the mother promised to take the children
- [ADHD Confirmed](https://epmonthly.com/blog/adhd-confirmed/) - I was signing out a couple of patients to the oncoming doc. "Mrs. H is a 63 year old lady with longstanding history of CHF who ran out of her medications a few days ago. I gave her some Bumex and some aspirin. Her vitals are stable. Once her labs come back ..." Suddenly she
- [Open Mic Night](https://epmonthly.com/blog/open-mic-night-2/) - I think that the last Open Mic went well, so I'm giving it another shot. Tonight and tomorrow anyone can comment on anything medically-related that they want to talk about. Mel Gibson's rants are ... interesting ... but trying to focus just on the medical stuff here. Please keep things civil. Remember that if you
- [The American Proposition](https://epmonthly.com/blog/the-american-proposition/) - Another great post by Greg Henry, MD https://epmonthly.wpengine.com/columns/oh-henry/examining-the-american-proposition/
- [Healthcare Update -- 07-16-2010](https://epmonthly.com/blog/healthcare-update-07-16-2010/) - Also see the Satellite Edition of this week's update with more news over at ER Stories. Making an appointment to have an emergency. California emergency department lets patients schedule emergency department appointments online to "alleviate crowded emergency rooms." Patients who schedule online are guaranteed to be seen within 15 minutes of their appointment time. There's
- [Turnabout](https://epmonthly.com/blog/turnabout/) - For the first time ever, I went to the pharmacy to fill a prescription for Vicodin. What a strange experience. I actually felt weird passing the prescription to the pharmacist. She looked at the prescription, then looked me up and down. "What is your address, sir?" I gave her my address. No I'm not coming
- [Don't Eyeball Me](https://epmonthly.com/blog/dont-eyeball-me/) - OK, I'm thinking we need a STAT consult from Walter Olsen at Overlawyered.com. If his blog isn't on your list of daily reads, it should be. A Muslim woman named Rona Mohammedi comes to the Somerset Medical Center emergency department with "severe chest pain." She refuses to get undressed in front of a strange man
- [Concerned Family](https://epmonthly.com/blog/concerned-family/) - A patient in her early 70's was brought in by ambulance for difficulty breathing. She had been a smoker all of her life and her lungs were clearly wearing out on her. After the patient arrived, a daughter teetered up to the registration desk and asked if she could see her mother. The smell of
- [I Suppose It's Better Than Death Panels ...](https://epmonthly.com/blog/i-suppose-its-better-than-death-panels/) - Revealing article in Bloomberg online today about the latest way in which elderly patients are getting screwed by the system. Medicare reviews all admissions and if the patients don't meet indications for admission, the hospital doesn't get paid by Medicare. Medicare has also recently implemented a mercenary system called Recovery Audit Contractors (or RAC for
- [Drive Safely](https://epmonthly.com/blog/drive-safely/) - A graphic video that you need to watch. http://www.metacafe.com/watch/yt-az1smQMWHYk/unsafe_driving/
- [Late Night Entertainment](https://epmonthly.com/blog/late-night-entertainment/) - Hey All, it's ERP from ER stories doing a quick guest post. The myriad of ways that the staff entertains themselves late at night when there is a lull in the action is boundless. In fact, White Coat has blogged about this. There is the "Obituary Game" made famous on Nurse Jackie but widely known to
- [Healthcare Update -- 07-09-2010](https://epmonthly.com/blog/healthcare-update-07-09-2010/) - Should same sex partner of malpractice victim be entitled to a $2.45 million judgment? Man walks into Cleveland Clinic-affiliated emergency department and shoots himself in chest. Think that's bad? Daytona Beach man walks into hospital emergency department and sets himself on fire. "Health overhaul may mean longer ER waits, crowding". Massachusetts Governor Mitt Romney gasps
- [Could Medco Equal "Deadco"?](https://epmonthly.com/blog/could-medco-equal-deadco/) - After seeing Mrs. WhiteCoat argue on the phone with Medco representatives for 20 minutes about why one of her 80+ year old patients hadn't received her medicine despite three lost faxes to Medco, I had to write this post to let the public know what is going on with some mail order pharmacies. If you're
- [WTF Moment #897](https://epmonthly.com/blog/wtf-moment-897/) - Nurse [as she was walking out of the Dirty Utility room]: "Where's the timer for the pregnancy tests?" Secretary: "Oh, the lady from lab threw it out. It was expired." Nurse: "Wait. She came to our department and threw something in our department out? And she said that the timer expired?" Secretary: "Yeah. She said
- [The Downside of Being a Teacher](https://epmonthly.com/blog/the-downside-of-being-a-teacher/) - Recently I was asked if there were any downsides to being an attending in a teaching program. I came up with the following example of how being someone else's teacher can be a detriment sometimes. Mrs. WhiteCoat slipped on the stairs and injured her middle finger a few years back. I was working in the
- [Open Mic Night](https://epmonthly.com/blog/open-mic-night/) - I wanted to try something new, and got the idea from Ace of Spades. We'll see how it goes. Tonight and tomorrow, I'm leaving an open mic for comments. Anyone can comment on anything that they want to get off their chest. I'll throw my two cents in the comments section when I get some
- [Healthcare Update -- 07-02-2010](https://epmonthly.com/blog/healthcare-update-07-02-2010/) - Also see the satellite edition of this update at www.erstories.net. You've heard of GEICO Direct? Now there's MedMal Direct. A 20 minute call could save you 20% or more on your med mal insurance. One physician with 350 medical malpractice claims and 22 criminal counts against him. He had an international warrant for his arrest
- [Another Reason They Call It "Dope"](https://epmonthly.com/blog/another-reason-they-call-it-dope/) - In case you wanted another reason not to use drugs, here it is: You don't know where the drugs have been. A woman got brought into the emergency department in police custody. She was intoxicated and complaining of pain to her ankle and hip. The story we were given was that she jumped out the
- [It Wasn't Me](https://epmonthly.com/blog/it-wasnt-me/) - Between about 6PM and 9PM on most Sunday evenings, our emergency department seems to become more crowded with kids and their parents. It used to be less because Sundays were school nights, but now that the kids don't have to be in school the following morning, the numbers seem to be increasing. I've also noted
- [Regulating Radiation](https://epmonthly.com/blog/regulating-radiation/) - A recent article in the New England Journal of Medicine touches off another salvo about how nonclinicians have no problems judging the abilities of clinicians in the world of medicine. The article begins by presenting the case of a woman who awoke with facial paralysis and then went to the emergency department. On arrival, she
- [Blunt-ness](https://epmonthly.com/blog/blunt-ness/) - A man in his mid-30's gets brought by ambulance with palpitations. His mom arrived right behind the ambulance. The patient was obviously anxious and was dripping with sweat. We hooked him up to the monitor and he's in SVT up to the 160's. No medical problems. Occasional alcohol. Smokes half a pack a day. No
- [Why Freddie's Girlfriend Was Removed From the ED](https://epmonthly.com/blog/why-freddies-girlfriend-was-removed-from-the-ed/) - Freddie came in as a drug overdose. The medics couldn't get a line on him. He was unresponsive and his skin tone was somewhere between blue and purple. A sternal rub didn't do much to awaken him. We artificially ventilated him with an Ambu bag. His pupils were barely visible. Track marks were on his
- [*More* Serious Offenses](https://epmonthly.com/blog/more-serious-offenses/) - Following up on my previous post about Joint Commission micromanagement, we got word of another big "no-no" according to JCAHO's rules. We have now been informed that according to Joint Commission rules, in association with EPA studies, there is entirely too much drug contamination in the nation's water supplies. Therefore, hospitals must now separate waste
- [Poison Ivy – Son Of An Itch! (REPOST)](https://epmonthly.com/blog/poison-ivy-son-of-an-itch-repost/) - I got a request for information about poison ivy and decided to repost an article that I initially published a couple of years ago. Links have been updated accordingly. Dr. Ramona Bates put up a post on her Suture For A Living blog about poison ivy. I was planning on doing the same thing, but
- [Healthcare Update -- 06-18-2010](https://epmonthly.com/blog/healthcare-update-06-18-2010/) - No wait emergency departments. Great business model or way to encourage more abuse of already crowded emergency departments? Nice shackles. Memphis Med now changes policy so that prisoners wait in the waiting room like everyone else - with police escorts. Problem is that police are now paid to sit in the ED waiting rooms for
- [WhiteCoat Challenge #6 Winners](https://epmonthly.com/blog/whitecoat-challenge-6-winners/) - It was a close vote, but here are the winners for WhiteCoat Challenge #6: #14. A toast to MikeMD with the story about the boy who peed red wine #18. Nurse K's story about the hypochondriac who peed on his hand #38. Hawkeye's story about the patient's vision that went from 20/20 to "just 20"
- [Serious Offenses](https://epmonthly.com/blog/serious-offenses/) - Remember the movie Rainman where Dustin Hoffman whipped out his red book and wrote on his "Serious Injury List" how Charlie Babbitt "squeezed and pulled and hurt my neck"? If not, you have to rent that movie and watch it. One of my favorite all time movies. Well, the lab supervisor recently descended upon the
- [What's the Diagnosis #10](https://epmonthly.com/blog/whats-the-diagnosis-10/) - A 26 year old female comes in complaining of chronic neck pain for the past 6-8 months. She was seen in the emergency department 4-5 months ago for the same pain and was diagnosed with a neck strain. Since that time, she has had intermittent pain. She states that the pain is worse when she
- [Overheard in the Waiting Room ...](https://epmonthly.com/blog/overheard-in-the-waiting-room/) - The registration clerk in the emergency department overheard the following statement from one patient waiting to be seen made to another patient in the emergency department waiting room who is on "The List": "Just remember - you're the addict and I'm the dealer. You get what I give you after they prescribe it to me.
- [Back ...](https://epmonthly.com/blog/back/) - Just got back from an unexpected trip out of town for the past few days. Will be back up and running soon.
- [Murphy's Law of the ER](https://epmonthly.com/blog/murphys-law-of-the-er/) - Hey, it's ERP from ERstories.net doing a guest post. The other day during a shift I said to myself "Dang it, it's Murphy's Law again" when something went all FUBAR. That made me decide to compile a little list of how that law applies to my job. 1. The GYN cart will only be stocked
- [Healthcare Update -- 06-07-2010](https://epmonthly.com/blog/healthcare-update-06-07-2010/) - See more health care news from around the web over at the Satellite Edition on ER Stories. "I liked your testimony. By the way ... would you mind taking a look at this mole on my back?" Juror in trouble after asking defendant physician for medical advice during medical malpractice case. The now former juror
- [Government Declares War on Doctors](https://epmonthly.com/blog/government-declares-war-on-doctors/) - I was going to include this article in the rest of the Healthcare Update, but pulled it out and made it a separate post after reading this related article in the Christian Science Monitor - "Justice Department declares war on doctors" Five orthopedists sued for antitrust violations and settle case. Workers compensation in Idaho wasn't
- [Quote of the Day #214](https://epmonthly.com/blog/quote-of-the-day-214/) - Lots of strange offhand comments from patients lately ... Patient who took an ambulance to emergency department at 2:30 AM when she noticed vaginal bleeding. "When was your last period?" "About a month ago." "Was there something different that made you think this wasn't your period this month?" "No. I just wanted to be sure."
- [WhiteCoat Challenge #6 - Odd Chief Complaints](https://epmonthly.com/blog/whitecoat-challenge-6-odd-chief-complaints/) - I was going to just make a post about a weird chief complaint that a patient had recently, but then thought that we haven't had a good WhiteCoat Challenge in a while. A middle aged female patient presented at the registration window demanding to be tested for "aluminum toxicity." When she got back to the
- [Videos to Watch](https://epmonthly.com/blog/wild-youtube-videos/) - Had to share a couple of videos. One has repeatedly entertained our staff. One repeatedly entertains my kids. One video has been circulating around our ED staff e-mails for a few weeks, although it has been circulating on YouTube since 2006. Totally bizarre. Lots of swearing and f-bombs, so you have been warned. But still
- [Free Market Transparency on the Horizon?](https://epmonthly.com/blog/free-market-transparency-on-the-horizon/) - Now THIS is what I'm talking about! From an article in ModernPhysician.com (registration required)... Pricing transparency gaining renewed interest Led by a physician lawmaker, members of Congress on both sides of the aisle have shown renewed interest in mandating a boost in healthcare pricing transparency, including charges for physician services. More on pricing transparency from
- [How a Captain Affects the Crew](https://epmonthly.com/blog/how-a-captain-affects-the-crew/) - During a shift a while back, I was having a bad day and became frustrated with a patient who appeared to be drug seeking. A patient with chronic migraine headaches who happened to be visiting from out of town came in for "9.5 out of 10" pain. Apparently she had been around enough to know
- [Quote of the Day #212](https://epmonthly.com/blog/quote-of-the-day-212/) - Patient brought in by ambulance after allegedly drinking a bottle of Windex - making gruff statement about his previous history ... "Hey! This isn't the first time I've committed suicide, you know." The nurse and I just looked at each other, made those faces where you raise your eyebrows and open your mouth but keep
- [Healthcare Update -- 05-26-2010](https://epmonthly.com/blog/healthcare-update-05-26-2010/) - Also see the Satellite Edition of this week's update over at ER Stories - with his new and improved website design and no more rogue ad plugins. How does a patient break her foot badly enough to require surgery -- using a Wii? Click here to find out. Clue: Alcohol was involved. California's children not
- [Haven't I Seen You Before?](https://epmonthly.com/blog/havent-i-seen-you-before/) - Ambulance call goes out for a patient who is in "excruciating pain all over." She has a history of fibromyalgia and ran out of her pain medications at home. Time of call: 18:35 on a Friday night. Being out of pain medications after office hours on a weekend is a red flag. When she arrives,
- [Placebo Power](https://epmonthly.com/blog/placebo-power/) - This is a repost from a couple of years ago. I actually had a new post planned, but had to reference something on this post. When I moved from my old blog to EP Monthly, this post apparently didn't get transferred. Some fond memories below. ----- The effect of a placebo is based on someone’s
- [Florida Verdict May Threaten EMS Availability](https://epmonthly.com/blog/florida-verdict-threatens-ems-availability/) - Ambulance service held liable for failing to "do what was necessary" before accepting emergency transport of pregnant patient. I mentioned this case in a previous Healthcare Update. A child was born at 25 weeks gestation - 15 weeks premature - and was not breathing. Babies born at this age have a viability of 50-70%. In
- [Dr. WhiteCoat Goes to Washington](https://epmonthly.com/blog/dr-whitecoat-goes-to-washington/) - Sorry about the sparse posting lately - have been away in Washington at an ACEP conference Just so Matt and others don't think that all I'm all talk and no action, I'll let you in on some things that I did at the conference. I attended some excellent lectures about leadership. Colonel Thomas Kolditz gave
- [Healthcare Update - 05-18-2010](https://epmonthly.com/blog/healthcare-update-05-18-2010/) - Lather, rinse, repeat. Difficulty in accessing psychiatric care and lack of follow up blamed for a mentally ill Louisiana patient stabbing her grandmother to death. Sketchy episodic care doesn't address underlying psychiatric problems. Patients go from emergency department to psych hospital to emergency department. Because only 145 psychiatric beds are available in the entire state
- [Telephone Advice](https://epmonthly.com/blog/telephone-advice/) - What the secretary is required to say: "I'm sorry, ma'am. We're not allowed to give medical advice over the telephone. He's welcome to come to the emergency department to be evaluated at any time, though." What the secretary wanted to say: "What's the matter with his head?" What the patient's primary care physician wanted to
- [Aging Physicians](https://epmonthly.com/blog/aging-physicians/) - I came across a graph in AM News depicting how the physician population is aging. Notice how the the distribution of physicians in 1970 (brown graph) was skewed toward younger physicians. By 2008 (yellow graph), the number of young physicians is significantly lower than any other demographic - including physicians 65 years old and older.
- [Guaiac issues](https://epmonthly.com/blog/guaiac-issues/) - JCAHO apparently requires that the doctors show nurses results of all hemoccult testing. I can't find the actual requirement anywhere, but then again, JCAHO hides its patient safety requirements and makes anyone who wants to learn about patient safety purchase their books. In addition, whomever interprets the test must take a certifying exam every year
- [Will Insurance Deny Payment if You Leave AMA?](https://epmonthly.com/blog/will-insurance-deny-payment-if-you-leave-ama/) - Fifty seven percent of all health care providers (and probably just as many patients) believe that if you leave the hospital or the emergency department against medical advice, insurance companies will not pay for the visit. Half of doctors surveyed have told or would tell patients that insurance would not pay the bill if they
- [Healthcare Update -- 05-10-2010](https://epmonthly.com/blog/healthcare-update-05-10-2010/) - Coming soon to a hospital near you? Overcrowding and physician shortages at Royal Columbian Hospital in British Columbia having adverse effects on patient care. Volumes are up by 20% from a few years ago and the physician groups estimate they need about 25% more physicians to handle the patients. The result is significant overcrowding. A
- [Reverse Psychology](https://epmonthly.com/blog/reverse-psychology/) - The ED secretary gets a call from an unknown caller. "Is Dr. WhiteCoat working? I've seen him before and he's a really good doctor. I only want to see him for my problem. Is he there tonight?" "Ummm ... no, unfortunately he's not here tonight." "Can you tell me when he will be working again?"
- [Malpractice Systems in Other Countries](https://epmonthly.com/blog/malpractice-systems-in-other-countries/) - Nice article from the AMA comparing medical malpractice systems in other countries to that in the US. Highlights: Litigation costs in the US are twice those in other countries, with half of US payments going to legal costs rather than compensating patients. Few other countries allow cases to be decided by jurors. Most use judges
- [Airplane Quote](https://epmonthly.com/blog/airplane-quote/) - One more quote I heard on the trip home from visiting Gramma WhiteCoat - can't attribute it to my dad, but it was quoteworthy nonetheless: "Common sense. I don't even know why they call it 'common sense' any more. No one has it. They ought to start calling it 'uncommon sense.' People are a bunch
- [A Little Too Far?](https://epmonthly.com/blog/a-little-too-far/) - We were recently notified by hospital administration that reappointment to the medical staff will require that we submit to complete background checks, including credit checks, investigation of assets, and investigation of any legal issues including traffic violations and any litigation in which doctors are currently (or have previously been) involved in. So if I made
- [More Stuff My Dad Says](https://epmonthly.com/blog/more-stuff-my-dad-says/) - Relatively quiet day. Only had a couple of memorable quotes: [Expressing frustration over TV political commentators] "Oh, right. HE's a great source for information. These people disimpact themselves, look at their hands, then wave to the camera and expect you to take everything you see as gospel truth. Critical thinking isn't part of their thought
- [Stuff My Dad Says](https://epmonthly.com/blog/stuff-my-dad-says/) - I'm currently back visiting Gramma WhiteCoat and learning how whacked my dad (Grampa WhiteCoat) is getting. I'm thinking that if I travel home enough to see them, I'll be able to write a book like this guy (f-bomb alert) and retire early. I walk in the house and my mom is laying on the couch
- [Healthcare Update -- 05-02-2010](https://epmonthly.com/blog/healthcare-update-05-02-2010/) - Talk about drive-thru medical care ... North Carolina man tries to commit suicide by crashing his truck at a high rate of speed ... into the ICU entrance of a hospital. So should the pedestrians be hunted down and charged with murder? Man tries to help woman who is being beaten and becomes a victim
- [Risk Factors](https://epmonthly.com/blog/risk-factors/) - Hi all, it's ERP, from ERstories. I brought my blog back from the dead about a week ago after a major crash. Unfortunately, I lost nearly all my photos that I had uploaded but luckily did not lose the old posts and comments. Anyway, there are no pay-per-click ads at this point so you should
- [Product Placement](https://epmonthly.com/blog/product-placement/) - Running errands today and saw the above product display at a Sam's Club. #1: Is the pickle packaging too ... subliminal? #2: If you were the store manager, would you place beef jerky right next to a bunch of pickles in pouches? There's got to be a Saturday Night Live skit somewhere in here.
- [More Satisfied Customers](https://epmonthly.com/blog/more-satisfied-customers/) - As our hospital administrator emphasizes the importance of high patient satisfaction scores and "pleasing every patient every time," I'm really becoming disenchanted with emergency medicine. He's getting his directives from the hospital board and being pressured by statistics on some web site that only administrators look at, so it's tough to blame him, but this
- [Shotgun Testing](https://epmonthly.com/blog/shotgun-testing/) - Part of a resident's job is to learn the ropes in preparing for independent practice. While you're a resident, you get the benefit of having someone looking over your shoulder to critique you as you determine how you are going to manage patients. I frequently tell residents that different attending physicians practice medicine in different
- [Healthcare Update 04-26-2010](https://epmonthly.com/blog/healthcare-update-04-26-2010/) - No health insurance? No tax refund. IRS may withhold your tax refund if you don't purchase health insurance under the new health reform plan. Reading an article and then saw an interesting statistic (couldn't verify it anywhere else doing an internet search, though): 80% of all medical malpractice claims paid worldwide are made in the
- [Astute observation on poor business and economic decisions of unknown third parties](https://epmonthly.com/blog/ironic-comment/) - I overheard something at work regarding a patient and after mentioning it to several people, apparently I'm the only one that thinks that the statement is ironic. One patient to another patient's family member in a separate room (yes, it was a social event in the ED again): "I don't trust him anymore. Besides, he's
- [The Medications Worked](https://epmonthly.com/blog/the-medications-worked/) - A grandfather brings in his 14 year old grandson because the boy hurt his wrist ... for the second time in two days. The first time he was brought to the emergency department, x-rayed, and was diagnosed with a Salter Harris Type I fracture. He was put in a splint and sent home. This time,
- [This Isn't Football, Ma'am](https://epmonthly.com/blog/this-isnt-football-maam/) - If you've ever tried to insert an intravenous line before, you know how difficult of a task it can be with a child. Adults usually have thinner skin and most of the time have (not always) less fat on their arms. Infants and toddlers have lots of pudge on their arms and seeing a good
- [Pre-printed Prescriptions](https://epmonthly.com/blog/pre-printed-prescriptions/) - Some docs in our group have stamps for a certain number of Motrin or Vicodin pills that they stamp onto a prescription pad to save time and avoid fraud. One of the docs in our department went one step further and is becoming amused with himself by handing out these pre-printed prescriptions to chronic pain
- [Healthcare Update -- 04-15-2010](https://epmonthly.com/blog/healthcare-update-04-16-2010/) - When emergency departments close their doors, the patients don't stop getting sick - they just go to other hospitals. Now that St. Vincent's Hospital in New York is no longer taking ambulance runs, nearby hospitals are getting a surge in volumes. Bellevue Hospital is now the only level one trauma center in lower Manhattan and
- [What's The Diagnosis #9](https://epmonthly.com/blog/whats-the-diagnosis-9/) - A patient presents with an itchy rash to the elbow that started a week prior to presentation. After initially becoming red, the rash developed small blisters then the blisters ruptured, leaving small sores. There is no warmth or fluctuance to the area. The patient saw his primary care physician 5 days ago and was prescribed
- [Free Market Medicine](https://epmonthly.com/blog/free-market-medicine/) - If you read this blog regularly, you know that I am an advocate of free market medicine. Force medical providers to advertise their prices like all the other businesses, let insurance cover catastrophic costs instead of everyday costs, and let market forces go to work. In order for the free market concept to work, though,
- [Zofran Moment](https://epmonthly.com/blog/zofran-moment/) - A 52 year old intoxicated lady gets brought in by ambulance after getting in a fight with her ex-boyfriend. She had been thoroughly punched and kicked in her face. Both of her eyes were black and blue and were significantly swollen. One eye was swollen shut, the other was open just enough so you could
- [Funny Kid Quote #7](https://epmonthly.com/blog/funny-kid-quote-7/) - Since we were with other family members this weekend, we decided to take a trip to a museum. As we walked through the exhibits, we stopped to read descriptions of all the displays. My 9 year old nephew was becoming impatient because he wanted to see more exhibits and spend less time reading about them.
- [Healthcare Update - 04-09-2010](https://epmonthly.com/blog/healthcare-update-04-09-2010/) - Also see the Satellite Edition of this week's update over at ER Stories. Miami Medical -- a successor to the "ER" series? This critic says "not". Another consideration for infantile seizures in the emergency department ... licking the plate after mommy got done cutting up her crack cocaine for sale. Canadian attorney calls for criminal
- [Shout Outs](https://epmonthly.com/blog/shout-outs/) - I keep a list of medical blogs sorted by category over in the righthand margin. If you have a medical blog and want it listed, please e-mail it to me at whitecoat-at-epmonthly-dot-com and I will add it to the list. During down time over the past week, I had an opportunity to read some blogs
- [More on Criminalizing Medicine](https://epmonthly.com/blog/more-on-criminalizing-medicine/) - Just read about a case involving the next step down the slippery slope of criminal prosecution of physicians. First Michael Jackson's physician gets prosecuted when his physician gives him an unintentional overdose of an anesthetic medication when trying to help him sleep. According to a previous discussion on this topic, most people seemed to think
- [Mmm-huh](https://epmonthly.com/blog/mmm-huh/) - Maintaining our sanity in the emergency department sometimes means that we do silly things like giving patient reports in an Arnold Schwarzenegger voice, talking like a pirate, or repeatedly singing "Pants on the Ground." No one thought too much of it when one of our nurses started a new trend by in the nursing station
- [Resurrection](https://epmonthly.com/blog/resurrection/) - It is appropriate that this incident happened in the early morning hours of Easter ... A guy gets brought in by ambulance when he was found "unresponsive" in the front yard by two relatives. According to one of the relatives, all had been drinking to celebrate the Easter holiday. Didn't know Easter was one of
- [Virtual Operating Systems](https://epmonthly.com/blog/virtual-operating-systems/) - Suppose you want to try out a new Windows program but you don't want to mess up your registry. Or suppose you need Windows XP to run a program, but you don't want to install Windows XP on your computer. What if you want to leave absolutely no traces of your computer activity? Or maybe
- [Now THAT's Gotta Hurt](https://epmonthly.com/blog/now-thats-gotta-hurt/) - ERP from Erstories.net here for a quick post while White Coat is out for a little while. Some people have bad luck. I mean, it is bad enough luck to fall down in the bathroom when you are 70 years old because you don't get around so great any more. But to fall onto an
- [Healthcare Update -- 04-01-2010](https://epmonthly.com/blog/healthcare-update-04-01-2010/) - Tort reform lessens the risk of medical malpractice, "but it doesn't change the capriciousness of the legal system ... and it hasn't changed the nature of the risk." "If there is ANY DELAY AT ALL in the diagnosis of a condition, then they label it as 'malpractice.'" This Newsweek article explains very succinctly why defensive
- [Break](https://epmonthly.com/blog/break-2/) - I'm going to take a break - probably for the rest of the week. Grandma WhiteCoat is having unexpected surgery and needs our family support. I have several ideas that I just have to expand upon, so I may toss up a short post, but don't expect much. If you want to do a guest
- [Paybacks](https://epmonthly.com/blog/paybacks/) - He wasn't your ordinary patient in police custody. A burly kid in handcuffs was brought in by police after being in a fight with his girlfriend. He had been drinking and when the police arrived, he wasn't exactly cooperative. In fact, he irritated the officer enough that the patient got "tazed." The patient fell to
- [We the Government?](https://epmonthly.com/blog/we-the-government/) - I like to laugh at political cartoons, but it isn't too often that one makes me stop and think like this one did. Michael Ramirez from Investor's Business Daily (IBD Twitter link here) hit a home run with this depiction of the Constitution of the United States (I would have linked to the cartoon itself,
- [Healthcare Update -- 03-25-2010](https://epmonthly.com/blog/healthcare-update-03-25-2010/) - Florida's legislature seeks to make all emergency medical personnel "agents of the state" and therefore immune from liability. Reckless mistakes would be paid by the state and payouts capped at $200,000. Trial lawyers are vigorously fighting the proposed legislation, arranging press conferences with patients and families who have been maimed by emergency department malpractice. The
- [My COAT!](https://epmonthly.com/blog/my-coat/) - This story was recently forwarded to me in an e-mail. Walter Olson had it up at Overlawyered.com weeks ago, but I missed it for some reason. So I had to re-post it as yet another example of why we need a "loser pays" law in this country. Some upstanding Texas attorney named William Ogletree left
- [What's the Diagnosis #8](https://epmonthly.com/blog/whats-the-diagnosis-8/) - A 3 year old child is carried into the emergency department because of pain in her left hip. Her mother stated that she woke up with the pain and has refused to walk all day because of the pain. The patient has been running a low grade fever and "just wasn't acting right." The mother
- [Insurance For All](https://epmonthly.com/blog/insurance-for-all/) - While many legislators praise this vote as an historic event, it is a pyrrhic victory. I went looking for the final text of the health care bill and performed several internet searches. Came up with lots of results. Noted that the number of hits to this blog increased substantially looking for health care bill highlights.
- [Mini Ultrasound - Fad or Necessity?](https://epmonthly.com/blog/mini-ultrasound-fad-or-necessity/) - I came across this news video about pocket ultrasounds (see screen grab from video above), alleging that they are "revolutionizing" emergency medicine. The units are small, but, at a weight of almost 2 pounds, they appear to be too bulky for carrying around in a pocket. Definitely small enough to grow some legs if they're
- [One Adam-12, One Adam-12](https://epmonthly.com/blog/one-adam-12-one-adam-12/) - Courtesy of the police scanner in our emergency department, we've heard a run on concerned citizens reporting some odd things to the police lately. There's the report of the "reckless driver" who had the nerve to pass an elderly person's car coming into town. A "suspicious man" walking in an alley. An intoxicated individual walking
- [Healthcare Update 03-18-2010](https://epmonthly.com/blog/healthcare-update-03-18-2010/) - If you like these, check out the satellite edition of the Healthcare Update over at ERStories. "The only thing that changes is the names." Canadian patients dying waiting for emergency department care. One patient's family was told that the emergency department was short two doctors and four nurses and that "there was a 16-hour wait
- [Double Entendre](https://epmonthly.com/blog/double-entendre/) - ERP here from Erstories. A little quick post while I am out skiing. Yes, I admit I get a little juvenile on occasion during a shift. Other staff members do as well and I think this is a good thing. It lighten things up. A little silly laugh because someone said something that conjures Beavis
- [Why Sadie's Daughter Almost Became A Patient](https://epmonthly.com/blog/why-sadies-daughter-almost-became-a-patient/) - A middle aged woman walked up to the emergency department registration window and loudly announced that her mother was in the car and needed help. Several people ran out to the car to assist the woman's mother. It appeared that her mother was suffering from ATATPA. Unfortunately, she also weighed at least 300 pounds and
- [Add Another Thing to the List](https://epmonthly.com/blog/add-another-thing-to-the-list/) - In addition to calling it the "ER," using cell phones in said "ER," and engaging in baby talk, we can now add "scientific studies" like this to the list of things that drive me friggin batty. The American College of Radiology published this study that purported to analyze the "appropriateness" of outpatient CT and MRI
- [Ghoulish or Good Policy?](https://epmonthly.com/blog/ghoulish-or-good-policy/) - I read this article and was going to put it in the next healthcare update, but decided to make it a separate post. Immediate organ donation from the emergency department. You're involved in a serious car crash, the trauma team attempts to save you, but you end up dying. Instead of your body getting whisked
- [You Don't Listen!](https://epmonthly.com/blog/you-dont-listen/) - Little ol' Marge came waddling up to the registration desk asking to see a doctor because she was urinating blood. In tow behind her was her obviously unhappy husband who was making it clear that the reason for his unhappiness was his wife's trip to the emergency department. "Great. Now we can sit in the
- [Medicare Cuts Delayed Again --- PHEW](https://epmonthly.com/blog/medicare-cuts-delayed-again-phew/) - I had planned to log on and write a quick post reminding docs that they have less than a week to decide whether or not to remain a participating provider in Medicare in the face of 21% payment cuts -- and to encourage docs to drop Medicare. While perusing the morning news, I discovered that
- [Healthcare Update -- 03-10-2010](https://epmonthly.com/blog/healthcare-update-03-10-2010/) - If you like this, you'll also like the satellite edition of this week's Healthcare Update with more links over at ER Stories. ------- Dirtbag emergency department technician steals credit cards from plane crash victim's wallet while other personnel try to save the man's life. Then he buys himself some Armani clothes using the patient's credit
- [Raisins OK, Grapes ... Not So Good](https://epmonthly.com/blog/raisins-ok-grapes-not-so-good/) - Come on. Allergies to fresh fruit and vegetables? Guess all the chemicals used in processing are good for the immune system.
- [The Escape](https://epmonthly.com/blog/the-escape/) - I'm in Washington DC doing some lobbying for emergency medicine. It's near the end of the day and I'm sitting at a conference surfing the internet between lectures. I log in to this blog to jot down a quick post. As I'm writing, I get the feeling that I'm being watched. I look over my
- [Need "Entirely Free Health Care?" Go to the ER!](https://epmonthly.com/blog/need-entirely-free-health-care-go-to-the-er/) - After hearing Mitt Romney's views of emergency medical care during a recent interview, I've concluded that he is a dope. He was recently interviewed on MSNBC's "Morning Joe" about some book he's peddling and his response to one of the questions just shows that he has no clue about the economics of health care. Question:
- [What's in Your Pocket?](https://epmonthly.com/blog/whats-in-your-pocket/) - There are certain things that I always carry in my pocket. 1. Mini Mag Light - for looking down throats and into other dark places, also very useful for finding dropped toys in movie theaters 2. Pocket knife - indispensable for multiple things, used most often for opening packages 3. Chap Stick - for softening
- [Healthcare Update - 03-03-2010](https://epmonthly.com/blog/healthcare-update-03-03-2010/) - Bad debt causes Arkansas hospital to implement unpopular policy - make a $50 down payment before you can see the emergency physician. What!?!?! That's more than a carton of smokes and a case of PBR combined! Anger management classes are down the hall. Cape Cod punk getting treated for cuts to his hand he sustained
- [Focus On The Cost](https://epmonthly.com/blog/focus-on-the-cost/) - Yeah, I agree with Howard Fineman. You got a problem with that? Read his Newsweek article about his experiences being admitted to an Argentinian hospital and how he believes we should be focused on the costs of health care in this country. His bill for a hospital stay with dehydration in Argentina: About $1500. Similar
- [The Patient Who Lived at McDonalds](https://epmonthly.com/blog/the-patient-who-lived-at-mcdonalds/) - Yup. 7151 W. Main Street, Apartment 1 is not a residence. There's not even an apartment there. It's a McDonalds. A patient came in with a "hard lump" on his stomach which ended up being an abscess with quite a bit of surrounding cellulitis. The doc did an incision and drainage on the abscess and
- [Brinksmanship](https://epmonthly.com/blog/brinksmanship/) - I may end up eating my words about this. We'll see. James Rohack, the current AMA President, made a post at Kevin MD about why patients should care about fixing the pending Medicare payment cuts. Basically his take on the matter was that if the cuts go through, many physicians will stop seeing Medicare patients
- [Healthcare Update - 02-25-2010](https://epmonthly.com/blog/healthcare-update-02-25-2010/) - Also see the Satellite Edition of this week's Healthcare Update over at ER Stories. Seven secrets of the ER ... including quotes from GruntDoc. Among them, fretch if you want to get to a room more quickly and never lie to your ER nurse. Secret #1 in my hospital: Stop calling it the "ER" already.
- [False Advertising](https://epmonthly.com/blog/false-advertising/) - I got a run of advertisements in my e-mails about ED pills and goodies from the ED Meds Shop -- exclusively for me! So I click on the links wondering how much they're getting for Motrin, Xanax, Vicodin, and Oxycontin these days. They're all for stinking Viagra. Damn spammers.
- [The Other Brown Paper Bag](https://epmonthly.com/blog/the-other-brown-paper-bag/) - When grandma called the ambulance to come take her husband to the emergency department for his chest pains, she was all in a dither. They just got back from eating at the local diner and he wasn't feeling good at all. Paramedics swooped through the home, scooped up grandpa, grabbed his brown paper bag full
- [Reducing Bloodstream Infections](https://epmonthly.com/blog/reducing-bloodstream-infections/) - There's this light on my way to work that is just a royal pain. It's set up so that you have to wait for the arrow to make a left hand turn. The intersection is busy, especially in the mornings, and the arrow only stays lit for about 13 seconds. So you end up waiting
- [The Black Knight of the Night](https://epmonthly.com/blog/the-black-knight-of-the-night/) - A lady gets brought in by ambulance for suicidal ideation. During the radio report we can hear her screaming at the paramedics in the background. Bad sign. She started messing around with Jose Cuervo and Jose got her good. Drunk off her rocker. Going to kill herself and everyone around her. And she was an
- [Healthcare Update - 02-18-2010](https://epmonthly.com/blog/healthcare-update-02-18-2010/) - See also the satellite edition of this Healthcare Update with more links over at ER Stories. "The health reform bill sucks. Just start over." - 57% of Americans "Rare" multimillion dollar medical malpractice awards in the news ... Minnesota jury awards plaintiff born with cerebral palsy a record $23 million - more than double the
- [Chronic Nosebleeds](https://epmonthly.com/blog/chronic-nosebleeds/) - The cause for this patient's chronic nosebleeds became more apparent when the patient wasn't able to blow her nose and the resident was unable to insert a sponge into the patient's nostril to stop the bleeding. A history of chronic headaches and of more recent vision changes prompted the resident to order a head CT.
- [Got Breast Milk?](https://epmonthly.com/blog/got-breast-milk/) - A mom is given a newborn baby to nurse during middle of night in the hospital (one of Dr. Wes' hospitals of all places, too). Only problem was that the mom was accidentally given another family's infant. The mom then nursed another family's baby. A nurse walked in the room and was surprised to see
- [Nurse Acquitted](https://epmonthly.com/blog/4353/) - Anne E. Mitchell, the Texas nurse who had been charged with a felony for reporting the actions of a doctor to the state medical board, was acquitted after a jury deliberated for less than an hour about the case. Her attorney focused everyone on the pending litigation that Ms. Mitchell and the other accused nurse
- [Healthcare Update 02-10-2010](https://epmonthly.com/blog/healthcare-update-02-10-2010/) - Screw the client. According to the headlines of this news release (see above), juries have just started awarding verdicts directly to medical malpractice law firms, not to the patients who suffered the injuries. Foreshadowing? More hospitals jumping on the "no dialysis for you" bandwagon. As they refuse to provide outpatient dialysis for patients, they have
- [Ouch](https://epmonthly.com/blog/4342/) - I don't rant a lot about my personal life, but tonight you'll have to bear with me. I've had problems with chronic pain due to a disease I have. It comes and it goes. Some days I hardly realize it's there, sometimes it is significant. The past couple of days have been particularly bad pain
- [Whyyy?](https://epmonthly.com/blog/whyyy/) - When you're driving down the field in opposing territory in the fourth quarter with more than three minutes left, why would you ever throw a pass? Keep to the ground game and run down the clock so they can't get the ball back and have time to drive down the field and score again. If
- [On Nursing Home Transfers and Liability Reform](https://epmonthly.com/blog/on-nursing-home-transfers-and-liability-reform/) - Several times in the past few days we have gotten ambulance runs from the nursing homes in the middle of the night to evaluate elderly nursing home patients for "unresponsiveness". When the "unresponsive" patients arrive, they are at their baseline mental status and, after the obligatory workup to rule out the bad causes of "unresponsiveness,"
- [WTF Moment #871](https://epmonthly.com/blog/wtf-moment-871/) - A guy in his mid-60's came in thinking that he had a stroke. He "felt funny" but wasn't having any other symptoms. The initial part of his exam was normal, so I started doing a neuro exam. I break a cotton swab in half and use it to lightly poke his arms and legs to
- [When Will We Learn?](https://epmonthly.com/blog/when-will-we-learn/) - Hey, its ERP from ER stories doing a guest rant post. OK, I have blogged about this before, but nearly every shift, I have cases which emphasize the need to repeat myself. When the hell with doctors learn to stop obsessing about hypertension? I don't mean to say that we should not treat it -
- [Malpractice Reform Shot Down In Illinois](https://epmonthly.com/blog/malpractice-reform-shot-down-in-illinois/) - Today, the Illinois Supreme Court agreed with an earlier trial court's decision to abolish caps on medical malpractice judgments in Illinois, calling the legislation "facially invalid" due to a separation of powers issue with the Illinois Constitution. Apparently only the judicial branch of Illinois government has the ability to reduce verdicts. Because of an inseverability
- [Expect It](https://epmonthly.com/blog/expect-it/) - A patient came in for evaluation of head congestion. As the nurse was getting his vital signs in the room, he asked her who the emergency physician was. "Dr. WhiteCoat," she replied. He turned his head to the side and asked his wife over his shoulder "Is that the one?" His wife answered "Yup." The
- [An ER Doc in Haiti - The Series](https://epmonthly.com/blog/an-er-doc-in-haiti-the-series/) - I wasn't aware, but EP Monthly has been publishing Dr. Plaster's reports from Haiti in real-time. Here's a link to all his posts. Definitely some things that you don't read about in the newspapers. He's coming home now as larger organizations step up their efforts to assist those in need of care.
- [Healthcare Update - 02/02/2010](https://epmonthly.com/blog/healthcare-update-02022010/) - See more news stories from around the web over at ER Stories in the Satellite Edition of this week's Healthcare Update. When it's dead and you don't know what to do with it, send it to pathology. When it's alive and you don't know what to do with it, send it to the emergency department
- [A Link For My Loyal Attorney Readers](https://epmonthly.com/blog/a-link-for-my-loyal-attorney-readers/) - As a special thanks for inciting the wrath of everyone favoring tort reform who reads this blog, I present to you a money-saving link. Seriously. http://scholar.google.com/ Back in November, Google Scholar started making case law searches available for free. Now you can type in a case citation or a search topic and can get cases
- [An ER Doc in Haiti: Day 3](https://epmonthly.com/blog/an-er-doc-in-haiti-day-3/) - January 27: We're seeing a stabilization, but what about follow-up? We are right down town in Port-au-Prince today; pretty much every building around us is destroyed. The only thing still standing near us is a church, which is currently housing a local boy scout troop. The effort is starting to see a logical transition right
- [An ER Doc in Haiti: Day 2](https://epmonthly.com/blog/an-er-doc-in-haiti-day-2/) - Mark Plaster (R) and Father Jim Boynton ride through Port-au-Prince in the back of a pick-up January 26: Where there are no doctors Yesterday we just drove down the road and found an open area where we could set up a triage station. We pulled out a tarp, some line to hold everybody back, and
- [Tax Incentives for Providing On-Call Care](https://epmonthly.com/blog/tax-incentives-for-providing-on-call-care/) - Some states are having difficulty finding enough physicians to provide needed specialty care to patients who come to the emergency department. If a patient needs neurosurgery or trauma surgery and there is no one on staff that is able (or willing) to perform the necessary services, then the patient must be transferred to another facility.
- [On the Ground in Haiti: Notes from an Emergency Physician](https://epmonthly.com/blog/on-the-ground-in-haiti-notes-from-an-emergency-physician/) - The earthquake in Haiti has created a tremendous need for donations and support for the Haitian people. Emergency Physicians Monthly took the mission to heart. Editor Mark Plaster, MD went to Haiti and has been assisting in the relief effort since January 24. In addition to my posts, I'm going to add Mark's notes and
- [Contrast Allergy and Shellfish](https://epmonthly.com/blog/contrast-allergy-and-shellfish/) - A recent EMedHome Clinical Pearl sheds some light on the alleged relationship between "allergies" to radiocontrast/iodine and seafood allergies. The pearl noted that iodine is found throughout our bodies and is added to most kinds of table salt used in the United States. Our thyroid glands need iodine to function properly. While seafood contains iodine,
- [Want to Avoid Appendicitis? Get Your Flu Shot.](https://epmonthly.com/blog/want-to-avoid-appendicitis-get-your-flu-shot/) - Could appendicitis be a viral illness ... or be related to a viral illness? A recent Archives of Surgery article raises some interesting questions.Researchers performed a retrospective analysis of appendicitis cases and compared them to incidence of influenza, rotavirus, and gastrointestinal infections. Using 40 years of data, they noted that general trends for appendicitis and
- [Healthcare Update -- 01-25-2010](https://epmonthly.com/blog/healthcare-update-01-25-2010/) - I split the update again this week. Go over to ER Stories to read some more if you're interested. . According to a Canadian journalist who was recently hospitalized, one of the biggest problems facing hospitals in Canada is getting patients to leave. She describes some problems she had with her roommates hogging the bathroom
- [Sometimes You Wonder](https://epmonthly.com/blog/sometimes-you-wonder/) - Sometimes you wonder why a mom brings her 6 year old daughter with cerebral palsy into the emergency department at 2:00 in the morning for a fever. What were they doing up at 2:00 AM anyway? Sometimes you wonder whether parents even know how to take a temperature. The kid's "fever" was 100.6 when she
- [Can't Win For Losing](https://epmonthly.com/blog/cant-win-for-losing/) - Had a recent patient encounter that just underscored the importance of Dr. Edwin Leap's recent article on patient satisfaction. A demented patient was brought by ambulance from the nursing home. He was allegedly short of breath, but, when asked, stated that nothing was wrong. He was clinically stable, we diagnosed him with pneumonia, and I
- [Good doctors say "No"](https://epmonthly.com/blog/good-doctors-say-no/) - Emergency physician blogger Edwin Leap has a great post about patient satisfaction over at Kevin's blog. "[I]f being liked and producing satisfaction on paper is the end-game for this great adventure of medicine, then we are seriously off course, and we can simply throw out all research and focus on the science of pleasure. Medicine
- [HIPAA violation or political revenge?](https://epmonthly.com/blog/hipaa-violation-or-political-revenge/) - Here's a good one from WLBT News in Mississippi. Mississippi Governor Haley Barbour wrote this on his Twitter page, "Glad the Legislature recognizes our dire fiscal situation. Look forward to hearing their ideas on how to trim expenses". An administrative assistant at the University Medical Center School of Nursing who had apparently heard from several
- [How to Get Rid of a Customer](https://epmonthly.com/blog/how-to-get-rid-of-a-customer/) - Hello, ERP here from ER stories. The other day we had a woman come in the the ER with complaints of vague chest and back pain for many months. We noticed she had never been there before and was from out of state. When asked why she suddenly decided to come in for this problem,
- [Break](https://epmonthly.com/blog/break/) - Had a couple of things come up and am going to be away from the computer until next week. Enjoy all the other great blogs on my blog links page in the meantime. If your blog isn't on the list, drop a comment in the comments section on the page and I'll add it when
- [Healthcare Update 01-13-2010](https://epmonthly.com/blog/healthcare-update-01-13-2010/) - The game of medical funding hot potato continues. Miami hospital system stops providing dialysis for indigent patients due to mounting budget losses. Instead, patients are encouraged to go to the emergency department so that Medicaid will be forced to pay the cost for the visits. Rather than risk crowding in their hospital emergency departments, three
- [For an Elephant, Maybe](https://epmonthly.com/blog/for-an-elephant-maybe/) - A patient comes to be seen for intractable hiccups. When the secretary brings him back and puts him in a room, she gives us a look and says "here's a weird one for you." He gives a long drawn out story about how he had his hiccups for more than a week and he was
- [Double Your Computer's Speed -- For Free](https://epmonthly.com/blog/double-your-computers-speed-for-free/) - I used to like Norton Utilities for cleaning up my computer ... until it became bloatware. I haven't used Norton Utilities in several years. The ads on the radio touting a computer program that will "double your computer's speed" ... for only $39.98 per year ... prompted me to write this post. There are three
- [Healthcare for Some](https://epmonthly.com/blog/healthcare-for-some/) - On one hand, times like these try mens' souls. On the other hand, times like these can show you the goodness in people's hearts and the desperation that some patients face with medical illness. As the number of rural health clinics has fallen from 500 to 316 in Texas, here's a story about a small
- [You Don't See This Every Day](https://epmonthly.com/blog/you-dont-see-this-every-day/) - I heard stories of something like this happening during my residency training in a large city hospital, only in my case, it was a psych patient trying to escape from the guarded psych room. I thought it was just one of those urban legends. Here's proof from Serenity Now Hospital - pictures and all -
- [Healthcare Update 01-06-2010](https://epmonthly.com/blog/healthcare-update-01-06-2010/) - Also check out Part 2 of today's update over on ERP's site at ER Stories. ... Medicare on Rye, Hold the Mayo. The Mayo Clinic is no longer accepting Medicare patients at one of its primary care centers in Arizona as the reimbursements are too low and the system lost more than $800 million treating
- [Sexual Assault in the ED](https://epmonthly.com/blog/sexual-assault-in-the-ed/) - This story concerns me. On one hand, there is an emergency physician who, by some accounts, had a "sex addiction" and was accused of drugging intoxicated females and then groping their breasts. On the other hand, the females were so "incapacitated" that they were "unable to resist" or presumably to even yell for help when
- [Funny Kid Quote](https://epmonthly.com/blog/funny-kid-quote/) - Master Oogway had a great time at the WhiteCoat Transient Home for Displaced Reptiles, but is being brought back to his permanent home this morning. Since we never cared for a turtle before, Mrs. WhiteCoat went to the local pet store and consulted with a reptilian expert about the turtle's care. The reptile expert confirmed
- [Portable Apps](https://epmonthly.com/blog/portable-apps/) - I have a "thumb drive" attached to my keychain. That way, I always have information with me and I don't leave my drive behind when I leave (since I can't go anywhere without my keys). I keep two sets of files included on the keychain. First is a set of personal files that are encrypted
- [A Review of 2009](https://epmonthly.com/blog/a-review-of-2009/) - Lots of pretty cool blogging stuff happened this year. I left my old blog at WhiteCoat Rants and hooked up with EP Monthly. I have been repeatedly amazed at how EP Monthly helps me reach out to all of the emergency medical professionals in this country. Several times docs have come up to me with
- [Healthcare Update 12-31-2009](https://epmonthly.com/blog/healthcare-update-12-31-2009/) - Fudging numbers to please the pencil pushers. The NHS in Great Britain has a goal that no one waits to be treated in "casualty departments" (better than calling them "emergency rooms", I guess) for more than 4 hours. According to the records, a "vast majority" of patients are seen within 3 hours. Data collected from
- [$200 Billion Kool-Aid](https://epmonthly.com/blog/200-billion-kool-aid/) - With health care reform being heavily debated about the country, trial lawyers are trying to preserve one of their cash cows. Medical malpractice plaintiff attorneys continue to press their argument that lawsuits are essential to the nation's health care. In fact, the trial lawyers created a web site called 98000reasons.org and are putting ads for
- [Clipboard Conundrum](https://epmonthly.com/blog/clipboard-conundrum/) - Our hospital created new order sets to be compliant with all of the new JCAHO patient safety mandates. One of the JCAHO requirements is that pain medications must be administered according to a patient's rated pain scale. If a patient complains of pain of "3" they get one medication whereas if they complain of pain
- [Healthcare Update 12-23-2009](https://epmonthly.com/blog/healthcare-update-12-23-2009/) - This guy must have been really naughty this year. An assailant brutally beat a man who was stacking wood near his home, leaving him with gashes and bruises over most of his body. Emergency department staff were amazed that the patient was not in worse shape. Police are on the lookout for one of Santa's
- [Mandating medical care?](https://epmonthly.com/blog/mandating-medical-care/) - Should medical personnel be forced to help people in need of medical care? Two EMTs were asked to help someone who had collapsed at a donut shop. They told shop owners to call 911 and then left. Mayor Michael Bloomberg blasted the EMTs, stating that "there’s no excuse whatsoever" for their actions. Now the EMTs
- [Delish](https://epmonthly.com/blog/delish/) - Just so no one gets mad at me, don't read this if you have recently or plan to eat spaghetti or other similar dishes ... on second thought, don't read this if you are eating, have recently eaten, or plan to eat in the near future. I used to work in a garage. All the
- [Text THIS](https://epmonthly.com/blog/text-this/) - What is wrong with us? In December 2008 alone, Americans sent 110 BILLION text messages. That amounts to more than 3 billion text messages per day. My thumbs hurt just looking at those numbers. I'm guessing a good few hundred thousand of those messages were probably sent from our emergency department ... and this whole
- [Dialysis and the Right to Health Care](https://epmonthly.com/blog/dialysis-and-the-right-to-health-care/) - According to this Article from the Atlanta Journal Constitution, a court has ruled that at least some health care is not a right. In October, I linked to an article about how Grady Memorial Hospital in Atlanta was closing its dialysis clinics due to the significant financial burden. Grady has agreed to pay for the
- [Banning Bypass: Good Policy or Tempting Fate?](https://epmonthly.com/blog/good-policy-or-tempting-fate/) - Remember this skit from I Love Lucy? Lucy and Ethel worked on an assembly line and were responsible for wrapping all of the chocolates that came down the conveyor belt. At first, things were easy, but as more and more chocolates came faster and faster, eventually Lucy and Ethel became overwhelmed and the whole process
- [Could Satisfaction Surveys Be Harming Patient Care?](https://epmonthly.com/blog/could-satisfaction-surveys-be-harming-patient-care/) - A couple of weeks ago, I posted a survey about patient satisfaction surveys. To this point, 642 people responded to the survey, which is outstanding. Some of the responses were surprising. I'm getting the impression that the surveys really are more about satisFICTION that satisfaction, but you can judge for yourselves. Health care providers Of
- [Healthcare Update 12-12-2009](https://epmonthly.com/blog/healthcare-update-12-12-2009/) - Healthcare insurance does not equal healthcare access. Physicians are suing the state of Florida because more than 1.2 million children on Medicaid are not receiving access to critical medical care. Some children covered under Medicaid are unable to find any orthopedists willing to fix their broken bones. More than 750,000 children received no dental care
- [I'll Take That as a Compliment](https://epmonthly.com/blog/ill-take-that-as-a-compliment/) - Fractured Distal Radius (see Arrows) Complete Posterior Elbow Dislocation Hello, guest poster ERP here. If you read my blog, recently I posted about the first "Ice" day of the year. The day that always seems to surprise people, haplessly stepping out onto the stuff in their driveway, front steps, or sidewalk. We always get a
- [Aortogram](https://epmonthly.com/blog/aortogram/) - I was searching through a patient's x-ray files for a comparison film and came across this aortogram. Had never seen what an aortogram looks like prior to this exam. Looked more like an emaciated picture of Gumby when I first saw it. The head and body are the aorta. The arms are the renal arteries
- [Lawyers Keep Their Cut of Health Care Pie](https://epmonthly.com/blog/lawyers-keep-their-cut-of-health-care-pie/) - By a vote of 32-66, today the Senate rejected an amendment to the health care bill that would cap plaintiffs' lawyers fees to one-third of the first $150,000 of any judgment and one quarter of any amount above $150,000. Democrats reportedly stated that the amendment was "unfair" because it did not limit fees for defense
- [Healthcare Update 12-05-2009](https://epmonthly.com/blog/healthcare-update-12-05-2009/) - Obviously biased statistics published in the Metropolitan Corporate Counsel. "Four of ten medical malpractice lawsuits filed in America each year are groundless and overhead costs of malpractice litigation are exorbitant. These costs, of course, are imposed on doctors, hospitals and insurers, and then ultimately passed on to health care consumers." In addition, "the overall shortage
- [Michael Woods Case Settles](https://epmonthly.com/blog/michael-woods-case-settles/) - I previously linked to the Providence Journal's notes about the trial testimony from the Michael Woods case. Now comes word from the Providence Journal that the case has settled. Faced with the possibility of a multimillion dollar judgment against the hospital, this week Kent Hospital president Sandra Coletta made a phone call to plaintiff James
- [ERP Makes the News](https://epmonthly.com/blog/erp-makes-the-news/) - ERP, who guest posts on this very blog, got interviewed for an article about how to get treated "better" and "faster" in the emergency department published on AOL today. Congrats! The comment section to the article has some er, um ... interesting reactions ... and misperceptions about patients using emergency departments. All in all, the
- [I Always Feel Like ...](https://epmonthly.com/blog/i-always-feel-like/) - ... somebody's WAtching meeeeee. From one of my favorite magazines comes the story that we are being watched - a lot more than we know. Wired Magazine reports that Federal law enforcement obtained telephone GPS data about Sprint customers more than 8 million times in a year. About 220,000 times per day. More than 9000
- [The Demise of American Health Care](https://epmonthly.com/blog/the-demise-of-american-health-care/) - A couple of news headlines paint a bleak picture about the future of healthcare in this country. First are some comments made by US Republican Senator George LeMieux. During a news briefing (video here), LeMieux expressed a concern that Obama's healthcare plan would amount to "Medicaid for the masses" and would put all Americans on
- [Just Another Night in the ED](https://epmonthly.com/blog/just-another-night-in-the-ed/) - Grandpa was brought in by ambulance after being found "unconscious" on the floor of the kitchen. He either got the deal of a lifetime on candy canes at Walmart that night or he hit the peppermint schnapps a little too hard. His garbled sentences and my diagnostic acumen led me to choose the latter reason
- [Drug Testing Welfare Recipients](https://epmonthly.com/blog/drug-testing-welfare-recipients/) - From the steamy comment section of Nurse K's blog comes IglooDoc's link to an article showing how a state agency in Arizona is heading in the right direction in the war on drugs. Effective Tuesday, the Arizona Department of Economic Security started performing urine drug testing on individuals whom officials had "reasonable cause" to suspect

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- [ED/EQ](https://epmonthly.com/column/ed-eq/)
- [Calc Corner](https://epmonthly.com/column/calc-corner/)
- [MDCalc Corner](https://epmonthly.com/column/mdcalc-corner/)
- [Crash Cart](https://epmonthly.com/column/crash-cart/)
- [EM Coach](https://epmonthly.com/column/em-coach/)
- [StartUps](https://epmonthly.com/column/startups/)
- [EM Quiz](https://epmonthly.com/column/em-quiz/)
- [More Than Medicine](https://epmonthly.com/column/more-than-medicine/)
- [Train Yourself](https://epmonthly.com/column/train-yourself/)
- [Pros and Cons](https://epmonthly.com/column/pros-and-cons/)
- [Residents Corner](https://epmonthly.com/column/residents-corner/)

## Type

- [Columnist](https://epmonthly.com/type/columnist/)
- [Contributor](https://epmonthly.com/type/contributor/)
- [Editor](https://epmonthly.com/type/editor/)

## Type

- [Web exclusive](https://epmonthly.com/article_type/web_exclusive/)

## Keyword

- [quality performance](https://epmonthly.com/keyword/quality-performance/)
- [hospital rating](https://epmonthly.com/keyword/hospital-rating/)
- [star rating](https://epmonthly.com/keyword/star-rating/)
- [HVRP](https://epmonthly.com/keyword/hvrp/)
- [hospital score](https://epmonthly.com/keyword/hospital-score/)
- [CLABSI](https://epmonthly.com/keyword/clabsi/)
- [CAUTI](https://epmonthly.com/keyword/cauti/)
- [HCAHPS](https://epmonthly.com/keyword/hcahps/)
- [Affordable Care Act](https://epmonthly.com/keyword/affordable-care-act/)
- [Overall Hospital Quality Star Rating](https://epmonthly.com/keyword/overall-hospital-quality-star-rating/)
- [CMS](https://epmonthly.com/keyword/cms/)
- [telemedicine](https://epmonthly.com/keyword/telemedicine/)
- [Teladoc](https://epmonthly.com/keyword/teladoc/)
- [ipad](https://epmonthly.com/keyword/ipad/)
- [CT](https://epmonthly.com/keyword/ct/)
- [ultrasound](https://epmonthly.com/keyword/ultrasound/)
- [skype](https://epmonthly.com/keyword/skype/)
- [DTC](https://epmonthly.com/keyword/dtc/)
- [zika](https://epmonthly.com/keyword/zika/)
- [chikungunya](https://epmonthly.com/keyword/chikungunya/)
- [Brazil](https://epmonthly.com/keyword/brazil/)
- [dengue](https://epmonthly.com/keyword/dengue/)
- [mosquitoes](https://epmonthly.com/keyword/mosquitoes/)
- [virus](https://epmonthly.com/keyword/virus/)
- [cdc](https://epmonthly.com/keyword/cdc/)
- [soundings](https://epmonthly.com/keyword/soundings/)
- [Transabdominal Pelvic Ultrasound](https://epmonthly.com/keyword/transabdominal-pelvic-ultrasound/)
- [Non-Pregnant Patient](https://epmonthly.com/keyword/non-pregnant-patient/)
- [Pelvic Pain](https://epmonthly.com/keyword/pelvic-pain/)
- [Uterus](https://epmonthly.com/keyword/uterus/)
- [Endometrium](https://epmonthly.com/keyword/endometrium/)
- [Ovaries](https://epmonthly.com/keyword/ovaries/)
- [local anesthetic](https://epmonthly.com/keyword/local-anesthetic/)
- [orthopedics](https://epmonthly.com/keyword/orthopedics/)
- [anatomy](https://epmonthly.com/keyword/anatomy/)
- [wrist](https://epmonthly.com/keyword/wrist/)
- [scaphoid](https://epmonthly.com/keyword/scaphoid/)
- [Scapho-Lunate Dissociations](https://epmonthly.com/keyword/scapho-lunate-dissociations/)
- [Luno-Triquetral Dissociations](https://epmonthly.com/keyword/luno-triquetral-dissociations/)
- [Lunate Instability & Perilunate Dislocations](https://epmonthly.com/keyword/lunate-instability-perilunate-dislocations/)
- [The Triangular Fibro-Cartilage Complex](https://epmonthly.com/keyword/the-triangular-fibro-cartilage-complex/)
- [radiology](https://epmonthly.com/keyword/radiology/)
- [Reflexive NG Tube](https://epmonthly.com/keyword/reflexive-ng-tube/)
- [NASOGASTRIC TUBE INTUBATION](https://epmonthly.com/keyword/nasogastric-tube-intubation/)
- [NEBULIZED AND ATOMIZED LIDOCAINE](https://epmonthly.com/keyword/nebulized-and-atomized-lidocaine/)
- [ACUTE GI BLEEDING](https://epmonthly.com/keyword/acute-gi-bleeding/)
- [NASOGASTRIC LAVAGE](https://epmonthly.com/keyword/nasogastric-lavage/)
- [LAVAGE](https://epmonthly.com/keyword/lavage/)
- [NASOGASTRIC ASPIRATION](https://epmonthly.com/keyword/nasogastric-aspiration/)
- [BOWEL OBSTRUCTION](https://epmonthly.com/keyword/bowel-obstruction/)
- [ROUTINE NASOGASTRIC DECOMPRESSION](https://epmonthly.com/keyword/routine-nasogastric-decompression/)
- [NASOGASTRIC SUCTION](https://epmonthly.com/keyword/nasogastric-suction/)
- [ACUTE PANCREATITIS](https://epmonthly.com/keyword/acute-pancreatitis/)
- [standard of care](https://epmonthly.com/keyword/standard-of-care/)
- [rick bukata](https://epmonthly.com/keyword/rick-bukata/)
- [richard bukata](https://epmonthly.com/keyword/richard-bukata/)
- [bukata](https://epmonthly.com/keyword/bukata/)
- [CLIA](https://epmonthly.com/keyword/clia/)
- [freestanding emergency clinic](https://epmonthly.com/keyword/freestanding-emergency-clinic/)
- [FEC](https://epmonthly.com/keyword/fec/)
- [FED](https://epmonthly.com/keyword/fed/)
- [business plan](https://epmonthly.com/keyword/business-plan/)
- [payroll](https://epmonthly.com/keyword/payroll/)
- [benefits](https://epmonthly.com/keyword/benefits/)
- [licensure](https://epmonthly.com/keyword/licensure/)
- [medical societies](https://epmonthly.com/keyword/medical-societies/)
- [coding vender](https://epmonthly.com/keyword/coding-vender/)
- [billing vender](https://epmonthly.com/keyword/billing-vender/)
- [insurance](https://epmonthly.com/keyword/insurance/)
- [als](https://epmonthly.com/keyword/als/)
- [bls](https://epmonthly.com/keyword/bls/)
- [Advanced life support](https://epmonthly.com/keyword/advanced-life-support/)
- [basic life support](https://epmonthly.com/keyword/basic-life-support/)
- [pre-hospital](https://epmonthly.com/keyword/pre-hospital/)
- [ems](https://epmonthly.com/keyword/ems/)
- [cms billing](https://epmonthly.com/keyword/cms-billing/)
- [icd codes](https://epmonthly.com/keyword/icd-codes/)
- [Sanghavi](https://epmonthly.com/keyword/sanghavi/)
- [imposter syndrome](https://epmonthly.com/keyword/imposter-syndrome/)
- [self-esteem](https://epmonthly.com/keyword/self-esteem/)
- [imposter phenomenon](https://epmonthly.com/keyword/imposter-phenomenon/)
- [psychotherapy](https://epmonthly.com/keyword/psychotherapy/)
- [PHPs](https://epmonthly.com/keyword/phps/)
- [physician health program](https://epmonthly.com/keyword/physician-health-program/)
- [depression](https://epmonthly.com/keyword/depression/)
- [burnout](https://epmonthly.com/keyword/burnout/)
- [lawsuit](https://epmonthly.com/keyword/lawsuit/)
- [Douglas Talbott](https://epmonthly.com/keyword/douglas-talbott/)
- [MLBs](https://epmonthly.com/keyword/mlbs/)
- [FSMB](https://epmonthly.com/keyword/fsmb/)
- [Steven Miles](https://epmonthly.com/keyword/steven-miles/)
- [mental illness](https://epmonthly.com/keyword/mental-illness/)
- [stigma](https://epmonthly.com/keyword/stigma/)
- [finances](https://epmonthly.com/keyword/finances/)
- [Spending](https://epmonthly.com/keyword/spending/)
- [Income](https://epmonthly.com/keyword/income/)
- [Savings](https://epmonthly.com/keyword/savings/)
- [Net Worth](https://epmonthly.com/keyword/net-worth/)
- [Assets](https://epmonthly.com/keyword/assets/)
- [Liabilities](https://epmonthly.com/keyword/liabilities/)
- [Taxable Income](https://epmonthly.com/keyword/taxable-income/)
- [Total Income](https://epmonthly.com/keyword/total-income/)
- [Deductions](https://epmonthly.com/keyword/deductions/)
- [Capital Gain](https://epmonthly.com/keyword/capital-gain/)
- [Dividends](https://epmonthly.com/keyword/dividends/)
- [Interest](https://epmonthly.com/keyword/interest/)
- [chronic pain](https://epmonthly.com/keyword/chronic-pain/)
- [RN](https://epmonthly.com/keyword/rn/)
- [opioid](https://epmonthly.com/keyword/opioid/)
- [frequent users](https://epmonthly.com/keyword/frequent-users/)
- [care plans](https://epmonthly.com/keyword/care-plans/)
- [HIPPA](https://epmonthly.com/keyword/hippa/)
- [acute mesenteric ischemia](https://epmonthly.com/keyword/acute-mesenteric-ischemia/)
- [missed diagnosis](https://epmonthly.com/keyword/missed-diagnosis/)
- [Abdominal vascular catastrophes](https://epmonthly.com/keyword/abdominal-vascular-catastrophes/)
- [arterial embolism](https://epmonthly.com/keyword/arterial-embolism/)
- [arterial thrombosis](https://epmonthly.com/keyword/arterial-thrombosis/)
- [venous thrombosis](https://epmonthly.com/keyword/venous-thrombosis/)
- [non-occlusive](https://epmonthly.com/keyword/non-occlusive/)
- [bowel ischemia](https://epmonthly.com/keyword/bowel-ischemia/)
- [abdominal aorta](https://epmonthly.com/keyword/abdominal-aorta/)
- [oh henry](https://epmonthly.com/keyword/oh-henry/)
- [alice in wonderland](https://epmonthly.com/keyword/alice-in-wonderland/)
- [cyst](https://epmonthly.com/keyword/cyst/)
- [malignant tumor](https://epmonthly.com/keyword/malignant-tumor/)
- [radiograph](https://epmonthly.com/keyword/radiograph/)
- [ganglion](https://epmonthly.com/keyword/ganglion/)
- [Lipomas](https://epmonthly.com/keyword/lipomas/)
- [Hemangiomas](https://epmonthly.com/keyword/hemangiomas/)
- [fibroma](https://epmonthly.com/keyword/fibroma/)
- [tendon sheath](https://epmonthly.com/keyword/tendon-sheath/)
- [syria](https://epmonthly.com/keyword/syria/)
- [eu](https://epmonthly.com/keyword/eu/)
- [ecdc](https://epmonthly.com/keyword/ecdc/)
- [WHO](https://epmonthly.com/keyword/who/)
- [HIV](https://epmonthly.com/keyword/hiv/)
- [container Exchange](https://epmonthly.com/keyword/container-exchange/)
- [refugee](https://epmonthly.com/keyword/refugee/)
- [dear director](https://epmonthly.com/keyword/dear-director/)
- [homeless](https://epmonthly.com/keyword/homeless/)
- [discharge](https://epmonthly.com/keyword/discharge/)
- [escort](https://epmonthly.com/keyword/escort/)
- [hospital security](https://epmonthly.com/keyword/hospital-security/)
- [Bernie Sanders](https://epmonthly.com/keyword/bernie-sanders/)
- [Hillary Clinton](https://epmonthly.com/keyword/hillary-clinton/)
- [Donald Trump](https://epmonthly.com/keyword/donald-trump/)
- [Single payer healthcare](https://epmonthly.com/keyword/single-payer-healthcare/)
- [Medicare Access and CHIP Reauthorization Act](https://epmonthly.com/keyword/medicare-access-and-chip-reauthorization-act/)
- [MACRA](https://epmonthly.com/keyword/macra/)
- [British Medical Association](https://epmonthly.com/keyword/british-medical-association/)
- [UK](https://epmonthly.com/keyword/uk/)
- [United Kingdom](https://epmonthly.com/keyword/united-kingdom/)
- [Doctor strike](https://epmonthly.com/keyword/doctor-strike/)
- [junior doctor strike](https://epmonthly.com/keyword/junior-doctor-strike/)
- [National Health Service](https://epmonthly.com/keyword/national-health-service/)
- [Rivaroxaban](https://epmonthly.com/keyword/rivaroxaban/)
- [Xarelto](https://epmonthly.com/keyword/xarelto/)
- [Xa inhibitor](https://epmonthly.com/keyword/xa-inhibitor/)
- [anticoagulation](https://epmonthly.com/keyword/anticoagulation/)
- [vitamin K](https://epmonthly.com/keyword/vitamin-k/)
- [warfarin](https://epmonthly.com/keyword/warfarin/)
- [E-Prescribing](https://epmonthly.com/keyword/e-prescribing/)
- [EHR](https://epmonthly.com/keyword/ehr/)
- [EPCS](https://epmonthly.com/keyword/epcs/)
- [Rx](https://epmonthly.com/keyword/rx/)
- [prescription drug monitoring program](https://epmonthly.com/keyword/prescription-drug-monitoring-program/)
- [iStop](https://epmonthly.com/keyword/istop/)
- [New York](https://epmonthly.com/keyword/new-york/)
- [Nick Genes](https://epmonthly.com/keyword/nick-genes/)
- [Nicholas Genes](https://epmonthly.com/keyword/nicholas-genes/)
- [tick bite](https://epmonthly.com/keyword/tick-bite/)
- [tick](https://epmonthly.com/keyword/tick/)
- [IgE antibodies](https://epmonthly.com/keyword/ige-antibodies/)
- [alpha gal](https://epmonthly.com/keyword/alpha-gal/)
- [alpha-gal anaphylaxis](https://epmonthly.com/keyword/alpha-gal-anaphylaxis/)
- [anaphylaxis](https://epmonthly.com/keyword/anaphylaxis/)
- [Rocky Mountain Spotted Fever](https://epmonthly.com/keyword/rocky-mountain-spotted-fever/)
- [galatose-alpha-1](https://epmonthly.com/keyword/galatose-alpha-1/)
- [3-galactose](https://epmonthly.com/keyword/3-galactose/)
- [red meat](https://epmonthly.com/keyword/red-meat/)
- [Gastroenteritis](https://epmonthly.com/keyword/gastroenteritis/)
- [GE reflux](https://epmonthly.com/keyword/ge-reflux/)
- [abdominal pathologies](https://epmonthly.com/keyword/abdominal-pathologies/)
- [Pediatric ED](https://epmonthly.com/keyword/pediatric-ed/)
- [pyloric muscle](https://epmonthly.com/keyword/pyloric-muscle/)
- [pyloric channel](https://epmonthly.com/keyword/pyloric-channel/)
- [donut sign](https://epmonthly.com/keyword/donut-sign/)
- [hamburger sign](https://epmonthly.com/keyword/hamburger-sign/)
- [laparoscopic pyloromyotomy](https://epmonthly.com/keyword/laparoscopic-pyloromyotomy/)
- [pyloric stenosis](https://epmonthly.com/keyword/pyloric-stenosis/)
- [ketamine](https://epmonthly.com/keyword/ketamine/)
- [fentanyl lollipops](https://epmonthly.com/keyword/fentanyl-lollipops/)
- [OTFC](https://epmonthly.com/keyword/otfc/)
- [MASCAL](https://epmonthly.com/keyword/mascal/)
- [naloxone](https://epmonthly.com/keyword/naloxone/)
- [Mass Casualty Events](https://epmonthly.com/keyword/mass-casualty-events/)
- [shooting](https://epmonthly.com/keyword/shooting/)
- [Tactical Combat Casualty Care](https://epmonthly.com/keyword/tactical-combat-casualty-care/)
- [TCCC](https://epmonthly.com/keyword/tccc/)
- [non-invasive analgesia](https://epmonthly.com/keyword/non-invasive-analgesia/)
- [Out-of-hospital cardiac arrest](https://epmonthly.com/keyword/out-of-hospital-cardiac-arrest/)
- [double pad shock](https://epmonthly.com/keyword/double-pad-shock/)
- [double simultaneous external defibrillation](https://epmonthly.com/keyword/double-simultaneous-external-defibrillation/)
- [defibrillators](https://epmonthly.com/keyword/defibrillators/)
- [short-acting beta-blockers](https://epmonthly.com/keyword/short-acting-beta-blockers/)
- [physician extenders](https://epmonthly.com/keyword/physician-extenders/)
- [app](https://epmonthly.com/keyword/app/)
- [Advanced practice providers](https://epmonthly.com/keyword/advanced-practice-providers/)
- [Cervical fractures](https://epmonthly.com/keyword/cervical-fractures/)
- [geriatrics](https://epmonthly.com/keyword/geriatrics/)
- [c-spine](https://epmonthly.com/keyword/c-spine/)
- [NEXUS criteria](https://epmonthly.com/keyword/nexus-criteria/)
- [Canadian C-Spine Criteria](https://epmonthly.com/keyword/canadian-c-spine-criteria/)
- [geriatric cervical trauma](https://epmonthly.com/keyword/geriatric-cervical-trauma/)
- [geriatric trauma patient](https://epmonthly.com/keyword/geriatric-trauma-patient/)
- [greg henry](https://epmonthly.com/keyword/greg-henry/)
- [reading](https://epmonthly.com/keyword/reading/)
- [RICHARD STENNES](https://epmonthly.com/keyword/richard-stennes/)
- [JUDITH TINTINALLI](https://epmonthly.com/keyword/judith-tintinalli/)
- [EARL REISDORFF](https://epmonthly.com/keyword/earl-reisdorff/)
- [ED violence](https://epmonthly.com/keyword/ed-violence/)
- [supreme court](https://epmonthly.com/keyword/supreme-court/)
- [heroin](https://epmonthly.com/keyword/heroin/)
- [narcotics](https://epmonthly.com/keyword/narcotics/)
- [hospital security guards](https://epmonthly.com/keyword/hospital-security-guards/)
- [pain management](https://epmonthly.com/keyword/pain-management/)
- [war on oligoanalgesia](https://epmonthly.com/keyword/war-on-oligoanalgesia/)
- [ACEP](https://epmonthly.com/keyword/acep/)
- [AAEM](https://epmonthly.com/keyword/aaem/)
- [SAEM](https://epmonthly.com/keyword/saem/)
- [Sergey Motov](https://epmonthly.com/keyword/sergey-motov/)
- [junctional bleeds](https://epmonthly.com/keyword/junctional-bleeds/)
- [Containment and Protection System Utilizing Life Support](https://epmonthly.com/keyword/containment-and-protection-system-utilizing-life-support/)
- [CAPSULS](https://epmonthly.com/keyword/capsuls/)
- [CBRNE](https://epmonthly.com/keyword/cbrne/)
- [military working dogs](https://epmonthly.com/keyword/military-working-dogs/)
- [Resuscitative Endovascular Balloon Occlusion of the Aorta](https://epmonthly.com/keyword/resuscitative-endovascular-balloon-occlusion-of-the-aorta/)
- [REBOA](https://epmonthly.com/keyword/reboa/)
- [Selective Aortic Arch Perfusion](https://epmonthly.com/keyword/selective-aortic-arch-perfusion/)
- [SAAP](https://epmonthly.com/keyword/saap/)
- [Abdominal Aortic Tourniquets](https://epmonthly.com/keyword/abdominal-aortic-tourniquets/)
- [Abdominal Injectable Foams](https://epmonthly.com/keyword/abdominal-injectable-foams/)
- [SOMA](https://epmonthly.com/keyword/soma/)
- [The Special Operations Medical Association](https://epmonthly.com/keyword/the-special-operations-medical-association/)
- [rick's reviews](https://epmonthly.com/keyword/ricks-reviews/)
- [opioids](https://epmonthly.com/keyword/opioids/)
- [opiate](https://epmonthly.com/keyword/opiate/)
- [opioid-related deaths](https://epmonthly.com/keyword/opioid-related-deaths/)
- [EMTALA](https://epmonthly.com/keyword/emtala/)
- [chron](https://epmonthly.com/keyword/chron/)
- [PDMP](https://epmonthly.com/keyword/pdmp/)
- [opioid prescribing](https://epmonthly.com/keyword/opioid-prescribing/)
- [bedside ultrasound](https://epmonthly.com/keyword/bedside-ultrasound/)
- [brady pregerson](https://epmonthly.com/keyword/brady-pregerson/)
- [Point Of Care UltraSound](https://epmonthly.com/keyword/point-of-care-ultrasound/)
- [POCUS](https://epmonthly.com/keyword/pocus/)
- [survey](https://epmonthly.com/keyword/survey/)
- [augmented reality](https://epmonthly.com/keyword/augmented-reality/)
- [virtual reality](https://epmonthly.com/keyword/virtual-reality/)
- [VR](https://epmonthly.com/keyword/vr/)
- [Google Cardboard](https://epmonthly.com/keyword/google-cardboard/)
- [Oculus Rift](https://epmonthly.com/keyword/oculus-rift/)
- [HTC Vive](https://epmonthly.com/keyword/htc-vive/)
- [smartphone apps](https://epmonthly.com/keyword/smartphone-apps/)
- [AR goggles](https://epmonthly.com/keyword/ar-goggles/)
- [Fitbit](https://epmonthly.com/keyword/fitbit/)
- [iWatch](https://epmonthly.com/keyword/iwatch/)
- [Pebble](https://epmonthly.com/keyword/pebble/)
- [Garmin](https://epmonthly.com/keyword/garmin/)
- [Spire](https://epmonthly.com/keyword/spire/)
- [Withings](https://epmonthly.com/keyword/withings/)
- [wearables](https://epmonthly.com/keyword/wearables/)
- [telehealth](https://epmonthly.com/keyword/telehealth/)
- [Baghdad](https://epmonthly.com/keyword/baghdad/)
- [triage](https://epmonthly.com/keyword/triage/)
- [Iraq](https://epmonthly.com/keyword/iraq/)
- [deadly attacks](https://epmonthly.com/keyword/deadly-attacks/)
- [huffing](https://epmonthly.com/keyword/huffing/)
- [gasoline inhaling](https://epmonthly.com/keyword/gasoline-inhaling/)
- [octane](https://epmonthly.com/keyword/octane/)
- [toluene](https://epmonthly.com/keyword/toluene/)
- [nitrous oxide](https://epmonthly.com/keyword/nitrous-oxide/)
- [nitrates](https://epmonthly.com/keyword/nitrates/)
- [B12](https://epmonthly.com/keyword/b12/)
- [inhalants](https://epmonthly.com/keyword/inhalants/)
- [ataxia](https://epmonthly.com/keyword/ataxia/)
- [hypoxia](https://epmonthly.com/keyword/hypoxia/)
- [ALTE](https://epmonthly.com/keyword/alte/)
- [BRUE](https://epmonthly.com/keyword/brue/)
- [pediatrics](https://epmonthly.com/keyword/pediatrics/)
- [lower risk infant](https://epmonthly.com/keyword/lower-risk-infant/)
- [high risk infant](https://epmonthly.com/keyword/high-risk-infant/)
- [CPR](https://epmonthly.com/keyword/cpr/)
- [sepsis](https://epmonthly.com/keyword/sepsis/)
- [sirs](https://epmonthly.com/keyword/sirs/)
- [fever](https://epmonthly.com/keyword/fever/)
- [qSOFA](https://epmonthly.com/keyword/qsofa/)
- [SOFA](https://epmonthly.com/keyword/sofa/)
- [ICU](https://epmonthly.com/keyword/icu/)
- [Systemic inflammatory response syndrome](https://epmonthly.com/keyword/systemic-inflammatory-response-syndrome/)
- [sepsis mimic](https://epmonthly.com/keyword/sepsis-mimic/)
- [consent](https://epmonthly.com/keyword/consent/)
- [Joint Commission mandate](https://epmonthly.com/keyword/joint-commission-mandate/)
- [JC](https://epmonthly.com/keyword/jc/)
- [consent for treatment](https://epmonthly.com/keyword/consent-for-treatment/)
- [simple procedures](https://epmonthly.com/keyword/simple-procedures/)
- [bedside procedures](https://epmonthly.com/keyword/bedside-procedures/)
- [minimal-risk procedures](https://epmonthly.com/keyword/minimal-risk-procedures/)
- [reasonable practice](https://epmonthly.com/keyword/reasonable-practice/)
- [PA](https://epmonthly.com/keyword/pa/)
- [Compartment Syndrome](https://epmonthly.com/keyword/compartment-syndrome/)
- [Ovarian Torsion](https://epmonthly.com/keyword/ovarian-torsion/)
- [abdominal pain](https://epmonthly.com/keyword/abdominal-pain/)
- [risk management](https://epmonthly.com/keyword/risk-management/)
- [provider](https://epmonthly.com/keyword/provider/)
- [classic findings](https://epmonthly.com/keyword/classic-findings/)
- [intermittent torsion](https://epmonthly.com/keyword/intermittent-torsion/)
- [LLSA](https://epmonthly.com/keyword/llsa/)
- [ABEM](https://epmonthly.com/keyword/abem/)
- [JAMA](https://epmonthly.com/keyword/jama/)
- [mental health](https://epmonthly.com/keyword/mental-health/)
- [PHP](https://epmonthly.com/keyword/php/)
- [PTSD](https://epmonthly.com/keyword/ptsd/)
- [investment returns](https://epmonthly.com/keyword/investment-returns/)
- [stocks](https://epmonthly.com/keyword/stocks/)
- [savings rate](https://epmonthly.com/keyword/savings-rate/)
- [portfolio](https://epmonthly.com/keyword/portfolio/)
- [annual returns](https://epmonthly.com/keyword/annual-returns/)
- [doubling money](https://epmonthly.com/keyword/doubling-money/)
- [global em](https://epmonthly.com/keyword/global-em/)
- [flu](https://epmonthly.com/keyword/flu/)
- [vaccines](https://epmonthly.com/keyword/vaccines/)
- [avian flu](https://epmonthly.com/keyword/avian-flu/)
- [influenza](https://epmonthly.com/keyword/influenza/)
- [H5N1](https://epmonthly.com/keyword/h5n1/)
- [H7N9](https://epmonthly.com/keyword/h7n9/)
- [Zanamivir](https://epmonthly.com/keyword/zanamivir/)
- [chemoprophylaxis](https://epmonthly.com/keyword/chemoprophylaxis/)
- [MERS-CoV](https://epmonthly.com/keyword/mers-cov/)
- [graduation](https://epmonthly.com/keyword/graduation/)
- [trade school](https://epmonthly.com/keyword/trade-school/)
- [merle haggard](https://epmonthly.com/keyword/merle-haggard/)
- [brandeis](https://epmonthly.com/keyword/brandeis/)
- [american politics](https://epmonthly.com/keyword/american-politics/)
- [AMA](https://epmonthly.com/keyword/ama/)
- [AMA House of Delegates](https://epmonthly.com/keyword/ama-house-of-delegates/)
- [Steven Stack](https://epmonthly.com/keyword/steven-stack/)
- [MOC Resolutions](https://epmonthly.com/keyword/moc-resolutions/)
- [CME](https://epmonthly.com/keyword/cme/)
- [ACEP Section Council](https://epmonthly.com/keyword/acep-section-council/)
- [oxy](https://epmonthly.com/keyword/oxy/)
- [Oxycodone](https://epmonthly.com/keyword/oxycodone/)
- [hydromorphone](https://epmonthly.com/keyword/hydromorphone/)
- [respiratory depression](https://epmonthly.com/keyword/respiratory-depression/)
- [central nervous system depression](https://epmonthly.com/keyword/central-nervous-system-depression/)
- [non-opioid medications](https://epmonthly.com/keyword/non-opioid-medications/)
- [rx pad](https://epmonthly.com/keyword/rx-pad/)
- [semi-synthetic opioid](https://epmonthly.com/keyword/semi-synthetic-opioid/)
- [FDA](https://epmonthly.com/keyword/fda/)
- [balance](https://epmonthly.com/keyword/balance/)
- [long-term goals](https://epmonthly.com/keyword/long-term-goals/)
- [work life balance](https://epmonthly.com/keyword/work-life-balance/)
- [Morrison’s Pouch](https://epmonthly.com/keyword/morrisons-pouch/)
- [POINT-OF-CARE PELVIC ULTRASONOGRAPHY](https://epmonthly.com/keyword/point-of-care-pelvic-ultrasonography/)
- [OB/Gyn](https://epmonthly.com/keyword/obgyn/)
- [ovarian cyst](https://epmonthly.com/keyword/ovarian-cyst/)
- [pam benson](https://epmonthly.com/keyword/pam-benson/)
- [female emergency physician](https://epmonthly.com/keyword/female-emergency-physician/)
- [first female](https://epmonthly.com/keyword/first-female/)
- [Brian Zink](https://epmonthly.com/keyword/brian-zink/)
- [ACGME](https://epmonthly.com/keyword/acgme/)
- [Cerebral Venous Thrombosis](https://epmonthly.com/keyword/cerebral-venous-thrombosis/)
- [intracranial hypertension](https://epmonthly.com/keyword/intracranial-hypertension/)
- [Cavernous sinus thrombosis](https://epmonthly.com/keyword/cavernous-sinus-thrombosis/)
- [Cortical vein thrombosis](https://epmonthly.com/keyword/cortical-vein-thrombosis/)
- [CVT](https://epmonthly.com/keyword/cvt/)
- [CVST](https://epmonthly.com/keyword/cvst/)
- [intracranial pressure](https://epmonthly.com/keyword/intracranial-pressure/)
- [pathophysiological mechanisms](https://epmonthly.com/keyword/pathophysiological-mechanisms/)
- [metrics](https://epmonthly.com/keyword/metrics/)
- [director's corner](https://epmonthly.com/keyword/directors-corner/)
- [Michael Silverman](https://epmonthly.com/keyword/michael-silverman/)
- [Transparency](https://epmonthly.com/keyword/transparency/)
- [data](https://epmonthly.com/keyword/data/)
- [recruitment](https://epmonthly.com/keyword/recruitment/)
- [interview](https://epmonthly.com/keyword/interview/)
- [performance](https://epmonthly.com/keyword/performance/)
- [MIPS](https://epmonthly.com/keyword/mips/)
- [Performance Data](https://epmonthly.com/keyword/performance-data/)
- [Advancing care information](https://epmonthly.com/keyword/advancing-care-information/)
- [CPS](https://epmonthly.com/keyword/cps/)
- [Quality care](https://epmonthly.com/keyword/quality-care/)
- [SGR](https://epmonthly.com/keyword/sgr/)
- [Sustainable Growth Rate](https://epmonthly.com/keyword/sustainable-growth-rate/)
- [medicare](https://epmonthly.com/keyword/medicare/)
- [Centers for Medicare and Medicaid Services](https://epmonthly.com/keyword/centers-for-medicare-and-medicaid-services/)
- [DO](https://epmonthly.com/keyword/do/)
- [Osteopathic Medicine](https://epmonthly.com/keyword/osteopathic-medicine/)
- [ACOEP](https://epmonthly.com/keyword/acoep/)
- [AOA](https://epmonthly.com/keyword/aoa/)
- [The American College of Osteopathic Emergency Physicians](https://epmonthly.com/keyword/the-american-college-of-osteopathic-emergency-physicians/)
- [Single Accreditation System](https://epmonthly.com/keyword/single-accreditation-system/)
- [John Prestosh](https://epmonthly.com/keyword/john-prestosh/)
- [shifts](https://epmonthly.com/keyword/shifts/)
- [triggers](https://epmonthly.com/keyword/triggers/)
- [cancer](https://epmonthly.com/keyword/cancer/)
- [JAMA Pediatrics](https://epmonthly.com/keyword/jama-pediatrics/)
- [analgesia administration](https://epmonthly.com/keyword/analgesia-administration/)
- [opioid administration](https://epmonthly.com/keyword/opioid-administration/)
- [racial disparities](https://epmonthly.com/keyword/racial-disparities/)
- [discrimination](https://epmonthly.com/keyword/discrimination/)
- [racial differences](https://epmonthly.com/keyword/racial-differences/)
- [appendicitis](https://epmonthly.com/keyword/appendicitis/)
- [exertional compartment syndrome](https://epmonthly.com/keyword/exertional-compartment-syndrome/)
- [malpractice](https://epmonthly.com/keyword/malpractice/)
- [consultation](https://epmonthly.com/keyword/consultation/)
- [jury verdict](https://epmonthly.com/keyword/jury-verdict/)
- [Acute nontraumatic compartment syndrome](https://epmonthly.com/keyword/acute-nontraumatic-compartment-syndrome/)
- [H.R. 2646](https://epmonthly.com/keyword/h-r-2646/)
- [House of Representatives](https://epmonthly.com/keyword/house-of-representatives/)
- [The American College of Emergency Physicians](https://epmonthly.com/keyword/the-american-college-of-emergency-physicians/)
- [Medicaid](https://epmonthly.com/keyword/medicaid/)
- [president](https://epmonthly.com/keyword/president/)
- [aca](https://epmonthly.com/keyword/aca/)
- [Nightshift](https://epmonthly.com/keyword/nightshift/)
- [Mark Plaster](https://epmonthly.com/keyword/mark-plaster/)
- [high-touch cases](https://epmonthly.com/keyword/high-touch-cases/)
- [ACGME-I](https://epmonthly.com/keyword/acgme-i/)
- [IMG](https://epmonthly.com/keyword/img/)
- [International Medical Graduates](https://epmonthly.com/keyword/international-medical-graduates/)
- [FMG](https://epmonthly.com/keyword/fmg/)
- [foreign medical graduates](https://epmonthly.com/keyword/foreign-medical-graduates/)
- [Synthetic cannabinoids](https://epmonthly.com/keyword/synthetic-cannabinoids/)
- [K2](https://epmonthly.com/keyword/k2/)
- [Spice](https://epmonthly.com/keyword/spice/)
- [toxicology](https://epmonthly.com/keyword/toxicology/)
- [American College of Medical Toxicology](https://epmonthly.com/keyword/american-college-of-medical-toxicology/)
- [Toxicology Investigator’s Consortium](https://epmonthly.com/keyword/toxicology-investigators-consortium/)
- [ToxIC](https://epmonthly.com/keyword/toxic/)
- [ICD-10](https://epmonthly.com/keyword/icd-10/)
- [The Synthetic Drug Abuse Prevention Act](https://epmonthly.com/keyword/the-synthetic-drug-abuse-prevention-act/)
- [Severe Headache](https://epmonthly.com/keyword/severe-headache/)
- [brain MRI](https://epmonthly.com/keyword/brain-mri/)
- [stroke](https://epmonthly.com/keyword/stroke/)
- [migraine headaches](https://epmonthly.com/keyword/migraine-headaches/)
- [oral contraceptives](https://epmonthly.com/keyword/oral-contraceptives/)
- [posterior circulation stroke](https://epmonthly.com/keyword/posterior-circulation-stroke/)
- [hyperventilation](https://epmonthly.com/keyword/hyperventilation/)
- [acute thrombosis](https://epmonthly.com/keyword/acute-thrombosis/)
- [case manager](https://epmonthly.com/keyword/case-manager/)
- [geriatric case manager](https://epmonthly.com/keyword/geriatric-case-manager/)
- [NICU](https://epmonthly.com/keyword/nicu/)
- [L&D](https://epmonthly.com/keyword/ld/)
- [licensed clinical social worker](https://epmonthly.com/keyword/licensed-clinical-social-worker/)
- [LCSW](https://epmonthly.com/keyword/lcsw/)
- [Oral Contrast](https://epmonthly.com/keyword/oral-contrast/)
- [Gastric Perforation](https://epmonthly.com/keyword/gastric-perforation/)
- [Inflammatory Bowel Disease](https://epmonthly.com/keyword/inflammatory-bowel-disease/)
- [Bowel Altering Surgery](https://epmonthly.com/keyword/bowel-altering-surgery/)
- [abdominopelvic CT scan](https://epmonthly.com/keyword/abdominopelvic-ct-scan/)
- [CT scan](https://epmonthly.com/keyword/ct-scan/)
- [intravenous contrast](https://epmonthly.com/keyword/intravenous-contrast/)
- [IV](https://epmonthly.com/keyword/iv/)
- [Angioedema](https://epmonthly.com/keyword/angioedema/)
- [difficult airway](https://epmonthly.com/keyword/difficult-airway/)
- [subcutaneous tissue](https://epmonthly.com/keyword/subcutaneous-tissue/)
- [submucosal tissue](https://epmonthly.com/keyword/submucosal-tissue/)
- [mast cell-mediated](https://epmonthly.com/keyword/mast-cell-mediated/)
- [bradykinin-mediated](https://epmonthly.com/keyword/bradykinin-mediated/)
- [urticaria](https://epmonthly.com/keyword/urticaria/)
- [pruritus](https://epmonthly.com/keyword/pruritus/)
- [ACE-inhibitor](https://epmonthly.com/keyword/ace-inhibitor/)
- [ACEI](https://epmonthly.com/keyword/acei/)
- [Icatibant](https://epmonthly.com/keyword/icatibant/)
- [C1-INH](https://epmonthly.com/keyword/c1-inh/)
- [FFP](https://epmonthly.com/keyword/ffp/)
- [Hereditary Angioedema](https://epmonthly.com/keyword/hereditary-angioedema/)
- [HAE](https://epmonthly.com/keyword/hae/)
- [bradykinin](https://epmonthly.com/keyword/bradykinin/)
- [C1INH-AAE](https://epmonthly.com/keyword/c1inh-aae/)
- [ALS transport](https://epmonthly.com/keyword/als-transport/)
- [Athletes](https://epmonthly.com/keyword/athletes/)
- [ischemia](https://epmonthly.com/keyword/ischemia/)
- [stress fractures](https://epmonthly.com/keyword/stress-fractures/)
- [serum creatinine kinase](https://epmonthly.com/keyword/serum-creatinine-kinase/)
- [CK](https://epmonthly.com/keyword/ck/)
- [Chronic exertional compartment syndrome](https://epmonthly.com/keyword/chronic-exertional-compartment-syndrome/)
- [emergent orthopedic surgery](https://epmonthly.com/keyword/emergent-orthopedic-surgery/)
- [ultrasonography](https://epmonthly.com/keyword/ultrasonography/)
- [dignity](https://epmonthly.com/keyword/dignity/)
- [patient](https://epmonthly.com/keyword/patient/)
- [charlie brown](https://epmonthly.com/keyword/charlie-brown/)
- [linus](https://epmonthly.com/keyword/linus/)
- [hearfelt apology](https://epmonthly.com/keyword/hearfelt-apology/)
- [consequences](https://epmonthly.com/keyword/consequences/)
- [sorry](https://epmonthly.com/keyword/sorry/)
- [violence](https://epmonthly.com/keyword/violence/)
- [workplace violence](https://epmonthly.com/keyword/workplace-violence/)
- [Western Journal of Emergency Medicine](https://epmonthly.com/keyword/western-journal-of-emergency-medicine/)
- [harassment](https://epmonthly.com/keyword/harassment/)
- [victimization](https://epmonthly.com/keyword/victimization/)
- [Prevention and Management of Aggressive Behavior Program](https://epmonthly.com/keyword/prevention-and-management-of-aggressive-behavior-program/)
- [anticoagulant prophylaxis](https://epmonthly.com/keyword/anticoagulant-prophylaxis/)
- [Oral Factor Xa inhibitor](https://epmonthly.com/keyword/oral-factor-xa-inhibitor/)
- [prophylaxis](https://epmonthly.com/keyword/prophylaxis/)
- [The American College of Chest Physician](https://epmonthly.com/keyword/the-american-college-of-chest-physician/)
- [ACCP](https://epmonthly.com/keyword/accp/)
- [intussusception](https://epmonthly.com/keyword/intussusception/)
- [air enema](https://epmonthly.com/keyword/air-enema/)
- [intussusceptum](https://epmonthly.com/keyword/intussusceptum/)
- [intussuscipiens](https://epmonthly.com/keyword/intussuscipiens/)
- [rectum](https://epmonthly.com/keyword/rectum/)
- [bilious vomiting](https://epmonthly.com/keyword/bilious-vomiting/)
- [Hayfork sign](https://epmonthly.com/keyword/hayfork-sign/)
- [Pseudokidney sign](https://epmonthly.com/keyword/pseudokidney-sign/)
- [Unenhanced brain CT](https://epmonthly.com/keyword/unenhanced-brain-ct/)
- [noncontrast brain CT](https://epmonthly.com/keyword/noncontrast-brain-ct/)
- [complicated headache](https://epmonthly.com/keyword/complicated-headache/)
- [head trauma](https://epmonthly.com/keyword/head-trauma/)
- [altered mental status](https://epmonthly.com/keyword/altered-mental-status/)
- [CT findings](https://epmonthly.com/keyword/ct-findings/)
- [elevated intracranial pressure](https://epmonthly.com/keyword/elevated-intracranial-pressure/)
- [ICP](https://epmonthly.com/keyword/icp/)
- [CSF](https://epmonthly.com/keyword/csf/)
- [cerebrospinal fluid spaces](https://epmonthly.com/keyword/cerebrospinal-fluid-spaces/)
- [Lumbar Puncture](https://epmonthly.com/keyword/lumbar-puncture/)
- [tissue plasminogen activator](https://epmonthly.com/keyword/tissue-plasminogen-activator/)
- [TPA](https://epmonthly.com/keyword/tpa/)
- [alteplase](https://epmonthly.com/keyword/alteplase/)
- [Haloperidol](https://epmonthly.com/keyword/haloperidol/)
- [QT prolongation](https://epmonthly.com/keyword/qt-prolongation/)
- [Haldol](https://epmonthly.com/keyword/haldol/)
- [hypothyroidism](https://epmonthly.com/keyword/hypothyroidism/)
- [antipsychotics](https://epmonthly.com/keyword/antipsychotics/)
- [dementia](https://epmonthly.com/keyword/dementia/)
- [Intracerebral hemorrhage](https://epmonthly.com/keyword/intracerebral-hemorrhage/)
- [platelet transfusion](https://epmonthly.com/keyword/platelet-transfusion/)
- [PATCH](https://epmonthly.com/keyword/patch/)
- [antiplatelet therapy](https://epmonthly.com/keyword/antiplatelet-therapy/)
- [acute non-traumatic intracerebral hemorrhage](https://epmonthly.com/keyword/acute-non-traumatic-intracerebral-hemorrhage/)
- [PATCH Trial](https://epmonthly.com/keyword/patch-trial/)
- [Prescription Drug Monitoring Programs](https://epmonthly.com/keyword/prescription-drug-monitoring-programs/)
- [Centers for Disease Control and Prevention](https://epmonthly.com/keyword/centers-for-disease-control-and-prevention/)
- [drug seeking](https://epmonthly.com/keyword/drug-seeking/)
- [drug seekers](https://epmonthly.com/keyword/drug-seekers/)
- [opioid overdoses](https://epmonthly.com/keyword/opioid-overdoses/)
- [high-risk patients](https://epmonthly.com/keyword/high-risk-patients/)
- [Office of the National Coordinator of Health IT](https://epmonthly.com/keyword/office-of-the-national-coordinator-of-health-it/)
- [ONC](https://epmonthly.com/keyword/onc/)
- [Substance Abuse and Mental Health Services Administration](https://epmonthly.com/keyword/substance-abuse-and-mental-health-services-administration/)
- [SAMHSA](https://epmonthly.com/keyword/samhsa/)
- [EpiPens](https://epmonthly.com/keyword/epipens/)
- [Albuterol](https://epmonthly.com/keyword/albuterol/)
- [ComboPen](https://epmonthly.com/keyword/combopen/)
- [Sheldon Kaplan](https://epmonthly.com/keyword/sheldon-kaplan/)
- [Jokichi Takamine](https://epmonthly.com/keyword/jokichi-takamine/)
- [Adrenalin](https://epmonthly.com/keyword/adrenalin/)
- [epinephrine dosing](https://epmonthly.com/keyword/epinephrine-dosing/)
- [cardiac arrest](https://epmonthly.com/keyword/cardiac-arrest/)
- [BMJ](https://epmonthly.com/keyword/bmj/)
- [EpiPen](https://epmonthly.com/keyword/epipen/)
- [Mylan](https://epmonthly.com/keyword/mylan/)
- [Los Angeles Times](https://epmonthly.com/keyword/los-angeles-times/)
- [EpiPen price increase](https://epmonthly.com/keyword/epipen-price-increase/)
- [albuterol inhalers](https://epmonthly.com/keyword/albuterol-inhalers/)
- [Part D Medicare](https://epmonthly.com/keyword/part-d-medicare/)
- [Drug Price Relief Act](https://epmonthly.com/keyword/drug-price-relief-act/)
- [PRESCRIPTION DRUG COSTS](https://epmonthly.com/keyword/prescription-drug-costs/)
- [Congress](https://epmonthly.com/keyword/congress/)
- [Capitalism](https://epmonthly.com/keyword/capitalism/)
- [Ativan](https://epmonthly.com/keyword/ativan/)
- [CMS audit](https://epmonthly.com/keyword/cms-audit/)
- [Documentation](https://epmonthly.com/keyword/documentation/)
- [restraints](https://epmonthly.com/keyword/restraints/)
- [restraints policy](https://epmonthly.com/keyword/restraints-policy/)
- [physical restraints](https://epmonthly.com/keyword/physical-restraints/)
- [mechanical restraints](https://epmonthly.com/keyword/mechanical-restraints/)
- [chemical restraints](https://epmonthly.com/keyword/chemical-restraints/)
- [grace](https://epmonthly.com/keyword/grace/)
- [moral superiority](https://epmonthly.com/keyword/moral-superiority/)
- [gentleman](https://epmonthly.com/keyword/gentleman/)
- [Cervical Radiculopathy](https://epmonthly.com/keyword/cervical-radiculopathy/)
- [trapezius](https://epmonthly.com/keyword/trapezius/)
- [Spondylosis](https://epmonthly.com/keyword/spondylosis/)
- [nociceptive fibers](https://epmonthly.com/keyword/nociceptive-fibers/)
- [dermatomes](https://epmonthly.com/keyword/dermatomes/)
- [OSTEOPATHIC MANIPULATION](https://epmonthly.com/keyword/osteopathic-manipulation/)
- [inter-disc pressure](https://epmonthly.com/keyword/inter-disc-pressure/)
- [Steroid injections](https://epmonthly.com/keyword/steroid-injections/)
- [scientific assembly](https://epmonthly.com/keyword/scientific-assembly/)
- [w.h.o.](https://epmonthly.com/keyword/w-h-o/)
- [world health organization](https://epmonthly.com/keyword/world-health-organization/)
- [Aetna](https://epmonthly.com/keyword/aetna/)
- [Obamacare marketplaces](https://epmonthly.com/keyword/obamacare-marketplaces/)
- [Obamacare](https://epmonthly.com/keyword/obamacare/)
- [employer mandate](https://epmonthly.com/keyword/employer-mandate/)
- [UnitedHealth](https://epmonthly.com/keyword/unitedhealth/)
- [Humana](https://epmonthly.com/keyword/humana/)
- [out of pocket costs](https://epmonthly.com/keyword/out-of-pocket-costs/)
- [exchange premiums](https://epmonthly.com/keyword/exchange-premiums/)
- [ionizing radiation](https://epmonthly.com/keyword/ionizing-radiation/)
- [Molar pregnancies](https://epmonthly.com/keyword/molar-pregnancies/)
- [intra-uterine pregnancy](https://epmonthly.com/keyword/intra-uterine-pregnancy/)
- [thyroid panel](https://epmonthly.com/keyword/thyroid-panel/)
- [thyrotoxicosis](https://epmonthly.com/keyword/thyrotoxicosis/)
- [DEA](https://epmonthly.com/keyword/dea/)
- [Controlled Substances](https://epmonthly.com/keyword/controlled-substances/)
- [pediatric seizure](https://epmonthly.com/keyword/pediatric-seizure/)
- [Paramedics](https://epmonthly.com/keyword/paramedics/)
- [EMS protocols](https://epmonthly.com/keyword/ems-protocols/)
- [OLMC](https://epmonthly.com/keyword/olmc/)
- [The Controlled Substances Act](https://epmonthly.com/keyword/the-controlled-substances-act/)
- [CSA](https://epmonthly.com/keyword/csa/)
- [Protecting Patient Access to Emergency Medications Act of 2016](https://epmonthly.com/keyword/protecting-patient-access-to-emergency-medications-act-of-2016/)
- [HR 4365](https://epmonthly.com/keyword/hr-4365/)
- [Richard Hudson](https://epmonthly.com/keyword/richard-hudson/)
- [NAEMT](https://epmonthly.com/keyword/naemt/)
- [EMS on the Hill](https://epmonthly.com/keyword/ems-on-the-hill/)
- [ACEP Scientific Assembly](https://epmonthly.com/keyword/acep-scientific-assembly/)
- [ACEP16](https://epmonthly.com/keyword/acep16/)
- [ACEP Council Meeting](https://epmonthly.com/keyword/acep-council-meeting/)
- [radial shaft](https://epmonthly.com/keyword/radial-shaft/)
- [ulnar shaft](https://epmonthly.com/keyword/ulnar-shaft/)
- [distal radial-ulnar joint](https://epmonthly.com/keyword/distal-radial-ulnar-joint/)
- [proximal radial ulnar joint](https://epmonthly.com/keyword/proximal-radial-ulnar-joint/)
- [PRUJ](https://epmonthly.com/keyword/pruj/)
- [DRUJ](https://epmonthly.com/keyword/druj/)
- [Night stick Injuries](https://epmonthly.com/keyword/night-stick-injuries/)
- [Ulnar Injuries](https://epmonthly.com/keyword/ulnar-injuries/)
- [Monteggia Fractures](https://epmonthly.com/keyword/monteggia-fractures/)
- [Radius fractures](https://epmonthly.com/keyword/radius-fractures/)
- [Galleazzi fractures](https://epmonthly.com/keyword/galleazzi-fractures/)
- [Both Bone Forearm Fractures](https://epmonthly.com/keyword/both-bone-forearm-fractures/)
- [Monteggia](https://epmonthly.com/keyword/monteggia/)
- [Millennial Emergency Physicians](https://epmonthly.com/keyword/millennial-emergency-physicians/)
- [mike silverman](https://epmonthly.com/keyword/mike-silverman/)
- [video](https://epmonthly.com/keyword/video/)
- [History](https://epmonthly.com/keyword/history/)
- [MedGadget](https://epmonthly.com/keyword/medgadget/)
- [William Sullivan](https://epmonthly.com/keyword/william-sullivan/)
- [Medical-legal](https://epmonthly.com/keyword/medical-legal/)
- [legal](https://epmonthly.com/keyword/legal/)
- [Christina Shenvi](https://epmonthly.com/keyword/christina-shenvi/)
- [physician burnout](https://epmonthly.com/keyword/physician-burnout/)
- [mHealth Toolbox](https://epmonthly.com/keyword/mhealth-toolbox/)
- [ACEP's InnovatED](https://epmonthly.com/keyword/aceps-innovated/)
- [ICU director](https://epmonthly.com/keyword/icu-director/)
- [Complaint](https://epmonthly.com/keyword/complaint/)
- [Complaints](https://epmonthly.com/keyword/complaints/)
- [management](https://epmonthly.com/keyword/management/)
- [ICU Team](https://epmonthly.com/keyword/icu-team/)
- [presidential election](https://epmonthly.com/keyword/presidential-election/)
- [Democrats](https://epmonthly.com/keyword/democrats/)
- [Republicans](https://epmonthly.com/keyword/republicans/)
- [stock market returns](https://epmonthly.com/keyword/stock-market-returns/)
- [growth of one dollar](https://epmonthly.com/keyword/growth-of-one-dollar/)
- [long term stock market performance](https://epmonthly.com/keyword/long-term-stock-market-performance/)
- [election years](https://epmonthly.com/keyword/election-years/)
- [financial consult](https://epmonthly.com/keyword/financial-consult/)
- [James Mills](https://epmonthly.com/keyword/james-mills/)
- [Hill-Burton legislation](https://epmonthly.com/keyword/hill-burton-legislation/)
- [deferred pathology](https://epmonthly.com/keyword/deferred-pathology/)
- [Karl Mangold](https://epmonthly.com/keyword/karl-mangold/)
- [Fischer Mangold](https://epmonthly.com/keyword/fischer-mangold/)
- [American Board of Emergency Medicine](https://epmonthly.com/keyword/american-board-of-emergency-medicine/)
- [PPM](https://epmonthly.com/keyword/ppm/)
- [physician practice management](https://epmonthly.com/keyword/physician-practice-management/)
- [Tracheostomy](https://epmonthly.com/keyword/tracheostomy/)
- [airway management](https://epmonthly.com/keyword/airway-management/)
- [mechanical ventilation](https://epmonthly.com/keyword/mechanical-ventilation/)
- [American College of Chest Physicians](https://epmonthly.com/keyword/american-college-of-chest-physicians/)
- [chest compressions](https://epmonthly.com/keyword/chest-compressions/)
- [intubation](https://epmonthly.com/keyword/intubation/)
- [decannulation](https://epmonthly.com/keyword/decannulation/)
- [Tube Obstruction](https://epmonthly.com/keyword/tube-obstruction/)
- [Dislodgement](https://epmonthly.com/keyword/dislodgement/)
- [TIF](https://epmonthly.com/keyword/tif/)
- [migraine](https://epmonthly.com/keyword/migraine/)
- [head CT](https://epmonthly.com/keyword/head-ct/)
- [metoclopramide](https://epmonthly.com/keyword/metoclopramide/)
- [settlement](https://epmonthly.com/keyword/settlement/)
- [ischemic stroke](https://epmonthly.com/keyword/ischemic-stroke/)
- [radiologist](https://epmonthly.com/keyword/radiologist/)
- [CT scans](https://epmonthly.com/keyword/ct-scans/)
- [BASICS study](https://epmonthly.com/keyword/basics-study/)
- [neuroimaging](https://epmonthly.com/keyword/neuroimaging/)
- [headache](https://epmonthly.com/keyword/headache/)
- [Occam’s razor](https://epmonthly.com/keyword/occams-razor/)
- [Hickam’s dictum](https://epmonthly.com/keyword/hickams-dictum/)
- [The International Headache Society](https://epmonthly.com/keyword/the-international-headache-society/)
- [Site of injection](https://epmonthly.com/keyword/site-of-injection/)
- [hypoglycemia](https://epmonthly.com/keyword/hypoglycemia/)
- [Glucagon](https://epmonthly.com/keyword/glucagon/)
- [IV Dilaudid pump](https://epmonthly.com/keyword/iv-dilaudid-pump/)
- [drug absorption](https://epmonthly.com/keyword/drug-absorption/)
- [rapid delivery](https://epmonthly.com/keyword/rapid-delivery/)
- [IV drug administration](https://epmonthly.com/keyword/iv-drug-administration/)
- [IM absorption](https://epmonthly.com/keyword/im-absorption/)
- [Needle](https://epmonthly.com/keyword/needle/)
- [deltoid](https://epmonthly.com/keyword/deltoid/)
- [ACEP Informatics Section](https://epmonthly.com/keyword/acep-informatics-section/)
- [hack-a-thon](https://epmonthly.com/keyword/hack-a-thon/)
- [National Institute of Drug Abuse](https://epmonthly.com/keyword/national-institute-of-drug-abuse/)
- [NIDA](https://epmonthly.com/keyword/nida/)
- [National Institute on Drug Abuse](https://epmonthly.com/keyword/national-institute-on-drug-abuse/)
- [Opioid overdose](https://epmonthly.com/keyword/opioid-overdose/)
- [application](https://epmonthly.com/keyword/application/)
- [overdose](https://epmonthly.com/keyword/overdose/)
- [Methadone](https://epmonthly.com/keyword/methadone/)
- [and Hydrocodone](https://epmonthly.com/keyword/and-hydrocodone/)
- [naloxone auto-injector](https://epmonthly.com/keyword/naloxone-auto-injector/)
- [Evzio](https://epmonthly.com/keyword/evzio/)
- [intra-nasal spray](https://epmonthly.com/keyword/intra-nasal-spray/)
- [Narcan](https://epmonthly.com/keyword/narcan/)
- [CNS depression](https://epmonthly.com/keyword/cns-depression/)
- [respiratory stabilization](https://epmonthly.com/keyword/respiratory-stabilization/)
- [Cervical Spine X-Ray](https://epmonthly.com/keyword/cervical-spine-x-ray/)
- [CT scanners](https://epmonthly.com/keyword/ct-scanners/)
- [Siemens SOMATOM Force dual source scanner](https://epmonthly.com/keyword/siemens-somatom-force-dual-source-scanner/)
- [NEXUS trial](https://epmonthly.com/keyword/nexus-trial/)
- [RADIOGRAPHS](https://epmonthly.com/keyword/radiographs/)
- [COMPUTED TOMOGRAPHY](https://epmonthly.com/keyword/computed-tomography/)
- [TeamHealth](https://epmonthly.com/keyword/teamhealth/)
- [Blackstone Group LP](https://epmonthly.com/keyword/blackstone-group-lp/)
- [emergency medicine group acquisitions](https://epmonthly.com/keyword/emergency-medicine-group-acquisitions/)
- [AmSurg](https://epmonthly.com/keyword/amsurg/)
- [Jana Partners](https://epmonthly.com/keyword/jana-partners/)
- [Bloomberg](https://epmonthly.com/keyword/bloomberg/)
- [L.A. Kings hockey game](https://epmonthly.com/keyword/l-a-kings-hockey-game/)
- [Sujal Mandavia](https://epmonthly.com/keyword/sujal-mandavia/)
- [EMT](https://epmonthly.com/keyword/emt/)
- [chainsaw](https://epmonthly.com/keyword/chainsaw/)
- [staples](https://epmonthly.com/keyword/staples/)
- [laceration](https://epmonthly.com/keyword/laceration/)
- [antibiotics](https://epmonthly.com/keyword/antibiotics/)
- [medical lawsuit](https://epmonthly.com/keyword/medical-lawsuit/)
- [medical malpractice](https://epmonthly.com/keyword/medical-malpractice/)
- [Dexamethasone](https://epmonthly.com/keyword/dexamethasone/)
- [Asthma](https://epmonthly.com/keyword/asthma/)
- [Dex](https://epmonthly.com/keyword/dex/)
- [pediatric asthma management](https://epmonthly.com/keyword/pediatric-asthma-management/)
- [acute exacerbation](https://epmonthly.com/keyword/acute-exacerbation/)
- [predisone](https://epmonthly.com/keyword/predisone/)
- [prednisolone](https://epmonthly.com/keyword/prednisolone/)
- [breast pump](https://epmonthly.com/keyword/breast-pump/)
- [lactation](https://epmonthly.com/keyword/lactation/)
- [SCB](https://epmonthly.com/keyword/scb/)
- [benzodiazepines](https://epmonthly.com/keyword/benzodiazepines/)
- [psychosis](https://epmonthly.com/keyword/psychosis/)
- [schedule](https://epmonthly.com/keyword/schedule/)
- [nights](https://epmonthly.com/keyword/nights/)
- [weekends](https://epmonthly.com/keyword/weekends/)
- [holidays](https://epmonthly.com/keyword/holidays/)
- [Older Patients](https://epmonthly.com/keyword/older-patients/)
- [topical agents](https://epmonthly.com/keyword/topical-agents/)
- [physical therapy](https://epmonthly.com/keyword/physical-therapy/)
- [proximal humerus fracture](https://epmonthly.com/keyword/proximal-humerus-fracture/)
- [COPD](https://epmonthly.com/keyword/copd/)
- [Nerve blocks](https://epmonthly.com/keyword/nerve-blocks/)
- [Pain Control](https://epmonthly.com/keyword/pain-control/)
- [Hematoma Blocks](https://epmonthly.com/keyword/hematoma-blocks/)
- [Fragility Fractures](https://epmonthly.com/keyword/fragility-fractures/)
- [TXA](https://epmonthly.com/keyword/txa/)
- [Traumatic Bleeds](https://epmonthly.com/keyword/traumatic-bleeds/)
- [Tranexamic acid](https://epmonthly.com/keyword/tranexamic-acid/)
- [antifibrinolytic drug](https://epmonthly.com/keyword/antifibrinolytic-drug/)
- [clot stabilizer](https://epmonthly.com/keyword/clot-stabilizer/)
- [lysine](https://epmonthly.com/keyword/lysine/)
- [fibrin clot](https://epmonthly.com/keyword/fibrin-clot/)
- [intravenous](https://epmonthly.com/keyword/intravenous/)
- [epistaxis](https://epmonthly.com/keyword/epistaxis/)
- [postpartum hemorrhage](https://epmonthly.com/keyword/postpartum-hemorrhage/)
- [Trauma-related hemorrhage](https://epmonthly.com/keyword/trauma-related-hemorrhage/)
- [CRASH-2 trial](https://epmonthly.com/keyword/crash-2-trial/)
- [cutaneous bleeding](https://epmonthly.com/keyword/cutaneous-bleeding/)
- [mucous membrane](https://epmonthly.com/keyword/mucous-membrane/)
- [Glass](https://epmonthly.com/keyword/glass/)
- [HMO](https://epmonthly.com/keyword/hmo/)
- [granuloma](https://epmonthly.com/keyword/granuloma/)
- [radio-opaque](https://epmonthly.com/keyword/radio-opaque/)
- [foreign body](https://epmonthly.com/keyword/foreign-body/)
- [small parts probe](https://epmonthly.com/keyword/small-parts-probe/)
- [high frequency linear array transducer](https://epmonthly.com/keyword/high-frequency-linear-array-transducer/)
- [contralateral](https://epmonthly.com/keyword/contralateral/)
- [adult mortality](https://epmonthly.com/keyword/adult-mortality/)
- [adult mortality in the emergency department](https://epmonthly.com/keyword/adult-mortality-in-the-emergency-department/)
- [death](https://epmonthly.com/keyword/death/)
- [palliative care](https://epmonthly.com/keyword/palliative-care/)
- [dataset](https://epmonthly.com/keyword/dataset/)
- [hospice](https://epmonthly.com/keyword/hospice/)
- [critical care fellowships](https://epmonthly.com/keyword/critical-care-fellowships/)
- [emergency critical care](https://epmonthly.com/keyword/emergency-critical-care/)
- [holiday handouts](https://epmonthly.com/keyword/holiday-handouts/)
- [Patient Gifts](https://epmonthly.com/keyword/patient-gifts/)
- [policy on gifts](https://epmonthly.com/keyword/policy-on-gifts/)
- [no gifts policy](https://epmonthly.com/keyword/no-gifts-policy/)
- [ED Admission Rates](https://epmonthly.com/keyword/ed-admission-rates/)
- [Admission Rates](https://epmonthly.com/keyword/admission-rates/)
- [EM Abstracts](https://epmonthly.com/keyword/em-abstracts/)
- [variation](https://epmonthly.com/keyword/variation/)
- [EMR](https://epmonthly.com/keyword/emr/)
- [EMRs](https://epmonthly.com/keyword/emrs/)
- [CT angiograms](https://epmonthly.com/keyword/ct-angiograms/)
- [Kanavel](https://epmonthly.com/keyword/kanavel/)
- [pyogenic flexor tenosynovitis](https://epmonthly.com/keyword/pyogenic-flexor-tenosynovitis/)
- [PFT](https://epmonthly.com/keyword/pft/)
- [Staphylococcus](https://epmonthly.com/keyword/staphylococcus/)
- [Streptococcus](https://epmonthly.com/keyword/streptococcus/)
- [MRI](https://epmonthly.com/keyword/mri/)
- [vancomycin](https://epmonthly.com/keyword/vancomycin/)
- [nurse manager](https://epmonthly.com/keyword/nurse-manager/)
- [CEO](https://epmonthly.com/keyword/ceo/)
- [chief nursing officer](https://epmonthly.com/keyword/chief-nursing-officer/)
- [CNO](https://epmonthly.com/keyword/cno/)
- [United Front](https://epmonthly.com/keyword/united-front/)
- [C-suite](https://epmonthly.com/keyword/c-suite/)
- [Year in Review](https://epmonthly.com/keyword/year-in-review/)
- [opioid epidemic](https://epmonthly.com/keyword/opioid-epidemic/)
- [2016](https://epmonthly.com/keyword/2016/)
- [Merit-Based Incentive Payment System](https://epmonthly.com/keyword/merit-based-incentive-payment-system/)
- [PSYCHIATRIC BOARDING](https://epmonthly.com/keyword/psychiatric-boarding/)
- [Pulmonary Hypertension](https://epmonthly.com/keyword/pulmonary-hypertension/)
- [Dyspnea](https://epmonthly.com/keyword/dyspnea/)
- [high morbidity](https://epmonthly.com/keyword/high-morbidity/)
- [high mortality](https://epmonthly.com/keyword/high-mortality/)
- [Primary pulmonary hypertension](https://epmonthly.com/keyword/primary-pulmonary-hypertension/)
- [Pathophysiology](https://epmonthly.com/keyword/pathophysiology/)
- [Pulmonary artery](https://epmonthly.com/keyword/pulmonary-artery/)
- [right ventricle](https://epmonthly.com/keyword/right-ventricle/)
- [pulmonary vascular resistance](https://epmonthly.com/keyword/pulmonary-vascular-resistance/)
- [RV failure](https://epmonthly.com/keyword/rv-failure/)
- [diastole](https://epmonthly.com/keyword/diastole/)
- [Cincinnati](https://epmonthly.com/keyword/cincinnati/)
- [residency training](https://epmonthly.com/keyword/residency-training/)
- [1960](https://epmonthly.com/keyword/1960/)
- [Dr. Herbert Flessa](https://epmonthly.com/keyword/dr-herbert-flessa/)
- [The American Medical Association](https://epmonthly.com/keyword/the-american-medical-association/)
- [Bruce Janiak](https://epmonthly.com/keyword/bruce-janiak/)
- [401k](https://epmonthly.com/keyword/401k/)
- [IRS](https://epmonthly.com/keyword/irs/)
- [expense ratio](https://epmonthly.com/keyword/expense-ratio/)
- [internal expenses](https://epmonthly.com/keyword/internal-expenses/)
- [IRA](https://epmonthly.com/keyword/ira/)
- [Gambling](https://epmonthly.com/keyword/gambling/)
- [new year](https://epmonthly.com/keyword/new-year/)
- [international](https://epmonthly.com/keyword/international/)
- [international EM](https://epmonthly.com/keyword/international-em/)
- [FIFEM](https://epmonthly.com/keyword/fifem/)
- [Fellow of the International Federation for Emergency Medicine](https://epmonthly.com/keyword/fellow-of-the-international-federation-for-emergency-medicine/)
- [locum tenens](https://epmonthly.com/keyword/locum-tenens/)
- [Lucidity](https://epmonthly.com/keyword/lucidity/)
- [passion project](https://epmonthly.com/keyword/passion-project/)
- [Beach Body](https://epmonthly.com/keyword/beach-body/)
- [HealthyER Doc](https://epmonthly.com/keyword/healthyer-doc/)
- [Modafinil](https://epmonthly.com/keyword/modafinil/)
- [Eugeroics](https://epmonthly.com/keyword/eugeroics/)
- [caffeine](https://epmonthly.com/keyword/caffeine/)
- [night shifts](https://epmonthly.com/keyword/night-shifts/)
- [OSA](https://epmonthly.com/keyword/osa/)
- [SWSD](https://epmonthly.com/keyword/swsd/)
- [shift work sleep disorder](https://epmonthly.com/keyword/shift-work-sleep-disorder/)
- [narcolepsy](https://epmonthly.com/keyword/narcolepsy/)
- [Armodafinil](https://epmonthly.com/keyword/armodafinil/)
- [Nuvigil](https://epmonthly.com/keyword/nuvigil/)
- [R-enantiomer](https://epmonthly.com/keyword/r-enantiomer/)
- [amphetamines](https://epmonthly.com/keyword/amphetamines/)
- [Adderall](https://epmonthly.com/keyword/adderall/)
- [methylphenidate](https://epmonthly.com/keyword/methylphenidate/)
- [Ritalin](https://epmonthly.com/keyword/ritalin/)
- [neuro-enhancers](https://epmonthly.com/keyword/neuro-enhancers/)
- [Mobile CT stroke programs](https://epmonthly.com/keyword/mobile-ct-stroke-programs/)
- [Mobile CT](https://epmonthly.com/keyword/mobile-ct/)
- [mobile CT stroke units](https://epmonthly.com/keyword/mobile-ct-stroke-units/)
- [hyperechoic soft tissue](https://epmonthly.com/keyword/hyperechoic-soft-tissue/)
- [blind-ending loop](https://epmonthly.com/keyword/blind-ending-loop/)
- [psoas muscle](https://epmonthly.com/keyword/psoas-muscle/)
- [Intrauterine Devices](https://epmonthly.com/keyword/intrauterine-devices/)
- [IUDs](https://epmonthly.com/keyword/iuds/)
- [LARC](https://epmonthly.com/keyword/larc/)
- [Long Acting Reversible Contraception](https://epmonthly.com/keyword/long-acting-reversible-contraception/)
- [PID](https://epmonthly.com/keyword/pid/)
- [Pregnancy](https://epmonthly.com/keyword/pregnancy/)
- [NSAIDS](https://epmonthly.com/keyword/nsaids/)
- [prostaglandin inhibition](https://epmonthly.com/keyword/prostaglandin-inhibition/)
- [contraceptive](https://epmonthly.com/keyword/contraceptive/)
- [Missed Airways](https://epmonthly.com/keyword/missed-airways/)
- [HIPAA Headaches](https://epmonthly.com/keyword/hipaa-headaches/)
- [HIPAA](https://epmonthly.com/keyword/hipaa/)
- [obese](https://epmonthly.com/keyword/obese/)
- [obesity](https://epmonthly.com/keyword/obesity/)
- [video laryngoscopy](https://epmonthly.com/keyword/video-laryngoscopy/)
- [Facebook](https://epmonthly.com/keyword/facebook/)
- [HIPAA compliance office](https://epmonthly.com/keyword/hipaa-compliance-office/)
- [EM Docs](https://epmonthly.com/keyword/em-docs/)
- [Physician Moms Group](https://epmonthly.com/keyword/physician-moms-group/)
- [residency](https://epmonthly.com/keyword/residency/)
- [resident](https://epmonthly.com/keyword/resident/)
- [Short Ride in a Fast Machine](https://epmonthly.com/keyword/short-ride-in-a-fast-machine/)
- [specialty](https://epmonthly.com/keyword/specialty/)
- [John Adams](https://epmonthly.com/keyword/john-adams/)
- [American Board of Medical Specialties](https://epmonthly.com/keyword/american-board-of-medical-specialties/)
- [ABMS](https://epmonthly.com/keyword/abms/)
- [National Academy of Medicine](https://epmonthly.com/keyword/national-academy-of-medicine/)
- [Institute of Medicine](https://epmonthly.com/keyword/institute-of-medicine/)
- [Steven J. Stack](https://epmonthly.com/keyword/steven-j-stack/)
- [American Medical Association](https://epmonthly.com/keyword/american-medical-association/)
- [John W. Becher](https://epmonthly.com/keyword/john-w-becher/)
- [American Osteopathic Association](https://epmonthly.com/keyword/american-osteopathic-association/)
- [John C. Moorhead](https://epmonthly.com/keyword/john-c-moorhead/)
- [Willy Wonka](https://epmonthly.com/keyword/willy-wonka/)
- [Alex Spyropoulos](https://epmonthly.com/keyword/alex-spyropoulos/)
- [clinical thrombosis](https://epmonthly.com/keyword/clinical-thrombosis/)
- [venous thromboembolism](https://epmonthly.com/keyword/venous-thromboembolism/)
- [VTE](https://epmonthly.com/keyword/vte/)
- [Transplant Patient](https://epmonthly.com/keyword/transplant-patient/)
- [Organ transplantation](https://epmonthly.com/keyword/organ-transplantation/)
- [infection](https://epmonthly.com/keyword/infection/)
- [rejection](https://epmonthly.com/keyword/rejection/)
- [transplant rejection](https://epmonthly.com/keyword/transplant-rejection/)
- [immunosuppression](https://epmonthly.com/keyword/immunosuppression/)
- [Immunosuppressive medications](https://epmonthly.com/keyword/immunosuppressive-medications/)
- [uterine contractions](https://epmonthly.com/keyword/uterine-contractions/)
- [fluid leakage](https://epmonthly.com/keyword/fluid-leakage/)
- [PPH](https://epmonthly.com/keyword/pph/)
- [Tone](https://epmonthly.com/keyword/tone/)
- [Trauma](https://epmonthly.com/keyword/trauma/)
- [Tissue](https://epmonthly.com/keyword/tissue/)
- [Thrombin](https://epmonthly.com/keyword/thrombin/)
- [HELLP syndrome](https://epmonthly.com/keyword/hellp-syndrome/)
- [Uterine packing](https://epmonthly.com/keyword/uterine-packing/)
- [fee-only advisor](https://epmonthly.com/keyword/fee-only-advisor/)
- [corporate retirement plan](https://epmonthly.com/keyword/corporate-retirement-plan/)
- [financial advisor](https://epmonthly.com/keyword/financial-advisor/)
- [tax return](https://epmonthly.com/keyword/tax-return/)
- [tax deduction](https://epmonthly.com/keyword/tax-deduction/)
- [Summa](https://epmonthly.com/keyword/summa/)
- [Summa Health System](https://epmonthly.com/keyword/summa-health-system/)
- [SEA](https://epmonthly.com/keyword/sea/)
- [USACS](https://epmonthly.com/keyword/usacs/)
- [Akron City](https://epmonthly.com/keyword/akron-city/)
- [EPM](https://epmonthly.com/keyword/epm/)
- [Dominic Bagnoli](https://epmonthly.com/keyword/dominic-bagnoli/)
- [Thomas Malone](https://epmonthly.com/keyword/thomas-malone/)
- [RFP](https://epmonthly.com/keyword/rfp/)
- [CORD](https://epmonthly.com/keyword/cord/)
- [EMRA](https://epmonthly.com/keyword/emra/)
- [Summa Health](https://epmonthly.com/keyword/summa-health/)
- [CMGs](https://epmonthly.com/keyword/cmgs/)
- [GruntDoc](https://epmonthly.com/keyword/gruntdoc/)
- [Tom Kinney](https://epmonthly.com/keyword/tom-kinney/)
- [Trump](https://epmonthly.com/keyword/trump/)
- [Rand Paul](https://epmonthly.com/keyword/rand-paul/)
- [Tom Price](https://epmonthly.com/keyword/tom-price/)
- [HR 2300](https://epmonthly.com/keyword/hr-2300/)
- [abdomen](https://epmonthly.com/keyword/abdomen/)
- [pelvis](https://epmonthly.com/keyword/pelvis/)
- [DKA](https://epmonthly.com/keyword/dka/)
- [ectopic pregnancy](https://epmonthly.com/keyword/ectopic-pregnancy/)
- [ketones](https://epmonthly.com/keyword/ketones/)
- [Callback](https://epmonthly.com/keyword/callback/)
- [patient follow-up](https://epmonthly.com/keyword/patient-follow-up/)
- [patient follow-up calls](https://epmonthly.com/keyword/patient-follow-up-calls/)
- [staff meetings](https://epmonthly.com/keyword/staff-meetings/)
- [virtual meetings](https://epmonthly.com/keyword/virtual-meetings/)
- [PowerPoint](https://epmonthly.com/keyword/powerpoint/)
- [Prednisone](https://epmonthly.com/keyword/prednisone/)
- [Hippocrates](https://epmonthly.com/keyword/hippocrates/)
- [Paul Kalanithi](https://epmonthly.com/keyword/paul-kalanithi/)
- [Hippocratic Oath](https://epmonthly.com/keyword/hippocratic-oath/)
- [lisa morena-walton](https://epmonthly.com/keyword/lisa-morena-walton/)
- [Cuba](https://epmonthly.com/keyword/cuba/)
- [Cuba Libre](https://epmonthly.com/keyword/cuba-libre/)
- [Havana](https://epmonthly.com/keyword/havana/)
- [CRASH2](https://epmonthly.com/keyword/crash2/)
- [Master of Urgencias Médicas](https://epmonthly.com/keyword/master-of-urgencias-medicas/)
- [ED ICU](https://epmonthly.com/keyword/ed-icu/)
- [JET’s desk](https://epmonthly.com/keyword/jets-desk/)
- [Pancreatic Cancer](https://epmonthly.com/keyword/pancreatic-cancer/)
- [Whipple](https://epmonthly.com/keyword/whipple/)
- [cachectic chemo](https://epmonthly.com/keyword/cachectic-chemo/)
- [chemo](https://epmonthly.com/keyword/chemo/)
- [jaime hope](https://epmonthly.com/keyword/jaime-hope/)
- [Non-Opioid Pain Patch](https://epmonthly.com/keyword/non-opioid-pain-patch/)
- [lidocaine patch](https://epmonthly.com/keyword/lidocaine-patch/)
- [opioid abuse](https://epmonthly.com/keyword/opioid-abuse/)
- [hydrogel adhesive](https://epmonthly.com/keyword/hydrogel-adhesive/)
- [neuralgia](https://epmonthly.com/keyword/neuralgia/)
- [Lidocaine](https://epmonthly.com/keyword/lidocaine/)
- [Breastfeeding](https://epmonthly.com/keyword/breastfeeding/)
- [Esther Choo](https://epmonthly.com/keyword/esther-choo/)
- [JAMA Internal Medicine](https://epmonthly.com/keyword/jama-internal-medicine/)
- [male and female physicians](https://epmonthly.com/keyword/male-and-female-physicians/)
- [gender](https://epmonthly.com/keyword/gender/)
- [gender-based differences](https://epmonthly.com/keyword/gender-based-differences/)
- [gender bias](https://epmonthly.com/keyword/gender-bias/)
- [gender differences](https://epmonthly.com/keyword/gender-differences/)
- [Vietnam War](https://epmonthly.com/keyword/vietnam-war/)
- [Vietnam](https://epmonthly.com/keyword/vietnam/)
- [US. Military medicine](https://epmonthly.com/keyword/us-military-medicine/)
- [trauma care](https://epmonthly.com/keyword/trauma-care/)

## Blog Type

- [WhiteCoat’s Call Room](https://epmonthly.com/blog_type/whitecoat/)
- [Crash Cart](https://epmonthly.com/blog_type/crash_cart/)

## Category

- [Random Thoughts](https://epmonthly.com/blog_category/random-thoughts/)
- [Health](https://epmonthly.com/blog_category/health/)
- [News Commentary](https://epmonthly.com/blog_category/news-commentary/)
- [Patient Encounters](https://epmonthly.com/blog_category/patient-encounters/)
- [Medicare](https://epmonthly.com/blog_category/medicare/)
- [Policy](https://epmonthly.com/blog_category/policy/)
- [CMS](https://epmonthly.com/blog_category/cms/)
- [Joint Commission](https://epmonthly.com/blog_category/joint-commission/)
- [FDA](https://epmonthly.com/blog_category/fda/)
- [Medical Topics](https://epmonthly.com/blog_category/medical-topics/)
- [Medical-Legal](https://epmonthly.com/blog_category/medical-legal/)
- [Comics](https://epmonthly.com/blog_category/comics/)
- [Medical History](https://epmonthly.com/blog_category/medical-history/)
- [Insurance](https://epmonthly.com/blog_category/insurance/)
- [Vaccinations](https://epmonthly.com/blog_category/vaccinations/)
- [Never Events](https://epmonthly.com/blog_category/never-events/)
- [Funding Crisis](https://epmonthly.com/blog_category/funding-crisis/)
- [Funny](https://epmonthly.com/blog_category/funny/)
- [Access to Care](https://epmonthly.com/blog_category/access-to-care/)
- [Medical Studies](https://epmonthly.com/blog_category/medical-studies/)
- [ED Closures](https://epmonthly.com/blog_category/ed-closures/)
- [Healthcare Update](https://epmonthly.com/blog_category/healthcare-update/)
- [What's the Diagnosis?](https://epmonthly.com/blog_category/whats-the-diagnosis/)
- [EMTALA](https://epmonthly.com/blog_category/emtala/)
- [Trial](https://epmonthly.com/blog_category/trial/)
- [Computers](https://epmonthly.com/blog_category/computers/)
- [Haiti Mission](https://epmonthly.com/blog_category/haiti-mission/)
- [Defensive Medicine](https://epmonthly.com/blog_category/defensive-medicine/)
- [Health care reform](https://epmonthly.com/blog_category/health-care-reform/)
- [Press Ganey](https://epmonthly.com/blog_category/press-ganey/)
- [Guest Posts](https://epmonthly.com/blog_category/guest-posts/)
- [Crash Cart](https://epmonthly.com/blog_category/crash-cart/)