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Posts tagged ED

A Wisconsin hospital offers an ATM like machine that dispenses prescription medications. Bad news is that patients need a credit or debit card to pay for the medications, no cash allowed.

In addition, you have to visit the hospital’s own ED or acute care clinic – no other prescriptions work in the machine.

Read more at: Ministry Good Samaritan

Ketamine, also known as “Special K” in some circles — produces effects similar to phencyclidine (PCP) and dextromethorphan (DXM), but it is also has many powerful treatment options.

Ketamine is primarily used for the induction and maintenance of general anesthesia, usually in combination with a sedative. Other uses include sedation in intensive care, analgesia (particularly in emergency medicine), and treatment of bronchospasm.

Let’s get down to the specifics..

Ketamine is a noncompetitive N-methyl D-aspartate (NMDA) receptor antagonist that blocks the release of excitatory neurotransmitter glutamate and provides anesthesia, amnesia, and analgesia by virtue of decreasing central sensitization and the “wind-up” phenomenon.

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In my Emergency Department we see our fair share of strange and obscure things, but nothing quite like this..

A man sought emergency treatment at hospital in Auckland this week with an eel stuck up his bottom.

The unnamed individual presented himself at the A&E department at Auckland City Hospital to explain his embarrassing problem. It is believed the patient was sent for X-rays and a scan, which showed there was an eel lodged inside him.

“The eel was about the size of a decent sprig of asparagus and the incident is the talk of the place,” a hospital source said. “Doctors and nurses have come across people with strange objects that have got stuck where they shouldn’t be before, but an eel has to be a first.”

Read more at: NZ Herald 

As a physician-in-training, specializing in Emergency Medicine — I thought I’d chime in on the Patient Protection and Affordable Care Act (PPACA). First off, this “mandate” everyone is talking about basically says if you can afford insurance but do not get it, you will be charged a fee — or in other words, taxed.

For some healthcare organizations, physicians, and hospital departments, today’s ruling will have significant implications — hospital emergency departments will be greatly affected.

In the ED, we’ll most likely experience a little increase in reimbursements, as 20 percent of the patients are uninsured. Basically, uninsured individuals, who have been paying for healthcare services independently —- the lowest form of reimbursement for hospitals and EDs —- will have access to insurance through Medicaid and state exchanges.

Aside from that, the EDs will most likely see volumes increase for two reasons.

First, the mere fact that more individuals will be covered by insurance will bring more patients to the ED, especially since the uninsured population has healthcare needs on reserve.

Second, there is not a primary care practice excess in the country. The odds are that newly insured individuals will not be able to see primary care practitioners and instead will visit an emergency room — thus contributing to even more emergency department overcrowding!

We already have our emergency departments full — when I’m in the ED, I constantly see beds in the hall. With PPACA, it will only lead to even more ED crowding, poorer access to emergency care for the truly vulnerable, and more losses for hospitals. It’s not just about the money — if we’re turning patients away due to capacity constraints, we won’t be able to provide adequate emergency care.

“Two gun shot wounds,” the emergency medical technician says, breathing fast, the summer night pouring down his face. “One in the right flank, one in the right thigh.”

“I don’t want to die, doc,” pleads the victim, whom I will call Mr. Smith. His vital signs are stable.

“This is the trauma team,” I say. “We’re going to take good care of you, but we need to ask lots of questions.” I press my stethoscope to his chest. “Can you take some deep breaths?” I listen for the airy hollow of a punctured lung but am calmed by the hum of normal respiration, even as his alcoholic breath warms my cheek — or so I believe. He denies drinking, but this is one of those overnight shifts when everyone — motor vehicle crashes, chest pains, depressions, confused grandmas, even rashes — has thrown back one or two.

Once inside, we palpate Mr. Smith’s neck, chest, back, abdomen, and muscular extremities. “Does it hurt here, and here, and here?”

He doesn’t answer us. Now he acts annoyed and bothered. “Call my cousin,” he says.

“Sure,” I say, “after we make certain you don’t have an injury that needs immediate attention.”

“And you are?” he says.

I’d already introduced myself, but I know what he means: Who am I in the hierarchy? “I’m the doctor in charge,” I tell him.

“Good,” he says. “Go call my cousin.”

“First things first,” I say.

“Hey, douchebag,” he says, his voice hardening. “Call my cousin.”

I pretend the comment was what he might, on reflection, consider a regrettable slip of the tongue. But his head arches off the stretcher and his eyes meet mine. “Now, douchebag.”

I feel the heat of the trauma team’s averted gazes. I say nothing, but inside, I grasp at explanations. He’s been popped with two bullets. Maybe he’s scared, anxious, emotionally shocked. Or he’s a thug, a power-fiend, and now he’s vulnerable. He distrusts authority. Perhaps he is drunk, his tongue greased.

He refuses intravenous fluids, blood draws, x-rays. “Let us take care of you,” I say, proffering shared control, thinking he’ll soften up and participate. “You don’t want to die, do you?”

“I’m not afraid of dying,” he says, despite his plea on arrival. “Listen up, douchebag. Are you calling my cousin or what?”

I swallow hard. The ache in my stomach will ease somewhat when I find time to eat my tuna sandwich. But the frustration feels bottomless — untouchable and undeniable. “What gives you the right to talk to us this way?” I finally say.

He stares me down. I tear the blood pressure cuff from his right bicep.

“I’m not fighting you. Many patients are waiting to be seen. You’re free to go if you want.”

He stares at me. “I’m calling my lawyer!”

“Good luck. We’ll dress those wounds before you leave.”

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What’s the worst thing you can say in an emergency room? This and other questions are answered in an informal survey of doctors, nurses and paramedics, who offer their own insights into the inner workings of hospital emergency rooms. Every year, the nation’s emergency rooms treat 117 million patients, and the average patient spends nearly three hours in the E.R.

But what really goes on behind the scenes? The magazine Reader’s Digest quizzed emergency health workers about the quirks and peeves of the E.R. Here is some of what they had to say.

“The busiest time starts around 6 p.m.; Mondays are the worst. We’re slowest from 3 a.m. to 9 a.m. If you have a choice, come early in the morning.” 
~ Denise King, R.N., Riverside, Calif.

“People who are vomiting their guts out get a room more quickly. The admitting clerks don’t like vomit in the waiting area.” 
~ Joan Somes, R.N., St. Paul, Minn.

“Never tell an E.R. nurse, ‘All I have is this cut on my finger. Why can’t someone just look at it?’ That just shows you have no idea how the E.R. actually works.”
~ Dana Hawkins, R.N., Tulsa, Okla.

“Don’t blame E.R. overcrowding on the uninsured. They account for 17 percent of visits. The underlying problem is hospital overcrowding in general.”
~ Leora Horwitz, M.D., Assistant Professor, Yale University School of Medicine

“Never, ever lie to your E.R. nurse. Their B.S. detectors are excellent, and you lose all credibility when you lie.”
~ Allen Roberts, M.D.

“We hear all kinds of weird stuff. I had a woman who came in at 3 a.m. and said she’d passed out while she was asleep.”
~ Emergency Physician, Suburban Northeast

“Your complaints about your prior doctor will not endear you to us. The more you say, the less we want to deal with you.”
~ Allen Roberts, M.D.

To hear all 50 insights from the emergency room, read both articles from Reader’s Digest, “15 Secrets the E.R. Staff Won’t Tell You,” and “35 More Secrets the E.R. Staff Won’t Tell You.” And then please join the discussion below.

I’ve seen this patient so many times!  Another reason to love the ED.

Do you know that when you walk into an emergency department, your physician may run a test for illicit-drug use without telling you?

Yes, this is something we can and often do. And in many cases, it’s done for a good reason.

Suppose you come in acting confused or excessively sleepy. Your doctors need to know right now whether your condition is caused by alcohol or drugs, or whether it’s something else like a brain infection, a stroke or a seizure. Learning that you have a mind-altering drug in your system is an important piece of the puzzle — especially if you are too confused or incoherent to tell us what is going on.

Or let’s say you come to the emergency department, flipping out — your family says they’ve never seen you like this before. If we test you for PCP and the result is positive, then we have a reason for your erratic behavior, and now we might be able to spare you a spinal tap (to look for that brain infection) or avoid artificially paralyzing you to keep your head still in the CT scan (while looking for that stroke).

So there it is — emergency-care providers must have the ability to obtain rapid laboratory drug-of-abuse tests on demand. These drug screens are an essential tool in our diagnostic kit, enabling us to take care of our patients and protect public health.

Of course, it isn’t so simple. There are some real tradeoffs to testing emergency-department patients for illicit drugs. As practitioners we need to pay attention to the downsides of these tests so we don’t overuse them.

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