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 alarm goes off, you’re thinking that the alarm is broken and someone needs to get that fixed. After about thirty false alarms, you’re feeling like going out there and busting up the car yourself – especially if the car alarm wakes you when you’re asleep.
So alarms can be good, but if there are too many “false positives” –- in other words if they go off too much when nothing is wrong –- people tend to become tired of listening to them and eventually ignore the alarms. On the other hand, if there are too many “false negatives” –- meaning that they don’t go off when something is wrong –- then the alarms aren’t fulfilling their purpose.
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
In the Emergency Department, we treat a wide variety of patients, so you must learn how to harmonize with everyone from CEOs and celebrities to blue-collar workers, alcoholics, drug dealers, criminals, feisty old folks, exhausted parents, defiant teenagers, babies, and everything in between.
As a first year resident in Emergency Medicine — I have had many colleagues ask me one simple question, “What about burnout?” To be honest, I never quite understood why so many non-Emergency Medicine colleagues seem to think burnout is more likely to occur in Emergency Medicine than in other specialties. Perhaps because Emergency Medicine is so appealing, that it must be too good to be true!?
But let’s be honest, working as an ER doc is probably more stressful than you imagine — but a career in Emergency Medicine is also vastly more rewarding than you likely realize. You will have some people wrap their arms around you and not want to let go, but you’ll also have other patients who will want to rip your spleen out and eat it. At the end of the day — saving lives is arguably the most important and rewarding job in the world. As an Emergency Physician, no other specialty will give you so many opportunities to help so many people in so many ways.
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.
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 shocked that any members of the band ZZ Top were still alive, let alone putting out new music that was actually getting airplay. Also strange, is that the song is a remake of an old rap song. The lyric reminded me of a patient who I won’t name. It would be a safe assumption that he was a gang member. He wore saggy, baggy pants, and was heavily tattooed and shirtless. He either spent 8 hours a day in the gym lifting weights, or ate a healthy diet of steroids. If he had killed half as many people as his tattoos indicated, it was certainly in my best interest to keep him happy. This was one patient satisfaction score I would ace. I’ll call him Lighterman.
“Yo doc! You gotta fix my hand, man,” Lighterman said in his gang accent. He held up his bleeding hand.
“What happened?” I asked.
“I used my knife to open a bottle of some Robitussin to put in my beer and I slipped,” he said. “My brother is home right now getting wasted on my stash.”
Halloween. The word conjures up wonderful memories for most people, and children often rate it as one of their favorite days of the year. However, it is also one of the 4 most likely days of the year that children will make trips to the emergency department. Injuries in both adults and children can run the gamut from trips and falls, as a consequence of ill-fitting costumes, to motor vehicle accidents resulting from excessive alcohol use. What are the factors that lead to the increase in risk? And what are the specific injuries and events seen in both adults and children on this often very frightening night?
“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
It is generally agreed upon that the more one values a good or service, the more he or she is willing to pay for it. Most will agree that shoes are important. They keep your feet from bleeding and hurting when you walk on the street. People seem happy to pay anywhere between $20 to $150 for them. Some will clamor to pay without complaint as much as $315 for sneakers that mimic those of their favorite basketball hero, or $865 for designer Manolo Blahnik “BB” Snakeskin Pumps. Many place great value on a youthful physical appearance and sex appeal and will gladly pay up to $15,000 cash for a new pair of breasts with little if any sense of resentment for the doctor providing the service and metering the charge. Having a car, most of us will agree is very important, and therefore paying around $30,000 is pretty average. Though it seems that many are outraged at a Plastic Surgeon charging $12,000 to repair a fingertip, most people consider their limbs and appendages important, and being able to use them of significant value. Therefore, it follows that a total cost of approximately $40,000 for a hip replacement tends be generally well accepted and frequently paid by insurance companies along with the physician portion of $1,505 (CMS CPT 27130.)
So how much is your life worth to you? Clearly it is worth more than a pair of shoes. Are we still in agreement? Certainly you would be more than happy to pay $20 to $150 to have it saved, if you or your insurance company had the finances. Is a human being’s life in total worth more than the $15,000 pair of augmented breasts on the human being? I’m sure most would agree it is. I’m sure as a society we must pay more than this for a human life saved, correct? I’m sure we all similarly agree that the entire value of a human life saved is greater than the value of a “spare replacement part” such as a $40,000 hip. We must certainly and gladly pay those who save our lives at least as much as we pay for sneakers, designer shoes, our cars or a spare hip, correct?
No. We don’t. It’s not even close!
A 76-year-old man presents to the emergency department with sudden-onset abdominal pain of 4 hours duration. The pain is present in the upper abdomen, centered in the epigastrium, and described as deep and burning. The patient has a medical history of coronary artery disease and hypertension. He also reports having “indigestion,” which has caused pain similar to today’s episode in his upper abdomen. In the past, food did not relieve this symptom.
On physical examination, the patient is pale and in obvious discomfort. His heart rate is 122 beats/min and his blood pressure is 110/65 mm Hg. The cardiovascular and respiratory findings are unremarkable, but he has tenderness in the epigastric region of his abdomen. His stool is brown and guaiac positive. Hyperactive bowel sounds are heard on auscultation. Laboratory investigations show a mild anemia, with a hemoglobin concentration of 127 g/L (12.7 g/dL) and BUN and creatinine values of 17.1 mmol/L (48 mg/dL) and 106 µmol/L (1.2 mg/dL), respectively.
What is the diagnosis? How would you approach this patient’s treatment?
Our thanks are extended to Gautam Dehadrai, MD, for providing the details of this case. Check back here in about two weeks when I post the diagnosis and follow-up for this patient.
Redditor johnboy9210 retrieved a football from a stagnant koi pond one day and contracted necrotizing fasciitis, the infamous flesh-eating disease. Fortunately, we don’t have to experience the tissue-chomping bacteria first-hand, and can instead witness his photographic account from the early signs of infection through his multiple surgeries.
Just 36 hours after the bacteria first entered his body, johnboy9210 took a photo of his swollen, throbbing pinky finger. When his pinky started turning black, he rushed to the ER. At first, the doctors planned to culture the bacteria from his finger, but it soon became clear that he needed immediate surgery to remove the infected tissue. It wasn’t until after his first surgery that he received his diagnosis, and learned exactly which bug it was: Streptococcus pyogenes. And that proved just the beginning of his medical adventure.
We’ve become a nation of hypochondriacs. Every sneeze is swine flu, every headache a tumor. And at great expense, we deliver fantastically prompt, thorough and largely unnecessary care. There is tremendous financial pressure on physicians to keep patients happy. But unlike business, in medicine the customer isn’t always right. Sometimes a doctor needs to show tough love and deny patients the quick fix. A good physician needs to have the guts to stand up to people and tell them that their baby gets ear infections because they smoke cigarettes. That it’s time to admit they are alcoholics. That they need to suck it up and deal with discomfort because narcotics will just make everything worse. That what’s really wrong with them is that they are just too damned fat. Unfortunately, this type of advice rarely leads to high patient satisfaction scores.
I couldn’t have said it better myself. What a fabulous paragraph, even if the article is a couple of years old. Click on the link below to read the rest of the article by Dr. Thomas A. Doyle. No, I don’t know who he is or anything about him either, except for the bit of blurb at the end of the article. But he has some very interesting things to say, don’t you think?
Read More via Emergency Physicians Monthly