[4 MIN READ]
ACOG has issued a practice advisory regarding the recent measles outbreak.
It is hard to fathom that a disease once considered eradicated is now in a state of progression across the United States. To date, there are 764 reported cases across 23 states; this number has increased by 60 cases from the previous week as reported by the CDC. No state is immune, and nationwide advancement is probable.
[3 MIN READ]
The risks we face as acute care practitioners are not static—they evolve over time. Just as we master the approach to a longstanding high-risk problem, a new risky patient presentation rears its head to challenge us. Consider ectopic pregnancy. Now that we routinely obtain pregnancy tests on all women from age 10 to 60 and have access to or skills in ultrasound, the evaluation of possible ectopic pregnancy has become largely an algorithmically routine matter, and errors involving ectopic pregnancy have plummeted as a result.
In today’s case presentation, we will navigate the difficult waters of patient refusal of life-saving care based upon religious beliefs. In this actual case, a woman’s life hung the balance. There was little time for formal mental status evaluation or communication with legal counsel or a local judge.
It was around 8:30 pm during a busy shift in the Cook County Emergency Department. A young woman had been rolled into the department with low blood pressure.
Providing care to psychiatric patients in the emergency department is a challenge for many reasons.
For the ED, however, the greatest risk and safety issue related to behavioral health is the appropriate evaluation and protection of the suicidal patient in the ED. We present 2 case studies to illuminate the uncommon but preventable catastrophe of suicide in the ED.
Clinicians issue tens of millions of warfarin prescriptions each year in the U.S., despite the increasing use of alternative anticoagulant medications. Practitioners will continue to encounter warfarin, known both for its irreplaceable value and potential for life-threatening complications. Due to the propensity for permanent disability and death from hemorrhagic complications, litigation is common and costly. Knowledge of the pharmacology, indications, monitoring, drug interactions and complications of warfarin is an essential tool to avoid patient harm, medical errors, and the medical-legal vulnerabilities associated with its use.
Infants and children with acute abdominal pain present to emergency departments, urgent care centers and physician offices with a variety of signs and symptoms. Since infants can’t localize pain and pre-school children are often imprecise in their responses, the healthcare practitioner may find it difficult to ascertain the actual dilemma.
Intoxication! Talk about a red flag! Let’s consider two “flavors,” if you will. First, the patient with an actual chief complaint AND who happens to be intoxicated. Next, the patient who presents with apparent intoxication and no other immediately obvious issues. And for those of you who have not had a busy shift in an urban emergency department, the number of patients with altered mentation secondary to alcohol can be remarkable. Unfortunately, many of these patients get to be regular visitors; they are well known by the emergency providers and are often on a first-name basis.
When a patient presents with chest pain or chest-related symptoms, the role of the triage nurse is to critically evaluate the relationship of risk factors to outcome potentials to make the best triage decisions. The more risk factors a patient has, the greater the triage nurse’s concern for a potential high-risk scenario. In this blog, we will propose several triage questions for chest pain and consider several serious concerns that can prompt a patient to present with chest-related complaints, not all of which involve the heart:
There are a number of laws in the various states that prohibit the abuse or exploitation of certain classes of people. The classes of persons who are protected generally include those who are particularly vulnerable to abuse and who may be incapable of defending themselves. The prohibition against child abuse is inherent in virtually all state statutory schemes and is widely known. Less well known, at least outside the long-term care industry, is the prohibition against the abuse or exploitations of the elderly and other vulnerable adults.
There are four time-sensitive emergencies that that every practitioner of acute care medicine should master to deliver the best possible care in the safest manner: Code Trauma, Code STEMI, Code Stroke, and today's topic – Code Sepsis. Depending on the specialty, practitioners are involved in sepsis care at one or more stages of sepsis. In the office, urgent care or ED, the first two stages are paramount – early recognition and aggressive resuscitation. Hospitalists and admitting practitioners continue the initial management through recovery.
