EM-Blog - Comments

tooscorgopy comments on Dermabond: A Great Shortcut? by Kevin Klauer, D.O.

tooscorgopy — Tue, 09 Mar 2010 15:20:30 +0000

thanks for adding me to the forum.

Dental Vallejo comments on I Volunteer To Be On The Emergency Medicine Death Panel! by William Mallon, M.D.

Dental Vallejo — Tue, 09 Mar 2010 06:33:57 +0000

Reading this article makes me think how heavy the responsibility of an Emergency Doctor/Surgeon. It is like you are trying to save someone else' life, but then you need to follow specific rules and some are threatening your professional practice. I hope they can find a better system to this. -Ariane

Daisy comments on Dermabond: A Great Shortcut? by Kevin Klauer, D.O.

Daisy — Tue, 09 Mar 2010 02:49:01 +0000

www.em-blog.com, how do you do it?

Aaron Johnston comments on Radiation Crunch Time in the ED by Stephen Colucciello, MD

Aaron Johnston — Mon, 08 Mar 2010 17:57:22 +0000

I think complexities of the relationship between emergency room docs and other specialist groups is also part of the issue.
In Canada there is a definite radiology bias towards CT scan, particularly after-hours as the scans can be read remotely, while after hours ultrasound is frequently unavailable as many hospitals do not staff after hours US-techs (ie. the radiologist would need to attend in person). The pay scale for CT-scan reads also reflects a CT positive bias in terms of dollars per minute versus other modalities.
A different dynamic exists in the relationship between emerg docs and various speciality groups, and we now often 'need' a definitive diagnosis before asking specialist colleagues to evaluate the patient. We recognize that our colleagues are overworked, overburdened and we reflexively attempt to ameliorate this by only referring positive cases to them. In reality the patient with an atypical surgical abdomen may be better served by a physical exam by a surgeon than by a CT scan (or more commonly a second/third or fourth CT scan).
In my opinion the demanding patient scenario is a red herring, or at best a minor factor, in the entire argument. 'My child hit her head and needs a scan' can be interpreted as 'I am worried my child is badly hurt'. The tactic of addressing that worry rather than the CT scan defuses most of these situations. For the parents who remain worried, and who cannot be reliably coached to observe for red flags, a 24 hour observational admission is an alternative (though I have never had anyone take me up on that offer when the child is well and I have explained my concerns about future cancer).
My 2 cents..
Aaron

AccectBaity comments on Dermabond: A Great Shortcut? by Kevin Klauer, D.O.

AccectBaity — Sat, 06 Mar 2010 02:56:44 +0000

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Sue Ieraci comments on Ethics In Our Practice: Doing Nothing by Jim Ducharme MD CM FRCP

Sue Ieraci — Thu, 04 Mar 2010 04:53:36 +0000

Thanks for this post. See my similar sentiments in my Feb 15th post - rules for respecting the elderly. My philisophy is not to do nothing, but to do something caring instead of something medical. Physical comfort and dignity should be our priorities.

Melissa, RN comments on Ethics In Our Practice: Doing Nothing by Jim Ducharme MD CM FRCP

Melissa, RN — Thu, 04 Mar 2010 00:21:50 +0000

Thanks for this post. About one week ago we resuscitated a older lady to came in to the ED who was in multisystem organ failure, who went into cardiac arrest while she was there. We got a hold of her daughter who of course wanted everything done. The patient didn't have a voice, so we did everything we could. We eventually got a rhythm back on her and shipped a shock trauma ICU only for her to be pronounce brain dead the next day. This situation really made me wish I had known what the patient might have wanted so we didn't have to put her through all of that.
Thanks
Melissa T, RN
IMC and Riverton Emergency departments

dr5string comments on Say It Isn't So by Gregory L. Henry, MD

dr5string — Sun, 21 Feb 2010 16:51:15 +0000

Is anyone else tired of the one-size-fits-all approach to medicine these days? When I was a resident, we published a case report of transient paraplegia caused by application of a collar, that was fortunately reversed with its removal. I learned to put clavicle straps on a fractured clavicle, stopped when the literature said they don't help, and after a positive personal experience with a strap after a fractured clavicle, now offer patients the option. After almost 3 decades of practice, I still don't know what to make of CPR. It seems to me the Journal of Trauma paper is piece of data to keep in mind when caring for individual patients......as well as another bullet in the arsenal of the plaintiffs' bar.

After enjoying a number of Dr. Henry's talks, I was surprised to find him fan of Dr. Hook (though I think the lyric quoted was from Dire Straits). Might I suggest "Freakin' at the Freaker's Ball"; certainly politically incorrect, but somewhat descriptive of Saturday night in my ED.

Electric Gate comments on Doctors and Antibiotics – It Is a Crime What We Do by Jim Ducharme, MD

Electric Gate — Thu, 18 Feb 2010 09:19:10 +0000

That catches my attention?

How come you, medical guys aren't doing your job well?

You should be expert on possible medication of certain illness and not just giving medicines which are not dependable!

That's frustrating!

Matt Perl, M.D., FAAEM comments on Frustrated in Haiti by Alfred Sacchetti, MD

Matt Perl, M.D., FAAEM — Wed, 17 Feb 2010 19:56:02 +0000

Scripps Healthcare in San Diego was able to send a small team over the first week, initially to assess where help might be provided, then later sent another small team of surgeons to provide direct patient care. You might try contacting the office of Chris Van Gorder, President and CEO of Scripps Health, for advice on coordinating a team.(858) 678-6840.