A better way to think about Altered Mental Status
I recently had occasion to prepare a talk on the various causes of Altered Mental Status. As it happens, EM:RAP had a nice Continuous Core Content segment recently on the same topic. (Don't listen to EM:RAP? You should. Want to try it for free? Rob Orman of ERCast has an offer for a three month free trial. Use the code ERTHANKS.)* They used a practical case-based format to structure the approach, which I like, but also fell back on the old mnemonic of AEIOU TIPS. God I hate that mnemonic. It's so haphazard and utterly disorganized: just like the typical approach to AMS.A ...
Source: Movin' Meat - February 9, 2016 Category: Emergency Medicine Source Type: blogs
Happy SGR Repeal Day
Yeah, it happened. The SGR is finally dead. Hooray! Sort of.I mean, it's great and all that — we'll no longer have the annual threat of a massive payment cut from a poorly crafted piece of legislation from the 1990s; we'll no longer have to endure the annual ritual of last-minute legislative theatrics to avert the yearly cuts, we'll no longer have to waste our lobbying time and effort to make sure those cuts were never allowed to go into effect.But let's not pretend this was in any way a win for physicians.The replacement for the SGR, in the "Medicare and CHIP Reauthorization Act of 2015" (MACRA - get to know that acrony...
Source: Movin' Meat - April 15, 2015 Category: Emergency Medicine Source Type: blogs
In Defense of the Hyperangulated Blade
Let me begin, as is my wont, with a story. Let's say, for the sake of discussion, that I was moonlighting at Janus General Hospital. I had a patient signed out to me by my partner: a young patient with COPD, influenza, and pneumonia. He was on BiPAP and supposedly stable waiting for an ICU bed. Murphy's law being what it is, immediately after my partner left, the patient deteriorated and clearly was going to require intubation. He had all the predictors of being a tough tube, so I made sure to have my back-up plans articulated and ready to go.My go-to technique for quite a few years is video laryngoscopy (VL) with the hype...
Source: Movin' Meat - February 4, 2015 Category: Emergency Medicine Source Type: blogs
On Call
Every ER has its call roster, that sacred list of oracles, laying out who we can call when our patients need some service that we cannot provide. If I need a cardiologist, or a neurosurgeon or even a dermatologist for some acute emergency condition, all I need to do is ring up the operator and tell them, “This is the ER doc, I need [insert name of specialty here].” And like magic, ten minutes later, I’m talking to the local expert in whatever the patient has.Fun fact: in the last month, I have consulted both physiatry and rheumatology from the ER.So I was a little surprised recently when I had a patient with a nine-m...
Source: Movin' Meat - July 7, 2014 Category: Emergency Medicine Source Type: blogs
Pain and Suffering in the ER
I took a recent family trip Down Under and had the good fortune to be in Australia's Gold Coast at the same time as the SMACCGold Conference. (Well, it wasn't entirely a coincidence.) I was happy to get to make it there one day and it was a great experience. I got to meet uber-tweeter and stalker Minh LeCong, organizer and LITFL dude Chris Nickson, St Emlyn's own Simon Carly, the Irish EM blogger Andy Neill, Kangaroo Island doc Tim, and many, many more. I had an extended conversation with Karel Habig of Sydney HEMS under the misapprehension that he was Cliff Reid. (Did I mention the open bar?) Sorry about that!I haven't th...
Source: Movin' Meat - June 16, 2014 Category: Emergency Medicine Source Type: blogs
Someone is WRONG on the internet! (Hospital admission edition)
The grandiosely-named "MD Whistleblower," recently wrote a post, reblogged at KevinMD, entitled "Why the ER admits too many patients."I will begin with the time-honored ad hominem attack, since I am aware of all internet traditions. "Whistleblower MD"? Really? That's so cute. You see, as a whistleblower, he is a genuine hero, someone who is willing to expose himself and his career to enormous personal risk in his unrelenting search for truth. Unlike the rest of us, who are just random jerks on the internet with a bunch of opinions. He's a truth-seeker, so his opinions should be given special weight and are clearly objectiv...
Source: Movin' Meat - June 7, 2014 Category: Emergency Medicine Source Type: blogs
This week in Children and Gunfire
Horrific:[View the story "This week in Children and Gunfire" on Storify] (Source: Movin' Meat)
Source: Movin' Meat - July 24, 2013 Category: Emergency Medicine Doctors Source Type: blogs
Gone Electric
Haven't written much in a while, but thought I'd throw in an off-topic post, just for the heck of it. A couple of months ago, I made a major change in my life: I traded in my old car, a 2004 BMW 530i and I went and got a Tesla Model SYep, I'm a proud member of what's been described as the "world's more expensive beta test."I've had it now for almost exactly two months, and I thought I'd share my observations.First of all: cost. Yes, it's an expensive car. No denying that. However, it's not quite as crazy expensive as the sticker price makes it seem. My default plan was to replace my old BMW with a new one, probably the 550...
Source: Movin' Meat - April 13, 2013 Category: Emergency Medicine Doctors Source Type: blogs
Mayor Bloomberg and Narcotics
I may be just a bit late in commenting on this, but last week (which was like ten years ago in Internet time) there was a bit of hue and cry regarding Mayor Bloomberg's report on the matter of prescription drug abuse and restrictions on new prescriptions for painkillers through the Emergency Department.Initially, I was concerned. I completely agree with the comment from the linked article: “Here is my problem with legislative medicine,” said Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians... “It prevents me from being a professional and using my judgment.” The verbiage used re...
Source: Movin' Meat - January 15, 2013 Category: Emergency Medicine Doctors Source Type: blogs
Apparently I'm a pimp
< div class= " separator " style= " clear: both; text-align: center; " > < a href= " http://2.bp.blogspot.com/-m2ZclLLHHSs/UPMMhq-mHpI/AAAAAAAABFo/Y5Kuq-1NFug/s1600/keep-calm-and-don-t-feed-the-troll-1.png " imageanchor= " 1 " style= " margin-left: 1em; margin-right: 1em; " > < img border= " 0 " src= " http://2.bp.blogspot.com/-m2ZclLLHHSs/UPMMhq-mHpI/AAAAAAAABFo/Y5Kuq-1NFug/s320/keep-calm-and-don-t-feed-the-troll-1.png " height= " 320 " width= " 320 " / > < /a > < /div > < div > < br / > < /div > I & nbsp;actually & nbsp;have no interest in < a href= " http://spectator.org/archives/2013/01/11/a-pimp-for-obamacare-f...
Source: Movin' Meat - January 14, 2013 Category: Emergency Medicine Source Type: blogs
Apparently I'm a pimp
I actually have no interest in responding to this. I decided some time ago that life is too damn short to waste it arguing with assholes on the internet. I've stuck to that reasonably well, and been happier for it. But since I have been personally named I suppose I should give it a perfunctory response. That's all it deserves. I wouldn't bother at all, in fact, if it weren't for the steaming mass of ad hominem attacks piled on top of it. But that's his style: he uses strawman arguments and personal insults to obscure fuzzy thinking. Apparently, in the minds of the free-market, anti-government zealots out the...
Source: Movin' Meat - January 14, 2013 Category: Emergency Medicine Doctors Source Type: blogs
Canadians can be funny
Who knew? By Bowser and Blue (Source: Movin' Meat)
Source: Movin' Meat - January 13, 2013 Category: Emergency Medicine Doctors Source Type: blogs
Discharge a PE? that's crazy talk!
So I recently sent home a patient with a Pulmonary Embolism (PE) for the first time. Or perhaps I should say that that it was the first time I ' ve < i > knowingly < /i > & nbsp;sent home a patient with a PE, but that ' s neither here nor there. < br / > < br / > This was an unusual case, to be sure. The patient was young and healthy, a triathlete in & nbsp;exceptional & nbsp;condition. He had had arthroscopic surgery on his left knee about a month ago, and a few days after that developed this sharp pleuritic left chest pain. The pain was quite severe, but he ignored it for about three weeks until finally, since it wasn ' ...
Source: Movin' Meat - November 21, 2012 Category: Emergency Medicine Source Type: blogs
