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The world of emergency neuroimaging is evolving and increasingly influencing time-sensitive treatment decisions. A basic understanding of the imaging studies and sequences you may be asked to obtain in the ED may help you better manage your patients. In this post, Dr. Matthew Siket reviews the major four neuroimaging modalities (CT, CTA, Perfusion, and MRI).
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Dr. Rachel Rempell is a pediatric emergency medicine physician in Boston, Massachusetts and is affiliated with Boston Children's Hospital. She is board certified in pediatrics, pediatric emergency medicine and completed an ultrasound fellowship with a focus on pediatrics. We were fortunate to have her as a guest speaker for our grand rounds where she gave us a tour of the current landscape of pediatric point of care ultrasound in emergency medicine.
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Professionalism and related personal attributes such as ethics, humanism, and communication have played a central role in the major critiques and calls for reform in medical education over the past century. The Association of American Medical Colleges currently recommends professionalism and interpersonal skills (including communication) as core competencies to be included in the curricula of medical schools. In part 2 of "difficult discussions", we share our approach for two difficult patient discussions - death notification and end of life care. This was recorded at the 2017 Tufts University School of Medicine Capstone Course.
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Professionalism and related personal attributes such as ethics, humanism, and communication have played a central role in the major critiques and calls for reform in medical education over the past century. The Association of American Medical Colleges currently recommends professionalism and interpersonal skills (including communication) as core competencies to be included in the curricula of medical schools. In part 1 of "difficult discussions," we share our approach for two difficult patient discussions - medical error and refusal of medical care. This was recorded at the 2017 Tufts University School of Medicine Capstone Course.
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Matthew Delaney is an emergency physician who also helps run a wound care clinic. With these dual roles, he has gained a unique perspective on both acute and chronic wounds that present to the emergency department. In this feature film, he discusses some pearls and pitfalls of wound care in the emergency department.
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In the United States an estimated 300,000 sports-related concussions occur annually. Many of these are young athletes who are referred to the emergency department for evaluation. While there are robust clinical decision aids to clarify the need for a CT brain, the literature around concussions is a bit murkier. Recently, athletes who sustained a concussion were recommended to avoid exercise and vigorous cognitive activity until their symptoms resolved entirely. Several studies over the last several years have challenged these recommendations. Dr. William Meehan is the director for the Micheli Center for Sports Injury Prevention. We were fortunate to “pick his brain” regarding questions we are often asked by the parents of the young athlete . . . when can their child return to play? When can they return to their full course work at school?
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No deep dive here, just the top five take aways from this month's high fidelity simulation cases (trauma in pregnancy, pediatric head trauma with hemophilia, thermal burns and severe facial trauma).
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Geriatric patients (> age 65) account for almost 1 in 5 of all cervical spine fractures, with 50% of cervical spine fractures occurring at the C1/C2 level. Recent literature has questioned whether these clinical decision rules may be applied in the geriatric population, where over half of identified cervical spine fractures result from ground level falls. Furthermore the reliability of physical exam, specifically midline tenderness, has been questioned in elderly patients. January's journal club examined three articles that addressed this specific population of blunt trauma patients at risk for cervical spine injury.
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Tomorrow, countless acute mental health patients will present to their local emergency department asking for help. Our typical response? Detain them for days until definitive resources are available. Ironic for a specialty whose defining characteristic is timely diagnosis and treatment. Door to balloon time for STEMI? t-PA for stroke within the window? Most emergency departments have complex operations, funding and resources to meet these goals. How about a door to psychiatric bed time? Not so much. Sadly, the behavioral health care crisis in this country is only getting worse. While the demands on emergency providers to treat these patients continues to rise, resources continue to decline. In this feature film, Dr. Kivela, current ACEP president, proposes some novel solutions to improve the care, cost and boarding times for this vulnerable population.
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Every month we summarize our simulation cases. No deep dive here, just the top 5 takeaways from each case. This month includes calcium channel blocker overdose, salicylate toxicity, iron overdose,
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Use of this blog and its associated media does not constitute the establishment of a physician-patient relationship. Content posted on this site is NOT medical advice and should not be used to treat patients or yourself. The website authors shall not be held responsible for any damages sustained from the use of this website. The information on this website should not be used to establish standard care or standards of practice for the purposes of legal procedures. The opinions expressed on the website are the opinions of the website and content authors alone and do not represent the policies or opinions of Maine Medical Center, Maine Medical Partners, MaineHealth, or Tufts University School of Medicine.
