J Emerg Med
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Medicaid expansion under the Affordable Care Act (ACA) is intended to provide a framework for increasing health care access for vulnerable populations, including the 1.2 million who experience homelessness each year in the United States. ⋯ Homeless persons report having less knowledge of the ACA than their housed counterparts, poor understanding of ACA qualification criteria, and limited access to phone and internet. ED-based outreach and education regarding ACA eligibility may increase their enrollment.
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Most hypertensive patients have essential (primary) hypertension; only 5% to 10% have a secondary cause. Two clinical characteristics suggestive of secondary hypertension are early onset (< 30 years of age) and severe hypertension (>180/110 mm Hg). When faced with these findings, clinicians should consider a secondary cause of hypertension. ⋯ A 22-year-old woman being evaluated for asthma exacerbation in the emergency department was noted to have severe persistent hypertension. Additional evaluation revealed severe hypokalemia, metabolic alkalosis, and hypernatremia. The patient was admitted to the hospital for blood pressure management, electrolyte replacement, and further evaluation of presumed hyperaldosteronism. Diagnostic imaging revealed a large adrenal mass. Surgical resection was performed, leading to a diagnosis of hyperaldosteronism caused by adrenal carcinoma. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Secondary hypertension is far less common than essential hypertension; however, considering the large volume of patients seen in emergency departments, it is likely that some will have secondary hypertension. Emergency physicians should be aware of the clinical characteristics that suggest secondary hypertension so that the appropriate diagnostic and treatment pathways can be pursued.
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The American Board of Emergency Medicine (ABEM) convened a summit of stakeholders in Emergency Medicine (EM) to critically review the ABEM Maintenance of Certification (MOC) Program. ⋯ Several suggestions to improve the ABEM MOC Program were discussed. ABEM will consider these recommendations when developing its next revision of the ABEM MOC Program.
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In 2004 and 2009, we examined the number of endowed faculty positions in academic departments of Emergency Medicine (ADEMs). ⋯ Thirty ADEMs (33.7%) currently have an endowed position, compared to only 19 (26%) 5 years ago. Emergency Medicine now has a total of 53 endowed positions, compared to only 25 such positions in 2009 and just 9 endowed positions in 2004.
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As per American Heart Association/American College of Cardiology guidelines, the delay between first medical contact and balloon inflation should not exceed 90 min for primary percutaneous coronary intervention (PCI). In North America, few prehospital systems have been developed to grant rural populations timely access to PCI. ⋯ This study demonstrated that a regionalized prehospital system for STEMI patients could achieve the recommended 90-min interval benchmark for PCI, while giving timely access to PCI to rural populations that would not otherwise have access to this treatment.