J Emerg Med
-
Faith and religion are topics that are not routinely discussed or of much significance in the emergency department (ED). However, there are certain cases when faith or religion can cause certain ethical dilemmas for the physician, patient, or hospital. Understanding patients' beliefs affects our own medical decision-making and the ability to treat certain illnesses. Hospital policy or religious views of the hospital can affect patient management. Spirituality or religion in the ED will not be an issue with every patient; however, there are times where religious beliefs will be at the very center of an ED visit, as shown by this case report. ⋯ This report highlights the importance of understanding the ethical questions raised from faith-based issues in the ED to be able to provide the highest level of patient-centered care.
-
At our institution, there were a number of adverse patient events related to an unstable airway that led to the formation of a designated critical airway response team (CAT). It was hoped that this would improve patient outcomes in such matters. ⋯ The creation of a critical airway has been considered a success in terms of patient management at our institution. It has been most commonly used in the management of life-threatening angioedema in the ED.
-
Version 1 (V1) of the National Emergency Medicine Fourth-year Student (EM M4) Examination was released in 2011 and revised along with release of V2 in 2012. Each examination contains 50 multiple-choice questions designed to assess knowledge in the EM M4 clerkship curriculum. Development and initial performance data were described previously. ⋯ Performance data for V1 remain stable after 2 years. Revisions of poorly performing questions improved question performance on V2. Questions with low rpb or low pdiff will continue to be revised annually. While examination forms differ statistically, the practical utility of the differences is not defined.
-
The effectiveness of point of care (POC) right upper quadrant ultrasound (RUQ US) in the diagnosis of biliary disease has been well studied. Extrabiliary pathology that might remain undetected in the course of typical, focused POC RUQ US has not been directly examined. ⋯ CSEBFs were seen in < 10% of ED patients undergoing comprehensive RUQ US. Nonspecific masses were seen in 3% of patients, but < 1% of patients were found to have a new malignancy.
-
Prothrombin complex concentrates (PCCs) are commonly used to rapidly reverse warfarin-associated coagulopathy; however, venous thromboembolism (VTE) is an established adverse event. ⋯ Patients with a prior history of PE or DVT who were given 3F-PCC for warfarin-associated ICH were 4.5 times more likely to sustain a VTE within 30 days. A careful analysis of risks and benefits of rapidly reversing anticoagulation must be made prior to the administration of 3F-PCC in this patient population.