Most commonly encountered ways of study for tutorials succeed
Dear audience, I feel you certainly will are in agreement with me when i state that lessons succeed is really a element of the educative program inside the college or university and university or college. Shows the ability of the students to succinctly express their thoughts, opinions and argue logically, even though this does not only test knowledge. Discussing the language of modern technology, the institution pupil requirement dedicated to rehearse the studies plans inside program deliver the results. The reality is, the procedure will be a method of acquiring this ambition, and do you know the aim of the lessons hard ...
Source: EPMonthly.com - January 13, 2017 Category: Emergency Medicine Authors: TJ Hume Tags: Writing tips Source Type: news

Design shoes and clothes by Dirk Bikkembergs for teenagers
Belgian fashionable Dirk Bikkembergs started providing his women’s and men’s collections of footwear and clothing as soon as in 1987. Even so, his build that paired sporty visuals and high-designer, was sophisticated and extremely favored. For girls and boys pretty much every time Bikkembergs gives the large choice of initial forms of shirts and shews for competitive sports and try to in indisputable style phenomena: , golf shoes and boots for kids, and high shoes, vividsneakers and shoes sneakers and toned trainers for girls. The clothing and shoes series by Bikkembergs for physical activities and energetic ...
Source: EPMonthly.com - January 12, 2017 Category: Emergency Medicine Authors: TJ Hume Tags: Kids Fashion Source Type: news

Get Project Assistance from the very best Assignment Helper Via internet
Kids are generally presented with responsibilities and they usually change from type susceptible to still another. These tasks either can be producing reports, math equations, et cetera. Students are usually required to complete their work if they want to get high grades or improve their grades on a certain subject. Being able to complete your homework is something that can boost your confidence. But the truth is, realize that you cannot assume all projects have grown quite easy to do. Additionally fluctuate in challenges. Some are very challenging and very difficult to do, as some of them are very easy to do. You could f...
Source: EPMonthly.com - January 10, 2017 Category: Emergency Medicine Authors: TJ Hume Tags: Education news Source Type: news

Classification of Academic Research Writing
Tired of creating persuasive documents or have no idea where to start Expository essays describe a specific issue and give the readers with information. Finest web site to obtain documents. Once you’ve produced a selection, it really is crucial that you think of how you need to write the article. As soon as you’ve simplified your Matter, you’re heading to want to set an intention for your own article. First and foremost it’s essential to go for an article subject. Article writing as the issue significantly. Individual storyline to begin essay. Reveal what virus protection is. It’s my wish that...
Source: EPMonthly.com - January 6, 2017 Category: Emergency Medicine Authors: TJ Hume Tags: Students Around The World Source Type: news

Sepsis Gets an Upgrade
Conclusion “These updated definitions and clinical criteria should clarify long-used descriptors and facilitate earlier recognition and more timely management of patients with sepsis or at risk of developing it. This process, however, remains a work in progress. As is done with software and other coding updates, the task force recommends that the new definition be designated Sepsis-3. With the 1991 and 2001 iterations being recognized as Sepsis-1 and Sepsis-2, respectively, to emphasize the need for future iterations.” Clinical Take Home Points Sepsis = Life-threatening organ dysfunction caused by a dysregulat...
Source: EPMonthly.com - December 31, 2016 Category: Emergency Medicine Authors: Matt McGahen Tags: Uncategorized Source Type: news

Emergency Physicians Emerge as Healthcare ’s Management Specialists
We have always been clinicians, but modern emergency physicians have also become the most skilled managers in the healthcare system. It’s time we capitalize on those talents and proactively learn from the management industry. History’s great achievers—Napoleon, da Vinci, Mozart—have always managed themselves. That, in large measure, is what made them great, according to Peter F. Drucker, father of modern management theory. This principle is especially relevant to emergency medicine today. The founders of our specialty and the wave of emergency physicians that followed them have carved us a unique po...
Source: EPMonthly.com - December 31, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

Stroke Care: A Balanced Approach to the tPA Debate
In conclusion, alteplase is the only treatment available for acute ischemic stroke that is effective in some patients. In order to improve tPA effectiveness and minimize risks, patients with symptoms suggestive of an AIS should get rapid assessment and treatment with tPA after careful review of the contraindications. Given that smaller strokes can still be associated with considerable long term neurological morbidity, treatment should still be considered in those patients after weighing the risks and benefits and in consultation with the patient and family. Advanced age should also not be a limiting factor. Although the NI...
Source: EPMonthly.com - December 31, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

Emergency Physicians Emerge as Healthcare ’s Management Specialists
We have always been clinicians, but modern emergency physicians have also become the most skilled managers in the healthcare system. It’s time we capitalize on those talents and proactively learn from the management industry. History’s great achievers—Napoleon, da Vinci, Mozart—have always managed themselves. That, in large measure, is what made them great, according to Peter F. Drucker, father of modern management theory. This principle is especially relevant to emergency medicine today. The founders of our specialty and the wave of emergency physicians that followed them have carved us a unique po...
Source: EPMonthly.com - December 31, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

My Macgyver Moment
  Since emergency physicians are the MacGyvers of medicine – mullet not included – we asked our readers to send in their best stories of improvising on the fly. What did you do when you were fighting against the clock and couldn’t find the supplies you needed? Here are our four winning entries, with comments by Ken Iserson, MD, author of Improvised Medicine. Published entrants gain free admittance to Blood and Sand, a tropical CME in Atlantis, Bahamas. For a chance to win, send your best MacGyver Moment to lplaster@epmonthly.com Give Me a Hand(stand) by Andrew Langsam I was getting ready to go...
Source: EPMonthly.com - December 31, 2016 Category: Emergency Medicine Authors: Matt McGahen Tags: Uncategorized Source Type: news

Flight Shift
This article does not represent the views or opinions of the USAF, DoD, or the US Government. They are wholly the opinion of the author. Dr. Novak is a former F-15C pilot and current emergency physician in Ohio. Have questions about how combat aviation training could be used in the ED? Email editor@epmonthly.com. The post Flight Shift appeared first on Emergency Physicians Monthly. (Source: EPMonthly.com)
Source: EPMonthly.com - December 31, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

Two Midnights, One New Challenge
This report stated: “Medicare beneficiaries had 1.5 million (limited?) observation stays in 2012; an additional 1.4 million long outpatient stays, and 1.1 million short inpatient stays”. Beneficiaries had over 600,000 hospital stays that lasted 3 nights or more but did not qualify them for SNF services.” Clearly a lot of money is on the table here. The report also noted wide variation and inconsistency in hospitals’ use of inpatient and observation/outpatient designation for similar diagnostic groupings. According to the OIG, many beneficiaries treated with observation stays incurred huge bills from...
Source: EPMonthly.com - December 28, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

Rethink the Salter-Harris I Fracture
The last 50 years of pediatric fracture management may have included a substantial misunderstanding of Salter and Harris’s original findings. In a recent issue of SMART EM we went under the evidence sea and into the depths of pediatric orthopedics, where there is a question trainees (and parents) with overdeveloped common sense have been asking for a half century: why do we immobilize bones that are clinically and radiographically normal? The infamous Salter-Harris type I fracture has, in many settings, become the most common type of pediatric ‘fracture’. And yet the diagnosis is, in the overwhelming majo...
Source: EPMonthly.com - December 28, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

When a “ Fall ” Isn ’ t a Fall: Screening for Elder Mistreatment
Up to 1 in 10 elders experience abuse, but most cases are missed during visits to the ED. by Chloe Sidley, MD and Lauren T. Southerland, MD Emergency departments are exceptional at detecting child abuse and they’ve trained SANE forensic nurses to assist with sexual abuse cases. So why aren’t we better at detecting elder abuse? During a shift on a bitterly cold winter day, a 76-year-old man is brought in by paramedics. He is disheveled and the medic team says that the home health aide found him in a freezing apartment with the heat off. The home health aide called 911 because t...
Source: EPMonthly.com - December 28, 2016 Category: Emergency Medicine Authors: Taja Whitted Tags: Uncategorized Source Type: news

How to Confirm Ankle Joint Penetration
Suspicious lacerations should be investigated, even if the X-ray is normal. A step-by-step pictorial guide. It is a busy Friday evening in the emergency department when you get called to the resuscitation bay for a 14-year-old female who was the restrained back seat passenger in a rollover motor vehicle crash. After a quick call to your significant other to ensure that your daughter is safe in bed, you proceed to evaluate this young patient. You are once again amazed by modern safety technology with the minimal amount of head, torso and abdominal trauma on this patient. After a thorough initial inspection you find that the...
Source: EPMonthly.com - December 28, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

Opening the Book on ED Metrics
Conclusions Medical directors are generally under pressure to improve some aspect of the department’s performance. While we always have to keep the overall operation of the department in mind, we are also at the mercy of how individuals perform. We can’t control every aspect of the ED visit. But things that we can control and things we can measure, we need to take advantage of. Start with awareness of the key metrics and then add in transparency. Be sure to establish goals and work with your under-performers on improvement strategies. As I’ve heard ACEP President Jay Kaplan say many times, “If you w...
Source: EPMonthly.com - December 28, 2016 Category: Emergency Medicine Authors: Matt McGahen Tags: Uncategorized Source Type: news

Do It Yourselfer
I’m proud of the fact that I’m self sufficient in the emergency department. And it irritates the fire out of me to see prima donnas (read surgeons) come into the department and require the entire staff to follow them around to do little things they could do for themselves. I guess you could say that I was trained well by a charge nurse by the name of Beatrix where I did my residency. Miss Bea, as she called herself, or Miss Behemoth as the interns called her under their breath, was a heavy set matronly type with a ruddy complexion. Her upper arms had extra fat that sagged and waved when she pointed to something...
Source: EPMonthly.com - December 28, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

Steps to Start An Investigation Report
Because you can observe, this really is an totally different procedure to compose an essay. Create a summary initially before you compose an essay. For me, composing documents isn’t a simple task. Yet another indicates to do so would be to take an completely diverse innovative approach to writing an essay. You don’t require to compose an essay for your blog posts, a few of paragraphs will do fine. You are able to be as imaginative as you need to be, so long as your composition expresses the appropriate info to the reader. These documents have to be composed completely by you, but be certain that the authorship ...
Source: EPMonthly.com - December 27, 2016 Category: Emergency Medicine Authors: TJ Hume Tags: Education Source Type: news

Is Physician Oz right about avocado oil
Authorship shouldn’t be an daunting occupation, actually when you’re writing a college essay. You can find several sorts of essays and each one of these includes a special structure. Your satirical article may make additional brownie points with a suitable name. If you are intending to put on such documents for all of us to examine, be sure your words tend not to lead every one to follow the incorrect route of therapy, medicine or exercise. The initial tip to take into consideration when learning how to compose essays is that you would like to have the ability to consider http://essayswriting.org/ the complete ...
Source: EPMonthly.com - December 26, 2016 Category: Emergency Medicine Authors: TJ Hume Tags: Education Source Type: news

How To Become A Fearless Leader
The essays may cover every prospective matter below sunlight. Do you really desire to get documents essays online. Each of the descriptive composition issues have their special one of a kind article issues. There are a few great matters for this sort of composition. An composition isn’t about fiction, is about the truth. For some thing to become a adequate convincing article matter, it must be an controversial problem. The more passion you’ve got for a creating issue, the simpler it’ll really be to carry that feeling to your own audience and generate a great descriptive article. Usually, you will contend ...
Source: EPMonthly.com - December 22, 2016 Category: Emergency Medicine Authors: TJ Hume Tags: Top News Source Type: news

Scholarships with March 2015 deadlines
Mentioned Items Morgan Franklin that is to be iPhone 6: $109 done by Apple. Check on below steps to make the agreement. Cannot really accomplish it cheaper anywhere else. Remain in the loop It is time for you to talk out for your to repair Beloved New Yorkers, At this time, Ny features a chance to pass the primary Truthful Repair statement in the country. We have to be able to royalessays service assure our directly to repair computers electronicslike smartphones, and also park equipment. We have an opportunity remain true for regional repair jobsthe nook mommy and to aid the environmental surroundings -and- fix stores tha...
Source: EPMonthly.com - December 21, 2016 Category: Emergency Medicine Authors: TJ Hume Tags: Uncategorized Source Type: news

What ’ s diabetic rash
In conclusion, if bee searching for a solution that is effective and safe to improve your sperm quantity, then Maca Medicine is what you need. Maca and horny goat weed support the libido. Maca Enhancer contain the amino acids that are required, but in addition provides the most powerful and effective herbal solutions that boosts health. Keep reading to the wording below to find out more about Enhancer. (Source: EPMonthly.com)
Source: EPMonthly.com - December 21, 2016 Category: Emergency Medicine Authors: TJ Hume Tags: Uncategorized Source Type: news

Tips on How to Keep Arranged On the Job
Key Variation between Domestic and International Business How to Strengthen Skills for Sixth-Graders Assistance Is the Best Decision for Numerous School Troubles Venture is a crowd providing assignments writing help. Our experts endeavor to provide a superior tutoring to students around the globe. Our writers are known by a great experience in ensuring of numerous college help. Our professionals provide not only school writing, we are engaged in offering on any possible issue. Our objective is to help school leavers and improve their progress in studies and enlighten them ongoing. That is why, making order at our company, ...
Source: EPMonthly.com - December 19, 2016 Category: Emergency Medicine Authors: TJ Hume Tags: Uncategorized Source Type: news

Research Report Support Detailed Research Paper Information
Based on Traditional convention, there is just a lei a string of blooms, leaves, covers, feathers, vegetables or additional objects used across the mind or throat for decoration. The custom was likely added by early Polynesian settlers to Hawaii from Tahiti to the islands. Leis in many cases are provided as welcoming presents or all – gifts. Todays leis might be created from report, a custom that likely started in Hawaii with the early visitor trade. In the early part of the 20Th-Century, in fact, lei designers made really intricate paper leis. Things You Will Need Rolls of paper Crochet thread Huge hook Scissors Rec...
Source: EPMonthly.com - December 16, 2016 Category: Emergency Medicine Authors: TJ Hume Tags: Uncategorized Source Type: news

Define Academic Performance
26.03.2015 Community by Leonard Write essays for cash uk Companionship needs compose along documents for money uk For write essay for me online posting shut x Thanks. Checkout our affordablepapers uk FAQs. Sometimes when Brave Supplicants and the creature wrestle they end-up mangling it. We just need to examine something inside your communication and will distribute it as esssays even as we may. Thanks for talking as standard as this about something. Women Empowerment Essay Writing Support. Acquire documents that are instructional Puppies that are online are of many types. Produce essays for cash uk feel in cases like this...
Source: EPMonthly.com - December 16, 2016 Category: Emergency Medicine Authors: TJ Hume Tags: Uncategorized Source Type: news

Just how to Create a Medical Report
Our documents available are certainly original and exclusive. When searching to find the finest essay helper for a pupil, always think of the quality of essays that that unique service generates. Over period, there is a heightened demand of essays. Very Good essay writers usually do not boost hasty function. Writing an article is a massive and complex work that needs an individual’s undivided consideration. As we’ve formerly mentioned that writing essays may be extremely hard should youn’t possess the easay writing know-how. That’s the only signifies to purchase article. Outsourcing your task might ...
Source: EPMonthly.com - December 16, 2016 Category: Emergency Medicine Authors: TJ Hume Tags: Education Source Type: news

Using the Case Study Method in PhD Study
Edit Article Just how to Turn Into A Movie Writer Producing programs for shows is a fascinating and worthwhile task for those who possess the imagination and fortitude to accomplish it. Noise divisions. Follow these ways to put yourself towards learning to be an occupation author for movies to the route. Ad Measures Train yourself to publish habitually. In the beginning, don’t be troubled with writing nicely or producing swiftly, but merely get into the routine of writing everyday. This is often completed stories, through sites, or screenplays themselves. Ad An account to be constructed by figure out how. Since you a...
Source: EPMonthly.com - December 16, 2016 Category: Emergency Medicine Authors: TJ Hume Tags: Uncategorized Source Type: news

Literature Template
Over 1500 consumers from startups to companies that are large Xicom is one of many largest global software company with more than 50,000+ male -decades of knowledge. Development Services Xicom offers stop -to- end development answers catering to consumer-centric needs. We provide complete company PHP internet applications which might be tailored to conform to organizational structure The post Literature Template appeared first on Emergency Physicians Monthly. (Source: EPMonthly.com)
Source: EPMonthly.com - December 15, 2016 Category: Emergency Medicine Authors: TJ Hume Tags: Uncategorized Source Type: news

Research Issues to get a Paper on Medications
Custom article writing in our company is commonly done by professional authors within the specific region research that have huge abilities in study and writing. These hints, alongside the normal correspondence writing rules, may aid you largely to compose a productive donation request notice. It’s therefore crucial that you just read the guidelines before you begin composing the article. This ought to be potential notice writing of the kind simpler for you as nicely. The scholarship essay writing need to be written utilizing the synopsis driven. The author must have a decent essay composing skills and abilities. Com...
Source: EPMonthly.com - December 14, 2016 Category: Emergency Medicine Authors: TJ Hume Tags: Education Source Type: news

Just how to Write and Deliver a Speech That May Allow You To Get Customers
Article writing help has to be sought from a business which gives plagiarism free papers. Writing analytical documents isn’t a really simple task and thus pupils must get aid from on-line essay writing firms. Opposite to other essay writing companies, offering authors which are trained on how best to publish academic papers with various essay composing designs. Writers of analytical essays should find enough information regarding the material they’re writing about. Most of online essay writing companies were in market to build an income. The custom on-line composition creating businesses will make your creating...
Source: EPMonthly.com - December 14, 2016 Category: Emergency Medicine Authors: TJ Hume Tags: Students Around The World Source Type: news

How to Write an Academic Composition
An essay is actually a variety of academic writing which is largely written in 5 paragraphs. Essay the kind of composition topics. You might find every among the essential components of composition writing on ProfEssays. It’s great to get a good example of an article composing that you could use as a model when you’ve got an composition writing assignment. Your article theme is really a core element of any form of essay. Deciding upon the composition topic needs to be done carefully. Deciding on the most appropriate subject should be carried through with attention as it is the essential basis of composition cre...
Source: EPMonthly.com - December 7, 2016 Category: Emergency Medicine Authors: TJ Hume Tags: Students Around The World Source Type: news

A Win for Patient Safety in the Electronic Era
Emergency medicine takes strides in developing a comprehensive reporting tool for EMR problems We’ve written – in these pages and elsewhere – about the great potential of electronic health records to improve emergency care. That potential includes better access to past histories and medications, easier coordination among the care team, improved guideline adherence and evidence-based practice through intelligent decision support. And yet, as the country belatedly moves to adopt EHR, the potential for improved care has often remained just that – potential. Even as a few decision support tools shine th...
Source: EPMonthly.com - December 2, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

Uncompensated Tasks: How Much Is Too Much?
Conclusion Although we are exempt from the FLSA, which means that we need to do whatever it takes to effectively complete our job, I’d like to think that the time each doc gives outside the clinical arena is similar to what other physicians around the hospital are giving. The good news is that whether you realize it or not, you likely benefit by this participation. Another way to think about your responsibility is to approach your position so that your hourly compensation includes different professional responsibilities that you pay back as the year goes on. This works whether you’re salaried for a number of ho...
Source: EPMonthly.com - December 2, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

4 Metrics That Can Change Medicine
1 The Changing Landscape: ED visits have increased by about 3% per year over 12 years from 369 visits to 451 per 1000 population. The ED population is aging in line with the demographics of the country, and EDs need to prepare to meet the needs of seniors. 2 Less Trauma, More Sickness: Over the past 40 years, American emergency care has trended away from trauma and towards high acuity illness. Injuries now represent only 29% of patient encounters, with the biggest group of injured patients being the elderly. 3 Inpatient Admissions: Hospital inpatient admissions that are processed through the ED now stand at 68%. The need f...
Source: EPMonthly.com - December 2, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

Dx: Ruptured Vessel
The ultrasound image shows a view of the globe with the retina at the bottom of the image. The vitreous humor appears anechoic (black) and the retina echoic (gray). Just in front of the retina is a small echoic area that was not present in the unaffected eye. It does not appear to be connected to the retina, making it a bit atypical in appearance for a retinal detachment. A vitreous detachment could also look like this on ultrasound, but would also be attached at some point to the posterior globe. Examination by ophthalmology with his fancy gadgets and unique skill set revealed that this echoic area seen on ultrasound was ...
Source: EPMonthly.com - December 2, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

The Right Job at the Wrong Time
Conclusion Timing is rarely perfect when it comes to considering unsolicited job promotions. Companies, including hospital networks, are usually facing time constraints to find new leaders and may not have many options. I’ve learned from my own experiences, as well as watching colleagues, friends and my wife change jobs, and believe the timing of a job change rarely ideally aligns with our personal lives. Sure, a new job environment can sometimes be a dramatic change from what we’re used to, but ultimately it’s the administrative opportunity that matters – and that may be the most important factor i...
Source: EPMonthly.com - December 2, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

4 Metrics That Can Change Medicine
1 The Changing Landscape: ED visits have increased by about 3% per year over 12 years from 369 visits to 451 per 1000 population. The ED population is aging in line with the demographics of the country, and EDs need to prepare to meet the needs of seniors. 2 Less Trauma, More Sickness: Over the past 40 years, American emergency care has trended away from trauma and towards high acuity illness. Injuries now represent only 29% of patient encounters, with the biggest group of injured patients being the elderly. 3 Inpatient Admissions: Hospital inpatient admissions that are processed through the ED now stand at 68%. The need f...
Source: EPMonthly.com - December 2, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

Put Up or Shut Up: What EM Can Learn from the Teamsters
If emergency physicians are going to have a chance at influencing healthcare policy in Washington, they’re going to need to get serious about organizing and fundraising. The power of unions is legendary. The Teamsters, formed in 1903, now boast more than 1.3 million members and are the 11th largest campaign contributor in the United States. Fortune magazine consistently ranks the National Education Association in the top 15 of its Washington Power 25 list for influence in the nation’s capital. In the words of Terry Moe, author of Special Interest: Teachers Unions and America’s Public Schools, “the p...
Source: EPMonthly.com - December 2, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

Geriatric ED: Cost-Efficient Hub of Care
Geriatric emergency departments can pay for themselves by meeting healthcare reform incentive goals No one can deny the aging of our population in general, and of the emergency department patient load in particular. But there is some disagreement about how EDs should respond – specifically whether it is appropriate to design geriatric emergency departments. After all, in an era of belt-tightening and budget slashing is it really our priority to invest in softer mattresses, warmer lighting and aromatherapy? I aim to dispel the myth that geriatric EDs are just about superficial aesthetic improvements and show that thes...
Source: EPMonthly.com - December 2, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

Visual DX- “ My Eye Popped Out ”
A 44-year-old male with hypertension presents via EMS with this ocular complaint after having sneezed. What’s your assessment? by Lauren Westafer, DO and Nicholas Daniel, DO A 44-year-old male with hypertension presented via EMS with the complaint “my eye popped out!” The patient reported right eye swelling and pain immediately after sneezing. He denied trauma or change in his visual acuity, but admitted to a prior history of cocaine abuse. Physical exam revealed periorbital subcutaneous emphysema and intact accommodation and extraocular movements. His pupils were equal and reactive to light. Visual...
Source: EPMonthly.com - December 2, 2016 Category: Emergency Medicine Authors: Taja Whitted Tags: Uncategorized Source Type: news

Dx: Prostatic Mass
Upon seeing the images on the screen, you notice a tinge of red in your resident’s cheeks as she begins her spiel about the need to perform a prostate exam as part of the work up today. She eloquently explains to the patient that the ultrasound results and his symptoms are concerning for a prostatic mass that is eroding into the base of his urinary bladder (Image 3). On the transverse view of the bladder a hyperechoic mass can be seen along the posterior wall of the bladder. In the longitudinal view, you can see the hypoechoic lumen of the mass originating from the prostate to the lower left of the bladder wall. Your...
Source: EPMonthly.com - December 2, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

Rethink the Salter-Harris I Fracture
The last 50 years of pediatric fracture management may have included a substantial misunderstanding of Salter and Harris’s original findings. In a recent issue of SMART EM we went under the evidence sea and into the depths of pediatric orthopedics, where there is a question trainees (and parents) with overdeveloped common sense have been asking for a half century: why do we immobilize bones that are clinically and radiographically normal? The infamous Salter-Harris type I fracture has, in many settings, become the most common type of pediatric ‘fracture’. And yet the diagnosis is, in the overwhelming majo...
Source: EPMonthly.com - November 25, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

The Elephant Test
A 28-year-old female passes out at home after a day of increasing abdominal cramping. What can you learn from this ultrasound? “Hey, I think I see an elephant.” Your trusty resident exclaims as she briskly wheels the ultrasound machine out of the patient’s room. Noting the spring in her step, you walk quickly over to her and ask her to tell you about the patient she just evaluated. “The patient is a 28-year-old G4P4 healthy female who presented to our ED with abdominal pain and syncope. She was at home earlier today when she noticed she was having increased abdominal cramping. This progressed th...
Source: EPMonthly.com - November 25, 2016 Category: Emergency Medicine Authors: Matt McGahen Tags: Uncategorized Source Type: news

Assessing Fever in Returning Travelers: Part II
  Zika continues to be the virus of the day for returning travelers, but there are several other diseases that we need to consider in these patients when they present to us in the emergency department. Chikungunya is epidemic in many of the same countries as Zika and can be even more devastating. And Avian and MERS-CoV is still present in many countries. Unlike patients infected with Zika virus, these patients do require isolation to protect our health care staff from infection. Chikungunya Chikungunya, which means “to walk bent over,” was likely endemic but unrecognized in the United States before the mos...
Source: EPMonthly.com - November 25, 2016 Category: Emergency Medicine Authors: Matt McGahen Tags: Uncategorized Source Type: news

Uncompensated Tasks: How Much Is Too Much?
Conclusion Although we are exempt from the FLSA, which means that we need to do whatever it takes to effectively complete our job, I’d like to think that the time each doc gives outside the clinical arena is similar to what other physicians around the hospital are giving. The good news is that whether you realize it or not, you likely benefit by this participation. Another way to think about your responsibility is to approach your position so that your hourly compensation includes different professional responsibilities that you pay back as the year goes on. This works whether you’re salaried for a number of ho...
Source: EPMonthly.com - November 25, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

The One Area you Shouldn ’t Diversify
  Diversity might be good when investing, but too many financial managers can be a bad thing. Here are five reasons to put your eggs in one basket. One key principle of successful investing is to diversify your portfolio as broadly as possible to minimize the risk that any one specific investment will crush you. Many physicians extrapolate that concept to mean that they should hire more than one financial advisor. That usually creates more problems, not more sophistication. Here are five reasons why you should work with only one advisor: You control risk Asset allocation – which is the broad mix of investments i...
Source: EPMonthly.com - November 25, 2016 Category: Emergency Medicine Authors: Matt McGahen Tags: Uncategorized Source Type: news

Severe Hyponatremic Encephalopathy following Bowel Prep for Colonoscopy
CONCLUSION This case highlights the need for physicians to be aware of the potential electrolyte disturbances that can occur in susceptible individuals during bowel prep for a colonoscopy. Any patient presenting with acute altered mental status in this setting should receive prompt electrolyte measurements and treatment of hyponatremia with hypertonic saline to help minimize associated morbidity. REFERENCES Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342 (21):1581-1589. Frizelle FA, Colls BM. Hyponatremia and seizures after bowel preparation: report of three cases. Dis Colon Rectum. 2005;48(2):393-396. doi:...
Source: EPMonthly.com - November 25, 2016 Category: Emergency Medicine Authors: Matt McGahen Tags: Uncategorized Source Type: news

Geriatric ED: Cost-Efficient Hub of Care
Geriatric emergency departments can pay for themselves by meeting healthcare reform incentive goals No one can deny the aging of our population in general, and of the emergency department patient load in particular. But there is some disagreement about how EDs should respond – specifically whether it is appropriate to design geriatric emergency departments. After all, in an era of belt-tightening and budget slashing is it really our priority to invest in softer mattresses, warmer lighting and aromatherapy? I aim to dispel the myth that geriatric EDs are just about superficial aesthetic improvements and show that thes...
Source: EPMonthly.com - November 25, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news

Goodbye SGR, Hello MACRA
How will CMS’s new physician payment policy impact emergency physicians? For nearly twenty years the debate in Washington surrounding physician payment policy revolved around the SGR, or the Sustainable Growth Rate. That all changed last year when Congress passed the Medicare Access and CHIP Reauthorization Act, commonly referred to as “MACRA” in and around the beltway. Many refer to MACRA as the “SGR-fix,” but in reality the legislation has much broader implications. It will not only change reimbursement rates but the entire payment formula and incentives for virtually every physician in the ...
Source: EPMonthly.com - November 25, 2016 Category: Emergency Medicine Authors: Matt McGahen Tags: Uncategorized Source Type: news

All about Oxy
  RX PAD With the death of the entertainer Prince attributed to a fentanyl overdose, and new FDA warnings, opioids have been making headlines. Since the most common reason patients visit the emergency department is for pain, it is not surprising that emergency physicians prescribe and administer medications such as oxycodone on a daily basis. Here are some of the basics about how oxycodone works, and also the reason why chronic users may be at even higher risk of unexpected respiratory depression. HOW IT WORKS: Oxycodone is a semi-synthetic opioid with analgesic properties. Oxycodone binds to mu, kappa, and delta opio...
Source: EPMonthly.com - November 25, 2016 Category: Emergency Medicine Authors: Matt McGahen Tags: Uncategorized Source Type: news

Uncompensated Tasks: How Much Is Too Much?
Conclusion Although we are exempt from the FLSA, which means that we need to do whatever it takes to effectively complete our job, I’d like to think that the time each doc gives outside the clinical arena is similar to what other physicians around the hospital are giving. The good news is that whether you realize it or not, you likely benefit by this participation. Another way to think about your responsibility is to approach your position so that your hourly compensation includes different professional responsibilities that you pay back as the year goes on. This works whether you’re salaried for a number of ho...
Source: EPMonthly.com - November 25, 2016 Category: Emergency Medicine Authors: Logan Plaster Tags: Uncategorized Source Type: news