Pearls for Abscess Incision and Drainage
Part 2 in a Series
Abscess incision and drainage should be loved and adored by all emergency providers because another abscess is waiting just behind the curtain. This month we highlight general guidelines for abscess incision and drainage, and show how to treat one in the video below. We will follow up with some additional videos in the months to come focusing on scalp, vaginal, and facial abscesses. And, just when you think you have seen it all, we will reveal a few more surprises.
Axillary abscess from hidradenitis. Photo by Martha Roberts.
The Approach
n Identification of an abscess appropriate for I&D....
Source: The Procedural Pause - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
General Guidelines Related to Abscess Incision and Drainage: Part II
Greetings! We’re excited to continue our series on abscess incision and drainage. This procedure should be loved and adored, because another abscess is waiting just behind the curtain. This month we will highlight (in video format) the final cut of abscess incision and drainage. We will follow up with some additional videos in the months to follow focusing on scalp, vaginal, and facial abscesses. And, just when you think you have seen it all, we will reveal a few more surprises.
The Approach
· Identification of an abscess appropriate for I&D
· If unsure, use ultrasound guide...
Source: The Procedural Pause - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Prescription Rates For Painkiller Vary Widely By State : Shots - Health News : NPR
There's no getting around the fact that the abuse of prescription painkillers is a huge problem in the U.S. Prescription drug overdoses now kill more people each year than car crashes.
But the overdose risks vary quite a bit depending on where in the country you live. One reason is that how often doctors prescribed the drugs, such as Percocet, Vicodin and generic opioids, varies widely by state.
The Centers for Disease Control and Prevention analyzed a commercial database of drug prescriptions looking for patterns. Nationwide, there were 82.5 prescriptions written for opioid painkillers for every 100 Americans in 201...
Source: Psychology of Pain - July 3, 2014 Category: Psychiatrists and Psychologists Source Type: blogs
Healthcare Update Satellite — 06-17-2014
Read more healthcare-related news from around the web on my other blog at DrWhitecoat.com
Oklahoma University Medical Center joins the growing ranks of hospitals that are requiring patients to pay a fee of $200 to be treated for non-emergency complaints. That amounts to an estimated 40% of OU’s emergency department visits. If patients do not want to pay for non-emergent care, they will be referred to nearby urgent care clinics.
This “triage out” protocol will eventually become a standard throughout US emergency departments. Count on it.
Emergency physician writes about how she almost diagnosed Lou Gehrig&...
Source: WhiteCoat's Call Room - June 17, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Failure To Communicate: The Dangers Of Inadequate Hospital Handoffs And What To Do About It
One of my biggest pet peeves is taking over the care of a floor-full of complicated patients without any explanation of their current conditions or plan of care from the physician who most recently treated them. Absent or inadequate verbal and written “handoffs” of patient care are alarmingly common in my experience. I work primarily as a locum tenens physician, traveling across the country to “cover” for my peers on vacation or when hospitals are having a hard time recruiting a full-time MD. This type of work is particularly vulnerable to gaps in continuity of care, and has heightened my awareness ...
Source: Better Health - March 24, 2014 Category: Health Medicine and Bioethics Commentators Authors: Dr. Val Jones Tags: Health Policy Health Tips Opinion Change Of Shift Communication Failure To Communicate hand off History And Physical Exam Hospital Sign-Outs Hospitalists Locum Tenens Medical Errors Nursing Progress Note Sign out Talk Source Type: blogs
Hospital Quality Measures: Value Based Purchasing 2.0 (The Funny Version).
For years, hospital quality measures have been tracked by private and government insurance programs to try and improve the healthcare services received by their beneficiaries. The most recent example is the Value-Based Purchasing Program (VBP) initiative by The Centers For Medicare & Medicaid Services (CMS). How does CMS describe VBP?"Under the Program, CMS will make value-based incentive payments to acute care hospitals, based either on how well the hospitals perform on certain quality measures or how much the hospitals' performance improves on certain quality measures from their performance during a basel...
Source: The Happy Hospitalist - March 14, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Nurses and Our Addictions
When we think of the addicted nurse, we may often think of addiction to prescription drugs, alcohol or illicit drugs. But other types of addictions can also have negative effects on our lives as well.Of course, addiction to alcohol, meth or heroin is indeed an enormous health risk and problem for many individuals---including nurses---but today's post is going to place our focus elsewhere.Technology AddictionI admit it. I can barely live without my laptop. While I continue to avoid buying a smart phone out of a desire to not have such easy access to the constant flow of web-based information that we all seem to rely on, I s...
Source: Digital Doorway - March 11, 2014 Category: Nurses Tags: blog carnivals nurse nurses nursing Source Type: blogs
Suboxone Controversy: Brattleboro Reformer gets a C
In their story about buprenorphine, Suboxone, and opioid dependence, the Brattleboro Reformer gets it about 60% right. They describe the shortage of physicians certified to treat addicts with buprenorphine, correctly identifying most of the diversion of buprenorphine as desperate attempts at self-treatment. They lose points, though, for allowing an ill-informed legislator to suggest getting rid of buprenorphine altogether, without pointing to the example of Georgia, the former USSR republic, where the ban on buprenorphine resulted in the birth of krokodil, a nightmare drug now found in parts of the US.
Cost concerns
...
Source: Suboxone Talk Zone - March 8, 2014 Category: Addiction Authors: J T Junig Tags: Addiction Buprenorphine Public policy Suboxone treatment cost of suboxone film patient cap on suboxone safety of buprenorphine and suboxone suboxone regulation Source Type: blogs
When A Prescription For Pain Pills Becomes A Gateway To Addiction : Shots - Health News : NPR
On the surface, the 39-year-old construction worker looks like any other patient with back pain. He came to the Washington, D.C., emergency room, where I work, in severe discomfort after moving heavy cinder blocks a few days before.The pain gets worse with twisting and bending, but he has no numbness or weakness in his legs. There's no tenderness along his spine, no difficulty urinating, no fever, so there's nothing to suggest a fracture, infection, spinal cord mass or anything other than a muscle strain.The resident I'm supervising orders a Percocet pill, a sensible option we choose almost every day. But the patient refus...
Source: Psychology of Pain - February 15, 2014 Category: Psychiatrists and Psychologists Source Type: blogs
Foreign Body to the Face and Facial Laceration Repair
Part 1 in a Series
Wound care and suture repair are two of the most frequently encountered issues in the emergency department. It is the midlevel provider’s job to be familiar with proper wound care and suturing techniques as well as quick and safe treatment of soft tissue skin injuries. You can use various suturing techniques and styles, but it is important to find a few that really work for you, often tailored to the area of injury.
This month, we are focusing on lacerations and puncture wounds to the soft tissue of the face. Future posts will touch on other suturing skills, with some great tips from our plastic surge...
Source: The Procedural Pause - January 31, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Give and Take Medicine (Good Doctor and Nurse Humor).
Being a great doctor or nurse means learning how to give and take. Healthcare professionals are not dictators and patients are not entitled to whatever they read on the internet. Nursing and doctoring are an art of skillful negotiation with patients and their families. As professionals, doctors and nurses have an obligation to seek out the care plan that is in the best interests of their patients. The Happy Hospitalists wants all patients to know that your doctor and nurse are there for you. They are ALWAYS thinking about how to make you the most satisfied patient. They have to because ...
Source: The Happy Hospitalist - January 26, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Anchors Aweigh!
An otherwise healthy 38 year old patient was brought in by her family with vomiting and mental status changes from her pain medications.
She had repair of a tibial plateau fracture performed four days earlier and was having a lot of pain. She didn’t like taking the Percocets that she was prescribed because they made her nauseous. She took one of them the day after her surgery and she was nauseous the rest of the day, so she vowed not to take any additional Percocets. However, her knee pain was worse that morning to the point that she couldn’t stand it any longer, so she took two Percocets … on an empty stomac...
Source: WhiteCoat's Call Room - December 10, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Medical Topics Patient Encounters Source Type: blogs
The Saga Continues: Posterior Shoulder Dislocation
We finish our shoulder dislocation series by paying our respects to posterior shoulder dislocation. Posterior shoulder dislocations are rare, and account for less than 4-5 percent of all shoulder dislocations, but all ED providers should know how to identify and relocate these injuries. Cases of misdiagnosis and even late diagnosis can occur. Early recognition and appropriate management can save a patient from complicated issues related to the dislocation as well as chronic pain.
Anteroposterior (AP) view, left, of a patient with a posterior dislocation. This dislocation may be difficult to appreciate on an AP view becaus...
Source: The Procedural Pause - December 3, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
My Green Mama Confessions
I live in organic kale smoothie, non-BPA, gluten-free, cloth diaperin’, homebirthin’, breastfeed them till they go to college, crunchity green land. That is, we live in the mountains outside of Boulder, which is like Boulder, but one step closer to your friends living in an Ashram and serving up their placenta for Thanksgiving dinner. And I am an active participator in this culture. Well, not the whole placenta-eating-part.
But I do have some confessions to make to my friends and neighbors: I had an epidural…twice…the very moment that I could and I would never ever ever consider the possibility of n...
Source: Conversations with Dr Greene - November 12, 2013 Category: Pediatricians Authors: Joelle Wisler Tags: Perspectives Parenting Source Type: blogs
Yet Another Shoulder Dislocation
No series on dislocations would be complete without mentioning shoulder dislocation. Most shoulder dislocations (>90%) are anterior (forward), and it should be noted that shoulder dislocations make up about half of all dislocations seen in the ED. Most shoulders can be relocated easily, while others may frustrate a provider. Associated fractures, artery or nerve compromise, and even rotator cuff injuries can worsen the situation. Relocation techniques can be difficult, and may be physically challenging for the provider and patient.
Acute shoulder dislocation with fracture of tuberosity. (Photo by James Roberts)
T...
Source: The Procedural Pause - November 1, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
