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Trauma & Triage Geriatric Teaching Moments from A.J. Heightman, MPA, EMT-P – JEMS Editor-in-Chief relative to the Texas Church Mini Bus Crash that Killed 13 Senior Citizens
When 13 senior citizens were killed in a horrible head-on collision between a San Antonio church mini bus and a pickup truck in southwest Texas, the AP story noted that the elderly occupants “were more susceptible to internal injuries and damage to vulnerable organs because of their advanced ages.” (see below as presented by the Associated Press). As an educator who spends a lot of time educating crews about the unique impact trauma can have on geriatric patients, I thought I would take the opportunity to present a few important facts about geriatric trauma and assessment tips to remember when you are tasked with triag...
Source: JEMS: Journal of Emergency Medical Services News - April 2, 2017 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT P Tags: Major Incidents News Patient Care Source Type: news
Teaching NeuroImages: Acute infarction of the left medial lemniscus masquerading as a peripheral neuropathy
A 58-year-old woman with hypertension and bilateral carpal tunnel syndrome presented with acute paresthesias in her right hand and foot. She had decreased sensation to vibration and pinprick in a right-sided stocking-glove distribution. MRI of the pons confirmed an acute infarction of a paramedian branch of the basilar artery in the left medial lemniscus (figure). In the posterior column pathway, sensory projections from the face, arm, and leg are somatotopically arranged medially to laterally within the medial lemniscus.1,2 Although strokes classically present with numbness, both thalamic and medial lemniscal infarcts can...
Source: Neurology - April 24, 2017 Category: Neurology Authors: Aamodt, W. W., Siegler, J. E., Elman, L. Tags: MRI, DWI, All Cerebrovascular disease/Stroke, Central pain, Infarction RESIDENT AND FELLOW SECTION Source Type: research
Teaching NeuroImages: Takayasu arteritis: Neuroimaging progression after immunosuppressant treatment
A 29-year-old woman presented with a 2-year history of heel pain, constitutional symptoms, and increased acute phase reactants. CT and magnetic resonance (MR) angiography revealed a thickening of aortic walls and a thread-like appearance of bilateral subclavian and common carotid arteries. The findings were consistent with Takayasu arteritis (TA)1 and the patient was prescribed methylprednisolone, followed by azathioprine. Follow-up MR angiography, 6 years later, showed an important improvement with only a mild luminal narrowing of both common carotid arteries (figures 1 and 2, A and B). TA is a large-artery inflammatory d...
Source: Neurology - May 15, 2017 Category: Neurology Authors: Martinez Rodriguez, L., Caminal Montero, L., Pena Suarez, J., Garcia-Cabo Fernandez, C., Calleja Puerta, S. Tags: MRI, Vasculitis, All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION Source Type: research
Is it an Emergency? Insurer Asks Patients to Question ED Visits
INDIANAPOLIS (AP) — Alison Wrenne was making waffles for her two young children one morning when abdominal pain forced her to the floor. A neighbor who is a physician assistant urged her to go to the emergency room.
Wrong decision, according to her health insurer. Wrenne was diagnosed with a ruptured ovarian cyst, but Anthem said that wasn't an emergency and stuck her with a $4,110 bill.
"How are you supposed to know that?" said the 34-year-old from Lexington, Kentucky. "I'm not a doctor ... that's what the emergency room is for."
In an effort to curb unnecessary and costly ER visits, the Blue Cross-B...
Source: JEMS Patient Care - November 10, 2017 Category: Emergency Medicine Authors: Tom Murphy, Associated Press Tags: Patient Care News Administration and Leadership Source Type: news
Prehospital Assessment for Stroke Isn ’t Perfect
Prehospital assessment tools for neurological deficits aren’t perfect
An approximately 30-year-old male answers the door to let you and your partner into the house you’ve been called to. Hank introduces himself and thanks you for coming, quickly adding that he’s concerned about his mother who’s “acting weird.”
Hank tells you he stopped by his mom’s house for lunch and found her using paper plates to heat food on the stove. He stopped her before the plate ignited. His mother seemed confused and so he called 9-1-1.
Patient Assessment
Margaret, Hank’s 53-year-old mother, appears to be in good healt...
Source: JEMS Patient Care - May 1, 2018 Category: Emergency Medicine Authors: Dennis Edgerly, EMT-P Tags: Patient Care Cardiac & Resuscitation Columns Source Type: news
Is it an Emergency? Insurer Asks Patients to Question ED Visits
INDIANAPOLIS (AP) — Alison Wrenne was making waffles for her two young children one morning when abdominal pain forced her to the floor. A neighbor who is a physician assistant urged her to go to the emergency room.
Wrong decision, according to her health insurer. Wrenne was diagnosed with a ruptured ovarian cyst, but Anthem said that wasn't an emergency and stuck her with a $4,110 bill.
"How are you supposed to know that?" said the 34-year-old from Lexington, Kentucky. "I'm not a doctor ... that's what the emergency room is for."
In an effort to curb unnecessary and costly ER visits, the Blue Cross-B...
Source: JEMS Patient Care - November 10, 2017 Category: Emergency Medicine Authors: Tom Murphy, Associated Press Tags: Patient Care News Administration and Leadership Source Type: news
A True Hematologic Emergency
BY GREGORY TAYLOR, DO, & JACKLYN MCPARLANE, DOA 33-year-old woman with a past medical history of sickle cell SS presented to the emergency department with chest pain, difficulty breathing, and a cough for two days. Her chest pain was diffuse, without radiation, and partially reproducible. Her cough was nonproductive, and she also reported fever and chills.The patient noted this was different from her normal back and leg pain from past sickle cell crises. She was following up with a sickle cell specialist, and was compliant with her hydroxyurea treatment.Her temperature was 102.8°F, blood pressure was 94/60 mm...
Source: The Case Files - June 26, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research
A Pregnancy Complication to Look out for even after Pregnancy
BY GREGORY TAYLOR, DO, & SHERIF G. EL-ALAYLI, DOA 30-year-old G5P3 presented to the ED with bilateral lower-extremity edema and headache for three days. She presented one week after an uncomplicated full-term vaginal delivery with an unremarkable pregnancy course and no prior requirement for antihypertensive therapy. The headache was described as achy to sharp, with associated photophobia. She also noted occasional vaginal spotting, which was common a few weeks after delivery. She denied any chest pain, shortness of breath, nausea or vomiting, abdominal pain, or any other symptoms. She admitted to occasional mild cr...
Source: The Case Files - August 28, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research
Novel electronic health record (EHR) education intervention in large healthcare organization improves quality, efficiency, time, and impact on burnout
A novel approach to advanced electronic health record (EHR) skills training was developed in a large healthcare organization to improve high-quality EHR documentation, while reducing stressors linked to physician burnout.
The 3-day intensive EHR education intervention covered best practices in EHR documentation and physician well-being. The specialty physician faculty used interactive teaching including demonstration, facilitation, and individual coaching. Laptops were provided for hands-on practice. Mixed-method evaluation included real-time feedback, daily surveys, and post-activity surveys to measure participant learni...
Source: Medicine - September 1, 2018 Category: Internal Medicine Tags: Research Article: Quality Improvement Study Source Type: research
How to stay healthy and happy through the decades
Successful aging can be the norm, says UCLA psychology professor Alan Castel in his new book, “Better with Age: The Psychology of Successful Aging” (Oxford University Press). Castel sees many inspiring role models of aging. French Impressionist Claude Monet, he notes, began his beloved water lily paintings at age 73.Castel cites hundreds of research studies, including his own, combined with personal accounts from older Americans, including Maya Angelou, Warren Buffett, John Wooden, Bob Newhart, Frank Gehry, David Letterman, Jack LaLanne, Jared Diamond, Kareem Abdul-Jabbar, John Glenn and Vin Scully.Castel notes that ar...
Source: UCLA Newsroom: Health Sciences - November 1, 2018 Category: Universities & Medical Training Source Type: news
Transoesophageal echocardiography current practice in France: A multicentre study.
CONCLUSIONS: TOE is safe, with a low rate of complications and few stops for intolerance. A shorter TOE duration and better patient feelings were observed for experienced operators, highlighting the importance of the learning curve, and paving the way for teaching on a TOE simulator.
PMID: 30539734 [PubMed - in process]
Source: Archives of Cardiovascular Diseases - December 1, 2018 Category: Cardiology Authors: Coisne A, Dreyfus J, Bohbot Y, Pelletier V, Collette E, Cescau A, Cariou E, Alexandrino C, Coulibaly S, Seemann A, Karsenty C, Theron A, Caspar T, Soulat-Dufour L, Ternacle J Tags: Arch Cardiovasc Dis Source Type: research
