Tactical Medicine News Blog

Musculoskeletal pain is a common ED presentation and emergency providers can often manage it with NSAIDs alone.1 On the other hand, when patients present with small localized areas of intense muscle spasm called trigger points, NSAIDs won’t cut it. A trigger point injection (TPI), however, is a safe and easy way to treat the underlying cause of trigger point pain, and requires only basic equipment already available in most the EDs.

Many of us have heard the saying that emergency medicine is the best 15 minutes of every other specialty. This, is in part, due to the wide breadth of disease and knowledge one must have to take care of patients.  In emergency medicine we typically focus on acute disease specific problems  and life sustaining treatments, but as the population gets older we are also having to deal with chronic conditions as well.  This was not an area that I was trained in residency, but certainly one that I am seeing more and more often.  There was a great review article published in the Journal of Emergency Medicine in January of 2018 titled, Palliative Care Symptom Management in the Emergency Department: The ABC’s of Symptom Management for the Emergency Physician. The lead author of this paper is Mari Siegel, MD, who I had the pleasure of interviewing for this episode.

Background: I received a text message from one of my colleagues inquiring about discharging a patient home with isolated traumatic subarachnoid hemorrhage and to be honest I had heard about this practice, but was not completely aware of the literature around it.  Turns out from a PubMed search there was a meta-analysis published just this past year trying to answer this very question.  When I was a resident, which is not that long ago, the standard practice was for patients to be assessed by neurosurgery for management which usually involved ICU admission or a trip to the OR with ICU admission. Isolated traumatic subarachnoid hemorrhage (itSAH) is typically defined as the presence of a SAH in the absence of any other traumatic radiographic intracranial pathology.  So the question is, is it safe to discharge patients home with itSAH?

With increased access to timely advanced diagnostic testing in ED rational resource utilization is becoming ever more important. In his Best Case Ever Dr. Shabhaz Syed argues that a patient at Janus General who presented to the ED with chest pain, died as a result of overinvestigation, and explains how understanding the factors that contribute to overinvestigation, Baysian theory, diagnostic decision analysis, radiation risk, and teaching "dogma" may help prevent overinvestigation in Emergency Medicine... The post BCE 72 Overinvestigation in Emergency Medicine appeared first on Emergency Medicine Cases.

With increased access to timely advanced diagnostic testing in ED rational resource utilization is becoming ever more important. In his Best Case Ever Dr. Shabhaz Syed argues that a patient at Janus General who presented to the ED with chest pain, died as a result of overinvestigation, and explains how understanding the factors that contribute to overinvestigation, Baysian theory, diagnostic decision analysis, radiation risk, and teaching "dogma" may help prevent overinvestigation in Emergency Medicine... The post BCE 72 Overinvestigation in Emergency Medicine appeared first on Emergency Medicine Cases.