Infective Endocarditis

IE is an infection of native or prosthetic heart valves, endocardial surface or an indwelling cardiac device (such as a pacer or defibrillator). In recent years, we’re seeing it happen in older and more chronically ill patients. And more MRSA. The diagnosis is tricky because the presentation can be fairly subtle. You need a high … Continue reading Infective Endocarditis →

Non-Traumatic Lower Back Pain

Most of us will have lower back pain in our lives (80–90% lifetime prevalence) and it accounts for 2–3% of ED visits (so quite a bit). As with everything in EM, there are benign and serious causes and we need to differentiate between the two. The serious causes include diagnoses in the back and those … Continue reading Non-Traumatic Lower Back Pain →

My Email Rules

Email can consume hours of your day stealing opportunities to do real work. Several people have devised plans to reclaim this time, so I stole the ones that work for me. These rules have one main goal: to respect my time and that of the receiver. 1. Keep as short as possible. “I’m sorry to … Continue reading My Email Rules →

Discharge Instructions

The October edition of EM-RAP had a great section on how to write good discharge instructions. This is not the pre-printed stuff that comes with the EMR but instructions written specifically for each patient. I modified my DCI (discharge instruction macro) to make those points more obvious. You have been diagnosed with ***, this is … Continue reading Discharge Instructions →

Brief Resolved Unexplained Events (BRUE)

ALTE has been deprecated and replaced with BRUE. Apparent Life-Threatening Events scared parents and led physicians to unnecessary testing. The American Academy of Pediatrics has issued the following guideline. BRUE ==== STEP 1: Meets DEFINITION of BRUE - BRIEF: less than 1 minute episode - RESOLVED: back to baseline/normal - UNEXPLAINED: no other etiology (no URI, … Continue reading Brief Resolved Unexplained Events (BRUE) →

HEART Score

Used to risk stratify patients for further cardiac workup in the ER according to risk of major adverse cardiac events (MACE). History 2: highly suspicious 1: moderately suspicious 0: slightly or non-suspicious ECG 2: significant ST-depression 1: non-specific repolarization 0: normal Age 2: > 65 years old 1: 45-65 years old 0: < 45 years … Continue reading HEART Score →

Mental Status Exam

For the inevitable moment when the medical record eats all my macros, I'm backing them up here. Also, if anyone finds them useful, feel free to steal them. I stole them from elsewhere. MENTAL STATUS EXAM: - Appearance: ***well-groomed, alert, co-operative - Mood: ***pt states they feel depressed - Affect: ***pt appears depressed, ***congruent with … Continue reading Mental Status Exam →

Active Shooter

Today, September 16, 2013, marks yet another day when a gunman opened fire upon civilians, killing unnecessarily. It seems that this is happening more frequently, and it would be foolish to think it is limited to schools, movie theaters and military compounds. As grim as it sounds, we should open the conversation as to what … Continue reading Active Shooter →

How Ed gets great Patient Satisfaction scores

We're all expected to get great patient satisfaction scores in addition to providing excellent care. No one does this more consistently than Ed Ward (click for his scores). So, we talked and he let me know what he does to get great scores. Not only are his scores good, but he also gets more surveys … Continue reading How Ed gets great Patient Satisfaction scores →

What Makes Yanina So Fast

We have a lot of people with great skills in our department with whom we can share our best practices. One thing Yanina excels at is efficiency. No one can deny she's a machine when it comes to seeing patients. Here she describes how she's able to keep her patients and the entire department moving. … Continue reading What Makes Yanina So Fast →