Archive for December, 2012

If Only

I think we’ve all experienced what I like to call “case envy.”  Or even sometimes, “shift envy.” You come on and your colleague immediately starts telling you about the interesting case, or the polytrauma, or the fantastic save/diagnosis/procedure that they just completed.

“Hey, bud, I just performed an open thoracotomy, cross-clamped the aorta and threw in a central line just after performing a cric while I was watching this guy’s aorta rupture during my ultrasound of his belly during which we lost pulses.  Sorry about the rest of the mess here in the ED, but those three pelvics and a disempaction might yield something interesting… Enjoy your shift!”


I sometimes hear the story and wonder what I might have done.  Would I have handled things the same way?  Is that the diagnostic approach I would have followed?  Would I even have considered things the same way?  Why don’t I ever get the cool cases…?

In residency, we had one colleague who was the perpetual “Black Cloud.”  Now, they got to see a lot of cool stuff.  However, you didn’t want to follow them because you knew it was going to be chaos in the ED when you arrived.  And, if you came before them, you knew the last part of your shift was going to start going to pot about an hour before the end of it.

So maybe it’s not so bad being a bit of a white cloud… but still… I think we all like to have a little something that gets the juices flowing, the mind working, a bit of “yeah for me” moment… After all, that’s why we got into Emergency Medicine… at least for me… how about you?

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ACEP Calls for Increased Investment in Mental Health Resources and a Ban on the Sale of Assault Weapons

ACEP President Dr. Andy SamaThe American College of Emergency Physicians (ACEP) today expressed deepest sympathy to all those affected by the senseless tragedy in Connecticut and called on government at every level to increase investments in mental health resources and to ban the sale of assault weapons and high-capacity magazines.

Emergency physicians see the tragic consequences of gun violence every day. Our hearts go out to the families of the victims and to everyone affected by this terrible event in Newtown.  We deplore the improper use of firearms and support legislative action to decrease the threat to public safety resulting from the widespread availability of assault weapons.  We also are urging policymakers to restore dedicated funding for firearms injury prevention research.

ACEP’s policy on firearm injury prevention endorses limiting the availability of firearms to those “whose ability to responsibly handle a weapon is assured.”  It also calls for aggressive action to enforce current laws against illegal possession, purchase, sale or use of firearms.

The nation’s emergency physicians call for increased funding for the development, evaluation and implementation of evidence-based programs and policies to reduce firearm related injury and death. We will fully support legislation that supports the principles of ACEP’s policy on firearms injury prevention.

The lack of mental health resources in the United States has contributed to a significant increase in visits to the emergency department.  Psychiatric emergencies grew by 131 percent between 2000 and 2007, according to a recent study in Annals of Emergency Medicine.  This is symptomatic of the lack of resources for these patients.

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Annals Audio for December: Posted!

Check out the December Annals of EM audio summary, now available. Highlights:

-ED occupancy and crowding on the rise: it’s not just boarding — it’s us
-Measuring ED utilization: encounters or patients?
-The UK 4-hour rule: gone now, but did it change care?
-The ED is now farther away… is mortality different?
-Endotracheal intubation: video versus direct
-Endotracheal intubation: should EMS do it for head injuries?
-Isolated A Fib, outcomes after ED discharge (real, real good)
-Modifying the criteria for diagnosing MI in patients with LBBB
-Ethnic differences in ACS symptom presentation

Check it out, and email any time at


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In All My Career…Stories from the ED





Please send your story to Tracy Napper ( today!


An example of lack of communication with the patient:

As usual the ER was full. The bed closest to my desk was undergoing thrombolysis for an acute MI. His nurse calls out V-tach! I run over to the bed and adminstered a good hard chest thump which converts him to sinus rhythm, ordered lidocaine and told the nurse to get him to the ICU immediately before he developed any more problems.

As he was going out the door, he asked the nurse “Why did the doctor hit me?”

James Meade, MD, FACEP

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