The Killer Aorta: Diagnosing Thoracic Aortic Dissection
January 16, 2017
Thoracic aortic dissection (TAD) is one of the most dramatic and life-threatening conditions encountered in all of medicine. Every year in the United States, there are an estimated 6,000 to 10,000 cases of TAD. Since it is an uncommon condition compared to the 5 million ED chest pain visits and more than 1 million acute…Read More
The Cognitive Autopsy
January 9, 2017
Ever since the Institute of Medicine’s report To Err is Human was released in 2000, healthcare has seen a surge in patient safety initiatives. Analysis of medical errors has become increasingly widespread, with several different methods being used by hospitals and practitioners. Of these methods, I suggest that cognitive error analysis may prove to be…Read More
The Focus of Patient Safety in 2017
January 3, 2017
healthcare industry will continue to have its radar locked on the issue of Patient Safety in 2017. Some of the targets and goals are only vaguely visible from the 30,000-foot level, while others are in clear focus on the ground before us. Depending on where you stand (or fly), opportunities abound to improve patient safety. Let’s take a forward…Read More
Very Abnormal Vital Signs & Death after Discharge: Remember That Patient You Sent Home Last Night?
December 12, 2016
The majority of malpractice suits in acute care and emergency medicine involve patients who were discharged home. These patients experienced an unexpected adverse outcome after they left the ED such as worsening of their illness or even death. For many of these patients, the “bad outcome” could not have been foreseen — the workup was…Read More
The Deceptive Pied Pipers: “Bedside Maneuvers” for Chest Pain
December 5, 2016
Malpractice claims related to the chief complaint of chest pain continue to plague clinicians. Foremost among these claims is the allegation of “missed MI,” which has now been expanded to include missed unstable angina as well as missed actual myocardial infarction. Although the evaluation of the adult with chest pain is fraught with many pitfalls,…Read More
Case: Failure to Diagnose Sepsis
November 28, 2016
Download audio of this case here. Download case as a PDF here. Sepsis is a regular visitor in the news as cases of flesh-eating bacteria and the dramatic speed with which victims deteriorate hit the headlines. The failure to diagnose sepsis remains a critical issue as delays in diagnosis significantly increase morbidity and mortality….Read More
The Ring of Death: Patient Safety in Radiology
November 21, 2016
It is a routine practice for hospital-based practitioners to order radiology studies during the evaluation of sick or injured patients. The information gained from these imaging studies provides crucial information needed to make a diagnosis and guide treatment. As many as 50% of ED patients get a plain X-ray during their visit. It is well…Read More
Veterans Healthcare: What Civilian Physicians Need to Know
November 7, 2016
There are approximately 21 million living U.S. military veterans, and the Veterans Health Administration (VHA) is the largest health care system in the country. Despite its size, the VHA is overwhelmed by the need to provide healthcare to the huge number of eligible veterans. As a consequence of this high demand for care, Congress enacted…Read More
The Chief Complaint of Pain: A Pain for You and Your Patient!
October 31, 2016
A chief complaint of pain is one of the most common encountered by practitioners in any specialty. The pain may be acute or chronic. It may be located in the abdomen, chest, head or any other body part. It may be spontaneous in onset or may be due to an injury. It can range from…Read More
Trick or Treat? Halloween in the Emergency Department
October 24, 2016
It should be no mystery to anyone that EDs see more than their share of fireworks injuries on July 4th and hangovers on New Year’s Day. But what about on Halloween? Will there be a deluge of patients with candy overdoses? Since I couldn’t recall any specific cases from my own Halloween emergency department shifts, I…Read More
