Biggest problems in the ER?

Started by DrBuro
Get help with your application

Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.

Browse articles Compare schools My application plan Read Interview Feedback
Practice for interviews Ask an Advisor
DrBuro

DrBuro

Senior Member
10+ Year Member
5+ Year Member
15+ Year Member
These could be anything from problems with gadgets to patient tracking. I am basically looking for things that physicians would like/need. I appreciate any help. Thank you.
 
A blood, urine, or body fluid test to truly assess one's pain would the best invention ever.

Then you could say no you're just a drug seeker looking for a high or wow we really need to treat your pain, instead of seeing the pain scale of 10/10 as usual or the dreaded 12/10.

I'm sure you weren't looking for this kind of answer, but it's the first thing that came to mind.
 
the biggest problem in the ER is that we are constantly in need of more space for patients and ways to move them through the ED to their final destination in the hospital more quickly. That being said, our dept is constantly in need of monitoring for aisle/hallway patients (sometimes radiology interferes with tele monitoring from other parts of the hospital and makes this tough when we run out of portable monitors.)

i think we're talking about marketing ED Bunkbeds pretty soon....
 
anonymousEM said:
the biggest problem in the ER is that we are constantly in need of more space for patients and ways to move them through the ED to their final destination in the hospital more quickly. That being said, our dept is constantly in need of monitoring for aisle/hallway patients (sometimes radiology interferes with tele monitoring from other parts of the hospital and makes this tough when we run out of portable monitors.)

i think we're talking about marketing ED Bunkbeds pretty soon....
Click to expand...

Does "final destination" include the afterlife?
 
I would absolutely LOVE a simple lab test (preferably available with bedside testing) that will, with great certainty, rule out an MI and tell us that the likelihood of imminent cardiac badness is essentially nill.

You know, sort of like a troponin, but that could allow us to safely send chest pain patients home instead of admitting them for 'r/o'.

Take care,
Jeff
 
Jeff698 said:
I would absolutely LOVE a simple lab test (preferably available with bedside testing) that will, with great certainty, rule out an MI and tell us that the likelihood of imminent cardiac badness is essentially nill.

May be on the way with new CT scans looking for calcification of the coronaries combined with some of the new ischemia markers.

Hopefully will replace the admit for R/o like head CT replaced X-ray.
Click to expand...
 
beyond all hope said:
Jeff698 said:
I would absolutely LOVE a simple lab test (preferably available with bedside testing) that will, with great certainty, rule out an MI and tell us that the likelihood of imminent cardiac badness is essentially nill.

May be on the way with new CT scans looking for calcification of the coronaries combined with some of the new ischemia markers.

Hopefully will replace the admit for R/o like head CT replaced X-ray.
Click to expand...

Maybe new ischemia markers, but not calcification of coronaries. Extremely common in the age group of interest, but not specific to active disease today.
Click to expand...
 
BKN said:
beyond all hope said:
Maybe new ischemia markers, but not calcification of coronaries. Extremely common in the age group of interest, but not specific to active disease today.
Click to expand...

Yeah, my vague understanding was that some of the thinks like myeloperoxidase would be very sensitive but not necessarily specific (ie d-dimer for PE). I use sestamibi's in the daytime when they're available... they're good for low risk rule outs.

mike
Click to expand...
 
bartleby's right - ask in spanish about SIGECAPS and bingo! (one of the things i learned having to actually do continuity clinic my prelim year)
 
Here's a big problem: patients claiming bogus allergies.

Think about all the bogus allergy crap we have to sift through every day:
-I'm allergic to everything but demerol.
-I'm allergic to doxy because it made my stomach upset.
-I'm allergic to PCN because my mom told me I am because my brother is.
-I'm allergic to ativan because it made me sleepy.
-I'm allergic to tylenol or epi or albuterol.
 
turtle said:
Had a lady who claimed to be allergic to corticosteroids ... 🙂
Click to expand...

You're right that she is more than likely either crazy or means she had an adverse reaction but Type I reactions to specific glucocorticoids have been well described

Anaphylaxis induced by glucocorticoids.

Erdmann SM, Abuzahra F, Merk HF, Schroeder A, Baron JM.

Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany. [email protected]

Glucocorticoids are frequently used to treat allergic reactions. Therefore, allergic reactions to systemic glucocorticoids in particular are considered most unlikely and are not well known. We report on a 23-year-old woman with atopic dermatitis who had an anaphylactic reaction after oral administration of prednisolone. On treatment with epinephrine, antihistamines and volume symptoms resolved. Skin testing with a panel of glucocorticoids showed immediate type reactions to prednisolone, prednisolone hydrogen succinate, prednisone, and betamethasone dihydrogen phosphate. In challenge testing the patient tolerated methyl prednisolone and dexamethasone. There is increasing evidence that true allergic immediate type reactions to glucocorticoids exist. The severity of the reaction can vary from a rash to anaphylaxis. However, a patient sensitized to one or a group of glucocorticoids does not have to refrain from all types of glucocorticoids. Careful challenge testing is by far the best way to select glucocorticoids that are safe for future treatment. Clinicians should be aware that allergic reactions to glucocorticoids can occur and that worsening of symptoms does not always mean treatment failure.
 
You've gotta love the Rx allergies..especially whittling down the narcotics to one preferred drug.

I've had a couple of pts claim steroid rxn. One said that it made them gain weight when they took it for a prolonged period and the other claimed that it upset their stomach. *sigh* I also had a pt say that their kid was allergic to steroids b/c it made them somewhat hyper.

Any actual documentation of benadryl allergy? I've had a surprising # of pts claim this. When I ask what kind of rxn they had it always is hives (with the exception of those I rule out immediately who say they're allergic b/c it made them sleepy or it made their kid active). I've just assumed that the benadryl simply didn't stop whatever allergic rxn they were taking it for.
 
DrMom said:
I also had a pt say that their kid was allergic to steroids b/c it made them somewhat hyper.
Click to expand...

i agree "somewhat hyper" isn't an allergy, but i've seen a few kids (and an adult) go nucking futs when given 'roids. not an allergy but definitely a reason to avoid them in those pts. :scared:

i've seen pts (during my time in allergy/immunology clinic) with IgE mediated reactions to nearly everything imagineable. the one that suprised me in its prevalence and relative severity is NSAIDS.

--your friendly neighborhood non IgE mediated caveman
 
You must log in or register to reply here.