A "must read!" Incredible power review on evaluation and management of the geriatric patient

What is going on? What do you do? Fluids? Inotropes?

Emergency physicians commonly care for poisoned patients. These exposures may be either intentional or unintentional. Salicylates are commonly found in many topical and over the counter preparations, yet salicylate toxicity is often overlooked and underestimated as a potential cause for illness in our patients. Below is a condensed quick-guide of common mistakes that emergency physicians may be making with respect to salicylate overdoses and how to fix them. The goals of care to take away from this article are prevention of intestinal absorption and CNS entry of salicylates, as well as drug elimination.

Current EM residents, as part of the Millennial Generation (born between 1981 and the present), now see this new technology as a way of life, and feel the need to be connected online at all times.5,6 As a result, many EM residents have abandoned the traditional lecture hall and textbooks, and have taken to their electronic devices and the World Wide Web for obtaining information. In order to continue providing quality education that meets the needs of the modern EM resident, the type and quality of educational resources that we deliver must also change. So the question becomes: How do we use these new resources to guide the education of our current EM residents both on and off shift?

Every few years, we come to a crossroads that makes us reexamine our current clinical practice and consider a better intervention. For the past twenty years, patients presenting with acute ischemic stroke have had essentially one option for therapy: intravenous thrombolytics. Since the NINDS-2 trial in 1995 [1], tPA has erupted onto the scene of stroke management and has become the gold standard despite ongoing questions behind the true efficacy of tPA.

To the Class of 2015 – Congratulations!! You’ve made it. After at least 11 years of post-high school education, you have finally reached that proverbial finish line and are ready to transition from resident to attending. What I would like to share with you is some advice about what life is like on the other side. Now that you have finished residency, it’s safe to say that you know the medicine really well. But, I have come to find that your learning about life as a professional is just beginning.

It’s 3pm on a Monday after a holiday. The department is bustling, and you feel like there are patients crammed into every conceivable space. Alarms are going off on patient monitors. You’re in the midst of discussing a case with a resident when a nurse puts an ECG in front of you to review and sign. Just as you finish reviewing the ECG, you turn back to your resident, only to get a phone call from the radiologist notifying you of an abnormal finding on another patient’s CT scan. After looking through the scan, you help guide your resident through an appropriate plan and disposition of the patient they saw, and decide it’s time to round on a few patients you need to see. As you rise from your chair, your EMS phone goes off, and you get word of a cardiac arrest that will arrive in 5 minutes. It’s just then that you realize you have to pee so bad it hurts. Sounds like a typical emergency department shift for many of us, doesn’t it?

I HAVE BECOME INFATUATED WITH THE PATIENT CARE EXPERIENCE. I believe the term “patient care experience” is a more inclusive term that describes our technical expertise while also including everything else, such as communication, department ambience, throughput, and the behavior of everyone a patient comes into contact with while in the department.