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Updates on Recommendations for STI Treatments & Empiric Therapy: When to Treat and What to Treat Depending on your Patient

It is essential for Emergency Physicians to know the standard of care for sexually transmitted infection (STI) treatments, as patients often present to Emergency Departments for evaluation and treatment shortly after exposure to these diseases. The Emergency Department provides patients with rapid screening, diagnosis, treatment regimens, and access to outpatient follow up.

practice updates

Palliative Care in the Emergency Department: A Practical Overview of Why and How

The role of palliative medicine in emergency care has received increasing attention since ACEP’s decision in February of 2013 to join the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely ® initiative. In an effort to maintain (and potentially improve) quality of care while reducing costs, ACEP identified discussions regarding hospice and palliative medicine (HPM) as one of ten opportunities for ED providers and their patients to eliminate low-yield and possibly harmful testing and treatments. The explicit directive is “Don’t delay engaging available palliative and hospice care services in the emergency department for patients likely to benefit.” Of note, EM residency trained physicians are eligible to complete many HPM fellowships and may subsequently obtain HPM board certification. However, gaining such a high-level of expertise is not necessary. The following discussion addresses how simple, fundamental skills in HPM can significantly enhance your practice in emergency medicine.

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The Multiple Layers of Diagnostic Uncertainty

The young female with lower abdominal pain. The middle-aged male with atypical chest pain. The elderly female that presents with vague symptoms of dizziness. These are just the tip of the iceberg of chief complaints we will see in our emergency medicine careers. Those with symptoms that don’t fit into a particular diagnostic box or with totally clean workups can be frustrating for patients and physicians alike. We are taught in medical school that 90% of diagnoses can be made with a very meticulous history and physical. But, until I was asked to write on the topic of diagnostic uncertainty, I had never really thought about how infrequently we actually make a slam dunk, no doubt about it diagnosis.

practice updates

R.E.B.E.L. EM – More Dogma: Epi in Digital Nerve Blocks

You are working as an EM resident and have just evaluated a patient with a right long finger DIP joint dislocation. You perform a digital nerve block with 1% lidocaine with 1:100,000 epinephrine, and go to present to your attending before attempting the reduction. Your attending, on hearing about the epinephrine use goes berserk, and says “don’t you know that you shouldn’t use epi in fingers, noses, ears and toes?”.

practice updates

Cholangitis: Deadly Cause of Right Upper Quadrant Abdominal Pain

Cholangitis should be considered in patients with undifferentiated sepsis. Ruling in or out the diagnosis of cholangitis is no longer based on clinical exam alone. The addition of imaging and bloodwork to the clinical exam are much more reliable. Resuscitation, antibiotics and consultation for early biliary decompression are the mainstays of cholangitis treatment.