practice updates

Managing Sexual Assault in the Emergency Department
This review will address patient stabilization, provide recommendations for obtaining a medical and assault history, and detail pregnancy and sexually transmitted infection prophylaxis. An in-depth discussion of the forensic examination will be omitted, as requirements regarding healthcare provider training, tools contained within forensic collection kits, time allotted between alleged assault and court admissible evidence collection, and chain of custody legislation vary according to individual state law.

The patient with a Foley catheter is common in the ED. Patients with these catheters can experience several complications, one of the most common being a catheter-associated UTI. This post evaluates this complication, with pearls, pitfalls, and some key components of evaluation and management.

Pelvic Inflammatory Disease (PID) is an important complication of sexually transmitted diseases. Adequate treatment is important to prevent complications such as infertility and systemic disease. This is a brief overview of PID , its workup and management in the emergency department.

This is the first of a two-part series on surgical emergencies. This series discusses “cannot miss” diagnoses that require immediate, or at least emergent, surgical intervention.

A significant number of patients in the ED present with psychiatric complaints. Unfortunately, the resources available for these patients have not kept up with with the increase in psychiatric issues. Emergency medicine acts as a safety net for a large percentage of these patients. These patients present significant challenges to emergency providers. This post is full of pearls for providers managing the psychiatric patient.

“Can’t Intubate Can’t Ventilate” is one of the frightening statements that causes massive surges of adrenaline in everyone. Unfortunately, most neural synapses don’t function well with that large surge of adrenaline, and it is, therefore, imperative to contemplate how to manage this scenario before it arises.

TIA is a brief neurologic deficit due to cerebral ischemia, with no permanent infarction. It affects over 200,000 U.S. patients per year and may precede 14% to 23% of strokes. Many have sought risk stratification tools to determine who may be appropriate for discharge with follow-up. This post evaluates the new ACEP guidelines for TIA and the controversies in the ED evaluation of TIA.

Allergic reactions are commonly seen in the emergency department and anaphylaxis is the most severe type. While most patients present with a rash, the diagnosis can be difficult to make when a rash is not present. This is a brief overview of the diagnosis and management of anaphylaxis in the emergency department.

Altered mental status in children can be subtle. Look for age-specific behaviors that range from irritability to anger to sleepiness to decreased interaction.
In the altered child, anchoring bias is your biggest enemy. Keep your mind open to the possibilities, and be ready to change it, when new information becomes available.
For altered adults, use AEIOU TIPS (Alcohol-Epilepsy-Insulin-Overdose-Uremia-Trauma-Infection-Psychosis-Stroke).

Rheumatoid arthritis is a progressive systemic polyarticular inflammatory arthritis of unclear etiology. While the disease itself is not fatal, complications of the disease make it the most common rheumatic disease requiring ICU admission. This article covers the management of this disease and its complications in the ED.