practice updates

All dialysis patients require some form of vascular access and unfortunately, complications such as bleeding may occur. This is a brief overview of the bleeding complications that may occur in the dialysis patient. Patient evaluation, workup and treatment regimens are discussed.

Chest pain accounts for approximately 8-10 million healthcare visits in the U.S. per year and can be associated with a variety of benign to life-threatening diseases. Acute coronary syndrome is one of the major considerations in the ED. Approximately 20% of lawsuits are due to misdiagnosis and mismanagement of ACS and a large percentage of patients are admitted due to this risk. However, few admitted patients go on to be diagnosed with ACS. Although commonly used to help risk stratify patients in the ED, there is no evidence that stress testing decreases risk of future cardiac events. This post will examine chest pain risk stratification in the ED and the utility of stress testing.

Organ transplantation is common and challenging in the emergency department. Transplant patients are at risk for a wide variety of complications, especially in the period immediately after surgery. This post will review complications specific to transplanted kidneys, livers and hearts.

Emergency departments cater to patients from all walks of life, some living under better circumstances than others. For those patients enduring difficulties outside the ED that are often unseen, here is a primer to raise that awareness and also encourage strategies to better care for these patients.

Pharyngitis accounts for a large number of Emergency Department and Urgent Care visits each year. The majority of cases are due to a viral etiology, and Group A Beta-hemolytic streptococcus accounts for 15% to 30% of cases. However, a wide array of diseases may present similarly, with several of these potentially life-threatening. This post looks at these mimics and more.

Organ transplantation is becoming increasingly common. These patients present a challenge to emergency physicians as they are on immunosuppressive medications and have anatomic and physiologic variations. Transplant patients are at risk for a number of complications including infection, medication effects, rejection and complications specific to the transplanted organ.

Immune Thrombocytopenic Purpura (ITP) is an immune-related cause of low platelet levels. It is more common in children than adults, but may occur in both populations. This is a brief review of the signs and symptoms of ITP and initial treatment options in the emergency department.

We have discussed several entities that may lead to a child limping. We have covered osteomyelitis, plantar punctures, and toddler’s fractures. We have also touched upon Osgood Schlatter’s Disease, SCFE, osteosarcoma and even Growing Pains. Now let us review a topic that always crosses our minds when considering the painful extremity: Septic Arthritis.

Disseminated Intravascular Coagulation (DIC) is a serious complication of some critical illnesses. Patients are very ill and can present with a multitude of symptoms. While treatment of the underlying illness is key, there are some key interventions that can be initiated in the emergency department (ED). This is a brief review of the the underlying pathophysiology of DIC and the interventions that can be initiated in the ED.

The most uncomfortable patient in the ED at any given moment may often be the male presenting with priapism. Know what to do and he will thank you forever.