practice updates

Tips for ensuring the safety of discharged patients, from a newly minted attending physician

Continuing with our EM Mindset series, here is another great piece by Dr. Mike Stone to kick off your week. Enjoy!

We’ve all heard it at one point or another: “Man, I’d HATE to have to intubate THAT!” Typically, this sentence is used to describe a patient in an ominous, sphincter-tightening situation, or the patient with the obviously suboptimal airway.

You walk by the door to the Resuscitation Bay or Trauma Bay, see that the patient is in respiratory distress, and rapidly breeze through your airway mnemonics and ultimately come to the conclusion that this would be a scary airway. The airways of myths and legends, and where heroes are made.

We have covered several other pediatric EM myths and misconceptions previously: Cuffed ETT are ok, a doughnut is not a good shape for LP Positioning, the 500:1 rule should not be used, Oral Rehydration is faster than IV, and you can/should give morphine to kids you are worried have appendicitis.

Recently, I was reminded of another myth that continues to have a foothold: Atropine and RSI.

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.