On a weekend night, I received a strange phone call from an emergency room resident. “This is an emergency,” he said, adding fragments of details, “… vaginal bleeding … her heart rate is in the 150s.” It was hard to figure out what was happening and his tone was oddly calm. “Is she in an exam room?” I asked. “No,” he replied, “we’re in the trauma bay.” I ran downstairs with ...

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It is well known that smoking cigarettes negatively impacts health and leads to an increased risk of stroke, heart disease, lung cancer and death. No one debates this anymore. But it wasn’t always this way, and it didn’t come easily. In the 1940s, almost half of the population in the United States smoked, and the tobacco industry was subsequently incredibly powerful and politically active. It spent millions of ...

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For almost 20 years, the value of the digital rectal exam (DRE), a long time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications. As recently as two months ago, trauma surgeon Michael McGonigal blogging at the Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable ...

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It has been documented that 1 in 3 women will experience rape in her lifetime, and this is most common in women under the age of 25.  Over 95 percent of victims of sexual assault are women worldwide, while in North America estimates place that at 85 percent.  These are the assaults we know about -- generous estimates say that, at most, 10 percent of rapes are reported to police ...

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We had a pretty busy shop when I was in residency. So busy, in fact, that we had three secretaries working simultaneously -- one for paging, one for order entry, and one for admissions. I haven't been back there in a long time, but I hope the secretarial staff has grown commensurately with the volume and acuity of the ED. But from what I've seen around the country in my ...

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I was a tumultuous cloud of hope and fear as I tiptoed into my new job on a recent Sunday after five months off. By Wednesday morning, with my first three nightshifts behind me, I had already stayed late three mornings to keep up with charting in an unfamiliar EMR and succumbed to stress-eating chocolate at the nurses' station. I was reacquainted with the challenges of staying awake all night, ...

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I always warn my medical students to be careful what they say in front of patients, or patients' families or friends. "You never know who's listening!" I add. They may think that I'm exaggerating — but I have my reasons. Early in my career as an internist/nephrologist, if I had a free moment, I'd head for the emergency room. I might get a referral, and the coffee and conversation were usually ...

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Jenna had it all: She was smart, pretty, inquisitive and popular, with just one more year until she graduated from high school. She was at the top of her class and couldn't wait until high school was over, and she could become a pediatrician just like her dad. One day, Jenna would be an MD. "One day at a time," her parents always told her, even though she wanted to rush to ...

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I’m an emergency physician. In common parlance, an ER doc. Which means, like a little kid who will eat dirt on a dare, there’s not much I won’t try in the practice of my profession. Many of my colleagues have had far more challenging careers than me, I assure you. But I have some stories to tell. Cyanide overdose while moonlighting as a resident. Patient nearly dying from bite by ...

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I first experienced the impact of drug shortages in the U.S. in my first month of my residency training in emergency medicine. The most common drug used to sedate patients for intubation, etomidate, was on national shortage. I learned to use the second most common drug, Propofol, until it went on shortage too. We use it as the first line medication for sedation for painful procedures like re-aligning broken bones, ...

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