Thursday, April 18, 2019

Why Did AAEM Take a Stand Against APP Independent Practice?

Author: AAEM APP Task Force

Physician members of the American Academy of Emergency Medicine have voiced concerns about the use of advanced practice providers (APPs) in the emergency department and their push for independent practice without the supervision or even availability of a physician. The task force spent hours discussing the issues, comparing the education of physician assistants, nurse practitioners, and board-certified emergency physicians, speaking to physicians about their concerns, and examining the literature. (J Emerg Med 2004;26[3]:279; Acad Emerg Med 2002;9[12]:1452; J Emerg Med 1999;17[3]:427; Acad Emerg Med 1998;5[3]:247; Ann Emerg Med 1992;21[5]:528.)

Most emergency physicians have worked with APPs and appreciate that they are talented clinicians who improve emergency department flow, efficiency, and quality of care under the guidance of the emergency physician-led team. Many emergency physicians are aware of situations that place APPs in clinical environments that are beyond their capabilities, level of training, and even scope of practice. This is not the quality of care our emergency patients deserve.

Thursday, April 11, 2019

Diving Emergencies - What You Need to Know on Your Next Shift

Image Credit: U.S. Central Command
This post was peer reviewed.
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Authors:
Joshua Goldstein, MSIII Medical Student
University of Miami Miller SOM

Tim Montrief, MD MPH
Jackson Memorial Health System/University of Miami
AAEM/RSA Publications and Social Media Committee Member

Introduction
SCUBA (Self Contained Underwater Breathing Apparatus) Diving is becoming increasingly popular, with an estimated 306 million dives made in the United States between 2006 and 2015.[1] During that same time there were 658 diving deaths in the United States and nearly 14,000 emergency department (ED) visits.[1] While the pathophysiology underlying many diving injuries is complex, the basic treatments for many life-threatening diving injuries are the same (Figure 1). It is important to understand the relatively simple therapies that underlie appropriate care for these injuries.[2,3]

Thursday, April 4, 2019

Testicular Torsion: Medicolegal Pitfalls

Image Credit: Wikimedia
This post was peer reviewed.
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Authors: Hannah Clode, MSII, University of Miami Miller SOM
Tim Montrief, MD MPH, Jackson Memorial Health System/University of Miami, AAEM/RSA Publications and Social Media Committee Member

Case
A 16-year-old male is brought to your emergency department complaining of acute-onset right lower quadrant abdominal pain that woke him from sleep two hours ago and is associated with some mild nausea and vomiting. His vitals are stable and his physical exam is unremarkable except for mild tenderness to palpation in the right lower quadrant. Labs show no evidence of leukocytosis, and his c-reactive protein is within normal limits. You order an abdominal ultrasound (US) to evaluate for possible appendicitis which is unremarkable. The patient’s pain improves, and you discharge him home. Unfortunately, the patient returns to the hospital three days later and is found to have a torsed, necrotic testicle which was unable to be salvaged. The patient’s family has decided to sue you for failing to diagnose testicular torsion (TT). How could this outcome have been avoided?