Updates in the Emergency Department Management of Acute Liver Failure

Authors: David Bostick, MD MPH; Megan Donohue, MD; Robert Brown, MD; and Nicholas Santavicca, MD
Edited by: Michael C. Bond, MD FAAEM and Kelly Maurelus, MD
Originally Published: Common Sense July/August 2017

Introduction
Patients with chronic liver disease and acute liver failure have disease specific needs for which Eps must be cognizant. Below we review topics related to acetaminophen hepatotoxicity, use of rifaximin and lactulose in hepatic encephalopathy, and thromboelastography (TEG) directed transfusion in patients with liver disease requiring procedures.

Communicate Your Way to Better Patient Satisfaction

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Image Credit: Wikimedia

Author: Bill Christian, MS-III
Ross University School of Medicine
AAEM/RSA Social Media Committee

Patient satisfaction has become more important recently for various reasons. Surveys have been developed to measure patients’ perspective of their hospital care. Such surveys ask about patients’ communication with various staff, experience in the hospital, and their overall rating.[1] While certain aspects of patient satisfaction has been studied in the past, performance on the surveys is now being coupled to insurance reimbursements, further encouraging the study of how to please patients.

Never Trust a Norwood: Emergency Management of the Sickest Congenital Heart Patients

Image Source: Pixabay

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Author: Ashley Grigsby, DO, PGY-4
Indiana University
RSA Social Media Committee Member

For many emergency physicians, the scariest patient to come through the doors is the crashing neonate. But make that same neonate a child with congenital heart disease (CHD) and you have a recipe for the so-called, “Code Brown.” One of the most unstable types of CHD is Hypoplastic Left Heart Syndrome (HLHS), a ductal dependent lesion that can be stabilized in the first few weeks of life with intravenous prostaglandins while awaiting surgical management. All patients with HLHS or single ventricle physiology, will require a stage 1 palliative surgery which is usually the Norwood procedure. Norwood patients are, arguably, the sickest of all CHD kids and are the most vulnerable to sudden death, leading many to live by the mantra, “Never trust a Norwood.”

Preparing for the Worst

Image Source: Common Sense

Author: Aaron C. Tyagi, MD
Sparrow/Michigan State University
Chair, RSA Social Media Committee
Originally Published: Common Sense July/August 2017

We in the world of emergency medicine like to think of ourselves as ready for anything. I have often heard the mantra that we are ready for anything that “walks, rolls, or crawls through the door.” Our world is one of relatively controlled chaos. That is to say, when we receive the chaos, it has started somewhere else, far off and distant and we receive a microcosm of it in the form of a patient. That patient is delivered (for the most part) calmly to our home base. However, what happens when the chaos starts at our home base?

Code Silver. It’s something no health care provider ever wants or expects to hear in his or her hospital. But it was something that became a reality for the patients and staff of Bronx-Lebanon Hospital at 2:50 PM on June 30th, 2017.[1] A disgruntled employee, a former physician at the hospital no-less, entered his former place of employ, traveled calmly to the 16th and 17th floors with an AR-15 neatly hidden under his coat. He was wearing a white coat, the symbol physicians traditionally wear to signify healing, and opened fire on his former colleagues. His brutal attack left one dead and six wounded requiring various levels of inpatient hospital care.

The Pulseless Extremity: An Approach to Acute Ischemic Limb

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Authors: Benjamin Mogni, MS-3
University of Kentucky
RSA Wellness Committee Member

Terren Trott, MD, Assistant Professor
University of Kentucky

A 55-year-old man with a past medical history of atrial fibrillation and aortic atherosclerosis presents to your emergency room with numbness, tingling, and pain in his left lower extremity below the knee. A tech is pushing him in a wheelchair because the pain is too great and he cannot move his foot. His foot appears pale in comparison to the other. The patient writhes uncomfortably in bed. Brief examination of the leg demonstrates a cold extremity with no posterior tibial or dorsalis pedis pulses.