bounce

Making broken bones better

The summer is a magical time when people who have been trapped inside by months of rain, snow, and the cold of the winter and spring emerge to find warmth, festivals, and vibrancy. As a PEM physician, the summer also means injuries. For example, to most people a bouncy castle is a symbol of childhood joy and freedom wrapped in a giant rainbow-colored beach ball. To me, it is a supracondylar fracture in waiting. Since one study of pediatric forearm fractures found that only 7% of patients did not need analgesia at home perhaps the next question should be what should you prescribe? Tylenol Read more [...]
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Answer: “The Lure of Ocular Ultrasound”

This post is in response to the August Ultrasound Image of the Month: “The Lure of Ocular Ultrasound.” To summarize, we had an obese teenage female complaining of weeks of headache that failed to respond to over-the-counter medications or intravenous medications. An ocular ultrasound was performed and the following image was performed which demonstrated papilledema as well as a enlarged optic nerve sheath diameter (ONSD) suggestive of Idiopathic Intracranial Hypertension (or pseudotumor cerebrii).  Her lumbar puncture demonstrated a significantly elevated opening pressure with an otherwise Read more [...]
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The Lure of Ocular Ultrasound

  This was an obese teenage female who had presented to the ED after being evaluated at multiple other hospitals for 3 weeks of persistent headache. Her headaches did not respond to over-the-counter medications or intravenous medications at the outside hospitals, and she came to CHONY for further management.  She endorsed photophobia but denied fevers, neck pain, nausea, vomiting, new medications, or trauma.  On exam, she had no neurological symptoms and no papilledema. However, it was noted that it was a challenging ophthalmologic exam due to her photophobia. Coincidentally, Read more [...]
masters

Master’s Degree Programs…should you?

The recent trend for academic and even non-academic clinicians is to pursue a Master's Degree.  Whether it's an MPH, MS, or other research-heavy degrees, MHA, MBA, or business & leadership, or even MEd for educational academics - lots of people are doing it.  There are plenty of others.  Should you? A variety of blogs and internet forums have discussed this at one point or another.  Here's a post from KevinMD.   Here's another on second degrees during medical school.  And there is a growing trend for dual degree - MD+something else NOS programs - for medical students these days. All Read more [...]
healthcarecosts

WOW- $15 billion per year on GME!

  A recent report from the National Academy of Sciences- Graduate Medical Education that Meets the Nation's Health Needs has proposed changes in the model of how GME is funded with a shift toward performance based GME payment.   This would require transformational changes that would involve an operational fund to support residency training and a transformation fund to finance initiatives to develop innovations in GME and to create/validate performance measures.  Click here for -- NPR Coverage on this WHAT WE PAY Overall Medical Care-  $3 trillion ($8,915 per person)- Read more [...]
Malpractice

Wake Up America! Lawyers Cannot Practice Medicine!

By: Virteeka Sinha* and Ameer Hassoun A teen came to the hospital complaining of testicular pain for the past few hours. I was the covering fellow. I examined the patient and documented a normal physical examination including the cremasteric reflex. I placed the Ultrasound probe and saw increased flow to the affected testis. I was happy I made the diagnosis right there and then! I went to my attending physician, a smart, experienced physician who has served as an expert witness in many litigations. I briefed him on my patient.  What follows is a snapshot of that conversation: Me: Read more [...]
summer2014.1

THE PEMNetwork SUMMER 2014 NEWSLETTER IS HERE

Are you looking for reading material: A. To take to the pool for leisure reading and then use as a sun-shield while you nap B. To read in the car as you wait for your kids to get out of soccer/chess/pottery/entomology/theatrical arts camp C. To read to residents on the overnight shift in efforts to keep the party going at 4:30am D. To make you laugh and make you cry and give you reason to believe again   Well if you answer is E. All of the above/none of the above... look no further!  How have you been balancing work and life this summer?   If its anything like me, Read more [...]
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Unintended Consequences

Everything we do can have unintended consequences. Accepting transfer of a sick cardiac transplant patient- when your PICU census is full is just one more decisional ingredient in cooking up a spicy “perfect storm” soup.  And while we can’t always predict which straw will break the proverbial camel’s back, they are further amplified by system changes that dictate decisions to multiple providers and may propagate errors, unless there is a concurrent commitment to 1) pre-testing 2) post-assessment 3) ongoing reassessment both for improvement in intended outcomes, but also Read more [...]