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To some, the term genital emergencies recalls junior high school with the typical adolescent male humor of the time. But to a physician, this term describes a collection of disorders with potential implications to reproductive, sexual, and urologic function. Since many of these disorders are progressive, with the potential to cause increasing injury with the passage of time, early recognition and treatment are important in minimizing damage. In this two-part series, the author discusses the current literature and makes treatment recommendations for both the common and rare emergent conditions that can affect the male genitalia.
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Traumatic injury remains one of the most important and persistent causes for morbidity and mortality in the United States. The establishment of a trauma team that is available to evaluate and manage trauma quickly and efficiently during the very critical first minutes after the injured patient arrives at the hospital has significantly improved survival and dramatically reduced sequelae from these injuries. An important component of this expedited evaluation has been the recognition of the utility of ultrasound to augment the imaging and triage of the injured patient. In this well-researched monograph, the authors describe this rapidly growing modality and its many applications. All members of the trauma team should be familiar with the indications and limitations of this important trauma tool.
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High-sensitivity cardiac troponin (hs-cTn) assays have higher sensitivity for myocardial ischemic injury and necrosis than conventional assays, but with reduced specificity.
An hs-cTn level below the detectable limit is very accurate at excluding AMI in an ED patient with chest pain.
The precision of hs-cTn assays enables serial sampling of cardiac biomarkers to exclude AMI to be done over 1-2 hours as opposed to 3-9 hours for conventional cTn assays.
A normal coronary CT angiography (CCTA) (< 50% stenosis in any epicardial coronary artery) performed in an ED patient with chest pain is associated with a good 30-day outcome.
Use of CCTA in ED patients with chest pain is associated with reduced length of stay, admissions, and overall costs compared to typical care that often involves myocardial perfusion imaging.
CCTA is associated with a small but consistent increase in invasive coronary angiograms and reperfusion procedures compared to typical care that often involved myocardial perfusion imaging.
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It is entirely understandable for emergency providers to question any new task or responsibility handed down by regulators or administrators. Busy providers are already stressed with burgeoning patient volumes and all the pressures associated with handling acute care crises.
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As the country moves toward full implementation of the Affordable Care Act, one issue that many safety-net hospitals are grappling with for the first time is market competition. While it is still not clear how many states are going to go along with the reform laws expansion of Medicaid, the thinking is that in areas where newly insured patients have options for where to receive care, safety-net facilities are going to have to compete with other facilities to be the hospitals of choice.
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With the proliferation of medical devices in recent years, hospital providers are now bombarded with a cacophony of sounds, signals, and other information emanating from these ubiquitous machines.
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Sometimes just making people aware of their performance is all that is necessary to significantly improve care. Investigators at the University of California at San Francisco (UCSF) found this to be precisely the case when they attempted to use this approach to improve door-to-needle times for stroke patients who presented to the ED for care at UCSF Medical Center.
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The face of health care compliance is rapidly changing. Having spent the past week attending the largest health care compliance gathering in the country, I am convinced that no one is immune to payer audits.
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