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Headache is a common chief complaint encountered by emergency physicians (EPs). It may be a symptom of benign diseases such as migraine headaches or a common virus. Unfortunately, it also may represent other, more life-threatening illnesses, including subarachnoid hemorrhage. Delineating which patients need radiologic imaging, spinal fluid testing, and even angiography is part of the challenge encountered by the EP. This issue will outline strategies for reducing risk in the headache patient. Specifically, diagnosis and management of subarachniod hemorrhage will be detailed.
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Documentation requirements for every patient encounter have increased, leaving less time for the actual practice of medicine. While documentation is a burden to physicians and nurses, it does have unlimited value. Documentation allows for appropriate billing for the time and efforts of the physician, nurse, and other medical specialists. Thorough documentation allows for maximum reimbursement without fear of subsequent legal retribution from various government programs. Furthermore, the medical record is an essential historical document of the patients previous medical encounters. Documentation of the patient encounter and treatment will provide a defense to potential subsequent litigation that may ensue. The emergency physician may be unaware that a medical expert is reading a case of a previous patient encounter right now. The documentation of the care provided may preclude the plaintiffs expert from making assumptions and opinions adverse to the physician. This months issue will detail the importance of documentation and outline strategies for reducing risk.
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The first part of this two-part series addressed the use of US for complications of early pregnancy in adolescent females and for testicular complaints in pediatric and adolescent males. This issue focuses on the use, role, and limitations of US in the evaluation of cardiac, abdominal, and renal disease processes.
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In part II of this two-part series, the Antibiotic Therapy in Bacterial Sinusitis (ATBS) Clinical Consensus Panel outlines risk-directed strategies for management of patients with acute bacterial rhinosinusitis. Outlining specific symptomatic, historical, and host criteria that prompt empiric antibiotic therapy, and a sequencing strategy for antimicrobial drug selection, this review provides practical, evidence-based strategies for patient management.
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The evaluation and diagnosis of the child with a limp can be challenging for the emergency physician. The authors review common causes for the acutely limping child, with special attention to those etiologies that need emergent or urgent intervention and referral. Additionally, the authors offer clinical and historical clues to help decipher the cause.
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