>EM Reflections – April 2015

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Thanks to Dr Natasha DeSousa for her excellent interactive session this month. Here is her summary:

1. Be thorough in your examination and work-up of elderly persons with multiple co-morbidities who present with syncope. See this useful post from Dr. Smiths ECG Blog on the work-up for patients presenting with syncope (thanks for the suggestion Dr French).

2. When taking handover, especially from the overnight physician, reassess patients before dispositioning them home, regardless of handover instructions.

3. Be aware that Triage notes, Triage Level and Patient Location all facilitate various forms of Framing Bias, which can lead to misdiagnoses and misses. (see, for instance, http://shortcoatsinem.blogspot.ca/2012/08/anchors-aweigh-cognitive-bias-where-is.html and http://en.wikipedia.org/wiki/List_of_cognitive_biases)

4. Avoid using unnecessary patient characteristic descriptors within the triage note. 

5. Document wound care discussions with patients.

6. In any patient with new falls, the question “Why is this patient falling?” requires an answer before a consideration of “discharge home” can be made.

7. Family members can be a valuable source of history, especially in patients presenting with falls or confusion.

8. Again, the EHS and nursing notes provide important, not-to-miss, information about the patient’s presentation.

9. Manage patients’ pain with the same diligence as you’d expect if your own family member presented to the Department in pain.

10.  Patients presenting more than 8 hours from time of ingestion of a concerning tylenol overdose should receive NAC immediately rather than waiting for an AST or Tylenol level. See this review 

ACTox

NAC

 

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