Pocket Emergency Medicine
Reviewer: Sarah E Mott, MD (Regions Hospital)Description: Now in its fourth edition, this pocket reference covers the essential clinical elements of chief complaints encountered in the emergency department. For each diagnosis, the authors provide an overview then review the recommended history and physical, evaluation, and treatment. Clinical pearls and updates are highlighted throughout. The previous edition was published in 2014; this edition has been revised and referenced to reflect the current standard of care.Purpose: The purpose, as stated by the authors, is to provide an "essential go-to reference for busy clinicians on the front lines." The format, a hardcover 6-ring binder with pockets, is designed to improve durability and encourage practitioners to use it at the bedside. Chapters are organized by organ system, then presenting condition, with the goal of facilitating rapid diagnosis and decision-making. The authors are successful in creating a portable, easy-to-read, and organized reference. It is concise yet provides enough information to at least initiate care for most every chief complaint.Audience: According to the authors, the audience is "busy clinicians who work on the front lines of emergency care." It is written at a level best suited for, and relevant to, resident learners and practicing midlevel providers (e.g. nurse practitioners and physician assistants). The book has more detail than would be expected for mastery by most medical students, but does not offer the nuances of care that attending level physicians typically provide. Appropriately, the book is authored by four emergency medicine residents and edited by senior faculty, certainly credible sources for reviewing management of diagnoses seen in the emergency setting.Features: The book covers common and relatively benign as well as less common, but life-threatening presenting complaints and diagnoses organized by organ system. It also offers an overview of diagnoses encountered in pediatrics and toxicology as well as a review of airway management and patients presenting after trauma. Each section includes important findings on history/exam, workup, treatment/disposition, and clinical pearls. Bullet points, charts, and mnemonics aid in locating and remembering information important in clinical decision-making. The inclusion of commonly used medications, including dosages, and review tables are particularly helpful.Assessment: This is a comprehensive, organized, and easy-to-read book that covers the most common clinical presentations in emergency medicine. Whereas other bedside references typically focus on as single aspect of care (e.g. pathophysiology or medical management), this pocket book condenses the most clinically relevant information from all domains including pathophysiology, history, workup, and management (including drug dosages) into a single portable format suitable for a pocket or small workspace. I highly recommend it for current and incoming emergency medicine residents as well as attending physicians looking for a portable, nonelectronic reference.
Pocket Emergency Medicine
Pocket Pimped: Emergency Medicine is a collection of the 1,500 most commonly asked questions in Emergency Medicine written by the residents and attendings who ask them. With contributions from internationally recognized faculty, Pocket Pimped, provides insight into the questions you will be asked as a student, PA, and resident. Small enough to fit in your pocket, this book ensures that you will never be unprepared. Use the Pocket Pimped advantage to succeed, and know exactly which questions you will be asked!
A paracentesis is the procedure by which clinicians gain access to and assess ascitic fluid that has collected within the confines of the peritoneal space. It is performed under sterile conditions by introducing an 18-20g needle into the peritoneal space where a large pocket of fluid has formed.1-2 The fluid collection may be solely for diagnostic purposes or also for therapeutic purposes in order to relieve symptoms caused by large volumes of intraperitoneal fluid.3 The remainder of this article will focus on traditional and up to date, evidence-based indications, contraindications, and the performance of paracentesis in the ED.
Traditionally, the performance of a paracentesis was done without imaging guidance, and a fluid pocket was located solely by percussing the abdomen until a significant area of dullness was isolated. However, ultrasound guidance has become routine to perform a paracentesis.9This does not, however, mitigate the importance of percussion as a physical exam technique when assessing patients with clinically apparent ascites. In addition, it is still important to know the anatomical landmarks and considerations for a paracentesis.
Utilizing the ultrasound, identify a pocket in the right or left lower quadrant that is lateral in the rectus abdominis. This is avoids the liver and spleen in the upper quadrants, as well as the inferior epigastric vessels in the medial lower quadrants.2,4,11It is also important to take into consideration more superficial abdominal anatomy such as engorged veins that may obstruct needle insertion during the procedure. Once a substantial pocket has been identified that does not contain superficial viscera at risk for perforation, the site should be marked, with anatomical landmarks taken into consideration. If it has not already be done, consent for the procedure should be obtained, after which you will be ready to set up and begin.
"We are Australasian critical care physicians and nurses exploring the changing world of eLearning, emergency medicine, critical care and toxicology through clinical cases, fictionalized anecdotes and medical satire."
But it is not just a simple drug reference text. There are numerous extra chapters providing in depth reference information for complicated prescriptions; acute pain relief, procedural sedation, medico-legal essentials, and emergency room skills. The Pocket Prescriber is aimed at the emergency and pre-hospital practitioner with practical guidance on drug selection, plus protocols and resuscitation guidelines
In the United States, an emergency room visit costs $2,200 on average, according to the most prominent insurance carrier in the U.S., UnitedHealthcare. Sometimes, a visit to the emergency room can exceed these prices since the actual price you pay out of pocket will depend on your condition and the diagnostic tests and treatments you undergo.
The price of your ER visit will depend on what types of treatments and medications you receive. For patients without health insurance, an emergency room visit can cost less than $2200. If your treatment is extensive, an ER visit can exceed this price. For instance, in some cases, especially where critical care is required and/or a procedure or surgery is performed, the cost could reach $20,000 or more.
Below is the average price for an ER visit in each state, from lowest to highest. This is the out-of-pocket cost with no health insurance coverage and for a moderate to severe ER visit.
Typically, emergency room patients receive one of five levels of care. Level 5 care represents minor problems treated, whereas level 1 care represents some of the most severe treatments an ER can provide. (hence we commonly call an academic medical center a level 1 trauma center). While levels of care exist for even higher and critically ill patients, these levels are used less frequently.
The Affordable Care Act (also known as Obamacare) requires all plans to cover emergency services. Under this legislation, insurers cannot charge you more for going to an out-of-network hospital or health care provider. In addition, insurers cannot require you to get pre-authorization before getting service.
Insurance status and categories greatly influence how much the patient has to pay out-of-pocket. For instance, health insurance plans with low monthly premiums may have a cap of around $250 on emergency room expenses. With ER costs ranging from $150-$3000, less extensive insurance plans may only cover the most basic ER visits.
Emergency rooms do not provide pricing for services upfront. When you seek care in an emergency room, the medical staff will determine your best care plan. Regardless of the services you are provided (stitches, MRI, prescription medication, etc.), it is likely that you will not know the exact cost of services until after your visit.
If you are experiencing a medical emergency that requires immediate attention, you should always seek care from an emergency room. However, urgent care may be a better alternative if your situation is not severe and does not demand immediate medical attention.
The decision to go to a hospital emergency room or an urgent care center likely depends on factors other than cost: convenience, time of day, seriousness of the problem and medical vulnerability of the sick or injured person.
Cuts, bites, broken bones, fever, flu symptoms and allergic reactions are often more quickly (and economically) treated at an urgent care center. More extreme medical conditions such as stroke, heart attacks and serious accidents call for a trip to the nearest emergency room.
The average wait by state in emergency rooms ranges from 1:44 to 3:48. One study, a National Hospital Ambulatory Medical Care Survey from 2018, showed that only 12.4% of emergency room visits resulted in hospital admissions.
The Library of Medicine, for instance, estimated emergency room visits in a targeted study of an Arizona medical center decreased by 20% in 2020 compared to the same time frame in 2019. While Covid-related emergency room visits increased, pandemic mitigation strategies reduced non-Covid ER visits.
Data suggests urgent care centers have reduced the stress on hospital emergency rooms, at least as far as non-emergent care goes. In a six-state survey, the National Library of Medicine in 2021 found that an open urgent care center in a ZIP code reduced the total number of ED visits by residents in that ZIP code by 17.2%. But ERs are still overused. 041b061a72