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Although diabetes mellitus is second only to asthma as the most prevalent chronic disease of childhood, the literature has very few comprehensive reviews of diabetic ketoacidosis (DKA), the most frequent cause of death in children with diabetes. The importance of an early diagnosis and appropriate management should not be underestimated. The authors provide a focused review for the ED physician for recognition and management of a child with DKA, with special attention to potentially serious complications.
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The authors review the classic course of common pediatric diseases associated with rashes, including varicella-zoster virus, herpes simplex virus (HSV), roseola, and rubella. Understanding the classic patterns, disease progression, high-risk populations, and potential complications allow the ED physician to avoid unnecessary testing in low-risk patients with a classic presentation, and aggressively approach potentially significant rashes in high-risk populations (e.g., neonatal HSV). This article also is designed to increase ED physicians awareness of treatment strategies associated with common viral exanthems.
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Hsu J, Reed M, Brand R, et al. Cost sharing: Patient knowledge and effects on seeking emergency department care. Med Care 2004; 42:290-296. Saketkhoo DD, Bhargavan M, Sunshine JH, et al. Emergency department image interpretation services at private community hospitals. Radiology 2004; 231:190-197. Lyons MS, Lindsell CJ, Trott AT. Emergency department pelvic examination and Pap testing: Addressing patient misperceptions. Acad Emerg Med 2004; 11:405-408.
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If it seems youre seeing more patients with mental illnesses recently, youre not imagining it. The number of people with mental illness seeking care in the ED has surged recently, and the increase is taking a toll on other ED care, says J. Brian Hancock, MD, president of the American College of Emergency Physicians (ACEP) in Irving, TX.
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When working with your radiology department to reduce the time it takes to get abdominal computed tomography (CT) scans for emergency patients, be sure to look at the issue from their perspective, suggests the nations leading radiologist.
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Your ED is overflowing with patients, the wait time is heading toward double-digit hours, and youre short-staffed again. So when you walk by an exam room and see a patient sitting there sipping contrast fluid the same contrast he was drinking an hour ago your blood pressure goes through the roof.
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Question: I know EMTALA signs are to be placed in registration areas, EDs, and public entrances. Right now we have signs in each of our four ED rooms, in the front hospital entrance, and the registration area. But I need to know if I should hang a sign in our back entrance leading to the ED. This entrance is not considered a public entrance, so do I need to put a sign there?
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Question: How do we avoid patient hoarding, in which nurses or physicians intentionally delay moving a patient out to delay the next patient and give themselves a breather? Weve already warned that hoarding wont be tolerated, but it still happens and thwarts our efforts to improve patient flow through and decrease waiting time.
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In addition to increased numbers of mentally ill patients, EDs are seeing more uninsured patients than in the past, and the numbers could grow, warns Brian Hancock, MD, president of the American College of Emergency Physicians (ACEP) in Irving, TX. Your budget planning should factor in more uninsured patients, not just the same level you have coped with for years.
