The Future of Emergency Medicine: An Evolutionary Perspective

From Academic Medicine:

Emergency medicine (EM) has grown rapidly over the past 50 years, evolving from a specialty defined by its locational identity—a hospital receiving room—to the specialty picked fourth-most-frequently by graduating U.S. medical students and to being the focal point of clinical care and of research on time-sensitive medical conditions. The authors review the forces that led to the growth of EM and those that will shape its future—in particular, cost, quality, and technology. A balancing of cost and quality considerations will likely drive EM education and research endeavors. The future of the field will be determined in part by resolution of the tension between the current inefficient conditions of emergency departments (EDs), which are crowded because of the temporary boarding of admitted patients for whom a bed is not yet ready, and the desired provision of quality care under emergent conditions. That is, patients with stroke, myocardial infarction, sepsis, or severe injuries from trauma require a working diagnosis and interventions that are initiated shortly after presentation, but ED personnel distracted by the demands of caring for boarded patients are unable to deliver optimal ED care. The reduction or elimination of boarding will enhance education and research within EDs and will contribute to an efficient system of high-quality EM services.

Telestroke

From Circulation:

Background and Purpose—Telestroke has been effective in the management of acute ischemic stroke. This study characterizes and compares stroke specialist (SS) and emergency physician (EP) perceptions of telestroke and identifies barriers preventing increased implementation.

Methods—A survey was developed and distributed nationwide to 382 SSs through an online survey system and in paper form to 226 EPs attending the 2008 American College of Emergency Physicians national conference.

Results—Stroke specialists perceived themselves to be more knowledgeable about telemedicine and telestroke (P<0.001 and P=0.010, respectively). A large majority of physicians in both specialties either strongly agreed or agreed that telestroke will reduce geographical differences in stroke management and that it is superior to telephone consultation. EPs perceived patient preference (P<0.001), recombinant tissue plasminogen activator side effects (P<0.001), level of technology (P=0.005), and recombinant tissue plasminogen activator not the standard of care (P<0.001) to be more significant obstacles to increased implementation of telestroke than SSs. However, SSs found increased personal work to be a greater barrier than EPs (P<0.001).

Conclusion—SSs and EPs report positive beliefs regarding telestroke; however, perceived obstacles exist to implementation. Differences between barriers perceived by EPs and SSs need to be addressed to enhance acute ischemic stroke treatment.

Man Is Living With No Pulse

From ClickOnDetroit:

After a suffering a series of heart attacks within two years, Robert Cooley experiencing heart failure. He ended up going to the hospital in cardiac arrest.

“I don’t remember anything. I woke up in the emergency room,” said Cooley.

At 75, Cooley was considered too old for a heart transplant. Doctors offered him another option: an FDA-approved device called the HeartMate II. It’s a small pump that provides circulatory support for advanced heart failure patients.

Experts said the device propels, but doesn’t pump, a stream of blood from a patient’s weakened heart. That means Cooley literally doesn’t have a pulse. It’s a strange quirk Cooley is taking in stride, but there is one caveat.

“I’m worried if I’m in an ambulance, and emergency people say ‘There’s no pulse,’ hopefully they don’t pull all the plugs,” said Cooley.