EM Quick Hits 56 – Nitroglycerin in SCAPE, REBOA, Diverticulitis Imaging, CRAO, Penicillin Allergy, Physician Personality
Apr 23, 2024
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Experts discuss high dose nitroglycerin in SCAPE, REBOA indications, diverticulitis imaging, CRAO diagnostic errors, penicillin allergy myths, and how ED physician personality influences patient outcomes in this informative podcast.
High-dose nitroglycerin is beneficial in sympathetic crashing pulmonary edema.
Reboa is a technique for temporary hemorrhage control with associated challenges.
CT plays a crucial role in evaluating diverticulitis, aiding in diagnosis and severity assessment.
Deep dives
High-Dose Nitroglycerin for Sympathetic Crashing Acute Pulmonary Edema
Using high-dose nitroglycerin in patients with sympathetic crashing pulmonary edema has shown significant benefits. Studies indicate improved outcomes with high doses compared to lower doses, with resolution of symptoms, reduced intubation rates, and overall better patient outcomes.
Resisted of Endovascular Balloon Occlusion of the Aorta (Reboa)
The podcast discusses the controversial topic of Reboa as a technique for controlling or stopping bleeding temporarily. It involves placing a catheter in the aorta and inflating a balloon to occlude blood flow distally, providing temporary hemorrhage control until definitive management. The episode outlines the indications, potential complications, and challenges associated with Reboa.
Workup of Diverticulitis in the Emergency Department
The episode highlights the importance of a comprehensive workup for diverticulitis, emphasizing the use of CT imaging as a first-line diagnostic tool. Guidelines from various organizations recommend CT for confirming the diagnosis, assessing disease severity, and detecting complications. While history and physical examination are crucial, CT plays a major role in the evaluation of diverticulitis cases.
Impact of Physician Personality Traits on Patient Outcomes
Physicians with higher scores in openness were associated with lower in-hospital mortality rates, decreased lab test costs, and shorter lengths of stay. Agreeable physicians helped patients save lab test costs, primarily benefiting low-income patients due to their empathy. Surprisingly, higher conscientiousness scores led to increased lab test costs and longer wait times for essential procedures, with no significant difference in patient outcomes.
Implications for Physicians and Administrators
Physicians and administrators should consider physicians' personality traits, such as openness, conscientiousness, and agreeableness, as potential factors influencing patient outcomes in the emergency department. Training programs may benefit from integrating awareness of these traits. Leveraging physician personalities could enhance healthcare management strategies, like optimizing ED schedules based on traits. Matching agreeable physicians with patients needing to save costs might help reduce patients' medical expenses, reflecting broader implications for improving healthcare delivery.
In this month's EM Quick Hits podcast: Justin Morgenstern on the first RCT of high dose nitroglycerin in SCAPE, Andrew Neill on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) indications and evidence, Brit Long on indications for CT in suspected diverticulitis, Tahara Bhate on Central Retinal Artery Occlusion (CRAO) and diagnostic error, Matthew McArthur on penicillin allergy labels, myths and penicillin challenges, and Susan Lu on how ED physician personality influences patient outcomes...
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