HiQuiPs: Resource Issues in the Emergency Department

In HiQuiPs by Shirley LeeLeave a Comment

Emergency departments are busy and are getting busier1, 2. Emergency physicians are faced with issues of overcrowding, departmental closures, and insufficient staffing. These issues are exacerbated by both the Covid pandemic3 and pressures found in the post-Covid “return to normal”4. Physicians are still expected to provide safe medical care in the face of these challenges. But what does that look like when your emergency department lacks appropriate resources? And how can physicians minimize …

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HiQuiPs: Optimizing your diagnostic reasoning – themes from CMPA medico-legal cases

In HiQuiPs by Shirley LeeLeave a Comment

A 49-year-old male presents to the emergency department with shortness of breath on exertion and left lower chest discomfort for the past 3 days. His past medical history is significant for hypertension and he has a family history of heart disease. At triage he is noted to have a pulse of 117 and normal blood pressure. His oxygenation is 94% on room air. His cardiac and respiratory exam are normal, and no other …

Quality Improvement in Nephrology Part 1 – Examining Patient Follow-up Practices

In HiQuiPs by Meherzad KutkyLeave a Comment

The Quality Improvement paradigm has been applied to a wide spectrum of settings and patient populations. There has been an exponential rise in QI publications over the recent decades.1​ In this new HiQuiPs Series we explore the QI paradigm applied to different medical specialties and settings. We start with an example of an outpatient nephrology setting.  Quality Improvement (QI) in nephrology for patients with kidney disease takes on many different forms depending on …

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Initiation of Congestive Heart Failure Action Plan in the Emergency Department

In Medical Concepts by Anthony LauLeave a Comment

A 72-year-old English-speaking male with a history of congestive heart failure (CHF) withreduced ejection fraction (EF) presented to the emergency department (ED) with acutedecompensated CHF. He had a two-year history of progressive dyspnea and exercise intolerance.Other comorbidities included coronary artery disease, hypertension, dyslipidemia, cardioembolicstroke, and gastroesophageal reflux disease. His medications included furosemide, apixaban,atorvastatin, carvedilol, and fosinopril. His furosemide was reduced from 40 mg to 20 mg daily by hisfamily physician five months prior …

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An Approach to Adult Burns in the Emergency Department

In Clinical Questions by Aafia MaqsoodLeave a Comment

Case: You are working as a 3rd year clerk in the ED and your staff has asked you to see Kathy, a 24 year old female caught in a house fire presenting with burns in multiple areas and difficulties breathing. Burn injuries result in the partial or complete destruction of the skin and can affect any of its three layers: the epidermis, dermis, or subcutaneous tissue.​1​ In this article, we will explore a …

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Clinical Question: How do I measure frailty in the Emergency Department?

In Clinical Questions by Karyssa HamannLeave a Comment

Mrs. Vivianne Dubois is an 84-year-old female presenting to your Emergency Department with her daughter. She tells you that she is here because she has been feeling weak and has had a fall. You speak to her daughter and find out that in the past year since her husband’s death, Vivienne has been struggling to take care of herself, requiring assistance with bathing and cooking. Recently, she has had several falls, and her …