Venous thromboembolism disease [VTE] (ie, pulmonary embolism and deep venous thrombosis) can significantly increase patients hospital stay and put them at risk for worse outcomes. However, preventing VTE does not come without its own risks. In this post we will discuss VTE prophylaxis in hospitalized adults, specifically the different modalities available, and when to use each one. This will focus specifically on patients admitted for medical reasons, as patients admitted for surgical reasons have additional considerations and different guidelines.
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Patients often present to the emergency with a variety of skin findings and worries about spider bites. In the United States, the two spiders that people are often worried about are the black widow (Latrodectus mactans) and the brown recluse (Loxosceles reclusa). Fortunately, there are only about 500 bites a year in the United States and deaths are very rare.
Presentation can range from mild (heat stress) to severe (heat stroke). Tolerance to heat varies by individual with many factors playing a role on the effect heat has on an individual including general health, overall conditioning, hydration status, and ability to acclimatize. Heat related illness is more common in the elderly and in children under 4 years old.
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Schools, hospitals, movie theaters, workplaces, grocery stores, concerts, churches, neighborhoods…nowhere is safe from the increasing gun violence plaguing communities across the nation. In 2020 the Centers for Disease Control and Prevention reported an estimated 45,222 firearm-related deaths in the United States, including homicide, suicide, unintentional injuries, and law enforcement-involved shootings³. These numbers continue to rise at record paces as we are now seeing gun violence as the leading cause of death among U.S. children and adolescents³. It is ever so apparent that gun violence is a public health crisis that can no longer be ignored.
You may have even noticed some patterns among these patients, such as patients from certain neighborhoods tend to be hospitalized more frequently for asthma.
When treating patients, you may wonder what can be done to better help these patients. While individual cases may vary, the answer often lies in working towards systemic changes to ensure health equity.
Over the past 20 years the number of children who died in motor vehicle accidents in the United States declined by 55%.² Much of the improvement in childhood injuries and fatalities due to motor vehicle accidents has been attributed to increased attention to age-appropriate restraints and laws regarding their use.³
Restraint systems decrease injuries and fatalities through several mechanisms:³
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Pneumonia is one of the most common reasons for hospitalization and ICU admission in the world, and disease burden increases with age.¹,² It is well recognized that racial, ethnic, and socioeconomic disparities have a significant impact on various clinical endpoints in patients with pneumonia, such as mortality, length of stay, and ICU admission. Although significant progress has been achieved over the past several decades in narrowing the gaps in outcomes, health disparities still exist and they have only been further highlighted by the recent COVID-19 pandemic.³,⁴
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Heat-related illness is caused by exposure to excessive environmental temperatures that surpass compensatory limits of thermoregulation. These illnesses are distinguished from febrile emergencies in that the increased temperature is caused by environmental heat stress, rather than a change in hypothalamic function in the setting of normothermic environmental conditions.
Presentation can range from mild (heat stress) to severe (heat stroke). Tolerance to heat varies by individual with many factors playing a role on the effect heat has on an individual including general health, overall conditioning, hydration status, and ability to acclimatize. Heat related illness is more common in the elderly and in children under 4 years old.
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The Supreme Court of the United States (often referred to by the acronym SCOTUS) leads the judicial branch of the federal government and is the highest judicial body in the country. Its main role is to be a guardian of the Constitution though hearing appeals cases and preventing laws that are unconstitutional. In doing so, the Supreme Court often decides on policies that affect the lives of millions of Americans.
You may have even noticed some patterns among these patients, such as patients from certain neighborhoods tend to be hospitalized more frequently for asthma.
When treating patients, you may wonder what can be done to better help these patients. While individual cases may vary, the answer often lies in working towards systemic changes to ensure health equity.
Over the past 20 years the number of children who died in motor vehicle accidents in the United States declined by 55%.² Much of the improvement in childhood injuries and fatalities due to motor vehicle accidents has been attributed to increased attention to age-appropriate restraints and laws regarding their use.³
Restraint systems decrease injuries and fatalities through several mechanisms:³
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An 8-year-old male presents with pain in his distal right arm after falling from a hoverboard onto an outstretched arm. He has no swelling or obvious deformity to arm but is very tender with palpation over the distal radius. There are no abrasions or lacerations, and patient is neurovascularly intact. Imaging shows no evidence of fracture. Despite negative imaging, you are still concerned that patient has a fracture. You wonder what to do next.
On examination patient seems restless and is drooling. She is tachycardic with a slightly elevated blood pressure. Respiratory rate and oxygen saturations are normal. Imaging shows a round esophageal foreign body just below the clavicles.
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In your medical practice, be it in the clinic, hospital, or emergency department, you may have noticed that some patients seem to be hospitalized more often or have a harder time managing their health. For example, some patients with diabetes have a harder time keeping their blood glucose under control than others, or some patients are more likely to have a heart attack than others.
You may have even noticed some patterns among these patients, such as patients from certain neighborhoods tend to be hospitalized more frequently for asthma.
When treating patients, you may wonder what can be done to better help these patients. While individual cases may vary, the answer often lies in working towards systemic changes to ensure health equity.
Over the past 20 years the number of children who died in motor vehicle accidents in the United States declined by 55%.² Much of the improvement in childhood injuries and fatalities due to motor vehicle accidents has been attributed to increased attention to age-appropriate restraints and laws regarding their use.³
Restraint systems decrease injuries and fatalities through several mechanisms:³
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A 1-year-old female presents with concern for refusing to eat and increased drooling. She had been doing well until earlier this afternoon when she was playing at a cousin’s house. She spit out most of her food during lunch and has refused to eat and drink since then. Since then, she has started drooling more, isn’t talking as much, and seems more restless than usual. Family initially thought she was tired from her usual routine being disrupted but grew concerned when she started developing an elevated temperature of 99°F.
On examination patient seems restless and is drooling. She is tachycardic with a slightly elevated blood pressure. Respiratory rate and oxygen saturations are normal. Imaging shows a round esophageal foreign body just below the clavicles.
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On average, 60% of patients admitted to the hospital receive an antibiotic, and in approximately 50% of those cases, antibiotic use is inappropriate (eg no indication, wrong antibiotic, incorrect dosing/duration, etc.).¹ This can result in direct harm to patients due to inadequate treatment of infection, toxic side effects, and superinfection with resistant bacteria. Combine this information with the fact that penicillins, one of the most prescribed classes of antibiotics, are often labeled as allergies in patients’ charts, prompting use of other classes of antibiotics which can lead to harm. Thus, antibiotics are unlike any other class of medications because of the potential public health consequences due to their selection of resistant bacteria, which may become dominant in the hospital and community.
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For some, even thinking about speaking with congress can feel intimidating, especially if the role of congress is a vague memory from high school government class. This post will focus on federal congress, reviewing powers unique to each branch, leadership roles, and key differences in deliberating bills.
Over the past 20 years the number of children who died in motor vehicle accidents in the United States declined by 55%.² Much of the improvement in childhood injuries and fatalities due to motor vehicle accidents has been attributed to increased attention to age-appropriate restraints and laws regarding their use.³
Restraint systems decrease injuries and fatalities through several mechanisms:³
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50-year-old male with a history of hypertension, hyperlipidemia, and two pack-per-day tobacco use history presents to the emergency department for sudden onset of crushing chest pain and pressure. The patient states the pain started while watching television at home and that the pain radiates down his right arm. He denies any shortness of breath, nausea, vomiting, or abdominal pain. Emergency medical services (EMS) provided the patient 324 mg Aspirin. EMS transported the patient to the nearest hospital with Percutaneous Coronary Intervention (PCI) capacity. EMS transmitted the following EKG:
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Long COVID is a constellation of symptoms due to the involvement of various body symptoms in COVID patients after the acute phase. This develops after COVID pneumonia and continues for greater than 12 weeks. Similar symptoms have been seen with Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and Influenza (H1N1 and H7N9). Symptoms can occur in hospitalized and non-hospitalized patients.
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The most dangerous thing children do as part of their daily lives is ride in a car. Motor vehicle crashes are the leading cause of death of children over four in the United States, and more than 5,000 children die in motor vehicle crashes annually.¹,² For every fatality, approximately 18 children are hospitalized, and more than 400 receive medical treatment following a car accident.¹
Over the past 20 years the number of children who died in motor vehicle accidents in the United States declined by 55%.² Much of the improvement in childhood injuries and fatalities due to motor vehicle accidents has been attributed to increased attention to age-appropriate restraints and laws regarding their use.³
Restraint systems decrease injuries and fatalities through several mechanisms:³
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A 12-year-old boy presents to the emergency department with pain, redness, and blisters to multiple toes. The patient had been sledding earlier in the day when he fell into a pond, getting his legs and feet wet. He continued to sled after the fall but decided to go home when he could no longer feel his toes. He walked home in the snow, removing his boots and socks when he got home. He reports that initially he was unable to feel is toes, but they became painful while watching cartoons. You are concerned for frostbite and pause to think about the next steps in management.
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A female physician finishes a patient encounter, only to be asked when the doctor will be in. A black medical student enters a patient room, the patient asks why she didn’t arrive to empty the trash sooner. These are just two of many situations when people’s biases reveal themselves in a way that makes others feel uncomfortable and insulted, also known as a microaggression.
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It is a common scene in the hospital at shift change: nurses giving report to the next shift; overnight residents relaying the events of an overnight rapid response to the daytime intern; OR staff calling report about the patient who is leaving surgery and headed to a room on the medical ward. At the end of a long shift it takes determination and a system dedicated to safety to consistently deliver a good patient handoff. But, it is essential to preventing avoidable errors!
There are also opportunities for ground-level employees and stakeholders to participate in QI. Kaizen is a LEAN approach that focuses on “Continuous Improvement” in small daily changes which support larger institutional initiatives.
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A 20-year-old male presents after falling through the ice on a partially frozen lake while ice skating. He was submerged from the chest down for several minutes before he was able to be rescued. He arrives via emergency medical services wrapped in blankets, but still wearing wet clothing. Core temperature is below 30oC. Your medical student asks how they can assist in warming the patient.
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Remember all those times you are called from the ED for a chest pain evaluation and admission to CCU and you think inside your head, “Ha, another one of those false calls”; but on reviewing the chart, getting the history and physical examination, you’re not so sure anymore? Well, you are not alone. And that’s not a bad thing either.
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Why State and Federal Advocacy Matters
Every day there are rules, regulations, laws, and programs that are being implemented or changed by government entities that effect our patients and the practice of medicine. As physicians, we have the unique opportunity to share our expertise and provide insight that would not otherwise be considered when creating these policies.
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