Utilizing the 4 D’s to exercise fluid stewardship
“Poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy.” -Paracelsus, date unknown
For patients in septic shock or those that are dehydrated, administration of fluid is top priority to restore adequate intravascular volume, increasing cardiac output, augment oxygen delivery, and improving tissue oxygenation.[Read more…] about Fluid Administration
Medicine has changed a lot since I began practicing 15 years ago. There were no MIPS measures, no sepsis protocols, no door to provider times; in fact, the term provider was not even a ‘thing’. Medicine wasn’t perfect, but the stress level was exponentially lower. Back in the early 2000’s, the biggest concern was malpractice. Now? We have times and measures and protocols and numbers and metrics AND malpractice. Add to this the government-mandated Electronic Medical Record (EMR), which can make documentation exponentially more cumbersome.[Read more…] about Creating your own happiness
Rachel Beatty, ARNP
Let’s discuss a common scenario. You have a 50 year old male who has not been seen by a PCP in two years. His past medical history includes arthritis and hypertension. He does not smoke and has an occasional beer on the weekend. He has been off his medications for his hypertension for over a year. His BP in office is 182/110, HR 70, Temp 97.6, Respirations 16, 02 saturation 98%. His physical exam is unremarkable and he is asymptomatic. Your medical assistant asks you if you would like her to give him clonidine and do an EKG. She then asks if we will be sending him to the emergency room. The patient is now anxious and is wondering if he is going to have a stroke. What would you do?[Read more…] about Primary Care: Should we throw away the clonidine?
Eye complaints, particularly vision complaints, can seem daunting to a provider in an urgent care or emergency department setting. The eye is a complex structure. The anatomy and the neurology behind vision is intricate. Often, you may be practicing in an environment without the ability to consult an ophthalmologist. An understanding of urgent and emergent eye and visual problems is crucial. This post will deal with painless vision loss.
Healthcare workers know that their job never ends. Patients don’t stop coming to the hospital because it is a weekend, holiday or late at night. Therefore, we provide 24-hour coverage and support in order to take care of our patients – because that is what we do! We are super-humans who save lives! But at what cost? At some point in your career you have likely had to take on night shift and that means that you have to fight your own circadian rhythm in order to stay awake! How messed up is that?!? This is my personal survival guide (with help from my nurses) for surviving the vampire shifts! I will start this list of with more serious topics to take note of. Then, in true night shift fashion, we will take a 90 degree turn and jump off the deep end with some fun suggestions from those who have made a few life mistakes previously![Read more…] about Night Shift Survival Guide
In our last edition, we discussed some ways of altering practice models or properly documenting patient care so that we stay within the current MIPS guidelines while continuing to provide the highest quality care. In this edition, we will discuss some of the MIPS guidelines as they pertain to Radiographic studies that are commonly ordered in ER/Urgent Care settings. As always, appropriate documentation as to why, or why not, a test was ordered is crucial not only for MIPS, but from a legal standpoint as well. So, let’s get into it![Read more…] about Decoding MIPS in Emergency Medicine – Radiology Edition