I have actual "concern" for meningitis once/year. I can't tell you the last time I actually had an adult with meningitis. At least not bacterial. I'm sure I've missed a few viral. I think I've seen maybe 3 through training and real job and I'm pretty sure on all 3 I walked in the room and was instantly like "this person is sick AF."
I distinctly remember mine because I missed it.
Someone came to the em forum not long ago to say something similar.
In anesthesia, we use 25G non cutting needles for our spinals. It’s requires a 20G cutting introducer needle.
So get some and stock them. It isn't that hard. Who is "yelling" at you anyway?
Nurses...obvi
The idea that I can effect this level of change in the emergency department makes it readily apparent that you don't work in one.
Agree. Although, I can’t remember the last time those things ever really mattered for emergent management. I don’t look at retinas anymore with an ophthalmoscope. Almost every otitis is viral. Cerumen isn’t an emergency. Ear foreign bodies - I guess… Mainly just ranting that I have to see these complaints as they aren’t emergencies. The physical exam is largely antiquated other than pushing on a belly. Even then I’m over all of the people and their fake guarding. Just enjoy the Haldol/Droperidol and let me enjoy my wine/scotch.
What clinical decisions are you making with an ophthalmoscope these days?
When to call ophtho vs when to tell grandma to eff off.
I was about to reply "I use my iPhone"...and then I finished reading your post.
Sounds like your retinal exam skills are far superior to mine.
I literally haven’t used an ophthalmoscope since med school. My algorithm for painless vision loss is:
Fair enough. Different practice environments. But then are you transferring vitreous detachments? Seems aggressive.
Your ED pan scans 5 patients a day who present with total body pain from a minor mechanism car accident the previous day?
We seem to be able to get new ultrasound machines and disposable fiberoptic scopes for the large monitor glidescope while also being unable to stock enough supplies to close a laceration without digging through three carts.
Like everywhere else, we have NPs who were triaged this patient.
We’re definitely the red haired step child of our hospital too but I just grab the kit and also grab a non cutting needle. The needles on our kits are annoying anyway because even the end of the needle is metal so you can’t see “flash” before it starts dripping out .. why don’t they put the good (~22 whitacre) needles in the LP kits though in the first place?
I guess I have the benefit of working in a group that controls our own staffing. We don't hire NPs. Period. We have a few PAs who are all solid and would never pull this crap. Nor, obviously, would any of the docs.
My understanding is that opening pressure is standardized to a 20 gauge cutting needle, but I could be very, very wrong.
Why is DVT emergent? In most cases, there is literally nothing emergent to be done about it. Putting them on blood thinners will gradually allow them to dissolve the clot, but likely won't change PE risk in the first couple of days. DVT should be urgent outpatient evaluation, not an ER referral.
This is one I don't fight. Sent in for DVT ultrasound? Order from triage.
I think it's a waste of patient and system money, but I'll see these patients and order the non-emergent emergent ultrasound every time.
