With the passage of meaningful use act of 2009, requiring a phased implementation of electronic health record (EHR) system, more and more healthcare organizations have rushed to beat the technology compliance clock and to be eligible for incentives and reimbursements. As a result of this electronic transformation, all patient-encounter data is now potentially more transparent, accurate and up to date.1 More importantly, data is more accessible, shareable, and coordinated.2 On the flipside, reliance of digital data can paralyze the entire system during system downtimes, data breaches, or data loss. In addition to this, back-up systems and servers that are sometimes thousands of miles away can potentially put sensitive personal patient information at risk. EHRs are also expensive and are challenging to successfully implement without growing pains. Electronic documentation also can be more tedious and time-consuming. In this article, we examine the impact of EHRs specifically on ED providers.read more
Baylor College of Medicine and Texas Children’s Hospital, H uston, Texas
Department of Pediatrics, Section of Emergency Medicine
9 year old female with history of acute lymphocytic leukemia (ALL), status post heart transplant 9 months ago for chemotherapy related cardiomyopathy, presented to the emergency department with 4 weeks of worsening neck pain and 2 days of dysphagia and voice changes. She stopped moving her neck, refuses solids, but is able to drink liquids. She has been afebrile. She has been seen twice by other providers over the last month, was diagnosed with torticollis, and given diazepam and acetaminophen with codeine without improvement. Home medications included tacrolimus, mycophenolate and prednisone.read more
Boston Medical Center / Boston University School of Medicine
A 17 year old teenager presents as a new immigrant from Haiti for evaluation of “heart murmur” diagnosed there. Has no immediate family with him so past medical or family history is unclear. He is on no medications and denies drug abuse.
Complaints of occasional chest pain, palpitations and shortness of breath.
His vital signs are within normal limits.
On examination patient is noted to be tall and thin, pectus excavatum and high arched feet. Has evidence of scoliosis, fingers are long and thumbs are very lax. Lung exam is normal. Cardiovascular exam is remarkable for a holosystolic murmur with mid-systolic click, heard best at the apex and accentuated by valsalva. Mental status is normal. Neurologic examination is also within normal limits.read more
Department of Emergency Medicine, University of Texas Medical School at Houston, Houston, Texas
Children’s Memorial Hermann Hospital, Houston, Texas
A one month old girl with a history of congenital complete Atrioventricular (AV) block with an implanted pacemaker placement on day of life 6, presented to the Emergency Department (ED) with rash and fever. One week prior to presentation she developed a rash on her face, which slowly spread to her chest, abdomen and extremities. On the day of presentation she developed a fever at home. Mom brought her to the pediatrician, who then referred them to the ED.read more
In a matter of seconds, life can change from one extreme to another.
Some recent examples that come mind are:
A 4-year old boy wearing Superman pajamas, just diagnosed with a brain tumor.
A 9-year old girl who is scared of doctors, diagnosed with acute appendicitis and in need of surgery.
A 12-day old boy with persistent fussiness with HSV meningitis.
A 13-year old girl playing Candy Crush on her iPad with new-onset diabetes.
A 17-year old boy taking a Calculus final exam in school found unconscious. He was in ventricular tachycardia.read more