Few shifts go by without ordering at least one urinalysis. While they are ubiquitously used, urine testing is often unneeded and frequently misleading. How often do you feel frustrated about a urine sample that takes too long to obtain? You may not need the sample in the first place. To understand why, we need to go back to the basics and think carefully about the indications for obtaining a urinalysis. Let’s look at three young female patients with differing symptom severities. For simplicity, we will focus only on the patients with suspected lower urinary tract infection (UTI). Patients with ..read more

A 9-month-old male presents to emergency department (ED) with his mother for seizure. The child was diagnosed with seizure disorder at 2 months of age and has had multiple visits to the emergency department (ED) for seizures. The child was delivered at term vaginally, with normal prenatal period and labor. Immunizations are up to date. The child drinks baby formula and has been advancing his diet using baby food. Review of the chart shows that the child has had several negative CT scans and MRIs, and no structural or congenital central nervous system (CNS) abnormalities. The child was started ..read more

The best questions often stem from the inquisitive learner. As educators, we love—and are always humbled—by those moments when we get to say “I don’t know.” For some of these questions, you may already know the answers. For others, you may never have thought to ask the question. For all, questions, comments, concerns, and critiques are encouraged. Welcome to the Kids Korner. In Children, How Successful Are Emergency Physicians at Extracting External Auditory Canal Foreign Bodies? Kids stick everything everywhere. In general, the type and the location of the foreign body (FB) dictates the need ..read more

Chronic knee pain is common and debilitating. Patients often seek care in the emergency department (ED) setting when flares of pain affect their ability to ambulate, climb stairs, or even stand up from sitting.1 In many cases, these patients have been dealing with pain for years and have already exhausted the standard analgesic cocktail of acetaminophen, NSAIDs, and/or topical agents. Patients and clinicians are both aware of the obvious downstream risks of adding opioids to this multimodal regimen. Intra-articular steroid injections can be an excellent option but come with their own risks giv ..read more

A 59-year-old man presents to your community emergency department (ED) with chest pain that is radiating to his back. His vital signs are normal and the ECG does not demonstrate a myocardial infarction. Your clinical gestalt has you suspecting an acute aortic dissection (AoD). While waiting for laboratory investigations, including troponin and d-dimer, you wonder if a quick point-of-care ultrasound (POCUS) examination looking for three sonographic findings could help determine the likelihood of this being an AoD. Background Aortic syndrome (AAS) has been called the lethal triad and includes Ao ..read more

A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operating room videos, recovery tips, and patients praising their plastic surgeon. With a little more digging however, you will also find women like Nelly Baptiste telling The New York Times, “When the pain came yesterday, I was like: I want my old body back” after undergoing a BBL in Miami. Or Helly Larson describing the first week after her Miami BBL as “absolute hell” to a Vox reporter.1,2 You’ll also find the story of Sheila Powell, a woman who suffered a pneumot ..read more

The clinical policy on the management of adult patients presenting to the emergency department (ED) with acute ischemic stroke, was approved by the ACEP Board of Directors in April 2023. Developed by the ACEP Clinical Policies Committee, the guidance was published in the August 2023 issue of the Annals of Emergency Medicine. You can find it on ACEP’s website, www.acep.org/clincialpolicies, as well as in the ECRI Guidelines Trust. Approximately 800,000 people in the United States are diagnosed with a stroke each year at an estimated cost of approximately 46 billion dollars. As a result, stroke ..read more

Physician leadership is a priority for ACEP President Aisha Terry, MD, MPH, FACEP. She’s approaching the issue from all sides. As she builds a programmatic approach within ACEP to identify and cultivate leaders, she is strengthening the “pipeline” and creating opportunities for newer physicians to thrive. The Leadership Spotlight highlights examples of emergency physicians using their foundation in emergency medicine to lead, teach, and inspire the next generation. Whether inside the hospital or beyond, the foundation laid by deep experience in the specialty is versatile, unique, and invaluabl ..read more

It was a beautiful spring day in 1981, back when I was working at a community hospital in Phoenix, Ariz. I had just gotten up from my day nap after a busy overnight shift. My doorbell rang and a nicely dressed young man asked if Daniel Mayer was there. As that is not my name—I’m Dan the tribe and not Daniel the prophet—I immediately said “No.” Realizing that he was just a messenger, I quickly reversed my answer and admitted that yes, that was me. He handed me an envelope and walked off. So started my voyage down the rabbit hole of being sued for medical malpractice. Having never had any educat ..read more

Emergency physicians have the lowest rate of practice ownership among specialties, per the American Medical Association 2020 Physician Practice Benchmark Survey. Only 27.9 percent of emergency physicians reported having an ownership stake in their clinical practice.   For nearly three-fourths of U.S. emergency physicians who are non-practice-owners, working conditions are determined through negotiations between employees and employers. Evidence is accumulating that those negotiations are going poorly.  The Medscape Physician Burnout & Depression Report 2024 showed that emergency ..read more