The propofol assassins. US vs CT for appy. Defensive documentation. Can you really be allergic to iodine?

ERCAST Rant-Off 2011

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It’s open mike time for whatever get’s your goat (in medicine, that is). Featured rants…

Cliff Reid of resus.me: The Propofol Assassins

Dave Peaslee: “Do you know what medicines you’re on, sir?”

Andy Neill of emergencymedicineireland: Are we thinking about PE the right way?

Mike and Matt from the emergency ultrasound podcast: US vs CT for appendicitis

Resident Jim: How I feel about attendings who do a full H&P before I get in the room

Dan Gromis: Can you really be allergic to iodine? I think not!

Gerry O’Malley: Why do we teach residents defensive documentation?

Steve Ayers: When can you really say someone has HTN?

Mike Jasumback: Wants an emergency medicine forum. Email him at EMforum@live.com

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9 Responses to The propofol assassins. US vs CT for appy. Defensive documentation. Can you really be allergic to iodine?

  1. Pingback: Propofol in RSI podcast | Air Ambulance Victoria HEMS

  2. Pingback: Listen to, laugh at, learn from and LOVE these ercast.org rants!!! | the underneaths of things

  3. EM Basic says:

    Any chance of getting a direct download link posted? I’m a luddite who burns these to CD and listens to them in my car and it’s easier than going through iTunes (waiting for the iPhone 5 to come out to join the iPhone masses…)

  4. Paramedic says:

    Rob makes a really good point regarding documentation: read the nurse’s AND paramedic’s reports.
    And be nice to the paramedic! Simply asking for a brief report, rather than getting the information through a game of telephone with the nurse, might be a very good use of your time. Even, “Anything serious?” may clue you into the fact that the paramedic is going to put something concerning into their report.
    And whatever you do, don’t blow off the paramedic who approaches you with a concern: “Do you know which doctor is going to see the patient in room 14?” The correct answer is NOT, “Nope.” How about trying, “Nope. Anything interesting?” You might find out the patient was incontinent before we cleaned them up, was complaining of saddle paresthesia at the scene, and had to be assisted to the cot. Probably you’ll get all that while you’re taking care of the rest of your patients, but if you don’t you’ll look pretty silly when the plaintiffs attorney points out that the paramedic mentioned the possibility of cauda equina syndrome in his or her report, or simply documented those symptoms. Loss of quality of patient’s sex life can sure be expensive…
    Show some interest in the medics and they will really respect you. They’ll often be wrong because they are looking for classic signs of disease, and as Amal says, “classic” is Latin for 10-15% of the time. But at least you’ll have some forewarning that they are likely to have something in their report worth addressing in your documentation.
    If you have time to teach-great, if you can only listen briefly-fine, but don’t ignore or ridicule (to our faces at least)!
    That’s my rant Rob. Love your podcasts and this last rant podcast was great!

    • emergencypdx says:

      Truer words never spoken. Paramedics are one of our best resources for getting the ‘boots on the ground’ history. The initial ED evaluation is shortened by at least 50% by listening to the paramedic report and asking questions as to scene management, the patient’s social situation, etc. Keep up the good work!

  5. Steve says:

    I’ve been meaning to comment on this episode for a while…

    Cliff Reid= my hero. This one clinical situation is a metaphor for everything else we do in EM. When will other specialties realize that what they do in their office, the OR, the ICU is a different ballgame than what we do in the ED or the resuscitation bay? Anesthesia can say that they are the experts of the airway…fine- we are the experts of the emergent airway. Surgeons aren’t the experts of undifferentiated abdominal pain- we are. Critical care doctors aren’t the experts of the undifferentiated crashing patient- we are. I can go on…and saying these things are not to make us cocky or pompous or to say that we don’t need our consultant’s help- its to say that we have our own set of unique skills that should be respected. We should stand up for our patients when certain specialties come to our playground, treat it like their own, and don’t do the right thing for the patient. Rant over

    Dr O’Malley’s rant- I agree with the crux of his argument- what you write down won’t matter much if something bad happens. I also agree that we need some serious malpractice reform so that we aren’t pawns in a chess game between the lawyers and our insurance company. While we shouldn’t be charting defensively, I don’t think this should be confused by saying that we should be ok with poor charting. I know he has heard all the arguments on this but what about this…The one area I can see is with documenting times and decisions when you talk to consultants. Making sure that you document that you talked to a consultant in a timely manner or that they are taking too long, don’t want to take someone to the OR, etc. can be the difference between being simply deposed and being dragged to trial as a defendant. Isn’t that a good enough reason to do good (but not defensive) charting?

  6. Pingback: The Wrath of Dr. Khan

  7. Adam Kessler says:

    All I have to say thank you. Great podcast !

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