March 25, 2021

Background: While we try not to think about it, the spectre of litigation hovers around the house of medicine. Medical malpractice books have been written, physicians have found their niche discussing and writing about it and blogs have been started covering this topic and how doctors can better protect themselves and their patients.  A 2011 study showed that emergency physicians have a 7.5% annual risk of being involved in a malpractice claim and 1.5% annual risk of a claim being paid either through settlement or verdict (Jena 2011). Physicians who have been involved in claims may practice more defensive medicine leading to more tests which then leads to increasing health care costs.  Previous studies have focused on malpractice risk in EM but they have small sample sizes or focused on specific diseases. One larger study did look at the national dataset but the data is now over a decade old and litigation rates may have changed or increased(Brown 2010).

March 22, 2021

Background:  Chest pain is one of the most frequent presenting patient complaints in emergency departments (ED) and has an extensive differential diagnosis with very different levels of severity (1). Many of these chest pain presentations require a significant stay in the ED to rule out acute coronary syndromes (ACS). Low-risk chest pain has been defined by consensus guidelines as having a less than 1% risk of a Major Adverse Cardiac Event (MACE) - a composite of death, myocardial infarction (MI) and coronary revascularization (2,3). There is certainly an overuse of troponin ordering in certain low-risk chest pain populations, translating into unnecessary resource utilization and possible downstream patient harm. The HEART Pathway combines a History, ECG, Age, Risk factors (HEAR) score and serial troponins to stratify patients with acute chest pain and attempt to identify those who most likely do not have ACS that are most suitable for early discharge from the ED without further testing (4). The HEART Pathway ideally reduces hospitalisations from the ED and outpatient cardiac testing, but it is not known if there exists a sub-population of very low-risk patients who could be objectively identified for discharge without any troponin testing at all. This study sought to measure the MACE rate among very low-risk chest pain patients, as defined by a HEAR score ≤1, and determine whether the HEART Pathway requires troponin testing among very low-risk patients to achieve an accepted missed MACE event rate of less than 1%.

March 20, 2021

Background: A major challenge during the COVID pandemic is balancing personal protection and communication. Being heard while wearing a surgical mask or N95 isn't too much of a challenge, communication can be significantly impaired while wearing a respirator mask. There are a number of fixes to this problem. Here, we share one simple, inexpensive option via Whit Fisher, MD (

REBEL Review 101: Richmond Agitation-Sedation Scale (RASS)

Created March 19, 2021 | Thoracic and Respiratory | DOWNLOAD