A reminder for all of us

A simple and nice 4 minutes to look at. You wouldn't waste your time watching it:

Your ED will more likely to have a higher mortality rate if you don't have this tool....

I'm not really sure that you can come up with something by looking at the title, but if I say a diagnostic tool that is repeatable, no radiation, and operator dependent, you will surely know what kind of tools what I had in mind...Good, man! it's the ultrasound..

I believe ultrasound is not a strange things anymore considering its wide use among doctors, even common people who are not doctors would know about the ultrasound. But, its use in the emergency department (ED) hasn't been widely enforced and I believe every ED doctors will eventually have to be able use it in the future. But, why is that? Ever heard about RUSH and FAST? Well, I'll let the professional do the work to explain it to you guys...

Rapid Ultrasound for Shock and Hypertension (RUSH):

Focussed Assessment Sonography in Trauma (FAST);

Blood taking hasn't been this easy!!

A practice of blood taking in Emergency Department is an usual sight. As the patient placed on the bed,  we usually take blood while setting the "plug" (IV line). Some may be done easily, since the veins are visible and were easily punctured, but then, some patients may suffer more because of the failure of puncturing. 

This was seen and been taken care of:

ISRN Emergency Medicine
Volume 2012 (2012), Article ID 508649, 6 pages
doi:10.5402/2012/508649
Research Article
Comparison of Full Blood Count Parameters Using Capillary and Venous Samples in Patients Presenting to the Emergency DepartmentR. Ponampalam,1 Stephanie Man Chung Fook Chong,2 and Sau Chew Tan1
1Department of Emergency Medicine, Singapore General Hospital, Outram Road, 169608, Singapore
2Department of Clinical Research, Singapore General Hospital, Outram Road, 169608, Singapore
Received 29 May 2012; Accepted 10 July 2012
Academic Editors: A. Banerjee, C. C. Chang, and A. Pazin-Filho
Copyright © 2012 R. Ponampalam et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Full blood count (FBC) analysis is a common investigation done in the emergency department (ED). The aim of this study was to determine the accuracy of bedside FBC analysis using capillary blood samples from a finger stab at point of care (POC) compared to a conventional venous blood sample analysis. A total of 314 consecutive patients presenting to the ED were recruited. After consenting, a sample of the patient’s venous (V) blood was obtained via venepuncture and sent to the haematology laboratory for analysis as standard practice. This was followed immediately by collection of a capillary (C) blood sample from a finger stab which was analysed at site using an automated FBC analyser at POC. Agreement between the paired samples for blood parameters including the total white cell count, hemoglobin, and platelet count was assessed by the statistical method of Bland and Altman using V sample as the gold standard. The results showed a statistically significant deviation between capillary and venous samples only for platelet counts (𝑃 < 0 . 0 0 1) and haemoglobin (𝑃 < 0 . 0 0 1). However, the magnitudes of this difference 7.3 × 109/L and 0.5 g/dL respectively, were not clinically significant. The study suggest that the analysis of capillary samples for FBC parameters is a reliable and acceptable alternative to conventional methods with the benefits of being a rapid, convenient, and minimally invasive technique.

The full article may be read here:

ISRN Emergency Medicine Journal

"Sorry mam, your husband is dead..."

As we work in emergency room, patient's condition may deteriorate anytime depend on the severity of the disease, and breaking the bad news to the family member become inevitable. We tend to be too busy saving lives, sometimes we forget to inform the family about the condition of the patient. Giving information to the patient or patient's family is one of the most important part to keep a stable doctor-patient (especially patient's family) relationship. A timely-wise report to the patient's family may even prepare the family to face the worst possible outcome.

This video might give us enlightening on how to make it happen: