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In the Acute Care scenario (the Dark Conspiracy RPG) the hospital is run by alien bug monsters who delight in torturing and experimenting on the hapless patients. This is not at all a metaphor for the American health care system.

#monsters #artists on tumblr #alien bugs #rpg illustration #dark conspiracy #acute care

Me: *walks into room at 4AM* Hi, I'm the supervising pediatric emergency doctor. I've heard about you from Dr [resident] and I just want to make sure that we have all the details straight, so-- Parent: It's been 8 hours and no one has seen or done anything for my child. Me: I'm sorry for the wait, but we can get things going if I can just-- Parent: Is it normal for a child with a fever to wait 8 hours to be seen? Me: Unfortunately, yes, when the emergency department is very busy and many children are very sick. Parent: How can that be okay?! My child has had a fever and no one came to see her-- Me: We are here now and we'd like to help, would it be okay for me to do a check so we can make a plan? Parent: You should be concerned! Me: ...I am concerned, which is why I want to do this check to figure out what we can do to take care of your child. Parent: Why didn't anyone do anything before? Me: ...The nurses cannot order tests or medications for patients until the doctor has-- Parent: LAST TIME we came here, the nurses just gave us a cup for her to get a urine sample as soon as we got here, and I've never had to wait this long and I've been here many times. Me: I'm glad that your experience previously has been as such, but unfortunately tonight there have been many children needing care. Parent: You have absolutely no bedside manner, you know that? Absolutely none. You have no compassion for a parent that's been waiting here with their child for 8 hours, I haven't slept, and no one came to see us. Me: I'm sorry you had to wait. I'd like to assess your child to help you now, if you'd like. If not, that's your choice. Parent: Of course you have to do something! I've been waiting here--I am not just going to go back home with nothing. --Exam done, tests ordered, parent again questions wait times and rants, there are many other kids in the department who have ALSO waited 8 hours to be seen, I have multiple acute respiratory patients on escalating oxygen therapy that I am now overdue to reassess, oncology patient comes in with fever and needs acute assessment, blah blah blah emergency department blah--

Nursing note x2 between triage and my resident's first assessment: Parent up to nursing station asking about wait time, writer expressed we are unable to estimate due to acuity of department. Parent upset; writer offered to reassess pt now, parent refused as child is sleeping.

...You have been here for 8 hours and no one came to see you.

I have no bedside manner.

#pediatric emergency medicine #paediatric emergency medicine #pem #peds emerg #paeds emerg #pediatrics #paediatrics #sigh #staff life #ER #EM #emergency medicine #urgent care #acute care #I mean sorry this is Canadian healthcare they'll only pay for one doc overnight...#so it's just me and the 40+ kids in this department and I gotta make sure no one dies #sorry you had to wait for that #also it's viral season tbqh I'm shocked that you've “never had to wait this long” before...#wait times have been >12h in our department at this time of year #also... your kid's fever was gone by the time you got to triage #anyway lol this is why it's rare for trainees to pursue this subspecialty recently #at least the general EM residents docs usually just walk out of the room when patients try to tear them a new one... ain't nobody got time #we're too soft in peds...#or at least I am...#probably could've seen 2 more patients in the time it took this parent to rant at me about wait times #in case non-Canadian medblrs are wondering #Canadian healthcare #is publicly funded...#so... free for Canadians #but I mean if you'd like to get what you want when you want you're welcome to go across the border and just pay for it

The provincial government will add 36 new acute-care beds to St. Boniface Hospital as a means of addressing mounting wait times in emergency

The provincial government will add 36 new acute-care beds to St. Boniface Hospital as a means of addressing mounting wait times in emergency rooms and other pressures on the health-care system. The beds will open in phases beginning with 10 in late March and be used to help transition patients from the ER to other areas of care in the facility, Health Minister Uzoma Asagwara announced during a news conference at the Winnipeg hospital Wednesday. "Under the previous PC government, health care wasn't invested in, it was cut year over year ... and when those decisions were made it forced a number of health-care workers out of our health-care system," said Asagwara, who was a psychiatric nurse before being elected MLA for Union Station in 2019.

Tagging @politicsofcanada

#cdnpoli #canada #canadian politics #canadian news #healthcare #acute care #hospitals #manitoba

Myocarditis in Emergency Practice

Myocarditis, an inflammatory condition affecting the heart's myocardial tissues, is a significant cause of sudden cardiac death and dilated cardiomyopathy. With diverse etiologies ranging from viral and immune-mediated causes to toxic exposures, diagnosing and managing myocarditis can be challenging. In this blog post, we will explore the important points regarding the etiology, pathophysiology, presentation, diagnostic testing, and treatment options for myocarditis, with a focus on the perspective of emergency physicians.

Myocarditis can be caused by infectious agents (bacterial, parasitic, viral), immune-mediated conditions, and toxic exposures. Viral causes include enteroviruses, influenza, hepatitis viruses, HIV, herpes viruses, and Parvo B-19. Immune-mediated causes include systemic lupus erythematosus (SLE), scleroderma, and giant cell types. Toxic agents such as doxorubicin, antiretroviral medications, clozapine, and cocaine can also trigger myocarditis.

Myocarditis follows a three-step process. In the acute phase, infectious, autoimmune, or toxic agents directly damage cardiac myocytes. Subsequent myocyte destruction triggers immune system activation and secondary inflammation. In the later stages, the immune system mistakenly attacks the myocytes themselves, leading to progressive myocardial damage.

Myocarditis presents with a wide range of symptoms, necessitating a high index of suspicion for timely diagnosis. Symptoms may include dyspnea, palpitations, orthopnea, and chest pain. Dyspnea is the most common presenting symptom, while chest pain can vary from pleuritic to anginal. Patients may exhibit symptoms of congestive heart failure, ranging from fatigue and peripheral edema to cardiovascular collapse. Skin manifestations can be present in cases triggered by medication exposure.

Diagnostic testing for myocarditis overlaps with other cardiopulmonary evaluations. Electrocardiogram (ECG) abnormalities, such as sinus tachycardia, ST-segment elevations, T-wave inversions, AV blocks, widened QRS durations, or prolonged QT intervals, may be observed. Troponin assays may be elevated, but their absence does not rule out myocarditis. Additional blood tests, including CBC, CRP, and ESR, are often abnormal but nonspecific. Imaging studies like chest radiography and echocardiography can provide valuable information.

TThe treatment of myocarditis primarily focuses on supportive care to prevent further damage to the heart. Stabilizing the patient's ABCs (airway, breathing, circulation) is the priority. Supplemental oxygen and non-invasive positive pressure ventilation may be required for hypoxia or pulmonary edema. Heart failure therapy, including diuretics and nitroglycerin, can be administered if systemic perfusion allows. Cardiac dysrhythmias may necessitate treatment with antidysrhythmic medications. Antimicrobial therapy is required for cases associated with bacterial or parasitic infections. In severe cases, advanced interventions such as intra-aortic balloon pumps, extracorporeal membrane oxygenation (ECMO), or ventricular assist devices (VADs) may be necessary.

Myocarditis presents a complex diagnostic and management challenge for emergency physicians. The diverse etiologies, varied clinical presentations, and overlapping diagnostic tests make timely diagnosis crucial. Supportive care, stabilization, and targeted interventions are key elements of treatment. While further research is needed to refine diagnostic and therapeutic approaches, understanding the etiology, pathophysiology, presentation, and treatment options can aid emergency physicians in effectively managing myocarditis cases.

#emergency medicine #acute care #emergency #health & fitness #biology #emergency physician #foamed #myocarditis