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We are in Las Vegas at ACEP 2016 and discuss high yield or cutting edge lectures each day.

Dr. Anne Daul – Emergency Care of the Transgender Patient

Most emergency medicine physicians and trainees lack training in caring for LGBTQ patients, let alone transgender patients [1].  Many members of the LGBTQ community may have delays in medical care including 21% of transgender patients in a Canadian survey[2].  Also, according to a 2010 task force, 19% of transgender patients report being denied care in some way [3].

Here is a video from SMACC Dublin from Thom O’Neill on caring for LGBT youth

https://www.youtube.com/watch?v=7ZsYgftEv2U&feature=youtu.be

Check out these FOAM resources from EPMonthly and Mayo.

Dr. David Callaway – Active Shooter

2% of active shooter events take place in the health care setting.

Plan of Action in Active Shooter Scenario: AVOID DENY DEFEND TREAT

• Avoid – stay away from the shooter.
• Deny – deny them access to you or the area. Lock doors, block pathways, turn off the lights, make it more difficult for them.
• Defend -.if necessary, defend yourself.
• Treat – once you are safe, and the scene is safe, treat and care for your patients.

Dr. Kevin Klaur – Lawsuits

Documentation and discharge instructions repeatedly come up in lawsuits.

• Documentation: If you document after the fact, particularly if there was a bad outcome – be straightforward that you are documenting after the fact. Do not document as though you do now know the outcome
• Discharge – lawsuits often come up because discharge instructions or documentation were not sufficient. Klauer argues that it is not sufficient to state “patient improved, discharged home.” He urges us to document a repeat exam or show HOW they are improved.

Dr. Klauer also gave some general pearls on lawsuits – high numbers for orthopedics/missed fractures and administration of RhoGham.  An additional pearl he gave was for cauda equina.

• These patients often have small post void residuals because it’s a neurogenic problem, not a mechanical obstruction.  Thus, if a patient has other features and has a post void residual of 100 cc, it’s not necessarily not cauda equina.

One ACEP16 lecturer talked about magnesium use in alcohol withdrawal – probably not ready for prime time, Cochrane agrees  [4].

References:

1. Moll J, Krieger P, Moreno-Walton L. The prevalence of lesbian, gay, bisexual, and transgender health education and training in emergency medicine residency programs: what do we know? Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 21(5):608-11. 2014. [pubmed]
2. Bauer GR, Scheim AI, Deutsch MB, Massarella C. Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a respondent-driven sampling survey. Annals of emergency medicine. 63(6):713-20.e1. 2014. [pubmed]
3. Grant JM, Mottet LA, Tanis JD et al. National Transgender Discrimination Survey Report on health and health care Findings of a Study by the National Center for Transgender Equality and the National Gay and Lesbian Task Force.  October 2010
4. Tejani SM. Magnesium for the prevention or treatment of alcohol withdrawal syndrome in adults. June 2013