• In Mesa, Arizona, just 20 minutes east of Phoenix, there is an opening for an Emergency Medicine Physician at a fairly active emergency department. Mountain Vista Medical center has 30 ED beds and the department sees between 25-35 thousand patients each year. Mesa is known for its focus on the arts and offers something for the entire family, including playgrounds, picnicking, local sports action, world-class resorts and plenty of fine dining. It all adds up to a great place to both make your home and further your professional career.

• At St. Luke’s Medical Center in Phoenix proper we have an immediate opening for a qualified physician. Volume at St. Luke’s is relatively light, between 15-25 thousand patients annually, but its Phoenix location will give you plenty of opportunity to utilize and expand your skills. Phoenix is also one of the most exciting cities in the West to live in, with world-class resorts, fine dining, exhilarating adventure, trendy shopping, modern nightlife and enriching culture. The area’s natural beauty offers rugged mountain ranges, Saguaro cacti that tower over relaxing hiking trails and spectacular, breathtaking sunsets.

• In Tempe, Arizona we have an emergency medicine job opening with excellent pay at a state-of-the-art facility. Tempe’s St. Luke’s Hospital has 19 ED beds and is a fairly active emergency department at 25-35 thousand patients annually. Nestled in southern Arizona with Phoenix to the west, Mesa to the east and Scottsdale to the north, Mesa is close to everything that this area of Arizona has to offer. With history, culture, shopping, dining, nightlife and more, Tempe has something for everyone.

All of our Arizona Emergency Medicine jobs come with full benefits and many have bonus opportunities. Browse our entire list of Emergency Medicine and Hospitalist Medicine jobs.

1. The patient has no previous history of suicide.
2. Patient has left her white blood cells at another hospital.
3. Patient’s medical history has been remarkably insignificant with only a 40 pound weight gain in the past three days.
4. She has no rigors or shaking chills, but her husband states she was very hot in bed last night.
5. Patient has chest pain if she lies on her left side for over a year.
6. On the second day the knee was better and on the third day it disappeared.
7. Discharge status: Alive, but without my permission.
8. Healthy appearing decrepit 69- year old male, mentally alert, but forgetful.
9. Patient had waffles for breakfast and anorexia for lunch.
10. She is numb from her toes down.
11. While in A&E, she was examined, X-rated and sent home.
12. The skin was moist and dry.
13. Occasional, constant infrequent headaches.
14. Patient was alert and unresponsive.
15. Rectal examination revealed a normal size thyroid.
16. She stated that she had been constipated for most of her life until she got a divorce.
17. Both breasts are equal and reactive to light and accommodation.
18. Examination of genitalia reveals that he is circus sized.
19. The lab test indicated abnormal lover function.
20. Skin: somewhat pale, but present.
21. Large brown stool ambulating in the hall.
22. Patient has two teenage children, but no other abnormalities.
23. When she fainted, her eyes rolled around the room.
24. The patient was in his usual state of good health until his airplane ran out of fuel and crashed.
25. Between you and me, we ought to be able to get this lady pregnant.
26. Patient was seen in consultation by Dr. Smith, who felt we should sit on the abdomen and I agree.
27. The patient was to have a bowel resection. However, he took a job as a stock broker instead.

So, let’s just presume I made this whole thing up. Still we have all likely read things in others medical records that are nearly as outrageous as these statements. It is ideal, within the functionality of a medical record to “paint a picture of your patient in time.” This allows for an accurate, reliable and complete record that can be referred to and translated by any professional needing to make good decisions about the patient they are evaluating using the information within the records provided. What can we take away from these invaluable misquotations?

These statements are not particularly defensible in a court of law, and they fail to document the details that may make the difference between credibility and laughability. Undeniably, “Dictated but not read” can be a recipe for a medical record disaster that may find its way to a viral internet publication!

• Brevard, North Carolina is located in the western Blue Ridge Mountains and is just 30 miles southwest of Asheville and all the entertainment, dining and cultural activities that Western North Carolina destination has to offer. Here in the heart of Transylvania County against the breathtaking backdrop of the Pisgah National Forest is Johnston Medical Center-Smithfield. This 94-bed facility has openings for physicians, nurse practitioners and physician assistants. It delivers a full range of services, including: cardiology, ICU/CCU, anesthesiology, OB/GYN, home health, radiology, speech/language therapy, respiratory therapy, laboratory, wound care/ostomy and podiatry.

• Johnston Medical Center-Smithfield is located on the Coastal Plain in Smithfield, NC and the 199-bed facility also has openings for physicians and NP/PAs. This affordable community is just 30 miles east of the Research Triangle city of Raleigh. With behavioral health, urgent care, surgical services and a cancer center, the Center plays an important role in the well-being of this friendly community.

• In Louisburg, North Carolina At Franklin Regional Medical Center we have Hospitalist jobs for a full or part-time physician. Here’s your chance to work for a state-of-the art medical system that delivers comprehensive services such as cardiac care, ultrasound, radiology, laboratory, critical care, plastic surgery, imaging, OB/GYN, nephrology, orthopedics, gastroenterology, urology and pediatric. Louisburg is located in the upper Piedmont plateau of North Carolina just 30 miles northeast of Raleigh and 45 miles northeast of Durham, so it offers close proximity to the resources and great quality of life of the Research Triangle.

Remember, we also have Medical Directorship opportunities at great facilities across the country. If you’re interested in Directorships, email us at Recruiting9@hppartners.com or call us at (800) 815-8377. Click here to view the complete list of North Carolina Hospitalist jobs or view all of our Hospitalist and Emergency Medicine jobs.

This adequately controlled and designed study collected ETCO2 samples from every other patient presenting to an ED that had been assigned triage acuity levels of 2 through 4. Using 30 control subjects and 320 study subjects they collected data and subsequently correlated vital signs, discharge diagnostic criteria (i.e. respiratory, metabolic etc.) ETCO2, and patient disposition data. The highlights of this study’s findings included the results that one in two subjects with normal vital signs and abnormal ETCO2 were admitted. One in 6 (10 with adjusted data) subjects with normal vital signs and normal ETCO2 were ultimately admitted. Lastly, ETCO2 readings outside the accepted range correlated with the need for patient admission. They concluded that ETCO2 may be a sensitive indicator of illness or injury and is predictive of the need for admission. Additionally, “Routine measurement of ETCO2 may contribute predictive information about severity of the disease process that may be missed by current standard vital signs.”

Let’s consider how this can fit into the Emergency Medicine and Hospitalist’s management of our patients. We are the providers ordering the measurement and interpreting its results. Certainly this gives us first hand insight on the potential severity of illness of the patient we will be caring for. Furthermore it can give us the awareness that there may be a need for more aggressive, attentive or individualized patient care. Clearly the discovery of an abnormal level in the patients’ evaluation produces an obligation to relay the significance of this data to the admitting MD for these patients.

The take home message: Here is scientific evidence of another potentially valuable use for ETCO2 in our diagnostic armamentarium. Make sure you are the most knowledgeable and accurate resource for both obtaining and interpreting this critical physiologic data point as you are often the resource that can save the patient’s life or at the very least are responsible for improving the efficiency of their evaluation and their overall quality of care.

Reference: Sidestream Quantitative End-Tidal Carbon Dioxide Measurement as a Triage Tool in Emergency Medicine, D. Williams, T. Morrissey, D. Caro, R. Wears, C. Kalynych : Annals of Emergency Medicine – ANN EMERG MED , vol. 58, no. 4, pp. S212-S213, 2011

• In Beckley there is an exciting opportunity at the Beckley ARH Hospital. The 26-bed emergency department treats 22,000 people annually and this full-time position requires that you work 144 hours per month. The Beckley market area includes over 200,000 people and offers beautiful state and national parks, great dining and shopping.

• Over in Oak Hill there is an immediate opening for an Emergency Medicine Physician at the Plateau Medical Center. Services available to ER patients include, but are not limited to, Respiratory Therapists, Laboratory and Diagnostic Imaging. Oak Hill is a growing city with a small-town feel and is home to some of the best-know attractions in West Virginia, including the New River Gorge Bridge.

• At the Greenbrier Valley Medical Center in Ronceverte, West Virginia, there is an opportunity for an Emergency Medicine Physician at a facility that offers an extensive array of medical, surgical and outpatient services. ER patient volume is between 15 and 25 thousand annually, providing an essential service to this historic city situated on the gently flowing Greenbrier River.

Hospital Physician Partners has more Emergency Medicine and Hospitalist jobs all across the country. Click here to browse.

• In Brevard, North Carolina, near the beautiful Blue Ridge Mountains, we have an opening for an Emergency Medicine Physician at a state-of-the-art emergency department. Transylvania Community Hospital has 10 ED beds and 94 hospital beds and sees between 15-25 thousand patients a year in its ED. Brevard is just 30 miles southwest of Asheville, NC and within a couple of hours of Charlotte so you’ll have the best of all worlds – breathtaking scenery, outdoor activities and plenty of entertainment nearby.

• At the Johnston Medical Center-Smithfield in Smithfield, NC we have great emergency medicine job opportunities for physicians, nurse practitioners and physician assistants. This is a fast-paced, professional environment with an annual emergency department volume of more than 50 thousand and the career rewards are many. Smithfield offers you comfortable and affordable accommodations, outstanding “Southern-style” restaurants, five area heritage museums, annual festivals and the largest selection of outlet stores in the state at Carolina Premium Outlets.

• In Washington, North Carolina we have an excellent emergency medicine job opening for a physician at a recently renovated facility with great mid-level support – and that means a rewarding job with less stress for you. Beaufort County Hospital has 149 beds and delivers a full range of services while its Eastern Carolina location offers affordable living, culture and a wide range of activities.

• Blue Ridge Regional Hospital, as its name implies, is located in the heart of the Blue Ridge Mountains in Spruce Pine, North Carolina. This facility has emergency medicine jobs available for qualified physicians, nurse practitioners and physician assistants. Spruce Pine is just an hour’s drive from Asheville and has plenty to offer close to home, including craft studios and galleries, the renowned Penland School of Crafts and the Museum of North Carolina Minerals.

• We have even more opportunities in great North Carolina communities such as Linville, Louisburg, Thomasville and Wilson, so be sure to check out all of the Emergency Medicine jobs available in North Carolina.

All of our North Carolina Emergency Medicine jobs come with full benefits and many have bonus opportunities. Click here to see the complete list of North Carolina Emergency Medicine jobs or browse our entire list of Emergency Medicine and Hospitalist Medicine jobs.

Additionally, the concussion rate was 0.39% for on ice fighting compared with the nearly 4.5% relative closed head injury risk per game from checking (aka ‘hitting’; defined as a number of defensive techniques used to separate the player from the puck).

Yet the rash of head injuries plaguing the sports world and the community is large and of importance to both of our professions. Since a head injury happens every 15 seconds and a patient dies of a traumatic brain injury (TBI) every 12 minutes we have a lot to learn from this venue for our patients.

So what has ice hockey research proposed? A group of scientists (Dr. Fisher, senior scientist in human physiology at Toronto General Research Institute, Univ. of Toronto; Dr. Smith, Univ. of West Virginia, Dr. Bailes brain injury expert for NFLPA, whose findings have been accepted for publication in the medical journal “Neurosurgery”), are working to develop a collar that would ‘increase’ blood flow to the head and keep the brain movement to a minimum. This collar slightly restricts venous return from the brain which would effectively give the brain an increased volume allowing less room to “slosh around” The pressure being applied by this collar is no more than a “tight collared shirt”. When they fitted rats with these collars and inflicted a “standard TBI” to the rats, the ones wearing collars had an overall brain injury reduction of 82.7% compared to the non-collared TBI rats!

In speaking with contemporary respected neurosurgeons at a regional trauma center in Southern California, the primary concern was the consequences due to the established alterations in the normal circulatory balance and its localized effects on intravascular pressures and venous/capillary/blood brain barrier permeability with these collars in place at the time of the TBI. In particular they have concerns over the short and long term sequelae related to the potential pathophysiology induced by said collars on significant TBIs. This is especially concerning to these surgeons since TBIs are not standardized.

So sit back and enjoy the Stanley Cup Playoffs in high definition (the only way to watch ice hockey unless you’re there in person) while personally gathering the real time study data the players continue to develop for you during the games. Perhaps even ice hockey can teach medicine a couple of things these days.

References:
Results of 1,300 Consecutive NHL Fights: Fists of Fury with Minimal Injuries
Annals of Emergency Medicine, Volume 58, Issue 4, Page S330
K. Pasternac, D. Weiner, D.P. Milzman

I can only speak for our company, but hats off to SHM for setting up the conference so we could accomplish our goal. This was by far the most successful conference we have attended with SHM. The weather was amazing. (It is San Diego afterall!) The exhibit hours were pretty good. The conference hall was navigable and easy to access and the SHM staff was easy to work with. Most importantly, we met alot of quality Hospital Medicine Physicians. Admittedly, we had a great location. (Booth 201 right up front)

I won’t spill our secrets, less our competitors read this (haha), but we actually had doctors hanging out in our booth. There was a general interest not only in our services, but also in talking about the industry. This is something I have noticed about Hospitalists, especially at Hospital Medicine conferences such as this, they are much more willing to engage exhibitors than many other clinical professions. Perhaps it’s the natural tendency towards bedside manner, patience, friendliness, and subsequent gentle touch. Or maybe we just had really cool giveaways. Either way, the attendees at this years Hospital Medicine 2012 were considerate, engaged, enthusiastic, and interested.

Again, thank you to SHM and all of the Hospitalist Physicians, Nurse Practitioners, Physician Assistant and administrators who visited us. We look forward to Hospital Medicine 2013 in National Harbor, MD. Guaranteed, Hospital Physician Partners will bring our swag (promo items), our great team, our energy, and our unique brand of approachability; and hopefully we’ll attain even greater success than we had this year.

CO toxicity impairs oxygen delivery and utilization at the cellular level. It therefore has the most profound impact on the organs with the highest oxygen requirement. Toxicity is caused primarily from cellular hypoxia due to impairment of oxidative phosphorylation and electron transport. CO reversibly binds hemoglobin which effectively causes a relative anemia. It binds hemoglobin 230-270 times more strongly than oxygen. A room with a CO level of 100 ppm can cause a HbCO of 16% at which is enough to produce clinical symptoms. The binding of CO to hemoglobin causes an increased binding affinity of oxygen molecules on the other 3 hemoglobin oxygen-binding sites. This causes a leftward shift in the oxyhemoglobin dissociation curve further lowering the availability of oxygen to the issues. CO binds to cardiac myoglobin with an even greater affinity than to hemoglobin resulting in myocardial depression and worsening hypotension. Studies have shown that CO may cause inflammatory changes in the brain. Following severe intoxication, patients do display central nervous system (CNS) pathology, including white matter demyelination. This leads to edema and focal areas of necrosis.

Symptoms typically begin with headaches at levels around 10%. Levels of 50-70% may result in seizure, coma, and death. Misdiagnosis is common. Because of how vague and varied the complaints are, symptoms often are attributed to a viral illness. Therefore, asking about possible exposures is important. This is even more important in the winter months. Another clue can be recognizing when more than one patient in a house presents with the same complaints. Remember, severity of symptoms may not correlate well with HbCO levels. The most common symptom is usually headache (37%) followed by dizziness (18%) and nausea (17%).

Physical examination is not very helpful because there is no one defining feature pointing to the diagnosis. Inhalation injury or burns should always make one consider the possibility of CO exposure. Vital signs would be consistent with a nonspecific acidosis and metabolic derangement; tachycardia, hypertension or hypotension, hyperthermia, and tachypnea. The classic skin sign of cherry red is rare because pallor is actually more common. The chest x-ray may be negative or show non-cardiogenic pulmonary edema. The most common abnormality on an electrocardiogram is sinus tachycardia. Arrhythmias may be secondary to hypoxia, ischemia, or infarction. Patients may have memory problems including retrograde and anterograde amnesia and may even confabulate. They demonstrate emotional lability, impaired judgment, and decreased cognitive ability. Stupor, coma, gait disturbance, movement disorders, and rigidity may be present. Long-term exposures or severe acute exposures can lead to long-term neuropsychiatric problems. Some individuals even develop delayed neuropsychiatric symptoms several days to weeks later. Patients with preexisting heart disease can experience increased exertional angina with HbCO levels of just 5-10%. At high HbCO levels, even young healthy patients develop myocardial depression. Nontraumatic rhabdomyolysis can result from severe CO toxicity and can lead to acute renal failure. Lactic acidosis, hypokalemia, and hyperglycemia may be seen with severe intoxication. Methemoglobinemia should be considered in the differential diagnosis of cyanosis with low oxygen saturation but normal PaO2. Chronic exposures may present with a loss of dentition, gradual-onset neuropsychiatric symptoms, or recent problems with cognitive ability. Two thirds of all acutely exposed patients eventually recover completely.

HbCO absorbs light almost identically to that of oxyhemoglobin. Although a linear drop in oxyhemoglobin occurs as HbCO level rises, pulse oximetry will not reflect it. Pulse oximetry gap, (the difference between the saturation as measured by pulse oximetry and one measured directly), is equal to the HbCO level. Pulse CO-oximetry units are available which can screen for CO toxicity at the bedside. Patients need immediate and continuous 100% oxygen therapy until the patient is asymptomatic and HbCO levels are below 10%. In patients with cardiovascular or pulmonary compromise, lower thresholds of 2% are recommended. One can calculate an estimate of the necessary therapy duration by using the initial level and half-life of 30-90 minutes at 100% oxygen FIO2. In uncomplicated intoxications, measuring venous HbCO levels and oxygen therapy are sufficient. HbCO analysis requires direct spectrophotometric measurement in specific blood gas analyzers. Bedside emergency department pulse CO-oximetry requires a special unit and is not a component of routine pulse oximetry. Elevated levels are significant; however, low levels do not rule out exposure, especially if the patient already has received 100% oxygen or if significant time has elapsed since exposure. Individuals who chronically smoke may have mildly elevated CO levels as high as 10%. Presence of fetal hemoglobin, as high as 30% at 3 months, may be read as an elevation of HbCO level to 7%. When interpreting an arterial blood gas, PaO2 levels should remain normal. Oxygen saturation is accurate only if directly measured, not if calculated from PaO2, common in many blood gas analyzers. One can estimate PCO2 levels by subtracting the carboxyhemoglobin (HbCO) level from the calculated saturation. PCO2 level may be normal or slightly decreased.

CO is eliminated through the lungs. The half-life of CO at room air temperature is 3-4 hours. One hundred percent inspired oxygen reduces the half-life to 30-90 minutes. Hyperbaric oxygen therapy (HBO) for the treatment of CO poisoning is controversial. There is a true, increased rate of elimination of HbCO. Certain studies demonstrate large reductions in delayed neurologic sequelae, cerebral edema and pathologic central nervous system (CNS) changes. But with all those positive findings, systematic reviews have not revealed a clear benefit of HBO, so no clear guidelines for its use have been determined. Furthermore universal treatment criteria do not exist. The most common selection criteria for use of HBO (regardless of HbCO level) include coma, transient loss of consciousness, ischemic ECG changes, focal neurologic deficits, and abnormal neuropsychiatric testing. HBO at 3 atm raises the amount of oxygen dissolved in the serum to 6.8% which can maintain cerebral metabolism. This reduces the elimination half-life to 15-23 minutes. Treatment regimens are usually provided at FIO2 of 100% at 2.4-3 atmospheres for 90-120 minutes Hyperbaric oxygen at 2.5 atm with 100% oxygen reduces it to 15-23 minutes. Hyperbaric therapy should be considered immediately for patients with levels above 40% or cardiovascular or neurologic impairment. Additionally, persistent impairment after 4 hours of oxygen therapy necessitates transfer to a hyperbaric center. Pregnant patients with carboxyhemoglobin levels above 15% should be considered for hyperbaric treatment.

Since sudden death has occurred in patients with severe arteriosclerotic disease at HbCO levels of only 20%, all patients require continuous monitoring. Serial neurologic examinations, including funduscopy, CT scans, and, possibly, MRI, are important in detecting the development of cerebral edema which require intracranial pressure and invasive blood pressure monitoring to guide therapy. Head elevation, mannitol, and moderate hyperventilation to 28-30 mm Hg PCO2 are indicated in the initial absence of ICP monitoring. Acidosis should improve with oxygen therapy. Patients with HbCO levels of 30-40% or above 25% with associated symptoms will usually be admitted.

• Hancock Medical Center is a new state-of-the art facility located in Bay St. Louis, a beach community on Mississippi’s Gulf Coast. This beautiful, quaint, beach town has both a fantastic cost of living and a solid economic base, with employers that include: NASA, 2 casinos, 2 plastic plants, Calgon Carbon and Dupont Chemical. Doctors and nurse practitioners and can enjoy rewarding emergency medicine jobs while working with a great team and a highly educated and insured patient population.

• In the Northeast corner of Mississippi in the town of Booneville we have an opening for an Emergency Medicine Physician. Booneville is just 100 miles southeast of Memphis and is near the Bay Springs Lock and Dam area where there is plenty of swimming, boating and fishing to enjoy. With breathtaking beauty along the Natchez Trace Parkway and exciting history throughout nearby Tishomingo State Park, Booneville offers area residents plenty of things to do year-round.

• Oxford is the home of the University of Mississippi and here we an opportunity for an Emergency Medicine Physician at beautiful facility — Baptist Memorial Hospital – that is situated just off the Ole Miss campus. Oxford has plenty of activities for the entire family, from Ole Miss football games on campus to fun city festivals downtown.

• For physicians and nurse practitioners we have Emergency Medicine jobs available at Baptist Memorial Hospital in the vibrant town of Columbus. Columbus is located 120 miles west of Birmingham, AL and was named one of Mississippi’s Dozen Distinctive Destinations. It’s a vibrant town that preserves the past and promotes the future with historic homes, a great Southern atmosphere and community events.

Full benefits are available and many of these Emergency Medicine jobs come with bonus opportunities. Click here to browse Hospital Physician Partners’ entire list of Emergency Medicine and Hospitalist Medicine jobs.

Located just 60 miles west of the First Golf Course in the US, Beckley is the largest city in southern West Virginia and its market services more than 200,000 people. Beautiful state and national parks offer plenty of skiing, hiking, fishing, and camping; with all that, Beckley also offers great dining, shopping and the lowest crime rate in the country. Did we mention the climate? Enjoy near perfect temperatures of high 70s in the summer & high 30s & 40s in the winter. Not too hot and not too cold! It’s easy to see why the city Beckley is a great place to live and work! Learn more about Beckley here

Beckley ARH is a 173 bed Acute Care Hospital & Level IV Trauma Center with 26 ED beds – 10 of which are for patients pending admission. It plays a critical role in the health of the local community and you’ll be working with a great staff. Services here include: AIDS complex, CT scan, Alcohol/Chemical Dependency – Inpatient Home Health, ICU, Lithotripsy, MRI, PET, Nuclear Medicine, Pediatrics, Ultrasound, and Inpatient Wound Care.

For our Emergency Medicine Job the Beckley ARH Hospital ED will be treating 22,000 patients annually. You would have the benefit of certified mid-level coverage from noon to midnight daily. The combination of access to full group Health & Benefits working at a distinguished 173-bed facility and the chance to live in a friendly community make this an opportunity you won’t want to miss.

For our Hospitalist Medicine Job you can work a 7 on and 7 off schedule and have a variety of services at your fingertips including AIDS complex, CT scan, Alcohol/Chemical Dependency-Inpatient Home Health, ICU, Lithotripsy, MRI, PET, Nuclear Medicine, Pediatrics, Ultrasound and Inpatient Would Care. Enjoy living in this affordable community, working with a top-notch staff and our attractive benefits

These Emergency Medicine & Hospitalist jobs in Beckley, WV are exceptional opportunities that won’t last long! Apply Now or contact a recruiter opportunities@hppartners.com . To see all of our Emergency Medicine and Hospitalist jobs throughout the United States, click here.

They concluded that “although chest CT frequently detects injuries missed on CXR in blunt trauma patients, it rarely changes patient management. Given this low yield and the concerns for radiation cost and ED crowding they are developing a clinical decision instrument for selective chest CT in blunt trauma.” We all acknowledge that trauma medicine is inherently high-risk (especially for the patient). Furthermore, none of us want to hear THAT QUESTION: “Remember that patient you saw the other night?” Let’s consider the potential consequences if one was to take away from this study that since the CT findings rarely lead to management we should consider not performing that CT. Which one of us would like to be a member of the 40% patient group which would not receive management changes to a significant intra-thoracic chest injury if our doctor decided to take the conclusion prematurely to heart?

The take home message: Within all of the fine emergency medicine peer reviewed literature, one must still beware of new trends and old traditions. We have to place studies like these into perspective. It is our responsibility to practice in a method which has been shown to be best for the patient until a new clinical decision instrument becomes the standard of care. Otherwise we could find ourselves in a TICU from a car accident, wondering if we were unfortunate enough to be one of those 5.5% of all cases that the trauma service was no longer looking for due to a new protocol that hasn’t met the test of time.

Reference: Does Chest CT Detect Clinically Significant Injuries Missed on Chest X-Rays in Blunt Trauma Patients? — B. Kea, San Francisco General Hospital; University of California, San Francisco, School of Medicine. Scientific Assembly 2011 Conference, 10/15-10/18. ACEP

Three Rivers Health, a 60-bed community hospital, has an immediate need for a Hospitalist Physician who is board-certified in Internal Medicine. This excellent facility offers a full range of services, including allergy & immunology, anesthesiology, cardiology, gastroenterology, family practice/GP, infectious disease, neurology, internal medicine, oncology, pediatrics, orthopedics, radiology, urology and OB. You’ll have a chance to have a real impact on the health of the community and work with a great support staff.

Best of all, you can take advantage of Hospital Physician Partners’ “Base Pay Plus” monthly bonus payouts. With this incentive program you get predictable income and bonuses paid within 30 days, putting cash in your pocket quickly and consistently.

This position in Michigan comes with full benefits. We also have Emergency Medicine jobs and Hospitalist jobs available across the United States. Click here to view.

Why should you attend?

1. SEMPA is a meeting dedicated to Emergency Medicine Physician Assistants and Nurse Practitioners with the most talented, knowledgeable and entertaining educators in Emergency Medicine assembled at one conference.

2. SEMPA is offering hands-on workshops in cardiology, dental, ultrasound, airway management, wound care and more as well as expanded breakout sessions focused on specific areas of both clinical content and professional practice.

3. You will enjoy the dramatic expansion of the SEMPA Exhibit Hall with the information and resources provided leaders of the healthcare industry that attend.

4. Don’t forget about the ample opportunities to network with HUNDREDS of your Emergency Medicine colleagues and educators!

5. And finally, SEMPA has not forgotten that one of the factors in your conference selection is being able to unwind, have some fun and enjoy beautiful warm weather! Tucson has the gorgeous weather covered and the resort’s 4 star accommodations and abundant amenities will melt away those achy muscles from the long shifts in the Emergency Room.

Deanna will personally be at there and would like to meet with you to share the exciting Emergency Medicine careers we have to offer. Be sure to stop by Booth 408 and join us for the HPP Putting Challenge and enter our Grand Prize drawing for a Fitbit – Personal Fitness Monitor. We hope to see you at the conference and let’s see who is a better putter…

Perhaps this confidence is unfounded. An abstract published in the Annals of Emergency Medicine: Accuracy of Body Weight Estimates in Acute Emergency Department Stroke Patients, compared actual versus estimated weight determinations performed by the EDMDs and Neurologists caring for these patients. While 90% of the estimates were within +/- 0.20 mg/kg, the study concluded that 10% of patients enrolled in the study had the potential to receive a clinically relevant overdose or under-dose of TPA. Furthermore, the patients had an equal potential to be overdosed versus under-dosed. The authors went on to say that based on this initial analysis, they recommended all patients have their weight measured by scale prior to receiving that weight sensitive medication. Of note, the total patient sample number was low (N = 61).

The study raises a valid point for the physician ordering medications with narrow therapeutic indices. Obviously, the Hospitalist or EDMD needs to generate these orders accurately while maintaining care standards. Maybe “the eyes are bigger than the stomach” idiom applies to ordering for these patients too!

References:

1. RAIO C et al., Accuracy of Body Weight Estimates Acute Emergency Department Stroke Patients. North Shore-LIJ, Manhasset, New York

It has been stated by experts in the field of microbiology and immunology that 80% percent of all infectious diseases are transmitted by direct and indirect contact; direct meaning such as kissing and indirect meaning such as shaking someone’s hand. On the other hand (pardon the pun), many studies have found that only a small portion of bacteria on donor hands is recovered on the recipient’s hands. With this information to consider, we need to take a close look at the other side of the coin. A 2011 study from Case Western Reserve University School of Medicine titled, Evaluation of Patient Hygiene Practices During Emergency Department Visits, sheds light on the hands we shake in the ED.

The conclusion was that patient-reported hand washing following potential contact with their bodily fluids after vomiting, urinating or defecating during their ED visit was low. This included only 13% after defecating at bedside and 62% after defecating in the ED restroom. With that in mind, one can see the landmines faced trying to treat people with respect, warmth, and decency through a warm handshake while practicing favorable customer service practices.

That friendly handshake truly has the potential to provide a gift that keeps on giving to you, everyone, or everything you touch until you decontaminate your appendage! This study’s findings certainly support the recommendations from the CDC regarding hand washing following each patient contact even if it is no more than a hello thank you or goodbye. If this knowledge doesn’t propagate self-motivation for the practice of frequent hand washing after casual friendly handshake, nothing will.

Reference:
Luz J Cydulka et al/ Case Western Reserve University School of Medicine, Cleveland OH: MetroHealth Medical Center, Cleveland, OH

(Photo: Scott Olson/AFP)

One of the affected communities was West Liberty, Kentucky, home to Morgan County ARH Hospital, a long-time HPP client. While damage is still being assessed, the destruction is extensive. As a company, we are assisting in providing additional clinical support. At times like this, we appreciate the desire for our partners to provide support and assistance to those in need. Should you desire to help, there are two links available to you which are safe and secure:

The ARH Foundation and The Red Cross. We will be posting updates as they become available through our social media links: Facebook, Twitter, LinkedIn, and Google+.

The Hospital Physician Partners family sends our deepest thoughts and prayers to all who have been affected by the recent tornadoes.

• In the historic community of Sebring, world-renowned for its Formula One racing, we have Emergency Medicine job openings for both physicians and NP/PAs. This full-service, 126-bed facility plays a critical role in the health of the local community and you’ll be working with a great staff. Sebring’s central location gives you easy access to Orlando, fun water activities on hundreds of lakes and all that Florida has to offer.

• Also in Central Florida, physicians and nurse practitioners can take advantage of exciting Emergency Medicine job opportunities at Lake Wales Medical Center. Lake Wales is rich in Florida culture and history with unique architecture, diverse accommodations, charming shops and restaurants along with outdoor and recreational attractions. The chance to live in this friendly community and work at this excellent 160-bed facility is an opportunity you won’t want to miss.

• In the town of Milton on Florida’s Panhandle we have Emergency Medicine jobs for physicians, nurse practitioners and physician assistants. Twenty minutes from Pensacola, the Milton/Pace area has the nearby Gulf beaches to the south and beautiful countryside for fishing, hunting camping, canoeing and hiking. Also, access to great dining and shopping is only a short drive away. Enjoy living in this affordable community and working with a top-notch staff.

These Emergency Medicine jobs in Florida come with full benefits and many have bonus opportunities. To see all of our Emergency Medicine and Hospitalist jobs throughout the United States, click here.

• At Jennie Stuart Medical Center in Hopkinsville, Kentucky we have emergency medicine jobs available for physicians, nurse practitioners and physician assistants. Hopkinsville is located at the Kentucky-Tennessee border just 45 minutes from Nashville and maintains its small-town charm while proactively pursuing initiatives to ensure a skilled workforce, attractive opportunities for business, residential and tourism growth and a safe, clean community that everyone is proud to call home. Here you’ll have a chance to join an expert team of caring medical professionals at a first-class facility.

• In Hazard, Kentucky, we have Emergency Medicine jobs for both physicians and nurse practitioners. At Hazard ARH Medical Center we have an excellent opportunity for an Emergency Medicine Physician. ARH Medical center is a 308-bed, acute-care and psychiatric hospital and enjoys a reputation of excellence as a patient-oriented, rural health facility. Also in Hazard, Kentucky, we have emergency medicine job openings for nurse practitioners and physician assistants at ARH Hospital. This facility has a 13-bed emergency department with an annual volume of approximately 26,000 patients. Here’s an excellent opportunity for new graduates looking to pursue an Emergency Medicine career as candidates will be considered without any prior emergency medicine experience!

• Over in Middlesboro, Kentucky, at Middlesboro ARH Hospital we have an immediate job opening for an Emergency Medicine Physician. This 96-bed facility offers an aeromedical heliport, case management, CT scan, home health, ICU, laser surgery, MRI, labor & delivery and outpatient services, plus pediatrics and ultrasound. Middlesboro is located in southeastern Kentucky, just a short drive from Knoxville and its shopping, dining and big city events, while at the same time has breathtaking views of the Cumberland Gap National Historic Park and Pine Mountain State Park.

We also have Kentucky Emergency Medicine jobs in Fulton, Hyden, McDowell, South Williamson, West Liberty and Whiteburg. In addition, we have Emergency Medicine jobs and Hospitalist jobs available across the United States. Click here to view.

Interestingly only medical centers certified by the American College of Cardiology and American College of Surgeons are included. The app offers recommendations for facilities with the best patient outcomes in the fields of trauma, stroke, eye, pediatric, cardiac and burns. The writer touted the app as “vital when emergency rooms are equal distances in order to allow you to choose the center that specializes in treating your particular health problem”.

How many times have you been at work and begin having an acute vertebral artery dissection with a brainstem TIA and a cerebellar stroke and decided to dive into your i-phone to determine which hospital has the best invasive neuro-radiologist on staff to stent your artery? In point of fact, who knows, maybe the general public will all have this app and we will never have to worry about EMTALA or transfer a high acuity patient again.