AHRQ reports that there were 115.3 million visits to emergency departments in 2005 and roughly 42 million of them were by adults ages 18 and older.  The most common principal clinical diagnoses were sprains and strains, superficial injury or bruise, abdominal pain, nonspecific chest pain, back or spine pain, open wounds of extremities, headache including migraine, upper respiratory infections, skin and subcutaneous tissue infections, and urinary tract infections.  Three conditions — nonspecific chest pain, urinary tract infections, and skin and subcutaneous tissue infection — were associated with a double-digit rate of hospital admission, with rates of 21.1%, 17.8%, and 15.4% respectively.  Now you don’t have to go to the link.
http://omniphysicians.com/2008/03/16/strains-sprains-and-chest-pains/
Why does the flu bug survive winter?  One study indicates its ability to create a hardened coat that makes it impervious to the cold.  Once the “bug” gets in the warm cozy atmosphere of the lungs, the coat melts, and trouble ensues.  That’s enough science for the day.
http://omniphysicians.com/2008/03/16/why-flu-in-winter/
This is a case report on a patient who had an increase in her methadone which resulted in torsade de pointe.  Cardioversion, magnesium & lidocaine infusions saved the day.  “Torsade de pointe” : Sounds like a sauce you ask for to put on your escargots.  “Oh, garcon.  I’ll have ‘escargots Belgique’ with some torsade de pointe on the side, s’il vous plait.  Go heavy on the torsade, and not so much pointe this time.”
http://omniphysicians.com/2008/03/15/chronic-methadone-therapy-complicated-by-torsades-de-pointes-a-case-report/
A case report about a fellow who got “Tased” and developed back pain.  Seems he had a vertebral fracture.  A result of the sudden musculature contraction; not direct trauma.  “Don’t Tase me, bro!” 
http://omniphysicians.com/2008/03/15/thoracic-spine-compression-fracture-after-taser-activation/
The Pneumonia Severity Index has been validated in multiple studies for admitting the right high-risk patients and discharging the right low-risk patients.  This abstract from the J of Emer Med shows many times clinical judgement was inconsistent with the PSI, but it was judged that the clinical judgement was correct in most of those cases.  Hurray for clinical judgement!!!!!!
http://omniphysicians.com/2008/03/15/clinical-judgment-versus-the-pneumonia-severity-index-in-making-the-admission-decision/
There are 30,000 cases of SAH each year.  If there are over 115 million ER visits annually, then statistics-wise (0.026%) why are we so-o–o worried about missing a case of SAH when we have a headache patient?  But I digress.  We are stuck with the medico-legal implications of missing a case despite its relative rarity.  So we spend an inordinate amount of patient-care time, waste a good chunk of the healthcare Euro, and subject many of these patients to needless needlesticks in the back and cancer-causing radiation to the brain.  But I digress.  This abstract emphasizes the importance of CT and LP and the necessity of not missing a case and allows me the opportunity to rail against the system.
http://omniphysicians.com/2008/03/15/aneurysmal-subarachnoid-hemorrhage-update-for-emergency-physicians/quick cash loan 500 faston payday line loan 500 advance500 payday loan credit51 link payday loanloan com 55 79 paydaypayday link loan 57payday loan 12 8 personal loansa loan fhaus loan a securedloan credit consolidation accept card debt

MedPage Today, 3/8/08: 

While the economy’s dropping faster than a hooker’s self-esteem, let’s see what’s up in the realm of Emergency Medicine:

Detective work on the Great Heparin Caper is getting more and more convoluted.  Now, the theory is that the problem may not have occurred at the factories, but at the pig farms.  You’ll recall that the ingredients associated with heparin emanates from the intestines of pigs.  Also, did you know that China is the largest producer of heparin in the world?
http://omniphysicians.com/2008/03/15/are-pigs-the-root-cause-of-the-heparin-problem/

There have 3 cases of college students who contracted bacterial meningitis.  One died.  This is something we should be aware of since students may be returning home on Easter or mid-semester break.
http://omniphysicians.com/2008/03/15/3-suspected-cases-of-bacterial-meningitis-in-ny/

The FDA says that generic drugs are the same as pioneer drugs because they use the standard of “bioequivalence.”  Critics feel that “bioequivalence” is not a good standard and that generic drugs may not yield the same medical results as the original drug.  These critics believe that “therapeutic equivalence” should be the FDA standard.  This LA Times report provides a good examination of the issue.
http://omniphysicians.com/2008/03/15/bioequivalence-versus-therapeutic-equivalence/

This may be a tempest in a teapot, but the Organic Consumers Association is concerned that many “natural” or “organic” products contain trace amounts of 1,4-dioxane which has been proven to cause cancer in animals.  Products that contain 1,4-dioxane include Jason Fragrance Free Satin Soap, Citrus Magic 100 Percent Natural Dish Liquid, Alba Botanical Passion Fruit Body Wash and Whole Foods Market 365 Everyday Value Shower Gel. The FDA is not concerned by the amounts.  But if the FDA isn’t worried, that should make you check your medicine cabinet.
http://omniphysicians.com/2008/03/15/concern-over-naturalorganic-products/

Take care,

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A new US study on the Influenza viruses, published recently in the journal Nature Chemical Biology, has shed light on why winter is the flu season. The research, conducted by the National Institute of Child Health and Human Development (NICHD), one of the National Institutes of Health, has found out that viruses which cause flu coat themselves in fatty material that hardens and protects them in colder temperatures.

This gives them an edge in the cold temperatures of the winter season. The special insulator coating melts in the lungs and the virus is freed to infect the host. This means that if the Influenza viruses are in a warm environment but outside an infectable host, such as is the case in summer, they die rather quickly and can hardly infect another person.