How smartphones and apps are changing emergency department care

A mainstay of the “Star Trek” TV and movie franchise is the medical tricorder. This versatile piece of technology allows doctors to scan a patient and instantly receive a complete diagnosis of their injury or illness.  

Though we don’t yet have tricorders, we have access to sophisticated information-gathering and diagnostic programs in our emergency department. And one of our most vital pieces of equipment is something many of us have in our pockets or purses: the smartphone. With access to the internet and dedicated medical apps wherever we are, we can spend more time with patients and less time searching books for medical information. These tools help us make specific medical recommendations for each patient.  

In my experience, patients appreciate that we double-check our recommendations with medical apps and additional research. It’s comforting to them to know that there’s additional evidence supporting medical decisions besides an emergency-department doctor they’ve never met before telling them they’re OK or that they need additional treatment. 

Patients appreciate that we double-check our recommendations with medical apps and additional research. -Dr. Jeffrey Dubin via @MedStarWHC

The transition away from medical books

It’s simply not possible for doctors to memorize every piece of medical information needed to treat patients. That’s especially true in the emergency department, where we care for everything from cases of heart attacks,  trauma and burns and everything in between, as well as other conditions that just can’t wait for a doctor’s visit in the morning.

When I was doing my medical training, and for a number of years after that, every emergency department used to have reference books. These textbooks were there for doctors to refer to when they needed to refresh their memories on how to do a procedure or treat a condition. But nobody does that anymore.

The internet has replaced the old practice of reading pages of dense medical textbooks to find the snippets of information we need. Medical textbooks are available online, and they’re searchable, which saves us valuable time. Many e-book versions of medical textbooks include embedded videos that demonstrate procedures. Videos of many procedures are available online specifically for doctors’ reference.  

Powerful medical apps for smartphones

Our emergency department doctors spend less time finding information and more time treating patients thanks to mobile medical apps. We’ve incorporated some of these clinical decision-making tools into our electronic medical record to help us make patient care decisions.  

Mobile medical apps let emergency-department doctors spend less time finding information and more time treating patients. via @MedStarWHC

I don’t like cluttering my phone with screen after screen of medical apps. I tend to find one or two apps that do the jobs I need and stick with them. Two I use frequently are MDCalc and Epocrates.  

MDCalc

MDCalc provides a range of clinical decision-making tools that include calculators for determining patients’ risks for various conditions and rules for when to order diagnostic tests or provide treatments.

A good example of how I use MDCalc is when a patient comes in after a car accident. Cars are so well-built these days that they usually absorb all the forces from a typical fender-bender. Most people walk away with no significant injuries, but they may want to get X-rays to make sure nothing’s broken.

MDCalc has collected clinical decision rules from published research doctors for determining when someone who’s been in a car accident actually needs to have X-rays taken and when we shouldn’t to minimize the person’s radiation exposure. If I need to double-check these rules, it’s really easy. I just open the app, type in the rule I’m looking for and refer to it during the patient’s exam.  

Some other features of MDCalc that I use include:

  • A list of questions to determine if a person has a problem with drinking alcohol
  • Scoring systems for a person’s risk for stroke
  • Key identifiers that a patient may have appendicitis  

Epocrates

Epocrates is a database of medications and their safety information, including dosing, side effects and potential interactions with other medications. I can pull up a specific medication’s listing and walk the patient through its possible side effects.  

Epocrates also is useful for comparing a patient’s symptoms to their listed medications. I often have patients come in and tell me they feel dizzy or have an itchy rash, and sometimes those are side effects of a new medication or a possible interaction between two medications.  

We no longer have to refer just to textbooks from 10 or 15 years ago for clinical data. With smartphone apps built specifically for doctors, we can access the most accurate, up-to-date information to help us make accurate recommendations for our patients. These and other innovations will continue to improve the way emergency department doctors like me practice medicine and care for our patients. 

Common Household Items to Avoid

As an ER doctor at the largest and busiest emergency department in the nation’s capital, I see patients on a daily basis with a variety of conditions, from broken bones to cuts to those with serious or life-threatening symptoms, such as heart attacks and strokes.

And as a mother of a two-year-old, safety is of the utmost importance to me and my family, especially in and around my home. The truth is that a large number of accidents do occur in our own homes because we often overlook household appliances or other everyday items that can potentially cause serious injury.

Below is a list of 10 common household items that can pose significant health and safety threats to adults and children.  Read though the list.  And ask yourself, "Do I really need these items?" If you do, please use them responsibly. When appropriate, keep them locked up and out of reach and out of sight of children.  I hope this list will be helpful in keeping you and your loved ones safe at home.

 

1. Unused medications: There are a host of medicines that are “one pill killers” in children; particularly heart and blood pressure medications as well as sedative and pain medications. If you are not using a medication, dispose of it properly or store it up and out of reach. Keep all medications in child-resistant packaging.

2. Gas space heaters: They can produce the toxic gas carbon monoxide, which can poison an entire household. Using electric heaters and installing carbon monoxide monitors can mitigate the risk. Make sure to check the batteries in carbon monoxide and smoke detectors when you change your clocks in the spring and fall.

3. Trampolines: Most trampoline accidents happen when people fall off or land wrong while jumping. The most common injuries are extremity fractures that may require surgical treatment. Although surrounding nets can prevent a ground impact from a fall, injury can still occur by landing improperly on the trampoline itself. Children may also injure themselves if they get too close to the spring connectors or if they land in between them.

4. Swimming pools: Drowning is the leading cause of accidental death for children ages 1 to 4. Seventy-five percent of all drowning occur in home swimming pools. Adults can also drown or injure themselves when swimming is combined with alcohol. In addition, improper diving can lead to head and neck injuries. To prevent accidents, stay within arm’s reach of a child at all times in and around the pool, make sure the pool is fenced in, learn how to swim and learn CPR.

5. Nicotine products: We all know the dangers of smoking cigarettes, but recently, “vaping” has become very popular. Electronic cigarettes vaporize a very concentrated nicotine fluid as an alternative to smoking. Although there are fewer carcinogens in electronic cigarettes, these products contain several solvents and we don’t know the long-term health effects of vaping. E-cigarettes are potentially fatal in the hands of children. The liquid in a single cartridge contains enough nicotine to be lethal to a small child and the flavored products are particularly appealing to this age group.

6. Choking hazards: Hot dogs, grapes, carrots, apples, nuts, popcorn, or hard candy can be choked on easily. Either avoid these foods or cut them up into small pieces to avoid the risk of choking or aspiration.

7. Pods:  Laundry pods or dishwasher pods are more concentrated than traditional detergents, which contain large amounts of water and are less toxic. Pod exposures can result in skin and eye irritation, coughing, choking, respiratory distress, and even death. These outcomes are rarely noted with traditional products.

8. Drain cleaners: These household chemicals are caustic and can cause severe chemical burns to the esophagus or airway, even with a single sip. Discard unused products or keep it in a secure area.

9. Antifreeze and windshield wiper fluids: These products can appeal to children because of their color and sweet flavor and can be toxic in as little as a few sips. Because of their appealing taste, these fluids may also poison pets. The most common toxicities are renal failure or blindness. Another tip is to not transfer any chemical products into drinking cups. This is a recipe for a mix up.

10. Button batteries: Because of their small size and shiny appearance, they can be easily ingested by toddlers. In as little as two hours, these batteries can cause severe caustic burns to the esophagus, which can lead to lifelong disability, or even death. Children often do not have any symptoms until the damage has been done. If you have a product that requires a button battery, be sure to place them in a secure area.

 

 

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