Spontaneous Spinal Epidural Hematoma from Rivaroxaban.

Spontaneous spinal epidural hematoma (SSEH) is a rare diagnosis. One known risk factor is anti-coagulation medication. We present a case of SSEH in a 74-year-old male on rivaroxaban therapy who clinically presented with an intermittently resolving and then worsening neurological exam.

Using pharmacists to optimize patient outcomes and costs in the ED.

Participation of hospital clinical pharmacists in the care of inpatients is widespread, often encouraged by the dicta promulgated by regulatory bodies. For years, clinical pharmacists have ventured out of the pharmacy to participate in rounds and, otherwise, in the care of patients on hospital floors and in intensive care units. In fact, it has been well documented in many research studies published in the last 20 years that having pharmacists prospectively involved with orders generates significant cost savings for the hospital and benefit to patients.

"Lives there who loves his pain?": empathy, creativity, and the physician's obligation.

Like most EM physicians presented with a wide assortment of patients I've never seen before, will probably never see again, and cannot schedule for a more convenient return visit when there are not three ambulances pulling up to the door, I sometimes get a bit cranky when I interview a patient who has registered for a less-than-valid "emergency." As a resident in Mel Konner's Becoming a Doctor put it, "Low back pain? Low fucking back pain? You're waking me up for low fucking back pain?" Although I ceased a long time ago to ask, "Why now?"-you almost never get an answer that is satisfying-I still think it. Often, I am sad to say.

Lidocaine toxicity misinterpreted as a stroke.

For more than 50 years lidocaine has been used to treat ventricular arrhythmias. Neurologic dysfunction, manifested as a stroke, occurred acutely in an 87-year-old woman after she had been administered repeated doses of lidocaine, a lidocaine infusion, then an intravenous amiodarone infusion for ventricular tachycardia. This was ultimately diagnosed as lidocaine toxicity with a serum lidocaine level of 7.

Physician reporting of medically impaired drivers.

Emergency physicians frequently encounter patients whose medical conditions represent a risk of loss of control while driving, e.g., epilepsy and diabetes.