An Expert Interview With Robert McNamara, MD
Based on 25 years as an emergency medicine attending physician and program director, Robert McNamara, MD, imparted some of the lessons he has learned to attendees at the American Academy of Emergency Medicine (AAEM) 16th Annual Scientific Assembly, held February 15 to 17 in Las Vegas, Nevada. Dr. McNamara is professor and chair of the Department of Emergency Medicine at Temple University School of Medicine in Philadelphia, Pennsylvania, and is a founding director and past president of the AAEM...."Medscape: In your presentation at the AAEM, you noted the importance of tachycardia. Could you discuss how that fits into your assessment of the patient?
Dr. McNamara: It's well known for pulmonary embolism, but a lot of these soft tissue infections can be a little hard to diagnose — necrotizing fasciitis, methicillin-resistant Staphylococcus aureus (MRSA) infections. Oftentimes, patients come in looking relatively benign, and the only clinical clue is tachycardia. Why are they tachycardic? It's not something the patient can fake, and if they remain persistently tachycardic, you've just got to think that maybe you're in the early stages of a serious illness. I've seen a couple of cases of MRSA infections, serious soft tissue infections, in which that was the only initial clinical clue. It can be an early indicator of sepsis. It's amazing the cases you see in which the people have a serious soft tissue infection, and the exam and the history [suggest] a pulled muscle, except the heart rate happens to be up. Why would it be up with a pulled muscle? It's just a scary disease".