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It is reasonably settled that from a legal and/or ethical viewpoint that a competent patient has the right to direct his or her own medical care in any scenario. However, when the patient who is receiving medical care is no longer legally competent or never was legally competent to undertake medical decisions, the legal and ethical waters become murky.
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One of the most challenging evaluations that an emergency department (ED) physician is asked to perform is the examination of a child with potential child abuse. The majority of ED physicians feel overwhelmed, and although they would like to perform the "ideal" history and physical examination, they find themselves feeling inadequate in these situations.
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Domestic violence is a serious problem that, unfortunately, is seen all too commonly in our emergency departments. Statistics show, however, that physicians, including emergency physicians, are not good at identifying victims of domestic violence.
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In a child who is critically injured there is the potential for many serious or life-threatening injuries. The initial focus must always be to stabilize the child's airway and breathing and, then, rapidly identify shock and aggressively correct volume deficits.
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Everyone who provides care for patients in emergency departments is well aware of the annual winter-spring spike in patient volume due to influenza disease and its complications.
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In North America, rotavirus gastroenteritis is a predictable winter epidemic every year--young children presenting to emergency departments and outpatient clinics with fever, vomiting, diarrhea, and varying degrees of dehydration.
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