Emergency Medicine - Adult and Pediatric
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Emergency Department Management of Violent Patients
A violent patient is someone under medical care who is a threat of danger to themselves, other patients, or hospital staff. Like many of the problems we face in the emergency department, the management of a violent (or potentially violent) patient is not always straightforward. Each encounter will be influenced by the patient’s background, underlying health conditions, comorbid issues, psychiatric history, socioeconomic factors, and much more.
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Identifying Pediatric Cervical Spine Injuries
Cervical trauma in pediatrics is fortunately uncommon, but associated with significant morbidity. Early recognition and timely management are essential to optimize the child's outcome. Balanced against this is the need to minimize unnecessary radiation in young children. The authors comprehensively review identifying pediatric cervical spine injuries.
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Thyroid Emergencies
Thyroid emergencies, while rare, are life-threatening conditions that require prompt recognition, diagnosis, and treatment to optimize patient outcomes.
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ED Visit Is Teachable Moment on Stroke Care
Researchers provided an ED-based educational intervention to 100 Black patients at an urban facility, including video, brochure, and verbal counseling. After, participants were much more likely to demonstrate confidence in the ability to recognize stroke symptoms in themselves or others and were more likely to feel confident about calling 911 in the case of stroke warning signs.
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Updated Abdominal Pain Guidelines Close Knowledge Gap
Without clear guidelines, patients could undergo unnecessary testing (or not receive tests they need), which could lead to misdiagnoses — or worse.
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Admissibility of ED Recordings Depends on Multiple Factors
Even if the patient recorded the entire discharge instructions, relevant discussions might have happened throughout the visit. The defense can challenge the admissibility based on that argument, but the ruling could go either way.
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Emergency Providers Uneasy About Recording Visits
Clinicians might need more information, such as specifics on who would record the discharge instructions, whether it would be recorded on the patient’s personal smartphone, and what safeguards could be required to ensure patient privacy. Combined with possible involvement of the hospital’s legal department, this might make providers more comfortable with the idea.
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Many Charge Nurses Receive Little, if Any, Training
Charge nurses are responsible for patient flow, moving them from the waiting room to appropriate disposition. To be effective, these nurses must understand the clinical conditions of the patients in the waiting room. This informs good decision-making on which patients to bring in, in collaboration with the triage nurse, and which nurses to assign those patients.
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Misconceptions About Homelessness Put Patients, EDs at Risk
Engage these patients in care plans the same as anyone else. Ensure the patient understands the treatment plan, and can carry it out if discharged.
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Legally Protective Charting Sticks to the Facts
Charts containing emotional statements, accusations, and speculations might be compelling reading, but they are legally problematic.