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Less than two weeks after instituting a Post-Arrest Hypothermia program for heart attack patients, Providence (CA) Tarzana Medical Center has applied the body-cooling treatment in three cases, and each patient showed remarkable neurologic recovery.
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Emergency medicine physicians routinely deal with cardiac emergencies in adult patients but rarely encounter infants with critical cardiac conditions. While the infant's cardiac physiology can be very different from an adult's, the general principles of preload, afterload, contractility, and vascular resistance are the same.
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The Advanced Trauma Life Support (ATLS) course for doctors was introduced in Nebraska in 1978 and given nationally for the first time in 1980 by the American College of Surgeons. The goal of ATLS is to serve as a safe and reliable method for managing patients with traumatic injury and provide a "common baseline for the continued innovation and challenge of existing paradigms in trauma care."
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What do parents do when their child is out of control? Often, they all end up in the ED. The child is sullen and defiant, occasionally agitated. The parents are frustrated and often at the end of their rope. So, as the emergency physician on duty, how do you evaluate this situation?
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Entrapments and retained foreign bodies represent a common cause of emergency department (ED) visits. A majority of these pediatric presentations are easily assessed and managed by emergency physicians. However, even when accurately identified, this injury pattern may present therapeutic challenges.
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Over the years, emergency medicine physicians and pediatricians have been sued many times for failure to recognize and report non-accidental trauma and vulnerable children. Unfortunately, there are a number of ways to go wrong when it comes to reporting child abuse, and there are three recognized liability issues: A liability for failure to report suspected abuse, liability for reporting suspected abuse and liability for unauthorized release of confidential information during the course of reporting.
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Use of excessive force. Misapplication of restraints. Failing to follow standards from the Centers for Medicare & Medicaid Services (CMS) or The Joint Commission. Any of these practices can result in a liability claim from an ED patient for injuries arising from restraint.
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Long ago, one of my mentors staunchly opined that "only a 'real doctor' should be allowed to testify that a 'real doctor' breached the standard of care." Two recent high-level court decisions upholding tort state reforms bring us closer to that reality, i.e., requiring the plaintiff's physician expert to actually practice medicine in order to testify in a medical malpractice lawsuit.
