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Project IMPACT, a proprietary database originally created by the Society for Critical Care Medicine and now maintained by Cerner Corp., collects data from a voluntary consortium of ICUs across America.
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Paralytic agents such as vecuronium and cis-atracurium have been used as "rescue therapies" in patients with ARDS for many years, but, as with other rescue strategies including prone mechanical ventilation or inhaled vasodilators, evidence of a mortality benefit from this intervention has been lacking.
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Although corticosteroids are beneficial in treating severe exacerbations of chronic obstructive pulmonary disease (COPD), studies to date have not shown high-doses (such as methylprednisolone, 2 mg/kg or more per 24 h) administered intravenously (IV) to be superior to lower doses (e.g., prednisone, 40 mg/day) given orally, with respect to clinically important outcomes.
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In this issue: FDA Advisory Committee recommends approval of dabigatran, safety of proton pump inhibitors, effectiveness of glucosamine and chondroitin, FDA Actions.
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Michigan appeals court allows use of hospital's internal policies and ACEP's Clinical Chest Pain policy as evidence against hospital and urgent care physician in malpractice case.
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A 25-year-old male patient is brought to an ED because of suicidal statements made to his ex-wife. The patient arrives via police escort and is placed in a room. The ED nurse assesses the patient, who denies suicidal ideation or intent. Although the man admits to drinking alcohol, he does not appear to be overtly intoxicated and is coherent. The ED is extremely busy, and the physician assistant (PA) picks up the chart.
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Leslie S. Zun, MD, chairman of the department of emergency medicine at Rosalind Franklin University of Medicine and Science in North Chicago, IL, says that if a patient discharged from the ED later commits suicide, "there are a number of issues that can place the emergency physician at risk." Zun gives these five major areas of risk involving ED psychiatric patients:
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If a psychiatric patient harms himself or someone else after being transferred or discharged from your ED, can he or she successfully sue for malpractice? If so, would a jury agree that the ED was at fault? That depends, in large part, on the details contained in the patient's chart.
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Margaret Bergin, an attorney with Palumbo Wolfe in Phoenix, AZ, and a former hospital risk manager, says the longer the psychiatric patient is allowed to remain in an ED without mental evaluation, the higher the possibility that the patient will leave against medical advice (AMA).
