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There are specific injury mechanisms that should lead the practitioner to suspect the presence of intra-abdominal injury, such as a handlebar injury to the upper abdomen and seat belt signs from a motor vehicle accident.
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A new study strongly suggests that for children who present to the ED with minor blunt head traumas, a short period of observation can make an important difference in helping clinicians determine whether to order computed tomography (CT) scans or not.
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While EDs are designed to respond to acute care needs, they are often inundated by patients with complex medical, social, and behavioral health problems that require comprehensive solutions. Not surprisingly, the results of this mismatch can involve long wait times, inefficient care, and less than satisfactory outcomes.
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Malpractice claims alleging missed or delayed diagnosis of sepsis, in which a patient is initially brought to the emergency department (ED) and ultimately dies or suffers a highly adverse outcome, can rarely be traced to a single mistake, according to Damian D. Capozzola, JD, of The Law Offices of Damian D. Capozzola in Los Angeles, CA.
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Since ancient times, caring for alcohol-intoxicated patients in the emergency department has always been troubling and risky for emergency physicians and hospital staff. In a high-profile case in New York, the state's highest court essentially held that physicians and hospitals are not thy intoxicated brother's keeper.
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After a patient on a psychiatric hold managed to escape restraints, he ran out of the emergency department (ED) and was hit by a truck.
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Even if a patient with a suspected stroke meets the criteria for tissue plasminogen activator (tPA), emergency physicians (EPs) are sometimes reluctant to administer it without having a neurologist evaluate the patient, says Joseph Shiber, MD, FACEP, FACP, FCCM, associate professor of emergency medicine and critical care at University of Florida College of Medicine Jacksonville.
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The most common scenario in malpractice lawsuits involving frequent ED patients is failure to adequately diagnose, treat, and stabilize an emergent medical condition, says John Burton, MD, chair of the Department of Emergency Medicine at Carilion Clinic in Roanoke, VA.
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The paradigm I grew up with in emergency medicine is that there are a limited number of ways to die, and our role was to intervene and prevent death using the principles of A, B, and C: airway, breathing, and circulation. This concept works well for the previously healthy acutely ill or injured patient. But for the patient nearing the end of a life-limiting illness, it is not appropriate and can even be cruel. The introduction of palliative care to the emergency department at first seems out of place; that is the place where patients are snatched from the jaws of death. But as the authors of this issue explain, the ABC of resuscitation can be revised to the ABCD of palliative care assessment to provide better care to patients and families in times of crisis.
