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After you have security escort patient Joe Jones out of the ED for causing such a ruckus when he couldnt get any Vicodin, youre thinking youd like to avoid this obvious drug seeker in the future. So maybe you should add his name to the list of frequent flyers or the kook book your staff keep at the nursing station.
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Some 20 trials dedicated to the pursuit of more rapid and more complete reperfusion have been published in the last few years, and sorting through the literature can be dizzying. The following article will highlight the major recent developments in AMI reperfusion therapy. It will accent which of the many therapeutic options currently are considered acceptable, and present treatment guidelines for the emergency physician faced with the patient who presents to the emergency department with acute ST elevation MI.
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Question: Were debating two questions in our hospital regarding when EMTALA applies. First, does the law apply to patients who only are holding in the ED because there are no beds available in the hospital? And does it apply when an air ambulance uses our helipad but does not bring the patient to our ED?
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The first step in formalizing your list of drug seekers or other frequent visitors to your ED is to avoid any disparaging names for them or the list, says Joel Geiderman, MD, FACEP, co-chair of the ED at Cedars-Sinai Medical Center in Los Angeles.
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Whether you use a list or not, the best way to deal with drug seekers in your ED is to get tough with them, says John Burke, commander of the Warren County (OH) Drug Task Force in Cincinnati, and a former police officer.
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To illustrate how EDs set themselves up for malpractice liability when treating head injuries, Diane M. Sixsmith, MD, MPH, FACEP, chairman of emergency medicine at New York Hospital Medical Center of Queens in Flushing, tells the story of a 22-year-old boxer who was knocked out in a training session.
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Patient satisfaction improves dramatically if your staff pay more attention to the soft skills of ED care, such as the way you talk to people, while simultaneously improving the physical surroundings.
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Recent cases involving the undertreatment of pain, the over-treatment of pain (and thereby the creation of addicts), and whether drug seekers have any legal rights to pain management have created management problems for the emergency physician. This issue of ED Legal Letter will look at some of these cases. The author addresses recent changes in pain management medications, and readers will be able to develop a practical approach to the patient with pain with fewer worries about the legal consequences.
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The emergency physician plays a key role in the management of HIV. Emergency physicians encounter all phases of the illness, from counseling patients on safe sex practices to treating the medical complications of chronic immunosuppression. Despite all of the recent advances, HIV infection and AIDS remain challenging and continually evolving diseases. In this issue of Emergency Medicine Specialty Reports, the authors provide a comprehensive update on the diagnosis and clinical management of HIV infection and its complications.
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Although pediatric cardiac diseases infrequently are seen in the emergency department (ED), early diagnosis and aggressive management is critical. Most importantly, the clinician must include these diseases in their differential and have a thorough understanding of typical and atypical presentations for congenital heart disease, dysrhythmias, myocarditis and pericarditis. Any child who has a clinical presentation suggestive of cardiac disease, must receive appropriate diagnostic testing and timely referral to optimize the childs outcome. The authors provide a thorough, focused review of the most commonly encountered cardiac diseases in the ED and key aspects to stabilization.
