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Have you ever had parents bring their teenage daughter into the ED to be checked out? So, how do you approach this? There are conflicting imperatives. Some are possibly your personal feelings if you are a parent yourself. Then there is your duty as a physician to provide the best care to the patient, the adolescent female. But also, there are the state laws and regulations that apply to this situation, especially if the patient is refusing an evaluation. The issues of sexual activity and parental authority are controversial and potentially divisive issues in society.
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Identifying and managing agitated pediatric patients in the emergency department (ED) can be stressful and challenging for patients, families, and providers.
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AIDS- and HIV-related infections have changed significantly over the last decade. Although the overall incidence has declined, young adults have shown an increase in AIDS, with 50% of all new HIV infections in this age group. Many of these new HIV infections are in patients who are late presenters. These patients have received less care and are more likely to have unknowingly transmitted the infection. Routine screening identifies patients earlier, decreases the stigma associated with HIV testing, and increases the likelihood of future testing during risky behavior periods. The authors review the current role of the ED provider in identifying and managing patients with potential HIV.
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All across the country, states, hospital associations, communities, and emergency departments (EDs) are attempting to deal with the growing incidence of prescription pain medication abuse, overdoses, and deaths.1 Opioid pain medications now kill more Americans than cocaine and heroin combined, and over the past five years, there have been more drug-induced deaths than motor vehicle accident deaths.2
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Consent to an intervention or treatment is generally implied when a patient comes to the ED, but there are some exceptions to this, according to Andrew H. Koslow, MD, JD, an assistant clinical professor of emergency medicine at Tufts University School of Medicine in Boston, MA, and an emergency physician (EP) at Steward Good Samaritan Medical Center in Brockton, MA.
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Diagnostic errors are the most common, most costly, and most deadly medical errors, according to a recent analysis of 25 years of malpractice payouts from the National Practitioner Data Bank.1
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Too often, ED staff dont report violence due to onerous reporting processes, according to Terry Kowalenko, MD, clinical associate professor in the Department of Emergency Medicine at University of Michigan Health System in Ann Arbor. Research suggests that violent incidents occurring in EDs are far more frequent than statistics reveal.1-3
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It has been 13 years since the Joint Commission on Accreditation of Healthcare Organizations directed hospitals to treat pain as a "fifth vital sign."
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Pediatric burns, with all of their challenging aspects, are a common injury faced by emergency medicine physicians. Burn injuries are painful for the patient, distressing to the parent, and often raise some difficult questions for the physician in regard to recognition and assessment of non-accidental trauma and the clinical dilemma of disposition. The authors review the current standard for recognition, evaluation, and management of pediatric burn injuries.
