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Several decades ago, two patients arrived in my emergency department with intense vomiting, bronchorrhea, and seizure-like activity. Their symptoms started about 30 minutes after consuming a mushroom stew. The wife considered herself to be an expert in mushroom identification and had picked several species of mushrooms, including a few very large ones with bright red tops. Both patients required intubation and several milligrams of atropine to handle their bronchial secretions. Several hours before, they had eaten a mushroom stew containing mushrooms they had picked that morning.
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"Everyone knows that a patient with a heart rate higher than 90 should be admitted to the hospital."
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A 12-year-old boy with an unremarkable familial and medical history presents with global aphasia and right hemiplegia 14 days after a streptococcal pharyngeal infection. A neurological examination performed three hours after symptom onset reveals a conjugate gaze deviation to the left, right hemiplegia, hemihypesthesia, and extensor plantar sign. The NIHSS score is 22. Laboratory examinations are normal. A cerebral CT shows a hyperdense left MCA and early signs of infarction in that area.
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Delays for treatment for heart attack patients will continue to be a high-risk area for EDs legally, predicts Robert L. Norton, MD, a professor in the Department of Emergency Medicine at Oregon Health & Science University in Portland.
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In the emergency department (ED), a central component of a physician's daily care and job performance is to administer or prescribe drugs.
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Ken Zafren, MD, FAAEM, FACEP, FAWM, EMS medical director for the state of Alaska and clinical associate professor in the Division of Emergency Medicine at Stanford (CA) University Medical Center, says that while much attention has been paid to the problem of plaintiff experts making false statements about ED care, he's also experienced defense experts making false statements.
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At what point after a lawsuit alleging ED malpractice is filed will a sued EP learn what the opposing experts say about the case? This depends on the legal strategy being used by the plaintiff's attorneys and state laws, says Jonnathan Busko, MD, an EP at Eastern Maine Medical Center in Bangor and medical director of Maine EMS Region IV.
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ED nurses shouldn't wait to be the subject of an investigation to become familiar with the hospital's risk management department, says Karen Jarboe, RN, CEN, CCRN, a legal nurse consultant specializing in emergency medicine and a senior clinical nurse with the adult ED at University of Maryland Medical Center in Baltimore.
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The view that every emergency physician (EP) is going to get sued sooner or later is "a bit of an oversimplification," according to Stephen A. Frew, JD, vice president of risk consulting at Johnson Insurance Services and a Rockford, IL-based attorney.
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If an ED nurse is contacted by the state board of nursing about a medication error that harmed a patient, his or her first instinct might be to state, "I told them this would happen because we didn't have enough staff!"
