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Imagine a plaintiff's lawyer poring over stacks of documents provided by the defense as a result of a lawsuit alleging ED malpractice, and finding the statement, "This nurse will eventually kill a patient."
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If you don't believe a diagnostic test is truly necessary but you order it anyway, you must be prepared for results to come back unexpectedly abnormal, even if these "incedentalomas" have nothing to do with what brought the patient to the ED, warns Bruce Janiak, MD, professor of emergency medicine at Medical College of Georgia in Augusta.
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This is the first of a two-part series on liability risks involving ordering of diagnostic tests in the ED. This month, we'll cover the legal ramifications of deciding not to order a test, the legal risks of unexpectedly abnormal results, how ED protocols can help an EP's defense, and a new quality measure that increases liability risks for EPs.
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In this article, we present a series of actual clinical scenarios that could have turned out differently if the wrong management decision had been made.
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If there is absolutely no credible reason to think that a patient's symptoms are due to a heart attack, says John Burton, MD, chair of the Department of Emergency Medicine at Carilion Clinic in Roanoke, VA, you shouldn't be ordering tests such as cardiac enzymes.
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Quality measures from the Centers for Medicare & Medicaid Services (CMS) and other groups are putting EPs "in a huge bind," according to Sandra Schneider, MD, professor of emergency medicine at University of Rochester (NY) Medical Center.
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In this prospective study carried out in a 13-bed French medical ICU, Thille and associates sought to determine the clinical characteristics and outcomes of patients who experienced extubation failure the requirement for reintubation within 72 hours of either planned or unplanned extubation.
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In Part 1 of this two-part series on Pregnancy and Critical Care Medicine (see Critical Care Alert, March 2011, p. 89-93), we reviewed the normal physiologic changes that occur during pregnancy, examining changes occurring across multiple organ systems that affect our management of these patients as well as the ability of the pregnant woman to respond to various forms of stress, such as acute hemorrhage.