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You have just taken sign-out when a nurse comes up to you and says that there is a 64-year-old man in the critical bay who took an overdose of his medications. The patient has a history of hypertension, atrial fibrillation, and depression. The patient is lethargic but arousable, and reports he took about 40 tablets of immediate-release metoprolol three hours ago in an attempt to "end it all." The nurses are starting IV lines, checking vitals, and putting the patient on the monitor. You wonder, "Is it too late for gastric decontamination? If he is symptomatic, which therapy will I try first, and what are my options?"
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Although some ED physicians remain opposed to the idea of using tPA, the consideration of the use of thrombolytics such as tPA for stroke patients who are eligible candidates has become the public expectation
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If you aren't going to give tPA and would like to avoid a lawsuit, you'll want to be very clear in your documentation as to why the patient didn't meet treatment criteria. "And if you do give it, you should be very clear why the patient did meet the criteria," says John Burton, MD, chair of the Department of Emergency Medicine at Carilion Clinic in Roanoke, VA.
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Most emergency physicians will be sued during their career. Lawsuits can lead to interpersonal difficulties, loss of job satisfaction, and emotional distress. An understanding of the malpractice process and ways to reduce risk can help emergency physicians deal with this ever present threat.
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"Why didn't my grandmother see a neurologist immediately in the ED?" is a question that may arise in the event of a malpractice lawsuit involving stroke care.
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"It's too bad someone didn't give you thrombolytics, because you probably wouldn't be paralyzed now." Whether it's a nurse, doctor, or someone else making that statement to a stroke patient cared for in your ED, you could end up named in a lawsuit.
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