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The first part of this series discussed abdominal pain in pediatric patients. This second and final part will cover abdominal pain in elderly, immunocompromised, and pregnant patients. Those 65 years of age and older constitute the fastest-growing segment of the population, and currently comprise about 12% of the U.S. population. This means that abdominal pain in the elderly will be a commonplace occurrence in EDs.
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The evaluation of a febrile child is an extremely common scenario in most emergency departments. Emergency physicians must decide which children require a work-up, the nature of that work-up, and the need for antibiotics with or without hospitalization. This process often is in the context of evaluating many febrile children, with only subtle clues as to which child truly may be ill. Unfortunately, it is common for inadvertent errors in judgment to end up in the courtroom as a subject of malpractice lawsuits. This months issue focuses on some of the risks and controversies in the evaluation of the febrile child.
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Headache is a common chief complaint encountered by emergency physicians (EPs). It may be a symptom of benign diseases such as migraine headaches or a common virus. Unfortunately, it also may represent other, more life-threatening illnesses, including subarachnoid hemorrhage. Delineating which patients need radiologic imaging, spinal fluid testing, and even angiography is part of the challenge encountered by the EP. This issue will outline strategies for reducing risk in the headache patient. Specifically, diagnosis and management of subarachniod hemorrhage will be detailed.
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Documentation requirements for every patient encounter have increased, leaving less time for the actual practice of medicine. While documentation is a burden to physicians and nurses, it does have unlimited value. Documentation allows for appropriate billing for the time and efforts of the physician, nurse, and other medical specialists. Thorough documentation allows for maximum reimbursement without fear of subsequent legal retribution from various government programs. Furthermore, the medical record is an essential historical document of the patients previous medical encounters. Documentation of the patient encounter and treatment will provide a defense to potential subsequent litigation that may ensue. The emergency physician may be unaware that a medical expert is reading a case of a previous patient encounter right now. The documentation of the care provided may preclude the plaintiffs expert from making assumptions and opinions adverse to the physician. This months issue will detail the importance of documentation and outline strategies for reducing risk.
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The first part of this two-part series addressed the use of US for complications of early pregnancy in adolescent females and for testicular complaints in pediatric and adolescent males. This issue focuses on the use, role, and limitations of US in the evaluation of cardiac, abdominal, and renal disease processes.
