Emergency Medicine - Adult and Pediatric
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Emergency Department Evaluation of Vertigo and Dizziness
Vertigo can be a complicated complaint for emergency medicine physicians to manage. The differential for this is broad, ranging from benign processes, such as BPPV, to more devastating causes, such as posterior strokes.
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Wrongful Prolongation of Life Suits Persist, Even When a Patient’s Status Was DNR
Regardless of training or good intentions to preserve life, at the end of the day, this is the patient's choice.
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Ethicists’ Role if Clinicians Disregard Documented End-of-Life Wishes
Early involvement of the ethics team can be helpful. After an initial assessment, the healthcare team should arrange a family meeting with surrogates, clinicians, the ethics team, social workers, and other appropriate individuals (e.g., clergy). This should happen as soon as possible, no later than the following day. The ethics team should facilitate an honest and compassionate discussion about the plan to best honor the patient’s end-of-life decisions.
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Ethicists Can Resolve Conflicts Over Nutrition Therapy at End of Life
When deciding whether to administer, withhold, or withdraw end-of-life nutrition and hydration therapy, ethicists can help clinicians, patients, and families reach an equitable agreement.
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New Ethical Guidance on End-of-Life Nutrition Therapy
The guidance is intended to help clinicians understand what medically assisted nutrition and hydration can and cannot accomplish for different groups of patients.
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Intimate Partner Violence
Domestic violence and abuse is a national and global healthcare problem with massive consequences, affecting men, women, and children, which worsened during the COVID-19 pandemic. Awareness, recognition, and resource allocation, in addition to trauma management, is an important aspect of emergent care of the trauma patient possibly injured in a domestic violence incident.
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Endotracheal Intubation Lawsuits Often Name ED Providers
After analyzing 214 relevant claims, researchers reported payments averaged $2.5 million. Intubation injuries occurred in the operating room most often, followed by the ED (16.3% of cases). Most cases involving the ED resulted in some type of payout (either a settlement or a jury award). Anesthesiologists were most likely to be named in the lawsuits (59.8%), and EPs were second most likely (19.2%) to be named. The vast majority of claims (89.2%) alleged permanent deficits, half the cases involved death, and 37.4% of the cases involved anoxic brain injury.
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New Processes ‘Close the Loop’ on Imaging Findings
University Hospitals Cleveland Medical Center, radiologists report imaging findings through a standardized form integrated in dictation software. This automatically sends an email to a nurse navigator, who documents the findings and coordinates follow-up with patients, primary care providers, and specialists. From July 2021 to May 2022, 1,207 incidental finding reports were submitted, with the vast majority identified on CT scans. Ten new cancers were detected as a result of the program.
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EDs Can Mitigate Malpractice Perils of High-Risk Medications
Many emergency providers are hesitant to deprescribe medications taken by a patient they just met. Some are more open to the idea in certain cases, such as blood pressure medications associated with side effects or adverse outcomes. But if patients cannot identify the high-risk medications they are taking, or if the link between the medication and the chief complaint is weak, it makes the task harder.
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Just One Malpractice Payout Means Far Higher Risk for Future Claims
Of 841,961 physicians with zero paid claims in the 2009-2013 period, only 3.3% were the subject of one or more claims in the next five years (2018-2023). Of 34,512 physicians with one paid claim in the prior period, 12% were the subject of one or more claims in the next five years. Of 4,189 physicians with two paid claims in the prior period, 22.4% were the subject of one or more claims in the next five years. Of 1,214 physicians with three paid claims in the prior period, 37% were the subject of one or more claims in the next five years.