Emergency
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Using Ketamine in the Critically Ill: A Clinical Review
This is a guideline for ketamine use in the appropriate clinical setting from the practicing intensivist’s perspective.
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Acute Treatment of Pediatric Migraine
Migraines occur in young children, but may be challenging to diagnose. Migraines can have a great impact on pediatric patients’ quality of life with school absence and limitations on extracurricular activities. Treatment of pediatric migraines or possible migraines is difficult secondary to the lack of evidence for effective therapies in pediatric patients. Treatment includes traditional therapy with dopamine receptor antagonists (DRAs), nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, and combination therapies. Newer therapies include magnesium, valproic acid (VPA), and peripheral nerve blocks. The authors review the clinical presentation of migraines in children, guidelines for diagnosis, and therapeutic options.
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EPs, Hospitals Face Liability for ED Nurse Practitioners’ Negligence
If an ED nurse practitioner is sued for malpractice, the hospital will “almost always” be named, says one attorney. However, the hospital may not rally behind the care given by the nurse defendant. For this reason, nurse practitioners should carry their own malpractice insurance.
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Vague Symptoms Trigger Sepsis Care Delays and Lawsuits
More than one-third of ED patients with septic shock reported only vague symptoms at presentation, according to the authors of a recent study of septic shock patients discharged from a large urban ED. These patients had delayed antibiotic administration and were at a higher risk of mortality compared to patients with explicit infection symptoms. Another recent analysis revealed that a faster completion of a three-hour bundle of sepsis care and quick administration of antibiotics — but not rapid completion of an initial bolus of IV fluids — were associated with lower risk-adjusted, in-hospital mortality rates.
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High Policy Limits Make EP a ‘Deep Pocket’ for Plaintiff
One insider recommends emergency physicians spend money ensuring their assets are protected from third parties rather than on "higher premiums for larger limits."
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Was ED Unprepared for Critically Ill Child? Guidelines Could Help Prove It
The risk of a poor outcome for a critically ill child is high when a system is not ready to meet the emergency needs of that child. New guidelines from the National Pediatric Readiness Project can be used to prove that an ED fell short in this regard.
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30 ED-Related Cases Resolved Without Litigation
All cases were approached using a process of investigation, disclosure, and apology.
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ED Provider Apologies: Dangerous or Legally Protective?
Conventional wisdom holds that any EP who admits fault (or even displays empathy) probably will end up in court hearing their own words used against them. Still, a growing number of states are passing apology laws to protect against this possibility.
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Can Communication and Resolution Programs Prevent ED Malpractice Lawsuits?
If an ED patient is seriously hurt by a medical error, a costly, years-long malpractice lawsuit probably is inevitable, at least according to standard thinking. Yet there is growing awareness of an alternative to this all-too-familiar story.
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Investigators Find Patient Frustration With Chronic Fatigue Syndrome
The results of a new study suggest that patients with chronic fatigue syndrome (CFS) often are dissatisfied with their encounters in the emergency setting. In fact, investigators reported that many of these patients decline to seek care in the ED because they believe their symptoms will be dismissed as psychosomatic. However, the study also shed light on the most common reason why patients with CFS visit the ED.