Emergency
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ICU Bed Availability: Does It Make a Difference?
Nationwide, the volume of ICU admissions from the ED has increased significantly over recent years (by 50% from 2001 to 2009). When demand exceeds bed availability, complex decisions regarding ICU must be made. Does bed availability affect triage decisions? If many beds are available, patients who are too ill or too well to benefit from the ICU may be admitted. Conversely, if too few beds are available, ICU admission may be denied to patients who may benefit. In prior studies, ICU denial has been associated with increased hospital mortality.
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Is There a Role for Steroids in ARDS Management?
Mortality rates from acute respiratory distress syndrome (ARDS) remain high, even as therapy has improved over the last decade. Recent guidelines for management center on mechanical ventilation, with initial therapy beginning upon identification and treatment of the underlying cause of the ARDS. There is reasonable consensus regarding the use of lung-protective strategies, such as low tidal volume ventilation, prone positioning for those meeting criteria for severe ARDS, and restrictive fluid management after the initial resuscitation. However, for patients with the most severe disease, these treatments often are not completely effective, and we look for other therapies that might help.
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Cervical Spinal Injury
Although spinal injuries are uncommon, they should be considered when children have sustained head or neck trauma or multiple severe injuries. Children with severe or multisystem trauma are more likely to suffer a spinal injury. Thus, emergency department providers should have a lower threshold to immobilize and image such patients to prevent morbidity and mortality. This article reviews the most common pediatric spinal fractures and injuries and optimal management practices.
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Undetected Medical Conditions in ‘Psych’ Patients Are Legal Landmine
Once EPs conclude that a patient’s behavior is psychiatric, they may miss underlying medical conditions that are the real cause of the symptoms. This is less likely if a patient is behaving bizarrely, presents with a psychiatric history, and is taking psychiatric medications. Experts recommend obtaining a good history before deciding a patient is psychiatric.
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Good Documentation of ED Consult Makes It Clear EP Met Standard of Care
To avoid needless legal entanglements, experts say EPs should know when they’re in over their heads and remain firm about what they need from a consultant. Invariably, specialists testify that while the EP asked for their opinion, the EP never asked or insisted that the specialist come in — and that had the severity of the situation been explained, the specialist certainly would have come to the ED.
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Legal Exposure for ED and Hospital if Patients Refuse Discharge
Some patients may choose to remain in the ED against medical advice for several social reasons, including the fact the patient has no home, or views a hospital room as safer, more comfortable, or less lonely than going home.
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Survey: More Than Half of EPs Sued for Malpractice at Least Once
Fifty-one percent of EPs have been sued during their career, according to a recent report on medical liability claims frequency, the third highest percentage of all the specialties examined by the study’s authors.
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Many ED Visits Documented on Cellphones
Whether such recordings are admissible in court depends on many different factors.
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Sickle Cell Emergencies
This article provides an overview of the most frequently encountered complications associated with sickle cell disease seen in the emergency department. It will discuss recent guidelines and novel approaches to the treatment of entities such as acute chest syndrome, vaso-occlusive crisis, and stroke, as well as new treatments on the horizon.
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Hospitals Leverage Safety Huddle to Reduce Patient Harm, Boost Transparency, and Drive Culture Change
When implemented effectively, safety huddles can reduce harm and foster a culture of safety and accountability. Hospitals that have been successful with this process recommend that huddles be driven by executive leadership and include a structure that provides for accountability.