Emergency
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Crystalloid Resuscitation in Sepsis and Septic Shock: The Earlier, the Better
Although the most recent Surviving Sepsis Campaign guidelines authorized completion of 30 mL/kg of IV crystalloid within three hours of the recognition of sepsis and septic shock, there remains controversy regarding the benefits and harms of early, aggressive crystalloids, especially in specific patient populations.
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Soft Tissue Disorders of the Neck in Children
Pediatric patients frequently present to the emergency department with issues affecting the soft tissues of the neck. This article will focus on the assessment, evaluation, differential, and treatment of both superficial and deep neck soft tissue disorders that clinicians should consider in the emergency setting.
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Did ED Patient Threaten Violence? EP Might Have Legal Duty to Warn
EPs might have a legal “duty to warn” individuals if a patient threatens violence against them, depending on their state statute. EPs are shielded from allegations of breach of confidentiality if they warn someone of a threat. Importantly, EPs can be held liable if their failure to warn leads to a violent act.
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Psych Patients Elope or Are Discharged? Either Way, It’s a Wrongful Death Lawsuit
If psychiatric patients are discharged or elope from the ED and harm themselves or others, a wrongful death lawsuit is possible. To reduce risks, EPs can document that there was no evidence of homicidal or suicidal ideation at the time of the ED visit, contact a psychiatrist to support the decision to discharge, keep the patient secure until the evaluation is complete, and take reasonable precautions when patients are transported to another facility.
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Liability for EP if Admitted Patient’s Condition Deteriorated
EPs are not absolved of legal responsibility for admitted patients who remain in the ED while waiting for an inpatient bed to become available. Juries rely on documentation to determine what information was communicated to the admitting physician. Providing treatment to admitted patients can lead to the EP being held to a higher standard of care. Undocumented interactions are problematic for the defense.
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ED-based EHR Errors Caused More Significant Harm to Patients Compared to Other Settings
Seeking to obtain more information on health IT-related problems, researchers analyzed EHR-related cases occurring between 2011 and 2015. They found 420 cases in which the EHR was a contributing factor. Of this group, 50 cases occurred in the ED.
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The Opioid Minefield
The opioid epidemic has become not only a public health crisis, but also a political one. Legislative activity at the state and federal levels of government has reached a fever pitch, the ramifications of which certainly will affect the practice of emergency medicine.
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Airway Management in Trauma
The process of airway management has evolved considerably to include rapid sequence intubation (RSI), the use of various procedures, and sophisticated devices designed to assist in the placement of an endotracheal tube. This article summarizes the basic concepts of airway management, the technique of RSI, and post-intubation management in trauma patients.
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Advanced Imaging in Acute Ischemic Stroke
Any clinician who may have a role in the initial triage and management of these patients would be well-served to have an understanding of the currently available imaging modalities and techniques, and the applications of each in the evaluation of acute ischemic stroke.
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Opioid Crisis Affects Sickle Cell Patients Presenting With Related Pain
Experts note that opioids are still a first-line therapy for patients with sickle cell disease, but providers are reluctant to prescribe opioids in the current climate.