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The turnover of ED physician contracts at Methodist Hospital in St. Louis Park, MN, has brought into focus some of the major issues evolving in the competition between smaller, physician-owned ED groups and the larger corporate entities, such as EmCare, of Dallas; Team Health of Knoxville, TN; and Sterling Healthcare of Durham, NC. While some of those issues are philosophical, others are legal and may have significant implications for ED managers.
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This issue of Emergency Medicine Reports reviews urgent and emergent hypertension syndromes encountered in the ED and approaches to patient assessment and pharmacologic management. Part I will cover the clinical evaluation of hypertensive patients and hypertension syndromes. Part II will discuss antihypertensive medications and the management of hypertension in specific disease processes.
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An emergency physician often is the first and only health care provider that families interact with after a loved ones death. Yet emergency physicians often are uncomfortable and undertrained in delivering bad news. This is especially true when the death involves a child. Counseling families after a death needs to be performed properly and systematically to help manage the grief response of survivors. The emergency physician also must be well versed in the after care that is associated with a death in the emergency department, such as organ donation. This issue of Emergency Medicine Specialty Reports offers the means to provide an effective and compassionate death notification in a variety of circumstances.
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In its earlier years, the Emergency Medical Treatment and Active Labor Act (EMTALA) was defined by court decisions that often were inconsistent with real clinical practice. Although there still are uncertainties with the application of EMTALA to specific clinical scenarios, refinements to the statute have clarified some of its ambiguities. The author discusses some of the recent refinements to EMTALA that help to clarify the statutes meaning to hospitals and the practice of emergency medicine.
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This review will provide a guide to ventilator management to aid the ED physician. Pulmonary physiology and adverse effects of artificial ventilation on the pulmonary system will be discussed. Assist control ventilation is the most common mode of ventilation and should be used initially for patients in the ED. Pitfalls of therapy and troubleshooting the ventilator will be reviewed, recognizing that the respiratory therapist is a valuable reference and capable of handling the majority of mechanical ventilation issues. Finally, difficult cases will arise requiring early consultation with a critical care specialist to provide optimal ventilation while avoiding complications.
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This issue covers Part I of a two-part series on evaluation and management of sexual assault in the emergency department. Part I of the series discusses initial ED care, physical exam, and evidence collection. Part II will cover laboratory analysis, pharmacotherapy, disposition, follow-up, documentation, and court testimony.
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Applications particularly useful in the pediatric and adolescent patient populations will continue to gain wider recognition and acceptance by the physician community. Most ultrasound examinations are quick and simple to perform, and ED physicians can gain comfort and facility in performing these focused applications.
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The majority of deaths in American ICUS involve withholding or withdrawing life-sustaining therapy. When such decisions are considered, patients are typically unable to communicate for themselves and, therefore, family members may become the decision-makers.
