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Imagine finding a note in your ED patient's chart from a consultant, which recommends care that you believe is totally inappropriate. Should you quietly seethe, or report it to a higher-up?
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Lawsuits for "loss of chance" involving ED care are increasing, reports Jennifer L'Hommedieu Stankus, MD, JD, a medical-legal consultant, former medical malpractice defense attorney, and a senior emergency medicine resident at the University of New Mexico Health Sciences Center in Albuquerque. "This is a tricky legal concept that is gaining in popularity, particularly for things such as failure to offer [tissue plasminogen activator] to patients with acute ischemic stroke," she says.
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A five-year-old boy with a fever and rash was about to be admitted to the in-patient pediatric unit at Children's Hospital Boston for dehydration and infection.
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When patients with shortness of breath received either a partial or a full standing order set, their median treatment time decreased by 40 minutes, according to a study done at Johns Hopkins Bayview Medical Center in Baltimore.
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When a woman reported depression, migraines, and slurred speech over a period of months to Casie McMaster, RN, an ED nurse at St. Anthony's Hospital in St. Louis, MO, she reviewed her patient's home medications.
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If a patient's only complaint is dizziness, stroke may not be the first thing you think of, but patients with vertebral artery occlusion may present this way, says Karen Bergman, RN, neuroscience coordinator at Bronson Methodist Hospital in Kalamazoo, MI.
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As an ED nurse was inserting a urinary catheter in a young man who had been critically injured in a motor vehicle collision, the trauma surgeon was watching closely.
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A 28-year-old man was given an immediate EKG when he told ED nurses at Parkland Health & Hospital Systems in Dallas that he felt like someone was "holding my chest tight, like a band around my chest."
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The medications your elder patient is taking can cause a worsened injury or misleading vital signs, warns Chris Hoag-Apel, RN, TNS, SANE, trauma service supervisor at Freeman Health Systems in Joplin, MO.
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Emergency departments tend to be noisy, bright, and intensely focused on patient throughput.
