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NIV is increasingly accepted as an alternative to endotracheal intubation (ETI) for the management of respiratory failure, both acute and chronic.
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Most emergency physicians (EPs) would never consider leaving a patients chart completely blank, as theyre well aware of the resulting liability risks, but caring for an ED colleague without documentation is no different, according to Martin Ogle, MD, FACEP, senior partner and vice president of CEP America, an Emeryville, CA-based provider of acute care staffing solutions.
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Is a parent refusing recommended care for a minor patient in the ED?
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Was a patient transferred without being intubated first because the emergency physician (EP) wasnt comfortable managing a difficult airway?
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Informed refusal is the antithesis of informed consent, a natural extension of the doctrine. Informed consent is discussed in great detail in the medical, legal, and risk-management literature; whereas informed refusal has received less attention.
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If a patient deteriorates because of a transport and later sues, concerns will inevitably arise that the emergency physician (EP) didnt stabilize the patient prior to transport, or that the patient should not have been transferred, says John Tafuri, MD, FAAEM, regional director of TeamHealth Cleveland (OH) Clinic and chief of staff at Fairview Hospital, also in Cleveland.
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Over the past few years, we have learned that seemingly minor injuries can cause significant morbidity and, in some cases, even contribute to mortality. Astute emergency providers have learned to look beyond minor complaints and watch for signs of significant problems. Mild traumatic brain injury or concussion is one of the best examples of an injury that has been often dismissed. Post-concussive syndrome was overlooked for many years. Athletes in particular are prone to repeated injury, which we now know contributes to later cognitive impairment and even in some cases death.