Emergency medicine clinics of North America
-
The diagnosis of appendicitis is fraught with potential pitfalls, and despite its prevalence, appendicitis continues to be a condition at high risk for missed and delayed diagnosis. There is no single historical or physical finding or laboratory test that can definitively make the diagnosis. ⋯ Challenges of special populations, such as children, the elderly, and pregnant patients, are also discussed. Although appendicitis continues to be a source of medical legal risk and misdiagnosis, a clear understanding of the strengths and limitations of all tests in suspected appendicitis can improve the emergency physician's diagnostic accuracy in this high-risk disease.
-
Pediatric disorders that involve actual or potential airway compromise are among the most challenging cases that emergency department providers face. This article discusses the diagnosis and management of common and uncommon conditions in infants and children who may present with airway obstruction.
-
Emergency department (ED) crowding and ambulance diversion has been an increasingly significant national problem for more than a decade. More than 90% of hospital ED directors reported overcrowding as a problem resulting in patients in hallways, full occupancy of ED beds, and long waits, occurring several times a week. ⋯ This article gives a basic blueprint for successfully making hospital-wide changes using principles of operational management. It briefly covers the causes, significance, and dangers of overcrowding, and then focuses primarily on specific solutions.
-
Emerg. Med. Clin. North Am. · Nov 2009
ReviewTriage, EMTALA, consultations, and prehospital medical control.
Medical control of prehospital emergency services, triage in the emergency department, and the dual duties within the Emergency Medical Treatment and Active Labor Act challenge emergency medicine physicians with both statutory obligations and liabilities. Each independently may seem to present a definable boundary of liability for the practitioner. Under the Emergency Medical Treatment and Active Labor Act, the sequential duties of the medical screening examination and subsequent stabilization or transfer are confounded by the potential for tremendous sanction for a mechanistic violation. Nevertheless, the true obligation is to provide appropriate care to all who present to the emergency department and not simply weigh the totality of risk to the emergency medicine physician.
-
Patients presenting to the emergency department (ED) with behavioral disturbances account for approximately 6% of all ED visits. Emergency physicians are often responsible for the initial assessment of these patients' psychiatric complaints, which might include homicidal and suicidal behavior and acute psychosis. ⋯ The purpose of the medical screening is to identify medical conditions that might be causing or contributing to the psychiatric emergency or that might be dangerous or inappropriate to treat in a psychiatric facility. Appropriate treatment in the ED is essential to avoid morbidity and mortality resulting from misdiagnosis of medical conditions as psychiatric illnesses and from mismanagement of psychiatric illnesses.