Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Aug 2006
ReviewEthical dilemmas in the care of minors in the emergency department.
Minors may give consent for their own medical care in several situations: as emancipated minors, when they present with conditions covered by minor treatment statutes, and when they are designated as "mature" minors. Definitions vary from state to state. ⋯ A psychosocial assessment should be performed as part of the emergency department evaluation of most adolescent minors. The emergency physician should help facilitate the involvement of a parent or other support person in the health issues of adolescent minors whenever possible, especially with younger adolescents.
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Emerg. Med. Clin. North Am. · Aug 2006
ReviewInformed consent and refusal of treatment: challenges for emergency physicians.
Due to the distinctive features of the hospital emergency department and its patients, emergency physicians confront special challenges in respecting patient rights to informed consent to treatment. After a brief review of the doctrine of informed consent and of its significance in the emergency department, this article will examine three specific challenges for informed consent and refusal of treatment in emergency medicine: (1) assessing patient decision-making capacity, (2) performing procedures on the newly dead, and (3) making treatment decisions for patients in legal custody.
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Elderly patients who have abdominal pain remain one of the most challenging patient populations. Signs and symptoms of serious disease are often nonspecific. ⋯ In addition, the higher incidence of serious pathology in this population requires emergency physicians to be vigilant and thorough in their work-up. Vascular catastrophes are more likely to be seen in this population, and a broad differential diagnosis needs to be considered.
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The number of people living longer and staying active continues to rise, resulting in an increase in the incidence of trauma-related vis-its by older persons to emergency departments. The elderly sustain a disproportionate share of fractures and serious injury, and represent a unique subset of patients with special needs and considerations. This article reviews the current literature on the management of elderly patients with trauma, including the physiologic changes of aging relevant to the management of trauma, injury patterns unique to geriatric victims of trauma, and aspects particular to resuscitation and general management of geriatric trauma victims. We include a discussion of the evaluation and management of falls in the elderly, including assessment of fall risk.
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To better understand future emergency department use, it is valuable to analyze the current emergency department use rates of the geriatric population. This article reviews emergency department use by demographics, causes of death, principal reason for emergency department visits, number of emergency department visits per person per year, prescription drugs used, and recent trends in emergency department visits.