Emergency medicine clinics of North America
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Emergency medicine, as the nation's health care system's safety net, is facing ever increasing demands on its resources and infrastructure. Classic and modern theories of leadership, which include broader based models that in corporate team responsibilities, should be studied by anyone wearing the mantle of leadership in emergency medicine, and the Realpolitik of the modern hospital must be accommodated if leadership efforts are to succeed.
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Emerg. Med. Clin. North Am. · Feb 2004
ReviewStructure and function of the emergency department: matching emergency department choices to the emergency department mission.
Emergency caregivers experience considerable new challenges to the provision of competent, compassionate care. The good news is there are ample new approaches and new technologies to meet those new challenges. ED leaders who understand the ED mission and the resources available today and who engage vigorously in the change process will turn that mission into immensely beneficial action.
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There is a frequently spoken phrase in law known as "Res Ipsa Loquitur." This Latin phrase translates in English to mean, "The thing speaks for itself." It is hoped the title of this article speaks for itself. The simple truth is that a contract is only as good as the people and institutions it binds. This does not mean that contracts should not exist or that important details of a contractual relationship should not be in writing. In essence, contracts are society's best attempt to memorialize the details of a business relationship between people and entities.
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Several groups of patients are at increased risk for traumatic injury that is "occult," or not apparent on initial presentation. Perhaps the most notorious are those who abuse alcohol, but other groups include the elderly, coagulopathic, those with neurological disease, and the mentally ill. ⋯ Because delays or failures in diagnosis might result in unnecessary pain, morbidity, and mortality, it is important for the emergency physician to identify occult presentations of trauma before disposition. This review highlights commonly missed traumatic injuries in adult patients.
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The evaluation of abdominal pain can be considerably more challenging in elderly patients. A higher likelihood of life-threatening pathology combined with a myriad of diagnostic pitfalls in this population mandate a more cautious approach with greater use of diagnostic resources and specialist consultation.