Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Historical Article
What Emergency Physicians Should Know About Informed Consent: Legal Scenarios, Cases, and Caveats.
The basic concept of obtaining informed consent is familiar to emergency physicians, and many consider themselves well versed on the topic; however, lack of obtaining proper informed consent is a frequent source of lawsuits. The legal definitions and nuances of informed consent might surprise even the most experienced physician. ⋯ Special scenarios, caveats, and documentation recommendations are discussed. After reading this article the emergency physician will know how to practice and document the appropriate aspects of informed consent in emergency medicine, as well as understand available legal defenses if a lawsuit should arise.
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Observational Study
Diagnostic Characteristics of a Clinical Screening Tool in Combination With Measuring Bedside Lactate Level in Emergency Department Patients With Suspected Sepsis.
Early identification of sepsis and initiation of aggressive treatment saves lives. However, the diagnosis of sepsis may be delayed in patients without overt deterioration. Clinical screening tools and lactate levels may help identify sepsis patients at risk for adverse outcomes. ⋯ Use of a clinical screening tool in combination with early bedside POC lactates has moderate to good specificity but low sensitivity in adult ED patients with suspected sepsis. Elevated bedside lactate levels are associated with poor outcomes.
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The objective was to determine the association between asthma severity as measured by the Pediatric Respiratory Assessment Measure (PRAM) score and the likelihood of admission for pediatric patients who present to the emergency department (ED) with moderate-to-severe asthma exacerbations and who receive intensive asthma therapy. ⋯ The 3-hour PRAM scores best predicts the need for hospitalization. These results may be applied in clinical settings to facilitate the decision to admit or initiate more aggressive adjunctive therapy to decrease the need for hospitalization.
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Ultrasound guidance is now the standard of care when placing a central venous catheter (CVC), resulting in decreased complications and increased first-pass success rates. However, even with ultrasound guidance being used for the initial venipuncture, misplacement of a CVC in either an unwanted vein or in an artery still occurs. Here, we discuss a simple technique to assist in the adequate placement of the CVC in the vena cava using bedside echocardiography.