End of life care is a branch of medical care that helps patients in the final hours or days of their lives. It also applies to helping those paients diagnosed with fatal and incurable conditions. Physicians in this field typically prescribe palliative care (care that alleviates pain and suffering).
Emphysema is a progressive lung disease in which the primary symptom is shortness of breath. Emphysema patients suffer from destroyed lung tissue. It is one of the diseases in a group referred to as chronic obstructive pulmonary disease (COPD). Emphysema is typically caused by smoking, although it has been known to occur in nonsmokers.
An emergency surgeon is responsible for treating patients in urgent conditions. Some emergency surgeries are performed in order to close open wounds so that the patient does not lose too much blood; others are emergency surgeries on vital organs. Emergency surgeons must be highly trained and able to make split-second decisions in order to deal with stressful life-and-death conditions.
An emergency surgeon is responsible for treating patients in urgent conditions. Some emergency surgeries are performed in order to close open wounds so that the patient does not lose too much blood; others are emergency surgeries on vital organs. Emergency surgeons must be highly trained and able to make split-second decisions in order to deal with stressful life-and-death conditions.
The emergency room of a hospital or healthcare facility is the department whose physicians perform emergency medical treatments on patients with urgent conditions. Due to the unplanned nature of patient attendance, an emergency room must be well stocked and manned in order to handle any emergency patient. One of AME’s emergency room expert witnesses has written an exclusive medical malpractice article that we have provided, for your interest, below.Emergency Room – Medical Malpractice The usual problem with emergency medicine is a missed diagnosis and the failure to call in a consultant. A patient with chest pain should have an electrocardiogram. If there is an index of suspicion of heart attack and even if the electrocardiogram is normal, the patient should be admitted to the hospital and observed in the coronary care unit with electrocardiogram monitoring. Under those circumstances, eighty percent of patients who arrive in a hospital with a heart attack leave alive. The major cause of death, in these cases, is an irregular beating action of the heart, an arrhythmia called ventricular fibrillation, which is treatable with drugs and electric shock. A small percentage of patients will develop a rupture of the heart muscle wall from scar tissue weakening, after a severe heart attack, or total heart failure because the entire heart muscle has been turned to gangrene flesh due to lack of blood flow through a blocked main coronary artery. The controlling muscle struts of the heart valves can be damaged from the effects of the heart attack. Most patients, however, leave the hospital alive if their condition is immediately recognized and properly treated. Heart attack misdiagnosis is not an uncommon emergency room cause of action. Were the consultants called timely? Did the nurses intervene on their own when they saw problems? Was the patient hooked up to a monitor? Was the patient left alone? Was a proper history taken? We see the headache question. If the patient has an acute headache and high blood pressure, the blood pressure must be treated and a neurosurgeon called in if there are signs or symptoms of brain damage. One of those emergency conditions is an aneurysm, a weakening of a blood vessel at the base of the brain, supplying blood to the brain. If timely recognized, and if the blood pressure is reduced and anticlotting medication like the drug Amicar (also called epsilon or amino-caproic acid) is given, they can help prevent or limit the degree of hemorrhage into the brain substance. Blood pressure can be reduced rapidly with medications. Emergency surgery can be done. If the patient is stable, surgery can be delayed up to two weeks until the scarring around the blood vessel is thicker, making surgery safer. The decision to operate depends upon which blood vessels are involved and the clinical circumstances. Recognition is the key. The emergency room doctor must have an index of suspicion, and he must take a proper history. Did this patient have chronic headaches? Was this a severe and new headache, localized differently, which he never had before? High blood pressure or not, either way the patient should be observed. Consultants should be called. The purpose of an emergency room doctor is to treat emergencies, to have a high index of suspicion, to consider all differential diagnoses, and to call in consultants. Other than skin wounds, hand injuries and deep wounds should never be sutured in the emergency room. A hand surgeon, general surgeon, orthopedic surgeon or plastic surgeon should be called. The patient should be taken to an operating room where the wound is again cleansed thoroughly and the tendons are examined with the patient’s physical movements. The entire area of the tendon should be checked for complete or partial severance. The inside of the cut must be examined to be sure those structures weren’t injured, all foreign substances such as dirt and glass were removed, and appropriate x-rays taken. Suturing up the wound and leaving dirt behind, with gas gangrene infection setting in, is usually provable negligence in an emergency room situation, depending upon the circumstances. Human and animal bite wounds should never be sutured. They are highly contaminated and cannot be totally “sterilized”. If a patient had a dirty wound from falling down in their backyard, which the dog or cats use as a bathroom, we never suture that up because the patient can get gas gangrene from the germs that are present. We have to cleanse out the wound thoroughly, give antibiotics, and usually admit the patient to the hospital. Never close the skin primarily, including “old” cuts present for more than eight hours; the risk of infection developing is too great. Depending upon their condition and who is going to see the patient, sometimes they can be sent home. The point is, a consultant should be called and proper hospital care and follow up care given. All follow up instructions must be in writing and given to the patient or to a responsible person who can understand the instructions. Emergency room doctors recognize and respond to emergency situations; they must call in consultants immediately so that they can triage the patient to the proper person at the right time. Stab wounds, gun shot wounds, that’s obvious: he should call someone. In chest wounds, fractured ribs can pierce or collapse a lung. He must get a chest x-ray. Did they perform all the x-ray studies, take all the appropriate blood tests for the condition? Did they take the medical history properly? Did they give instructions for follow up care for head trauma? If the patient has a head injury, but no loss of consciousness, the x-ray is negative, and they are neurologically intact, they can be sent home. The family must be told to awaken the patient every hour. If there is a change in the neurologic condition, and confusion, lethargy, developing paralysis or vomiting occur, they are to bring him back immediately. A CAT scan should be taken at that point. (Perhaps a CAT scan before, depending upon the condition and the nature of the injury.) Follow up instructions are critical in emergency rooms. If they fail to provide these instructions, then they’re negligent. Emergency room doctors also see neck injury patients. With patients in automobile accidents, is there a fractured neck? What difference does it make? Well, if the neck is fractured and the bones are unstable, the spinal cord can be squashed, causing paralysis, paraplegia or quadriplegia. There has to be an index of suspicion. The patient has to be stabilized with the understanding that these conditions may exist until ruled out. The patient is stabilized, protected against himself when they’re drunk, and taken to x-ray with supervision, where x-rays of the neck are taken. X-rays of the whole neck should be taken, (not just of the first four cervical vertebrae, but of all seven) to look for a fracture, dislocation, to see stability, and to call a consultant in when necessary. Hospital personnel have a duty to have a high index of suspicion, and to use the tests that are available to them. Most emergency room doctors today are certified in Emergency Medicine, and every doctor working in an emergency room is held up to that standard of care. The moonlighting eye doctor taking care of a baby is held up to an emergency room standard of care. They must call the appropriate consultants.
Emergency medicine physicians diagnose a variety of illnesses and undertake acute interventions to stabilize the patient. Emergency medicine physicians practice in hospital emergency departments, in pre-hospital settings via Emergency medical services, other locations where initial medical treatment of illness takes place, and recently the Intensive-care unit. Just as clinicians operate by immediacy rules under large emergency systems, emergency practitioners aim to diagnose emergent conditions and stabilize the patient for definitive care.
Emergency Medical Service (EMS) is a branch of medical services that focuses on providing emergency care outside of hospital facilities, or transporting patients with urgent conditions to hospitals. Emergency professionals are responsible for responding to trauma and triage.
The emergency department of a hospital, clinic, or medical facility is essential because its physicians, nurses, and other personnel are responsible for responding to emergency situations. They must be qualified to handle trauma and triage situations. One of AME’s emergency department expert witnesses has written an exclusive medical malpractice article that we have provided, for your interest, below.The Emergency Department and Corporate Responsibility. The evaluation of patient care in the hospital emergency department often focuses only on the care itself and the practitioners that delivered that care. Too often, the responsibilities of the hospital in providing that care is overlooked or not looked at from the perspective of their corporate responsibilities. This is where a Hospital Administration Expert will answer those questions and fill the need from the corporate perspective. It is usually well understood that the hospital must comply with the standards promulgated by federal, state, and local authorities, including such things as the federal Emergency Medical Treatment and Active Labor Act and regional trauma regulations; the hospital must also comply with the standards of the Joint Commission if they are an accredited hospital. These Joint Commission standards are widely accepted in the United States as the standard of care for the provision of inpatient and ambulatory hospital care, and describe the accountability and responsibility of hospital leaders in the delivery of care at their facilities. Joint Commission standards require that hospital leaders establish a governance structure and management systems to oversee that appropriate rules, regulations, infrastructure, credentialing, and communication processes are in place to deliver high quality and safe care to their patients. The hospital is further required to establish systems to monitor the effectiveness of care and to correct any deficiencies. Ultimately, the hospital is responsible for the oversight of all professional services provided by its medical staff, employees, and any others that it credentials or contracts with to practice at the hospital, including emergency department contract physicians. Joint Commission standards are also used by the federal Centers for Medicare and Medicaid to determine compliance with the requirements of these programs, and are also used and accepted as the standard of care for hospital licensure in many states. It is increasingly common for hospitals to contract for emergency department physician services and presume that the contract with the physician company addresses all their responsibilities. This is not the case, as the hospital remains responsible for all patient care services that take place, and they must have the required policies and procedures in place to direct that care and, most importantly, must make certain that those policies are followed by the contract staff and all hospital employees as well. In the emergency department, these policies often focus on such things as timely care, accurate performance of diagnostic tests, and the communication of critical test result information to clinicians and patients. A common problem that occurs is the test result that comes back after the patient is discharged that is never communicated to the patient or their primary care physician. Another situation that may happen in many smaller hospitals is the use of part-time staff to read test results and this may be delayed due to the hours that the staff is present. In the evaluation of emergency department cases, it is recommended that risk managers and legal counsel, both defense and plaintiff, look at whether the hospital has fulfilled their corporate responsibilities in providing care and not just look at the medical care itself. The Hospital Administrator who prepared this article is available as an expert witness for your cases.
Emergency nursing is a nursing specialty in which nurses care for patients in critical condition. All nurses have some training in treating patients in emergency situations; however, emergency nurses are especially skilled at dealing with patients whose diagnosis has not yet been made.
American Medical Experts, LLC is a nationwide provider of low-fee expert witness services including expert witness reports, case summary reviews, and independent medical evaluations.
