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EMERGENCY MEDICINE MALPRACTICE, Second Edition gives you insight in 'plain English' on a broad variety of emergency medical procedures and recommended treatments for virtually all major injuries and situations (and many less common ones) seen in emergency department practices today. EMERGENCY MEDICINE MALPRACTICE helps to provide an understanding of the appropriate diagnosis and treatment in an emergency room. In addition to medical analysis and accepted ER procedures, this book also examines the legal aspects of those same procedures in each chapter, providing practice tips from five leading trial attorneys in the field. Sample plaintiff and defense documents are also included.

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• About the Author(p. xxv)
• Preface(p. xxvii)
• Chapter 1 Overview of the Emergency Department and Its Operations(p. 1)
• 1.01 Function and Organization of the Emergency Department(p. 3)
• [A] Function and Classification(p. 3)
• [B] Staffing(p. 7)
• [C] Other Emergency Care Centers(p. 10)
• 1.02 Nondiagnostic Danger Zones in Emergency Department Practice(p. 13)
• [A] Time of Day and Shifts(p. 13)
• [B] Communication Between Physicians(p. 14)
• [C] Patients Leaving Against Medical Advice(p. 21)
• [D] Failure to Treat or Admit Patients(p. 23)
• [E] Telephone Advice(p. 23)
• [F] Interhospital Transfer Guidelines to Avoid Liability(p. 25)
• [G] American College of Emergency Physicians (ACEP) Policy Statements(p. 27)
• 1.03 Medical Records(p. 29)
• [A] Basic Contents(p. 29)
• [B] Significance of Medical Records(p. 31)
• 1.04 Medical Direction and Control of Emergency Medical Services(p. 32)
• [A] Significance of Medical Control(p. 32)
• [B] EMS Physician(p. 33)
• [C] Evaluation Checklist of Emergency Department Practice(p. 34)
• [D] ACEP Clinical Policies(p. 35)
• Chapter 2 Legal Liability in Emergency Medicine(p. 39)
• 2.01 Introduction(p. 41)
• 2.02 Medical Negligence(p. 42)
• [A] Duty: The Physician-Patient Relationship(p. 42)
• [B] Breach of Duty: The Standard of Care in the Emergency Department(p. 46)
• [C] Proximate Cause(p. 48)
• [D] Damages(p. 57)
• 2.03 Negligence of Physicians and Non-specialists(p. 59)
• [A] Negligence of the Emergency Department Physician(p. 59)
• [B] Negligence of Non-specialists in the Emergency Department(p. 65)
• 2.04 Hospital Liability(p. 67)
• [A] Corporate Liability(p. 68)
• [B] Violation of Hospital Rules as Evidence of Negligence(p. 71)
• [C] Liability to Non-patient Bystanders and Visitors(p. 71)
• 2.05 Liability of Nurses for Negligence(p. 72)
• [A] In General(p. 72)
• [B] Emergency Department Nursing(p. 74)
• 2.06 Emergency Department Physician as an Independent Contractor(p. 77)
• 2.07 Duty to Forward or Inform Patient of Results of X-rays(p. 83)
• 2.08 Emergency Medical Technician Liability(p. 84)
• Chapter 3 Intrahospital Transfers(p. 87)
• 3.01 COBRA Legislation(p. 89)
• 3.02 Intent of COBRA(p. 91)
• 3.03 Definition of Terms(p. 93)
• 3.04 Civil Liability Under COBRA(p. 100)
• 3.05 COBRA Strict Liability Concept(p. 103)
• Chapter 4 Acute Myocardial Infarction and Chest Pain(p. 105)
• 4.01 Introduction(p. 109)
• 4.02 Anatomy and Physiology: Heart and Circulatory System(p. 109)
• [A] Blood Flow(p. 110)
• [B] Coronary Arteries(p. 112)
• [C] Cardiac Conduction System(p. 115)
• [D] Electrocardiogram(p. 116)
• [E] Blood Pressure(p. 124)
• [F] Angina(p. 125)
• [G] Acute Myocardial Infarction(p. 125)
• 4.03 Patient History(p. 129)
• [A] Chest Pain(p. 129)
• [B] Accompanying Symptoms(p. 132)
• 4.04 Physical Examination(p. 133)
• [A] General Observations(p. 133)
• [B] Vital Signs(p. 134)
• [C] Examination of the Neck Veins(p. 134)
• [D] Chest(p. 134)
• [E] Heart(p. 135)
• [F] Pulses(p. 136)
• [G] Abdomen(p. 136)
• [H] Legs(p. 137)
• 4.05 Diagnostic Tests(p. 138)
• [A] Laboratory(p. 138)
• [B] Electrocardiography(p. 140)
• [C] X-ray(p. 141)
• [D] Angiography(p. 143)
• [E] Treadmill Testing(p. 144)
• [F] Echocardiography(p. 145)
• 4.06 Chest Pain(p. 147)
• [A] Common Causes of Chest Pain(p. 148)
• [B] High-Risk Causes of Chest Pain(p. 148)
• [C] Review of General Information(p. 156)
• [D] Standard of Care(p. 157)
• 4.07 Treatment(p. 163)
• [A] In General(p. 163)
• [B] Therapy(p. 167)
• [C] Other Treatment Modalities(p. 185)
• 4.08 Complications(p. 193)
• [A] Arrhythmias(p. 193)
• [B] Pericarditis(p. 199)
• [C] Venous Thrombosis and Embolism(p. 201)
• [D] Aneurysm(p. 201)
• [E] Left Ventricular Thrombus and Arterial Embolism(p. 202)
• [F] Mechanical Complications(p. 203)
• [G] Cardiac Arrest(p. 208)
• 4.09 Missed Myocardial Infarction in the Emergency Department(p. 214)
• [A] Characteristics of Patients Sent Home(p. 216)
• [B] Gastrointestinal Versus Myocardial Pain(p. 219)
• 4.10 Recent Trends in Acute Myocardial Infarction(p. 223)
• 4.11 Summary of Acute Interventions in Myocardial Infarction(p. 225)
• [A] Not All Thrombolytic Candidates Are Treated(p. 226)
• [B] Identification of Appropriate Thrombolytic Therapy Candidates(p. 226)
• [C] Contraindications to Thrombolytic Therapy May Be Unclear(p. 227)
• [D] The Role of Primary Angioplasty Is Unsettled(p. 227)
• [E] Combined AHA/ACC Recommendations for Acute MI(p. 229)
• Chapter 5 Chest, Cardiac, and Vascular Injuries(p. 231)
• 5.01 Injuries to the Chest(p. 233)
• [A] Signs and Symptoms of Chest Injury(p. 233)
• [B] Chest Injuries(p. 235)
• [D] Complications of Chest Injuries(p. 244)
• 5.02 Cardiac Injuries(p. 248)
• [A] Rapid Screening by Ultrasound(p. 248)
• [B] Blunt Injuries to the Heart(p. 249)
• [C] Blunt Trauma Resulting in Rupture of the Heart(p. 256)
• [D] Penetrating Cardiac Injury(p. 257)
• [E] Cardiac Tamponade(p. 258)
• 5.03 Traumatic Vascular Emergencies(p. 260)
• [A] Diagnosis(p. 262)
• [B] Management(p. 262)
• [C] Traumatic Rupture of the Aorta(p. 262)
• Chapter 6 Respiratory and Thoracic Emergencies(p. 273)
• 6.01 Introduction(p. 275)
• 6.02 Anatomy and Physiology(p. 275)
• 6.03 Pneumothorax(p. 276)
• [A] Spontaneous Pneumothorax(p. 278)
• [B] Traumatic Pneumothorax(p. 280)
• [C] Iatrogenic Pneumothorax(p. 281)
• 6.04 Acute Pulmonary Embolism(p. 283)
• [A] Diagnosis of Pulmonary Embolism(p. 283)
• [B] Treatment of Pulmonary Embolism(p. 292)
• 6.05 Acute Respiratory Failure(p. 295)
• [A] Diagnosis of Acute Respiratory Failure(p. 296)
• [B] Treatment of Acute Respiratory Failure(p. 296)
• [C] Noninvasive Ventilation(p. 299)
• 6.06 Adult Respiratory Distress Syndrome(p. 301)
• [A] Defined(p. 301)
• [B] Diagnosis and Treatment of Adult Respiratory Distress Syndrome(p. 303)
• 6.07 Asthma(p. 304)
• [A] Extent of the Problem(p. 305)
• [B] Causes--Asthma Is Primarily an Inflammatory Disease(p. 305)
• [C] Diagnosis of Asthma(p. 307)
• [D] Treatment of Asthma(p. 309)
• [E] New Drugs for Asthma(p. 315)
• 6.08 Chronic Obstructive Lung Disease(p. 316)
• [A] Diagnosis of COPD(p. 317)
• [B] Treatment of COPD(p. 318)
• 6.09 Pneumonia and Empyema(p. 327)
• [A] Diagnosis of Pneumonia(p. 328)
• [B] Management of Pneumonia(p. 329)
• [C] Empyema(p. 331)
• 6.10 Latex Allergy(p. 331)
• Chapter 7 Gastrointestinal Emergencies(p. 335)
• 7.01 Introduction(p. 339)
• 7.02 Abdominal Area: Functional Anatomy(p. 339)
• [A] The Hollow Abdominal Organs(p. 340)
• [B] The Solid Abdominal Organs(p. 341)
• [C] The Urinary Tract Organs(p. 342)
• [D] The Female Reproductive Tract Organs(p. 343)
• 7.03 Patient History(p. 344)
• [A] Onset of Pain(p. 345)
• [B] Severity of Pain at Onset(p. 345)
• [C] Location of Pain at Onset and Changes in That Location(p. 345)
• [D] Referral of Pain(p. 347)
• [E] Associated Symptoms(p. 347)
• [F] Current Medications(p. 348)
• 7.04 Physical Examination(p. 348)
• [A] Vital Signs(p. 348)
• [B] General Appearance(p. 349)
• [C] Bowel Sounds(p. 351)
• [D] Palpation: Guarding, Tenderness, Rebound, Masses(p. 351)
• [E] Genitorectal Exam(p. 351)
• [F] Other Organ System Findings of Importance(p. 352)
• [G] ACEP Policy for Nontraumatic Acute Abdominal Pain(p. 352)
• 7.05 Diagnostic Studies(p. 352)
• [A] Laboratory(p. 352)
• [B] X-ray(p. 355)
• [C] Other Tests(p. 356)
• [D] ACEP Policy on Vaginal Bleeding(p. 356)
• 7.06 Common Causes of Abdominal Pain(p. 357)
• [A] Generally(p. 358)
• [B] Appendicitis(p. 365)
• [C] Perforated Peptic Ulcer(p. 387)
• [D] Gastrointestinal Bleeding(p. 389)
• 7.07 Abdominal Trauma(p. 396)
• [A] Blunt Abdominal Trauma: Assessment and Management(p. 396)
• [B] Penetrating Abdominal Wounds: Stab and Gunshot Wounds(p. 402)
• [C] Specific Abdominal Organ Injuries(p. 404)
• 7.08 The Standard of Care(p. 408)
• Chapter 8 Head and Spinal Injuries and Illnesses(p. 411)
• 8.01 Introduction(p. 413)
• 8.02 Relevant Anatomy(p. 413)
• [A] The Skull and the Vertebrae(p. 413)
• [B] The Central Nervous System(p. 414)
• [C] The Peripheral Nervous System(p. 417)
• [D] The Autonomic Nervous System(p. 418)
• 8.03 Head Injuries(p. 419)
• [A] Initial Care of the Head-Injured Patient(p. 420)
• [B] Diagnosis of Head-Injury: In General(p. 422)
• [C] Diagnostic Procedures(p. 427)
• [D] Head Injury: Pediatric Considerations(p. 429)
• [E] Mild Traumatic Brain Injury and Neuropsychiatric Evaluation(p. 430)
• [F] Skull Fractures(p. 433)
• [G] Cerebral Contusion and Concussion(p. 435)
• [H] Intracerebral Hematoma(p. 435)
• [I] Subdural Hematoma(p. 437)
• [J] Acute Epidural Hematoma(p. 439)
• [K] Decision to Admit the Conscious Patient to the Hospital(p. 441)
• 8.04 Spinal Injuries(p. 442)
• [A] Generally(p. 442)
• [B] Initial Evaluation and Management(p. 447)
• 8.05 Stroke(p. 453)
• [A] Role of CT Scan(p. 454)
• [B] Transient Ischemic Attack (TIA)(p. 458)
• [C] Anticoagulation to Prevent Stroke(p. 458)
• [D] Thrombolytic Therapy for Stroke(p. 460)
• [E] Current Recommendations for Thrombolytic and Antithrombotic Medications in Stroke(p. 462)
• 8.06 Seizures(p. 463)
• [A] Types of Seizures(p. 463)
• [B] Causes of Seizures(p. 464)
• [C] Clinical Features of Seizures(p. 466)
• [D] History and Physical(p. 467)
• [E] Diagnostic Procedures(p. 467)
• [F] Therapeutic Approach to Seizures(p. 469)
• [G] Drug Therapy of Status Epilepticus(p. 470)
• 8.07 Altered Mental Status(p. 471)
• [A] History and Physical(p. 473)
• [B] Diagnostic Tests(p. 474)
• [C] Treatment(p. 474)
• Chapter 9 Pediatric Emergencies(p. 477)
• 9.01 Pediatric Emergencies: In General(p. 479)
• 9.02 Anatomic Differences Between Children and Adults(p. 480)
• 9.03 Acute Bacterial Meningitis(p. 480)
• [A] Defined(p. 480)
• [B] History and Physical Examination(p. 483)
• [C] Diagnostic Tests(p. 487)
• [D] Treatment and Complications(p. 492)
• [E] Standard of Care Checklist(p. 499)
• 9.04 Epiglottitis(p. 501)
• 9.05 Diabetic Ketoacidosis(p. 503)
• [A] Causes of Diabetic Ketoacidosis(p. 504)
• [B] Assessment of the Patient with DKA(p. 505)
• [C] Laboratory Evaluation of the Patient with DKA(p. 505)
• [D] Emergency Treatment(p. 506)
• [E] Complications of Diabetic Ketoacidosis(p. 507)
• 9.06 Child Abuse(p. 507)
• 9.07 Febrile Seizures(p. 510)
• 9.08 Pediatric Trauma(p. 512)
• [A] Long-Term Sequelae Common(p. 513)
• [B] Common Causes of Pediatric Traumatic Injury(p. 515)
• [C] Differences Between Injured Children and Injured Adults(p. 517)
• [D] Seat Belt Injuries in Children(p. 518)
• [E] Need for Hospitalization(p. 519)
• 9.09 Pediatric Cardiac Arrest--Specific Differences(p. 519)
• Chapter 10 Obstetrical and Gynecological Emergencies(p. 521)
• 10.01 Introduction(p. 523)
• 10.02 Anatomy(p. 523)
• 10.03 Normal Delivery(p. 524)
• 10.04 Premature Labor(p. 525)
• 10.05 Ectopic Pregnancy: The Great Masquerader(p. 527)
• Case Study: Misdiagnosis of Ectopic Pregnancy(p. 527)
• 10.06 Pre-eclampsia and Eclampsia(p. 528)
• [A] Pre-eclampsia(p. 531)
• [B] Eclampsia(p. 533)
• 10.07 Placenta Previa(p. 534)
• 10.08 Abruptio Placenta(p. 536)
• Case Study: Failure to Diagnose Placental Abruption(p. 537)
• 10.09 Rupture of the Uterus(p. 537)
• 10.10 Sexual Assault: An Overview(p. 539)
• 10.11 Pelvic Inflammatory Disease(p. 540)
• Chapter 11 Musculoskeletal Emergencies(p. 543)
• 11.01 Introduction(p. 545)
• 11.02 Anatomy: The Skeletal System(p. 545)
• [A] Axial Skeleton(p. 545)
• [B] Appendicular Skeleton(p. 549)
• 11.03 Types of Injuries(p. 551)
• [A] Clinical Appearance of Fractures(p. 552)
• [B] X-ray Appearance of Fractures(p. 553)
• [C] Associated Injuries(p. 555)
• 11.04 Clinical Examination of Patients with Fractures(p. 556)
• [A] Clinical Features that Suggest Fracture(p. 556)
• [B] Clinical Investigation Checklist(p. 556)
• 11.05 Radiographic Examination of Patient(p. 558)
• [A] Errors in X-ray Interpretation(p. 558)
• 11.06 Principles of Fracture Treatment(p. 559)
• [A] Treatment of Uncomplicated Closed Fractures(p. 560)
• [B] Treatment of Open Fractures(p. 560)
• 11.07 Complications of Fractures(p. 562)
• [A] Complications Relating to Fracture Itself(p. 562)
• [B] Complications Relating to Associated Injury(p. 563)
• 11.08 High-Risk Fractures(p. 568)
• [A] Colles' Fracture(p. 568)
• [B] Navicular Fracture(p. 570)
• [C] Pelvis Fracture(p. 575)
• [D] Femur Fracture(p. 579)
• 11.09 Standard of Care(p. 581)
• [A] If in Doubt, Splint and Refer(p. 581)
• [B] Importance of Follow-up(p. 582)
• [C] Make No Guarantees(p. 582)
• 11.10 Pediatric Fractures(p. 582)
• [A] Treatment of Pediatric Fractures(p. 583)
• [B] Be Alert for Child Abuse(p. 583)
• Chapter 12 Emergency Management of Wounds and Burns(p. 585)
• 12.01 Types of Open Wounds(p. 587)
• 12.02 Principles of Wound Care(p. 588)
• [A] Control Hemorrhage (Bleeding)(p. 589)
• [B] Careful Inspection of the Wounded Area(p. 589)
• [C] Cleaning the Wound(p. 591)
• [D] Anesthetizing the Wound(p. 592)
• [E] Wound Closure(p. 593)
• [F] Wound Dressing(p. 595)
• [G] Tetanus Prophylaxis(p. 595)
• [H] ACEP Clinical Policy on Penetrating Extremity Trauma(p. 595)
• [I] ACEP Guidelines for Pediatric Conscious Sedation(p. 596)
• 12.03 Specific Complications Associated with Wounds(p. 596)
• Case Study: Negligent Treatment of Wound Resulting in Tetanus or Infection(p. 602)
• Case Study: Failure to Diagnose Glass in Wound(p. 603)
• 12.04 Treatment of Gunshot and Stab Wounds(p. 604)
• [A] History(p. 605)
• [B] Gunshot Wounds(p. 607)
• [C] Shotgun Wounds(p. 610)
• [D] Stab Wounds(p. 611)
• 12.05 Burn Assessment(p. 613)
• [A] Extent of Burned Surface(p. 614)
• [B] Depth of the Burn(p. 614)
• [C] Burn Severity(p. 618)
• [D] Respiratory Tract Burns(p. 619)
• 12.06 Thermal Burns(p. 619)
• [A] Pre-hospital Care for the Patient with Thermal Injury(p. 620)
• [B] Hospital Care for the Victim of Thermal Injury--Initial Priorities(p. 621)
• [C] Intravenous Fluid Replacement Essential(p. 621)
• [D] Detection and Treatment of Impaired Circulation in Circumferential Burns(p. 622)
• [E] Other Treatment Modalities(p. 623)
• [F] Burn Center Referral(p. 623)
• 12.07 Chemical Burns(p. 624)
• 12.08 Electrical/Lightning Burns(p. 625)
• [A] Patient Assessment(p. 627)
• [B] Care of the Patient with Electrical or Lightning Burns(p. 627)
• Chapter 13 Genitourinary Emergencies(p. 629)
• 13.01 Introduction(p. 631)
• 13.02 Anatomy(p. 631)
• [A] Reproductive Systems(p. 631)
• [B] The Urinary System(p. 634)
• 13.03 Urinary Tract Infection(p. 634)
• [A] Generally(p. 634)
• [B] Urinary Tract Infection in High-Risk Patients(p. 636)
• 13.04 Pyelonephritis(p. 637)
• 13.05 Prostatitis(p. 639)
• 13.06 Acute Epididymitis(p. 640)
• 13.07 Torsion of the Testicle(p. 641)
• Case Study: Failure to Diagnose Torsion of the Testicle(p. 643)
• 13.08 Acute Urinary Retention(p. 644)
• 13.09 Genitourinary Injuries(p. 647)
• [A] Renal Trauma(p. 647)
• [B] Bladder Injuries(p. 649)
• [C] External Genital Injuries(p. 650)
• Appendix Glossary of Terms(p. 653)
• Table of Cases(p. 669)
• Index(p. 675)