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Arnor Rae Bersamina Section 4 Group A

RISK MANAGEMENT IN A PEDIATRIC EMERGENCY ROOM.

Pediatricians who work in an emergency room are more likely to be sued than general
pediatricians. To identify factors that increase liability, these authors profiled 12 years of
experience at a Midwestern children's hospital.
Out of 320,000 visits, 25 malpractice claims were identified, but only 22 charts were available for
review. Of these 22 cases, 10 of the patients had private insurance, five had state public aid, and
seven had no insurance. Ten patients (46 percent) returned at least once more for the same
problem, and all had their diagnoses changed. Ten patients were seen between midnight and 8
a.m., a shift staffed only by a second-year resident. For comparison, the authors estimate that 2
percent of pediatric patients return to the emergency room and that 8 percent of all emergency
department visits occur between midnight and 8 a.m. No single diagnosis was overrepresented.
Sixteen of the suits were for failure to diagnose, and six were for inappropriate treatment.
To reduce the risk of a malpractice claim, the authors suggest that there be around-the-clock
supervision by an attending physician, and that a child's return visit for the same problem be
regarded as a special risk.

Reaction:

Malpractice happens everywhere especially when people or professionals don’t have the passion
in their line of work. Everyone involved in medical practice should join hands together in
preventing this kind of malpractices. Everyone should do their part to make a difference.
Reinchie An Cabrera Section4 Group A

Stress Testing in the Emergency Room.

A major challenge in the evaluation of patients presenting to emergency rooms with


chest pain is the rapid and accurate identification of low-risk patients who can be safely
managed on a conservative, outpatient basis. Recently, performance of exercise testing
in the emergency room has emerged as a possible way to do this. In this study, Harvard
investigators evaluated 276 patients who presented with chest pain, had an exercise
treadmill test within 48 hours, and had no clinical characteristics (such as rales,
hypotension, or severe pain) that would place them at higher risk.
Most patients were tested with the Bruce protocol. One hundred ninety-five patients had
negative tests, defined as the achievement of at least 3 METs of exercise and the
absence of ischemic ECG changes. Patients with negative tests tended to be younger
and to have benign-appearing baseline ECGs. During six months of follow-up, major
events (MI, PTCA, or CABG) were extremely infrequent among patients with negative
tests (only 2 percent versus 15 percent among those with positive tests). None of the
patients died. Patients with negative tests were also less likely to have repeat
emergency room visits (17 percent vs. 29 percent) and to be readmitted to the hospital
(12 percent versus 31 percent).

Reaction:
These data suggest that exercise treadmill testing, when combined with a history
and physical exam, can safely and accurately identify patients at very low risk for major
events during a short period of follow-up. These patients can be discharged from a
monitored environment reasonably quickly, with further management taking place on an
outpatient basis.
Reinchie An Cabrera Section4 Group A

Emergency Room Physicians Often Misjudge Patients' Pain

AORN Journal, Oct, 2009

Physicians do not always accurately judge whether anesthesia is needed for painful,

frequently performed emergency room procedures, according to a recent study in the

June 2009 issue of Annals of Emergency Medicine. Researchers at the State University

of New York, Stony Brook, evaluated more than 1,100 emergency room procedures and

asked the patients and physicians involved to assess the level of pain associated with

the 15 most common procedures. They found the correlation between patient and

practitioner pain assessments in individual patients to be poor to fair.

Although both patients and physicians identified nasogastric intubations, abscess

drainages, fracture reductions, and urethral catheterizations as the most painful of

emergency room procedures, their views differed as to whether anesthetics are needed

before these procedures. Physicians administered local anesthetics in 12.8% of the

procedures, yet 17.1% of the patients--those who gave higher pain scores--stated that

they would definitely request anesthetics if they were to undergo similar procedures in

the future. Researchers conclude that physicians should be sensitive to their patients'

individual anesthetic needs before performing painful procedures.

Reaction:

Physicians are being entrusted with a lot of responsibilities and have to live with it. They

should accept that everything if not almost everything is in their hands when it comes to

the life of the patients they handle. It is sad to know that often misjudged according to

studies the pain scores of patient to the emergency room. There is no excuse for that

wrong judgement. Every patient is entrusting their life to them so they should really work

hard to gain that trust.


Cecil Ann B. Cruz
Section4- group A
Electrocardiography
From Wikipedia, the free encyclopedia

Electrocardiograph (ECG, or EKG [from the German Elektrokardiogramm]) is a transthoracic


interpretation of the electrical activity of the heart over time captured and externally recorded by
skin electrodes. It is a noninvasive recording produced by an electrocardiographic device. The
etymology of the word is derived from the Greek electro, because it is related to electrical activity,
cardio, Greek for heart, and graph, a Greek root meaning "to write". In English speaking
countries, medical professionals often write EKG (the abbreviation for the German word
elektrokardiogramm) in order to avoid confusion with EEG.

The ECG works mostly by detecting and amplifying the tiny electrical changes on the skin that are
caused when the heart muscle "depolarizes" during each heart beat. At rest, each heart muscle
cell has a charge across its outer wall, or cell membrane. Reducing this charge towards zero is
called de-polarization, which activates the mechanisms in the cell that cause it to contract. During
each heartbeat a healthy heart will have an orderly progression of a wave of depolarization that is
triggered by the cells in the sinoatrial node, spreads out through the atrium, passes through
"intrinsic conduction pathways" and then spreads all over the ventricles. This is detected as tiny
rises and falls in the voltage between two electrodes placed either side of the heart which is
displayed as a wavy line either on a screen or on paper. This display indicates the overall rhythm
of the heart and weaknesses in different parts of the heart muscle.

Usually more than 2 electrodes are used and they can be combined into a number of pairs (For
example: Left arm (LA), right arm (RA) and left leg (LL) electrodes form the pairs: LA+RA, LA+LL,
RA+LL). The output from each pair is known as a lead. Each lead is said to look at the heart from
a different angle. Different types of ECGs can be referred to by the number of leads that are
recorded, for example 3-lead, 5-lead or 12-lead ECGs (sometimes simply "a 12-lead"). A 12-lead
ECG is one in which 12 different electrical signals are recorded at approximately the same time
and will often be used as a one-off recording of an ECG, typically printed out as a paper copy. 3-
and 5-lead ECGs tend to be monitored continuously and viewed only on the screen of an
appropriate monitoring device, for example during an operation or whilst being transported in an
ambulance. It is the best way to measure and diagnose abnormal rhythms of the heart,
particularly abnormal rhythms caused by damage to the conductive tissue that carries electrical
signals, or abnormal rhythms caused by electrolyte imbalances. In a myocardial infarction (MI),
the ECG can identify if the heart muscle has been damaged in specific areas, though not all
areas of the heart are covered. The ECG cannot reliably measure the pumping ability of the
heart, for which ultrasound-based (echocardiography) or nuclear medicine tests are used. It is
possible to be in cardiac arrest with a normal ECG signal (a condition known as pulse less
electrical activity)

Reaction:

Electrocardiograph is a transthoracic interpretation of the electrical activity of the heart


over time captured and externally recorded by skin electrodes. It is a noninvasive recording
produced by an electrocardiographic device. It is a noninvasive recording produced by an
electrocardiographic device.

It is use to determine the activity of the heart and other abnormal that the heart may do. It
is a simple procedure that needs knowledge and skills. It is always use in the emergency room
and other hospital setting to those that needs to monitor the heart activity. It has lead that needs
to put into the skin in order to get a result that form into a graph.
Karlo Angelo S. Barcelona
07-1-66008

But is it really an emergency? When to take a child to the ER

Naomi Zikmund-Fisher says her son's life was saved by her maternal instincts -- and her son's
flat ears.
One Friday night in May, Zikmund-Fisher looked across the dinner table at 3-year-old Jesse and
noticed that his right ear, which usually lies close to his head, was sticking out. She went over to
check it out and found a big red lump behind the ear.
She e-mailed her pediatrician, who said that it was probably just a mosquito bite and that as long
as Jesse otherwise felt fine, not to worry about it.
esse did otherwise feel fine, but something set off Zikmund-Fisher's "mommy meter." So the next
day, even though nothing had changed, she called the pediatrician's office and spoke to the
nurse.
"She told me, 'If you're worried about it, take him to urgent care,' " Zikmund-Fisher remembered.
Her husband took Jesse to the emergency room, and doctors determined that he had a classic
case of mastoiditis: an infection of the mastoid bone, just behind the ear. If not treated with
antibiotics, mastoiditis can be deadly.
Now Zikmund-Fisher tells other parents to trust their instincts and act, even when a pediatrician
tells them not to worry.
"It just didn't seem right to me," she said. "It just seemed like, if this was a mosquito bite, it would
have gone away, and this wasn't going away."
Dr. Assaad Sayah, chief of emergency medicine for the Cambridge Health Alliance in
Massachusetts, agrees that parents should use their instincts when deciding whether their child
needs quick medical attention.
"'When in doubt, bring them in' should be your first line of defense," he said. "If they don't look
right to you, call your pediatrician, or take them to the emergency department, and if they look
very sick, call 911."
Although relying on instinct is a good guideline, there are also some cut-and-dry situations when
a parent really should to take a child to the ER. Here are five examples.
1. Neck stiffness or rash with fever
According to the American College of Emergency Physicians, these symptoms could constitute
an emergency because they might mean meningitis.
2. Fever in a newborn
Any child 3 months old or younger who has a temperature over 100.4 F needs to be seen by a
doctor, says Dr. Jennifer Shu, spokeswoman for the American Academy of Pediatrics. The fever
can be a sign of infection or meningitis.
3. Head injury with loss of consciousness, confusion, headache or vomiting

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