Lec 1- intro Flashcards Preview

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Flashcards in Lec 1- intro Deck (20):
1

definition of implied consent

injury that threatens life and limb in the presence of

LOC, metal status change, acute psychosis, dementia severe intoxication language barrier

2

DMC -what is it

the right to accept, reject, w/d consent for tx
must be determined by the MD

3

DMC-what is it based on

must have mental capacity to understand information
must be able to evaluate and deliberate the info
must relaize condition present and suggest tx
must be able to present a choice and reasons for that choice
must consider LOC orientation or vital signs
MMSE
must consider language and personal values

4

how do you evaluate the if pts understand the consequences

what do you think is wrong with you
how will the tx suggested affect you
what will happen if you refuse
how will the benefits/risks of tx affect your life
help me understand how you reached this decision
what makes the treatment worse than no treatment
what can i do to help you get the tx needed

5

components of informed consent

1. The condition requiring tx/procedure
2. Description (name), purpose of the tx
3. Potential complications, “material risks”
4. Benefits, chances of success
5. Risks of failing to do it/have it
6. Alternatives: risks and benefits of those too
7. Identity of who will do it/administer it
8. Documentation – consent form/signature/witness/date/time

6

what are the rules around minors

1. Unless emergent, parental/guardian consent required
2. Treatment initiated until consent obtainable
4. Cannot refuse tx if parent consents
5. Can consent for themself if are an emancipated minor

unless emancipated

7

AMA should involve

i. Anyone with DMC can leave AMA at any time
ii. Not good - inform supervising MD immediately
iii. Discuss pt concerns, reasons, how can we help
1. Basically, assess DMC
2. No DMC? Should not be allowed to leave or sign AMA form
iv. Discuss risks, alternatives
v. Involve family, friends, social services, clergy, etc
vi. AMA form – signed by MD, witnessed
1. PAs cannot sign the form
vii. Specific return precautions, f/u plan, document. Provide tx when possible, act as their advocate even if they are making a bad decision

PT VOICES UNDERSTANDING

8

b. EMTALA an exceptions

1. Any person presenting to an ED must have a “medical screening exam” to determine if an emergency exists, regardless of ability to pay

Emergency Treatment and Active Labor Act ‘86

Exceptions
1. Pt can request transfer before stabilization
2. If benefits of transfer outweigh the risk of transfer (higher level of care)

9

Mandated Reporting

1. Suspected child, elder, or domestic violence
2. Felonious assaults and sexual assaults
3. Serious dog bites
4. Certain contagious diseases
5. Diseases causing impairment of driving
To local police
To Public Health dept
To DMV

10

signs of decrease in cerebral profusion (5)

anxiety
dizziness
aloc
syncope
coma

11

decrease in cardiac profusion signs . (4)

chest pain
pulmonary edema
arrhythmias

12

what is disability sick (6)

ALOC
acute paralysis or neglect
significant mechanism trauma
focal weakness
head injury
active seizures

13

what is the difference between direct and implied consent

direct is expressed in registration form and

implied is when the injury threatens life or limb

AND pt can't comprehend due to LOC mental status change acute psychosis dementia, severe intoxication or language barrier

14

is DMC the same thing as competence? why not

it is not because competence is a legal term

15

who is considered an emancipated minor

anyone pregnant
married
emancipated and supporting themselves
active military
requesting sexual abuse servise
STI
mental health support
substance abuse services

16

AMA need to be signed by

an MD

17

how doeas a 5150 work

does not allow you to treat someone unless they do not have DMC

then they can be sedated and treated but you can not sedate in order to treat

18

what are the RF for errors in the ED as far as pts go

age extremes and medications
psych nor intoxicated pts becasue of poor hx and f/u
language
cognitive diminished (tired )
just fallowing orders (inexperienced)

19

provider RF

anchoring-decide on dx early and stick to it

confirmation bias - follow hunch even though the hypothesis is weak

diagnostic momentum-establishing a dx without adequate evidence to match that dx

20

how to rule out cardiac etiology

low suspicion of ACS based on normal ekgs and troponin