Lec 1- intro Flashcards
(20 cards)
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
DMC -what is it
the right to accept, reject, w/d consent for tx
must be determined by the MD
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
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
components of informed consent
- The condition requiring tx/procedure
- Description (name), purpose of the tx
- Potential complications, “material risks”
- Benefits, chances of success
- Risks of failing to do it/have it
- Alternatives: risks and benefits of those too
- Identity of who will do it/administer it
- Documentation – consent form/signature/witness/date/time
what are the rules around minors
- Unless emergent, parental/guardian consent required
- Treatment initiated until consent obtainable
- Cannot refuse tx if parent consents
- Can consent for themself if are an emancipated minor
unless emancipated
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
b. EMTALA an exceptions
- 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
- Pt can request transfer before stabilization
- If benefits of transfer outweigh the risk of transfer (higher level of care)
Mandated Reporting
- Suspected child, elder, or domestic violence
- Felonious assaults and sexual assaults
- Serious dog bites
- Certain contagious diseases
- Diseases causing impairment of driving
To local police
To Public Health dept
To DMV
signs of decrease in cerebral profusion (5)
anxiety dizziness aloc syncope coma
decrease in cardiac profusion signs . (4)
chest pain
pulmonary edema
arrhythmias
what is disability sick (6)
ALOC acute paralysis or neglect significant mechanism trauma focal weakness head injury active seizures
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
is DMC the same thing as competence? why not
it is not because competence is a legal term
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
AMA need to be signed by
an MD
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
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)
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
how to rule out cardiac etiology
low suspicion of ACS based on normal ekgs and troponin
