Annals of emergency medicine
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We determine the feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves, performed by emergency physicians, to provide procedural anesthesia of the hand in the emergency department (ED). ⋯ Attending physicians, fellows, and residents can perform forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves quickly, without additional anesthesia and with high patient satisfaction, after minimal training. Although pilot data are suggestive, randomized controlled trials are needed to determine efficacy and safety. Ultrasonography-guided nerve blocks to provide anesthesia for hand procedures appear to be feasible in the ED.
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Gifts to physicians by the pharmaceutical industry pose numerous ethical questions. Although individual patients and physicians may benefit financially and educationally from certain gifts, the risk of bias resulting from such gifts makes them ethically challenging. ⋯ We then review the development of guidelines by professional societies, trade organizations, and government agencies. We conclude with a list of summary recommendations designed to help individual physicians, educators, and administrators engage in careful reflection and analysis and make sound ethical decisions about acceptance of gifts.
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Error in medicine is a subject of continuing interest among physicians, patients, policymakers, and the general public. This article examines the issue of disclosure of medical errors in the context of emergency medicine. It reviews the concept of medical error; proposes the professional duty of truthfulness as a justification for error disclosure; examines barriers to error disclosure posed by health care systems, patients, physicians, and the law; suggests system changes to address the issue of medical error; offers practical guidelines to promote the practice of error disclosure; and discusses the issue of disclosure of errors made by another physician.