J Emerg Med
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Emergency medicine is a high-risk specialty that carries a constant risk of malpractice litigation. Fear of malpractice litigation can lead to less-than-optimal patient care as well as impairments in physician quality of life. Although malpractice fear can be ubiquitous among emergency physicians, most receive little to no education on malpractice. ⋯ These legal defenses are illustrated and explained using defining precedent cases as well as hypothetical examples that are directly applicable to emergency medical practice. Knowledge of these special legal defenses can help emergency physicians minimize their risk of litigation when caring for patients.
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Massive pulmonary embolism (PE) is a common consideration in unstable patients presenting to the emergency department (ED) with chest pain, dyspnea, or cardiac arrest. It is a potentially lethal condition necessitating prompt recognition and aggressive management. Conventional diagnostic modalities in the ED, including chest computed tomography angiography and ventilation-perfusion scanning, require the unstable patient to leave the department, and raise concerns over renal injury. Several case reports document findings of massive PE on echocardiography performed in the ED; however, none was performed, interpreted, and acted upon in the form of thrombolytic therapy by an emergency physician without the additional benefit of a cardiologist's interpretation or a confirmatory imaging study. ⋯ In the hands of an experienced emergency physician ultrasonographer, ED focused bedside echocardiography provides a safe, rapid, and non-invasive diagnostic adjunct for evaluation of the patient suspected of having massive PE.
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Ectopic breast tissue is a rare occurrence in pregnant women and should not be confused with abscess or other causes. Ectopic breast tissue is present at birth but often only diagnosed after puberty, pregnancy, or lactation. ⋯ Surgical removal for the purpose of prophylaxis of malignant changes is not currently recommended. Definitive diagnosis is established by fine-needle aspiration and excisional biopsy.
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Although rare, cervical ectopic pregnancy (EP) represents a potentially lethal variation of a common first-trimester disease entity. ⋯ Familiarity with cervical EP and its sonographic appearance is essential for emergency physicians because it can be easily mistaken for an intrauterine pregnancy or other obstetric/gynecologic pathology, such as an incomplete abortion or nabothian cyst. The management of each of these differs substantially, making accurate diagnosis crucial.
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Wait times and patient satisfaction are important administrative metrics in emergency departments (EDs), as they are critical to return patronage, liability, and remuneration. Although several factors have been shown to impact patient satisfaction, little attention has been paid to understanding the psychology of waiting and patient satisfaction. ⋯ Interventions to decrease perception of wait times and increase the perception of service being provided, when combined with management of patient expectations, can improve patient satisfaction.