Assess capacity. Prioritise clinical assessment. Detain under Mental Capacity Act if lacking capacity and risk to self. Police Section 136 in ED if need to detain longer.
A teenager presents to your emergency department after a suspected acid attack sustained near their school. They are distressed with severe burning pain, facial and upper body chemical burns and contaminated clothing.
To follow on from the RCEMLearning blogs on Bullying in the ED and Undermining in the ED, we will move on to an unwanted behaviour that is less subtle.
A 44-year-old male collapses and is subsequently brought into Resus. He presents with sudden-onset chest tightness and sweating, preceded by progressive shortness of breath over the past 24 hours.
A 50-year-old male presents with painful Horner's syndrome. The initial CT scan is reported as normal, and stroke consultant suggests discharge, creating a challenge in clinical reasoning and professional advocacy.
Bullying is something that an unacceptably high number of healthcare workers will experience. Despite priding itself in being a friendly specialty with a flattened hierarchy, those working in emergency medicine, too, report experiencing bullying.
A 60-year-old patient presents to the ED with a leaking ambulatory chemotherapy pump. The chemotherapy helpline is unreachable, and staff must manage a potential cytotoxic spill safely.
A 34-year-old man presents to the ED with a red and painful left eye that is worsening over the past two days. He reports photophobia, blurred vision but no discharge.
The idea of “normalisation of deviance” is the brainchild of an American sociologist, Diane Vaughan, who thought that essentially people become used to accepting deviant behaviour as normal practice, the more it occurs.
It’s Friday evening and you’re at work in the ED (where else would you rather be??). Jack is a 15-year-old boy who has taken an overdose of paracetamol a couple of hours ago. He texted his girlfriend soon after and she called an ambulance.
The baby looks well at first, nothing really worrying - but he has been crying for last 2 days, which is unusual for him. His mother`s concern leads us to a serious diagnosis.
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Incivility in the Emergency Department