Medical Legal and Ethical Medical Legal and Ethical IssuesIssues

Dr. Abdul-Monim BatihaDr. Abdul-Monim BatihaAssistant ProfessorAssistant ProfessorCritical Care NursingCritical Care Nursing

Philadelphia University Philadelphia University

Medical Legal and Medical Legal and Ethical IssuesEthical Issues

IntroductionIntroduction-:-:

A basic principle of emergency care is A basic principle of emergency care is to do no further harm, any health care to do no further harm, any health care provider who acts in good faith and provider who acts in good faith and according to an appropriate standard of according to an appropriate standard of care usually avoids legal exposurecare usually avoids legal exposure..

Medical Legal and Ethical Medical Legal and Ethical IssuesIssues

1-Scope of practice, which is most 1-Scope of practice, which is most commonly defined by law, requires commonly defined by law, requires you to act or behave toward other you to act or behave toward other individual in a certain, definable individual in a certain, definable way, regardless of the activity way, regardless of the activity involve ,so you must be concerned involve ,so you must be concerned about the safety and welfare of about the safety and welfare of others.others.

2-Standard of care: - is a written, 2-Standard of care: - is a written, accepted level of emergency care accepted level of emergency care expected by legal or professional expected by legal or professional organizations so that patients are organizations so that patients are not exposed to unreasonable risk of not exposed to unreasonable risk of harm.harm.

Negligence: - is the failure to Negligence: - is the failure to provide the same care that a provide the same care that a person with similar training would person with similar training would provide it is deviation from provide it is deviation from accepted standard of care that may accepted standard of care that may result in injury to patient.result in injury to patient.

Abandonment is the unilateral Abandonment is the unilateral termination of care by the first aider termination of care by the first aider without the patient's consent and without the patient's consent and without making any provisions for without making any provisions for continuing care.continuing care.

Abandonment is the unilateral Abandonment is the unilateral termination of care by the first aider termination of care by the first aider without the patient's consent and without the patient's consent and without making any provisions for without making any provisions for continuing care.continuing care.

Consent: - Granting permission to Consent: - Granting permission to another to render care. Consent is another to render care. Consent is required from every conscious, required from every conscious, mentally competent adult before mentally competent adult before care be started.care be started.

Expressed consent: Is the type of Expressed consent: Is the type of consent in which the patient consent in which the patient expressly authorizer you to provide expressly authorizer you to provide care or transport care or transport

Implied (indirect) consent: - When a Implied (indirect) consent: - When a person is unconscious and unable to person is unconscious and unable to give consent or when a serious give consent or when a serious threat to life exists, the law threat to life exists, the law assumes that the patient would assumes that the patient would consent to care and transport to consent to care and transport to medical facility.medical facility.

Notes:Notes: Minors (infants and children) Minors (infants and children) and mentally incompetent adults are and mentally incompetent adults are unable to signs a consent.unable to signs a consent.

Ethical principleEthical principle

Ethics are related to moral actions Ethics are related to moral actions conduct, motive or character, ethics conduct, motive or character, ethics are related to what the profession of are related to what the profession of emergency medical service providers emergency medical service providers deems (thinks) right, so treating a deems (thinks) right, so treating a patient ethically means doing so in a patient ethically means doing so in a manner that conforms the manner that conforms the professional standards of conduct.professional standards of conduct.

Ethical principleEthical principle::

Caring for all patients with a sense of Caring for all patients with a sense of excellence (quality), so you must excellence (quality), so you must strive to be at your best at all times.strive to be at your best at all times.

Improve your performance through Improve your performance through hand-on experience and continuing hand-on experience and continuing education.education.

Honest reporting is essential which Honest reporting is essential which important for quality improvement.important for quality improvement.

Confidentiality: communication Confidentiality: communication between you and the patient is between you and the patient is considered confidential and cannot considered confidential and cannot be disclosed without permission be disclosed without permission from the patient or a court order from the patient or a court order

Records and report is essential.Records and report is essential.

Base line vital signsBase line vital signs

** Introduction:-Introduction:- Vital signs are an important element of the Vital signs are an important element of the

assessment process, they are indictors of assessment process, they are indictors of the patients present condition , baseline the patients present condition , baseline vital signs includes:vital signs includes: Respiration.Respiration. Pulse.Pulse. Blood pressure.Blood pressure. Body temperature.Body temperature.

Other key indications of the patientOther key indications of the patient’’s s respiratory, cardiovascular and respiratory, cardiovascular and central nervous system are:-central nervous system are:-Capillary refill Capillary refill Papillary reaction Papillary reaction Level of consciousnessLevel of consciousness

Body temperatureBody temperature-:-:

1-1-It reflect the balance between the It reflect the balance between the heat produced and the lost from the heat produced and the lost from the body, the average body temp of an body, the average body temp of an adult is between ( 36.7-37c) . There adult is between ( 36.7-37c) . There are four common sites for measuring are four common sites for measuring body temperature.body temperature.

Oral routeOral route-:-:

Most accessible and convenient and Most accessible and convenient and contra indicated forcontra indicated for

Children under 6 yrs of ageChildren under 6 yrs of age For patients who are confusedFor patients who are confused For patients who have convulsive For patients who have convulsive

disordersdisorders For patients following oral surgery.For patients following oral surgery.

Rectal routeRectal route

most reliable (accurate).most reliable (accurate). Contra indicated following: Contra indicated following:

rectal surgery. rectal surgery. newborn babies.newborn babies.

patient with diarrhea patient with diarrhea

Axillary routeAxillary route-:-:

Safest and non invasive Safest and non invasive

Tympanic routeTympanic route-:-:

Readily accessible very fast.Readily accessible very fast.

RespirationRespiration::

2-2-Breathing is continuous Breathing is continuous process in which each breath process in which each breath regularly follows the last with no regularly follows the last with no notable interruption, else it is notable interruption, else it is normally spontaneous automatic normally spontaneous automatic process that occurs with out process that occurs with out conscious thought, visible effort , conscious thought, visible effort , marked sounds or pain, marked sounds or pain,

You will assess breathing by You will assess breathing by watching the patientwatching the patient’’s chest rise s chest rise and fall, you must determine and fall, you must determine thethe-:-:

Rate:-Rate:-Are determined by counting the number Are determined by counting the number

of breath per a minute normal of breath per a minute normal respiratory rate varies according to age.respiratory rate varies according to age.

Newborn 30-60c/m Newborn 30-60c/m 2 yrs 20-30 2 yrs 20-30 c/mc/m

6 yrs 18-26 c/m Adult 12-20 c/m6 yrs 18-26 c/m Adult 12-20 c/m

qualityquality -: -:

Normal Normal Breathing is neither shallow nor deepBreathing is neither shallow nor deep

Average chest wall motion Average chest wall motion No use of accessory musclesNo use of accessory muscles

ShallowShallow

Slight chest or abdominal wall motionSlight chest or abdominal wall motionLabored Increased breathing effort Labored Increased breathing effort

Grunting, stridor Grunting, stridor Use of accessory muscles possible Use of accessory muscles possible

gaspinggasping Nasal flaring, supraclavicular and Nasal flaring, supraclavicular and

intercostals intercostals retractions in infants and childrenretractions in infants and children

NoisyNoisy

Increase in sound of Increase in sound of breathing, including snoring, breathing, including snoring, wheezing wheezing

RhythmRhythm-:-:

regular or irregular.regular or irregular. Depth :- shallow Depth :- shallow

3-3- PulsePulse

A wave of blood created by A wave of blood created by contraction of the left ventricles contraction of the left ventricles of the heart, the heart is of the heart, the heart is pulsating pump and the blood pulsating pump and the blood enter the arteries with the heart enter the arteries with the heart beat causing pulse wave. You beat causing pulse wave. You must assess the rate, strength must assess the rate, strength and regularity of the pulse.and regularity of the pulse.

pressurepressure

Arterial blood pressure is define Arterial blood pressure is define as a measure or the pressure as a measure or the pressure exerted by the blood as it flows exerted by the blood as it flows through the arteries there are 2 through the arteries there are 2 blood pressure measures:-blood pressure measures:-

Systolic pressureSystolic pressure-:-:

Is the pressure of the blood as a Is the pressure of the blood as a result of contraction of the result of contraction of the ventricles.ventricles.

Diastolic pressureDiastolic pressure-:-:

Is the pressure when the ventricles Is the pressure when the ventricles are at rest.are at rest.

The average blood pressure of a The average blood pressure of a healthy adult is 120/80 mm Hg.healthy adult is 120/80 mm Hg.

Hypertension:- is abnormally high Hypertension:- is abnormally high blood pressure over 140 mm Hg blood pressure over 140 mm Hg systolic and 90 mm Hg diastolic.systolic and 90 mm Hg diastolic.

Hypotension:- Is abnormally low Hypotension:- Is abnormally low blood pressure below 100 mm Hg blood pressure below 100 mm Hg systolic and 60 mm Hg diastolic.systolic and 60 mm Hg diastolic.

Level of consciousnessLevel of consciousness..

Is considered a vital sign because the Is considered a vital sign because the status of the respiratory, status of the respiratory, cardiovascular and central nervous cardiovascular and central nervous system are reflected by it.system are reflected by it.

TheThe GLASGOW COMA SCALEGLASGOW COMA SCALE-; -;

is a method of assessing a patientis a method of assessing a patient’’s s level of consciousness by scoring the level of consciousness by scoring the patient response to eye opening, patient response to eye opening, motor response and verbal motor response and verbal response . An assessment totaling 15 response . An assessment totaling 15 points indicates the client is alert and points indicates the client is alert and completely oriented . A comatose completely oriented . A comatose client scores 7 or less. see the figure.client scores 7 or less. see the figure.

PupilsPupils

The diameter of the pupils reflects the The diameter of the pupils reflects the status of the brains perfusion, oxygenation status of the brains perfusion, oxygenation and condition the pupils are normally and condition the pupils are normally rounded and approximately equal size.rounded and approximately equal size.

The letters PEARRAL stand for the following. The letters PEARRAL stand for the following. P = pupilsP = pupils E= EqualE= Equal A= AndA= And R= RoundR= Round R= Regular in sizeR= Regular in size L= React to lightL= React to light