Source: Jonathan C. Reiter: According to the Centers for Disease Control and Prevention (CDC), there are 145.6 million emergency room visits in the United States each year. In most cases, emergency room personnel perform life-saving measures and invaluable care for those who need it.
Unfortunately, not every ER visit unfolds as expected. In certain situations, a patient may be injured due to a doctor’s negligence or a nurse’s mistake. In other cases, a hospital’s error may lead to a patient injury.
When a patient sustains injuries or harm due to a mistake in the emergency room, a person may feel overwhelmed and intimidated by the hospital staff or administrators. It’s normal for a patient to feel confused and anxious after receiving an incorrect diagnosis or below standard care in the ER.
Stroke Diagnosis in the Emergency Room
There are two basic types of “stroke. ” An “ischemic stroke” occurs when a blood clot or plaque blocks one of the arteries that feeds the brain. The clot can arise from a distant source, such as the heart or other blood vessel, in which case it is called an embolic stroke; or it can arise in an an artery in the brain itself. A hemorrhagic stroke occurs when a blood vessel in the brain bursts. Both types of strokes can cause serious disability and death.
When a patient is brought to an Emergency Room with the signs and symptoms of a possible stroke, time is of the essence in making the proper diagnosis and initiating treatment. It is important for the Emergency Room triage nurse to recognize the urgency of the situation and make sure that the patient is seen promptly by a physician. The physician must obtain a history from the patient (or family member etc.) as to when the symptoms first occurred. The next step is to obtain a CT scan of the brain to see whether there are signs of a hemorrhagic stroke, because hemorrhage typically shows up on a CT scan soon after it occurs. By contrast, in the event of an ischemic stroke, the CT scan may initially look normal, because the signs of ischemia have not yet become apparent. In that case, the physician must make the diagnosis of ischemic stroke based upon the patient’s signs, symptoms and physical examination.
Many major hospitals have a stroke team, composed of specially trained neurologists, interventional neuroradiologists, neurosurgeons and other personnel. Smaller hospitals may not have a stroke teams, but are still obliged to have a neurologist on call to the emergency room.
Treatment of Ischemic Stroke in the Emergency Room and Beyond
The most important treatment available for ischemic stroke is the drug tPA, also known as “clot buster”. This drug can be administered intravenously to a stroke victim within 4 hours from the onset of the stroke. This drug has revolutionized stoke treatment, because it can dissolve clots in the brain and restore blood flow, thus providing needed oxygen and nutrients to the affected area of the brain. Another treatment option is a procedure called thrombectomy, in which a specially trained neuroradiologist mechanically removes clot with special instruments. This procedure should be performed within 6 hours after onset of symptoms in the case of stroke in the front (anterior) part of the brain, and 12 hours in the case of stroke involving the back (posterior) part of the brain to obtain maximum benefit. This procedure can be combined with catheter delivered tPA, which puts the clot busting drug directly into the clotted artery. These specialized procedures need to be performed in the neuroradiology suite of the hospital. If they are not available in a smaller hospital, the patient needs to be promptly transferred to a major stroke center hospital. These procedures have the ability to reverse or reduce the adverse effects of ischemic stroke, prevent long term disability, and in many cases, to save the life of the patient. They are not indicated for treatment of a hemorrhagic stroke because they can make the hemorrhage worse.
If the hospital fails to properly diagnose the stroke, or fails to timely treat the patient with tPA, or fails to transfer the patient to a stroke center hospital for more advanced treatment, the hospital may be liable for medical malpractice in causing the patient’s death or serious disability. Time is critical in treating stroke, because the window for successful treatment is short. If the hospital is negligent and that window expires without the initiation of proper treatment, the hospital may be liable for malpractice.
Can a Hospital Emergency Room Turn a Patient Away?
Generally, hospital emergency rooms can’t refuse to treat a patient regardless of whether they have insurance or can afford to pay for their care. Under federal law, any hospital that is a recipient of Medicare money can’t refuse care.
If a hospital receives Medicare funds, it must care for a patient until the patient is stable enough to transfer to a different facility.
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