Medical Legal and Ethical Issues

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					Medical Legal and Ethical
     Dr. Abdul-Monim Batiha
        Assistant Professor
       Critical Care Nursing
      Philadelphia University
  Medical Legal and Ethical
A basic principle of emergency care is to do
no further harm, any health care provider
who acts in good faith and according to an
appropriate standard of care usually avoids
legal exposure.
Medical Legal and Ethical Issues
   1-Scope of practice, which is most
    commonly defined by law, requires you
    to act or behave toward other individual
    in a certain, definable way, regardless of
    the activity involve ,so you must be
    concerned about the safety and welfare
    of others.
   2-Standard of care: - is a written,
    accepted level of emergency care
    expected by legal or professional
    organizations so that patients are not
    exposed to unreasonable risk of harm.
   Negligence: - is the failure to provide the
    same care that a person with similar
    training would provide it is deviation
    from accepted standard of care that may
    result in injury to patient.
   Abandonment is the unilateral
    termination of care by the first aider
    without the patient's consent and
    without making any provisions for
    continuing care.
   Abandonment is the unilateral
    termination of care by the first aider
    without the patient's consent and
    without making any provisions for
    continuing care.
   Consent: - Granting permission to
    another to render care. Consent is
    required from every conscious, mentally
    competent adult before care be started.
   Expressed consent: Is the type of consent
    in which the patient expressly authorizer
    you to provide care or transport
   Implied (indirect) consent: - When a
    person is unconscious and unable to give
    consent or when a serious threat to life
    exists, the law assumes that the patient
    would consent to care and transport to
    medical facility.
   Notes: Minors (infants and children) and
    mentally incompetent adults are unable to
    signs a consent.
            Ethical principle

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

   Caring for all patients with a sense of
    excellence (quality), so you must strive to
    be at your best at all times.
   Improve your performance through
    hand-on experience and continuing
   Honest reporting is essential which
    important for quality improvement.
   Confidentiality: communication between
    you and the patient is considered
    confidential and cannot be disclosed
    without permission from the patient or a
    court order
   Records and report is essential.
          Base line vital signs

 * Introduction:-
 Vital signs are an important element of the
  assessment process, they are indictors of the
  patients present condition , baseline vital signs
     Respiration.
     Pulse.
     Blood pressure.
     Body temperature.
   Other key indications of the patient’s
    respiratory, cardiovascular and central
    nervous system are:-
     Capillary refill
     Papillary reaction
     Level of consciousness
        Body temperature:-

   1-It reflect the balance between the heat
    produced and the lost from the body, the
    average body temp of an adult is between
    ( 36.7-37c) . There are four common sites
    for measuring body temperature.
              Oral route:-
   Most accessible and convenient and
    contra indicated for
   Children under 6 yrs of age
   For patients who are confused
   For patients who have convulsive
   For patients following oral surgery.
               Rectal route
    most reliable (accurate).
   Contra indicated following:
        rectal surgery.
        newborn babies.
   patient with diarrhea
           Axillary route:-
   Safest and non invasive
          Tympanic route:-
   Readily accessible very fast.

 2-Breathing  is continuous process
 in which each breath regularly
 follows the last with no notable
 interruption, else it is normally
 spontaneous automatic process
 that occurs with out conscious
 thought, visible effort , marked
 sounds or pain,
You will assess breathing by
watching the patient’s chest rise and
fall, you must determine the:-

 Are determined by counting the number of
  breath per a minute normal respiratory
  rate varies according to age.
 Newborn 30-60c/m        2 yrs 20-30 c/m
 6 yrs 18-26 c/m         Adult 12-20 c/m
                quality :-
  Normal
 Breathing is neither shallow nor deep
 Average chest wall motion
 No use of accessory muscles

 Slight chest or abdominal wall motion
 Labored Increased breathing effort
  Grunting, stridor
     Use of accessory muscles possible
     Nasal flaring, supraclavicular and
 retractions in infants and children
           Increase in sound of breathing,
    including snoring, wheezing
   regular or irregular.
   Depth :- shallow
             3- Pulse

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

      Arterial blood pressure is define as a
    measure or the pressure exerted by the
    blood as it flows through the arteries there
    are 2 blood pressure measures:-
           Systolic pressure:-
   Is the pressure of the blood as a result
    of contraction of the ventricles.
          Diastolic pressure:-
   Is the pressure when the ventricles are
    at rest.
   The average blood pressure of a healthy
    adult is 120/80 mm Hg.
 Hypertension:- is abnormally high blood
  pressure over 140 mm Hg systolic and 90
  mm Hg diastolic.
 Hypotension:- Is abnormally low blood
  pressure below 100 mm Hg systolic and
  60 mm Hg diastolic.
       Level of consciousness.

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

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

       The diameter of the pupils reflects the status
    of the brains perfusion, oxygenation and
    condition the pupils are normally rounded and
    approximately equal size.
   The letters PEARRAL stand for the following.
   P = pupils
   E= Equal
   A= And
   R= Round
   R= Regular in size
   L= React to light

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