1. Medical Legal and Ethical Issues Dr. Abdul-Monim Batiha Assistant Professor Critical Care Nursing Philadelphia University

2. Medical Legal and Ethical Issues Introduction:- 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.

3. 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. 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.

4. 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. 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.

5. 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. 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.

6. 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.

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

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

10. 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. 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.

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

12. 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 conduct. 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 conduct.

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

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

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

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

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

18. Base line vital signs *Introduction:- *Introduction:- Vital signs are an important element of the assessment process, they are indictors of the patients present condition, baseline vital signs includes: Vital signs are an important element of the assessment process, they are indictors of the patients present condition, baseline vital signs includes: Respiration. Respiration. Pulse. Pulse. Blood pressure. Blood pressure. Body temperature. Body temperature.

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

21. 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. 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.

22. Oral route:- Most accessible and convenient and contra indicated for Most accessible and convenient and contra indicated for Children under 6 yrs of age Children under 6 yrs of age For patients who are confused For patients who are confused For patients who have convulsive disorders For patients who have convulsive disorders For patients following oral surgery. For patients following oral surgery.

23. Rectal 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

24. Axillary route:- Safest and non invasive Safest and non invasive

25. Tympanic route:- Readily accessible very fast. Readily accessible very fast.

34. Respiration: 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, 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,

35. You will assess breathing by watching the patient ’ s chest rise and fall, you must determine the:- Rate:- Rate:- Are determined by counting the number of breath per a minute normal respiratory rate varies according to age. 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 Newborn 30-60c/m 2 yrs 20-30 c/m 6 yrs 18-26 c/m Adult 12-20 c/m 6 yrs 18-26 c/m Adult 12-20 c/m

36. quality :- Normal Normal Breathing is neither shallow nor deep Breathing is neither shallow nor deep Average chest wall motion Average chest wall motion No use of accessory muscles No use of accessory muscles

37. Shallow Slight chest or abdominal wall motion Slight chest or abdominal wall motion Labored Increased breathing effort Grunting, stridor Labored Increased breathing effort Grunting, stridor Use of accessory muscles possible gasping Use of accessory muscles possible gasping Nasal flaring, supraclavicular and intercostals Nasal flaring, supraclavicular and intercostals retractions in infants and children retractions in infants and children

38. Noisy Increase in sound of breathing, including snoring, wheezing Increase in sound of breathing, including snoring, wheezing

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

40. 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. 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.

43. pressure 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:- 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:-

44. Systolic pressure:- Is the pressure of the blood as a result of contraction of the ventricles. Is the pressure of the blood as a result of contraction of the ventricles.

45. Diastolic pressure:- Is the pressure when the ventricles are at rest. Is the pressure when the ventricles are at rest. The average blood pressure of a healthy adult is 120/80 mm Hg. The average blood pressure of a healthy adult is 120/80 mm Hg.

46. Hypertension:- is abnormally high blood pressure over 140 mm Hg systolic and 90 mm Hg diastolic. 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. Hypotension:- Is abnormally low blood pressure below 100 mm Hg systolic and 60 mm Hg diastolic.

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

51. The GLASGOW COMA SCALE ;- 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 figure. 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 figure.

53. Pupils 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 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. The letters PEARRAL stand for the following. P = pupils P = pupils E= Equal E= Equal A= And A= And R= Round R= Round R= Regular in size R= Regular in size L= React to light L= React to light