Medical Legal and Ethical
Issues
Dr. Abdul-Monim Batiha
Assistant Professor
Critical Care Nursing
Philadelphia University
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.
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
conduct.
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
education.

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
includes:

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
disorders
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.
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,
You will assess breathing by
watching the patient’s chest rise and
fall, you must determine the:-
Rate: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

Shallow
Slight chest or abdominal wall motion
 Labored Increased breathing effort
Grunting, stridor

Use of accessory muscles possible
gasping

Nasal flaring, supraclavicular and
intercostals
 retractions in infants and children

Noisy

Increase in sound of breathing,
including snoring, wheezing
Rhythm:

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.
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:-
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.
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.
Pupils



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
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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