Introduction to emergency medicine am

Introduction to emergency medicine am

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Introduction
to emergency medicine

Scope to emergency medicine
 Urgent: a serious sudden condition happening that does NOT need immediate attention. E.g. headache caused by space occupying lesion
 Emergency: a serious sudden condition happening that needs immediate attention
e.g. abdominal pain (acute) or asthma (acute on top of chronic)
What make case emergency:
 If acute
 Life threatening
 Chance of permanent morbidity.
Triage:
I) Normal days
 Refer
II) Multiple casualty
 Within capability of the hospital. (20 beds 20 patients)
 Take pt with most serious situation.
III) Mass casualty
 Beyond capability of the hospital.
 Take pt with least serious case (the least intervention. & most likely to survive)
 Clean the hospital.

The golden hour:
 Expression that time after the accident (moment of complaint) is of the highest value. Because there is high chance to reverse the situation. THE EARLIER THE BETTER.
 So, there are two types of care:
I) Pre-hospital care:
 Consist of two types of supports:
1) Basic life support:
o Without intervention.
o Like: splint, pressing wound, etc…
2)Advanced life support.
o Like: intubations, IV line.
o With intervention.
o Very useful in cardiac pt.
o Harmful in trauma pt. because the golden. Because this wake the golden hour waiting for the ambulance.
II)Hospital care:
o Behavior ant treatment different between ER and ward. Because in ER there is no time (deal with the core of the problem).

Approach to ER pt:
 History:AMPLE 3-5 MIN OR 1 IN TRAUMA
 Allergy
 Medication
 Past illness/pregnancy.
 Last meal. (IMPORTANT FOR INTUBATION)
 Event/ environment.
 Primary survey: ABCDE
 Airway (e.g. coma pt jaw-thrust relieve tongue obstrn, place vomiting pt on left side to deviate trachea)
 Breathing
 Circulation
 Disability (CNS).
 Exposure/ Environment: expose pt totally. Then cover with the blanket.
 Adjuncts:
o ECG
o Catheters (gastric for decompression, urinary to monitor output Good output = proper infusion)
o Pulse oximetry
o Xray (chest pneumothorax, cervical C1C2 fracturesresp arrest, pelvis for hemorrhage)
o ABG
 Secondary survey:
 full hx and exam
 Investigation according to suspicion (e.g femur xray, coronary)
 Tertiary survey: must be seen by consultant next morning.
 Re-evaluation. To maintain patient stability until given definitive management
 Definitive care: refer him to specialist.

Cases seen in ER
 Medical:
 Cardiac (e.g. ACS)
 Non-cardiac (e.g. DKA, GI bleeding, stroke)
 Surgical:
 Trauma (e.g. ATLS)
 Other (e.g. acute abdomen)

Procedures done in ER
 Venous access
 Central (femoral, subclavian, jugular)
 Peripheral (venous cut at lateral malleolar saphenous vein)
 Thoracic chest tube, pericardiocentesis, needle decrompression
 Surgical airways (tracheostomy, cricothyroidectomy)
 DPL & culdocentesis
 LP (give medication or take CSF)
 Intubation
 Compartmrnt pressure
Drugs used in ER
 Atropine  heart block
 Adrenaline anaphylactic shock
 Dopamine
 NE
 Hydralazine/nitroprusside  hypertension is emergency if NOT RESPONDING to medication or + organ damage
 IV fluids
 Adenosine
 Digoxin
 Verapamil
 Lidocaine
 Vasopressin
 Glucagon/insulin

Don’t forget:
 Records.
 Consent for treatment.
 Forensic evidence. (Bullet, knife, clothes).
 Assume pt has cervical injury.
 Finally don’t be panic…