1 - Approach To E Med Flashcards
ED approach (list)
Complete (focused) Hx PE Differential Diagnosis Lab test and imaging Diagnosis TX Med decision making Disposition
Go back and forth on this approach for a single patient as many times as needed
In a fixed facility, triage care is limited to __ and __?
Airway control
Hemorrhage control
DIME
Delayed: needs surg but can wait
Immediate: intervention now
Minimal: self/buddy aid
Expectant: not gonna make it
Primary concern for EM?
Life
Limb
Eyesight
If a patient may need surgery you should?
NPO immediately
EM approach “load the boat”?
Consult early, get everyone involved
1st impressions come from?
- Chief complaint
- Vital signs
- Initial appearance upon entering room
What is the “safety net”?
Monitor
IV
O2
Airway/crashcart on hand
This is a generalized thing to have on hand for most patients, it allows you to react quickly if things get worse
What type of Hx does the ER usually conduct?
Focused HX
- looking for pertinent Pos and Neg
Social Hx?
Living conditions
Tobacco
Drugs
ETOH
What is the primary survey?
1st impressions and vital signs
Includes ABC’s
Make sure to bounce your vital signs off of?
Patient presentation. Make sure they match and take again if not
Secondary survey?
Through, focused exam based on presumed disposition
During PE everyone should get?
Heart
Lungs
Abdomen
What are Well’s and PECARN?
They are pretest probabilities used in data gethering
How many diagnoses go in a DD?
3-5
What bedside labs are a good starting point?
Glucose iSTAT capability Guaiac UA UHCG
Who gets portable radiologic studies?
Why?
Unstable pts
You dont want them leaving the ED
What is the “specialty” of the ED?
Acute resuscitation
This is a dynamic process where continued evaluation is needed
What is MDM?
Medical Decision Making
- the medical reasoning of why you believe the patient does or does not have the diagnoses listed on your differential
Factors that go into the disposition?
Previous medical status Age Living conditions Likelihood to f/u Morbidity/mortality of diagnosis Hospital bed status Medical capabilities of facility Progression of condition Response to tx
What needs to be included with Discharge?
- F/U time (with PCM)
- Reasons to return to ED
- Discuss the discharge w patient
- ensure understanding
- discharge instructions (printed)
The Pt is your Pt until?
The admitting service has taken over care per an approved “hand off”
Radiology is?
Where unstable ED pts go to DIE
S/S of tension pneumo?
- Unstable or stable
- JVD
- tachy
- HOTN
- absent breath sounds
Treat with Needle D (needle thoracostomy)
GCS
Slide 27
Motor: 6
Verbal: 5
Eye open: 4
GCS numbers?
15: normal pt
8 (or less): intubation
3: Comatose
Now choke yourself.
[Pyle wraps his own hands around his throat]
Goddamn it, with MY hand, numb-nuts!
