1 - Approach To E Med

Question 1

ED approach (list)

Answer 1

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

Question 2

In a fixed facility, triage care is limited to __ and __?

Answer 2

Airway control

Hemorrhage control

Question 3

DIME

Answer 3

Delayed: needs surg but can wait
Immediate: intervention now
Minimal: self/buddy aid
Expectant: not gonna make it

Question 4

Primary concern for EM?

Answer 4

Life
Limb
Eyesight

Question 5

If a patient may need surgery you should?

Answer 5

NPO immediately

Question 6

EM approach “load the boat”?

Answer 6

Consult early, get everyone involved

Question 7

1st impressions come from?

Answer 7

• Chief complaint
• Vital signs
• Initial appearance upon entering room

Question 8

What is the “safety net”?

Answer 8

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

Question 9

What type of Hx does the ER usually conduct?

Answer 9

Focused HX

- looking for pertinent Pos and Neg

Question 10

Social Hx?

Answer 10

Living conditions
Tobacco
Drugs
ETOH

Question 11

What is the primary survey?

Answer 11

1st impressions and vital signs

Includes ABC’s

Question 12

Make sure to bounce your vital signs off of?

Answer 12

Patient presentation. Make sure they match and take again if not

Question 13

Secondary survey?

Answer 13

Through, focused exam based on presumed disposition

Question 14

During PE everyone should get?

Answer 14

Heart
Lungs
Abdomen

Question 15

What are Well’s and PECARN?

Answer 15

They are pretest probabilities used in data gethering

Question 16

How many diagnoses go in a DD?

Answer 16

3-5

Question 17

What bedside labs are a good starting point?

Answer 17

Glucose
iSTAT capability
Guaiac
UA
UHCG

Question 18

Who gets portable radiologic studies?

Why?

Answer 18

Unstable pts

You dont want them leaving the ED

Question 19

What is the “specialty” of the ED?

Answer 19

Acute resuscitation

This is a dynamic process where continued evaluation is needed

Question 20

What is MDM?

Answer 20

Medical Decision Making

- the medical reasoning of why you believe the patient does or does not have the diagnoses listed on your differential

Question 21

Factors that go into the disposition?

Answer 21

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

Question 22

What needs to be included with Discharge?

Answer 22

• F/U time (with PCM)
• Reasons to return to ED
• Discuss the discharge w patient
• ensure understanding
• discharge instructions (printed)

Question 23

The Pt is your Pt until?

Answer 23

The admitting service has taken over care per an approved “hand off”

Question 24

Radiology is?

Answer 24

Where unstable ED pts go to DIE

Question 25

S/S of tension pneumo?

Answer 25

• Unstable or stable
• JVD
• tachy
• HOTN
• absent breath sounds

Treat with Needle D (needle thoracostomy)

Question 26

GCS

Answer 26

Slide 27

Motor: 6
Verbal: 5
Eye open: 4

Question 27

GCS numbers?

Answer 27

15: normal pt

8 (or less): intubation

3: Comatose

Question 28

Now choke yourself.

[Pyle wraps his own hands around his throat]

Answer 28

Goddamn it, with MY hand, numb-nuts!