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EMED Unit 1 > 1 Role of the PA in EM > Flashcards

1 Role of the PA in EM Flashcards

1
Q

About ____% of all PAs work in Emergency Medicine

A

13%

2nd largest specialty after surgical subspecialties

And 19% of newly certified PAs practice in urgent care or ED

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2
Q

Advantages of ED PAs

A

Cost effective

Efficient

Reduce wait times

Increase patient satisfaction

Provide care in underserved areas

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3
Q

What items are in the top basket of the crash cart?

A 
Large gloves
Surgical cone mask
Defibrillator pads
Adult multi-function electrodes
Peds Multi-function electrodes
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4
Q

What items are in the bottom basket of the crash cart?

A

Adult BVM with adult masks
Peds BVM with #2, 3, 4 masks
5in1 connector and O2 tubing

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5
Q

What hangs off the right side of the crash cart?

A

Sharps container

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6
Q

What hangs off the left side of the crash cart?

A

O2 tank and gauge
Adult and Peds crash cart inventory list
Anaphylaxis treatment guide

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7
Q

What will you find on the back of the crash cart?

A 
Clipboard with:
• Procedures sheet
• Crash cart check off list
• Pharmacy charge sheet
• Code blue team sign in sheet
• Code blue record sheets

Backboard

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8
Q

What will you find in the first drawer of the crash cart?

A

ADULT DRUGS

Amiodarone
Atropine
Calcium chloride
Dextrose
Dopamine
Epi
Lidocaine
Sodium bicarbonate
Sodium chloride
Sterile water 
Vasopressin
Povidone-iodine swabstick
Alcohol swabs
Blank labels
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9
Q

What will you find in Drawer 2 of the crash cart?

A

IV SOLUTIONS AND PEDS DRUGS

Peds:
Atropine
Sodium bicarb
Saline flush syringes
Sodium chloride

IV:
Sodium chloride 0.9% 100 ml
Dextrose 5% 250 ml
Sodium chloride 0.9% 1000ml

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10
Q

What will you find in Drawer 3 of the crash cart?

A

ADULT INTUBATION SUPPLIES

Macintosh #3, #4
Miller #3
14 Fr styles

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11
Q

What will you find in Drawer 4 of the crash cart?

A

PEDS INTUBATION SUPPLIES

Miller #0-2, Macintosh #2
Peds 8 Fr
Neonatal 6 Fr

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12
Q

What will you find in Drawer 5 of the crash cart?

A

IV START SUPPLIES

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13
Q

What will you find in Drawer 6 of the crash cart

A

IV SUPPLIES AND TUBING

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14
Q

What will you find in Drawer 7 of the crash cart?

A

PROCEDURE TRAYS

Surgeon’s gloves
Sensi care latex free gloves
Sutures
Cut down packs
Crico pack**
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15
Q

What are the three most common supervision models utilized for PAs in the ED?

A

PA sees patients fairly autonomously and consults PRN with the supervising physician

PA sees patients, physician follows up with each patient as well

Physician sees all patients outside of PA scope and available for second opinions

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16
Q

What are the different parameters that determine a PA’s scope of practice in the ED?

A

State laws and regulations
Facility/institution policies
Experience/expertise of the PA
Supervising physician delegation

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17
Q

Commonly performed procedures for ED PAs

A 
Wound exploration and de ride meant
Simple/multiple layer laceration repair
Incision and drainage of abscess
Removal of RB from (ENT or soft tissue)
Arthrocentesis
Lumbar puncture
Slit lamp exam
Emergency ultrasonography
Nail trephination/removal
Closed reduction of fractures and dislocations
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18
Q

Advanced procedures that PAs may or may not perform in the ED

A 
Rapid Sequence intubation
Cricothyrotomy
Needle thoracentesis
Chest tube thoracotomy
Central/arterial line placement
Procedural sedation
Provide medical direction for EMS
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19
Q

Top 10 reasons for ED visits

A 
Abdominal pain
Chest pain
Fever
Cough 
HA
SOB
Back pain
Pain (other) 
Laceration
Throat symptoms
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20
Q

What are some examples of RED FLAGS in a patient’s history?

A 
Sudden onset of Sx (esp if fist episode)
Rapid, significant worsening of Sx
Altered level of consciousness or loss of consciousness
CV/Pulm Sx (dyspnea, CP)
Extremes of age
Immunocompromised
Poor historian
Frequent, recent ER visits
Unvaccinated or under-vaccinated
Patient signed off to you at the end of shift****
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21
Q

_________ is an extremely important first impression

A

General appearance

Are they uncomfortable?
What is their level of social interaction
Hydration status
Lethargy
Diaphoresis
Skin changes (pallor, jaudice)
22
Q

How can you tell a peds pt is dehydrated?

A

Crying but with minimal tear production

23
Q

How to be mindful in the ED

A

Listen carefully, even if you feel “time crunched”

Don’t act rushed (patients can tell…)

24
Q

How to be thoughtful in the ED?

A

Speak slowly, avoid medical jargon

Utilize translator if needed (even if they have a family member - might not be a reliable translator)

25
Q

What are some ways to be sensitive to patients in the ED?

A

Focus on the patient
Offer to tie the patient’s gown
Share normal findings immediately
If there is an abnormal finding, let the patient know if it is not a concern at the time (REASSURANCE!)

26
Q

How to be gentle in the ED

A

Examine non-tender areas first

Warn patient prior to examining painful area

27
Q

How to be thorough in the ED

A

Check skin

Check for pain above and below a joint injury

28
Q

How to be efficient in the ED

A

Not all patients need a full exam

Base exams on your differential diagnoses

29
Q

What things do you need to re-evaluate regularly in the ED?

A

Review vitals
Appearance
Pain level
Response to interventions

30
Q

What things do you need to make sure you “wrap up” before discharge?

A

Recheck vitals prior to discharge (don’t trust others to do it for you)
CLEAR DISCHARGE INSTRUCTIONS
Ask if the patient has questions before they leave

31
Q

PAs in triage reduce patients who leave without being seen by _____ and patient wait times by _____.

A

80%

50%

32
Q

PAs aid in compliance with ….

A

EMTALA (Emergency Medical Treatment and Labor Act)

33
Q

What is EMTALA?

A

Ensures all individuals access to emergency care, regardless of citizenship, legal status, or ability to pay

May transport patient to another facility only if needed

Requires medical screening exam (MSE), which must be done by a PA/NP/Physician (not RN) to determine if an emergent medical condition exists

34
Q

PAs may perform ______ for EMTALA as long as written hospital policy specifies

A

Medical Screening Exams (MSEs)

35
Q

In which cases may PAs initiate hospital transfers under EMTALA?

A

PA must consult SP first

SP must co-sign the order within the timeframe specified by hospital policy

Some hospital transfers mandate “Doc to Doc” interaction

36
Q

Who goes to the “fast track”?

A

Patients with stable vital signs and minor illnesses

Examples:
Lacerations
Minor bites/burns
Abscesses and cellulitis
Rashes
HA (Hx of migraines or similar prior HA)
Earaches, sore throats, cough, and congestion
Back pain
Dysuria (if simple, no fever)
37
Q

Examples of PAs working in pre-hospital settings

A

Care for patients at scene of EMS calls and during transport to ED
Care for patients during transport from one facility to another
Care for people at events (concerts, sporting, etc)
Part of EMS team in rural areas (where transport times longer)
Military (transport to medical facilities in combat situations)

38
Q

What is your only defense against malpractice when working in the ED?

A

Your very detailed ED note - must be thorough and complete

Think of the worst possible scenario and document how you ruled it out

Reflects credibility and competency

39
Q

Components of the ED note

A

Identifiers - Name, DOB

DOS, time/mode of arrival, time of triage or exam room, time examined

CC, Pertinent Hx, Vitals, Pertinent PE

Orders (labs/imaging) and Results

Dx

Disposition (where are they going), time of disposition

Discharge instructions if applicable

40
Q

Exact _______ is not always possible/necessary, but appropriate __________ is key

A

Diagnosis - Disposition

Is the patient sick or not sick?

Are they stable enough to go home with close f/u?

Do they need to be admitted for further work up/monitoring

41
Q

Disposition examples

A

Discharge

Leaving against medical advice (AMA)

To OR

Admit to Observation (typically 24h, non-cardiac CP, asthma)

Admit to Med/Surg, Telemetry, ICU

Transfer (skilled nursing facility, hospice)

42
Q

You can always ask for a _______, whether you are admitting the patient or not

A

Consult

With admission - Inpatient IMED/Hospitalist

For specialty - Cardio, Pulm, ID, Surg, Anethesiology, ENT, Opto, Neuro

43
Q

Goals of informed consent

A

Support patients to make their own decision

Give info - more than we think we need to give

Make info understandable

Offer guidance in weighing goals and possible outcomes

Allow autonomous authorization (patient may consent or refuse)

44
Q

Exceptions to informed consent

A

Unconscious patient

Incapable of consenting

Imminent harm from non-treatment

No surrogate available

45
Q

What questions do you need to ask yourself to justify an emergency exception to informed consent

A

Will failure to treat quickly result in serious harm to the patient?

Would most capable and reasonable people want treatment for this type of injury?

Is the patient unable to participate in care decisions?

Can patient preferences be related in a timely way from a surrogate?

Is there any evidence that the patient would refuse this specific treatment?

46
Q

Components of the procedure note

A

Patient name and DOB

Date/time of procedure

Indication

Consent

Description of procedure

Estimated Blood Loss (EBL)

Complications (if any)

47
Q

What is ADC VANDISMAL?

A 
Acronym for the components of an admission note
Admit to
Dx
Condition
Vitals
Allergies (food and meds)
Nursing
Diet
IVF or I/Os
Specials (ie DVT prophylaxis)
Meds
Activity
Labs
48
Q

What are the different components of the discharge note

A

Discharge Dx
(Secondary Dx, incl all active medical problems)
Discharge meds
Discharge instructions, include ED precautions
Follow-up

49
Q

Leaving against medical advice is most common in…

A

Young patients
Men
Drug/EtOH Hx
No insurance/low income

50
Q

What should review with a patient who insists on leaving AMA?

A

Current medical condition
Specific risks and benefits of proposed treatment and alternatives
Specific potential consequences of leaving AMA

DOCUMENT REASON!

51
Q

In addition to reviewing and documenting risks with the patient, what else do you need to do for patients leaving AMA?

A

Assess mental capacity of the patient - do they understand proposed treatment, consequences of refusal, reasoning for refusal

Follow up - advise patient when to seek medical attention, arrange with social services, family members to follow up

EMED Unit 1 (5 decks)

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