Approach to EM Flashcards
What is EM always looking for?
the worst case scenarios
What do we care more about in a EM diagnosis?
what it is NOT
What does the EM live for?
Acute resuscitations
Airways and procedures
Variety of presentations and etiologies
Making a tangible difference NOW
Who is the sickest of the sick?
Acute resuscitations
What are the DDX for EM based on?
threat to patient safety, not commonality
What type of patients are seen in the ER now?
primary care or chronic illnesses
Why are primary care being seen in the ER?
NO access to care, shortage of primary care providers
What is the order of work for EM?
Discharge patients
Checking for pending results
See new patients
Review results and prep for discharge or admi
When does preparation start for the EM?
day before
What are 3 common courtesies in the EM?
Shake their hand
Introduce your self
Don’t interrupt for at least 30 sec
When should the patient not be interrupted for at least 30 secs?
after asking why your in the ER
What things are crucial for knowing during the patient turnover?
History Exam Assessment Labs Imaging Necessary orders/results, consults Tentative Disposition
When picking up a new patient what must be reviewed?
age, sex, c/c, vital signs
When should staff be notified about sick patients?
early
What type of physical exam should be performed?
focused w/ basics
What component of the physical exam should be performed on EVERYONE?
HEART AND LUNGS!
Should you adjust doses on pt chronic meds?
NO, DO NOTHING!
What guides imaging and labs?
differentials
What shouldn’t you be stingy with?
EKGs
When it comes to charting what must be performed?
mark every box and don’t chart at the bedside
What is flow of clinical decision making?
history > physical exam > differential and tentative dispositions > data gathering > diagnosis or differentials + what it’s not
What things make up the ED Safety Net?
Peripheral IV O2 Supplementation Vital sign monitor Chest Xray CBC, CMP \+/-Pregnancy, UA, Tox screen \+/-EKG \+/-Finger stick glucose
What is considered the most dangerous time in the ED?
patient turnover
When should DNR questions be asked?
upfront
Who becomes the medical decision maker when a patient is unresponsive w/ unclear wishes?
Next of kin
What federal law requires that anyone coming into an ED has to be stabilized and treated regardless
Emergency Medical Treatment and Labor Act
When was EMTALA passed?
1986
What is termed “Patient Anti-Dumping” statue?
EMTALA
What words should be used, and what should be used?
hot button terms
use: alleged, patient reports, patient decribes
What exam has high liability for provider performing the screening?
Medical Screening Exam
What exam is used to r/o or identify life-threatening problems?
Medical Screening Exam
Ped patient medications require?
weight based dosing
Ped patient equipment requires?
pedi size
What can cause long term harm in a pedi pt?
testing
What are 3 ways a geri pt can present?
stoic presentations, under-selling symptoms, or reduced pain sensation
What is a common symptom seen in geri pt?
AMS
AMS can present in what 4 ways in geri pts?
sepsis UTI Pain Poly-pharmacy New meds
What represents infection in a geri pt?
hypothermia
What is the #1 step in sexual assault pt?
accessing for threatening injuries and asking if they want a forensic exam
Who performs the forensic exam?
SANE examiner
If a pt wants a forensic exam DO NOT:
remove clothing, perform GU or rectal exam (UNLESS- required to stabilize life threatening injury)
What should be avoided in Geri pt?
anti-histamines
What does anti-histamines cause in a geri pt?
delirium or excitation
What is “Pop Drop”
when the geri pt is left in the ED by a family member
If a pt doesn’t want to forensic exam?
treat like any other pt
What STI post-exposure prophylaxis (PEP) meds should be used?
Rocephin, azithromycin, possible HIV PEP
What STI post-exposure prophylaxis (PEP) labs should be used?
Acute and chronic Hep panel, Anti-HBs, HCV screening, HIV screening, RPR
What is the 1st step when receiving a psych pt?
r/o if the pt is a danger and r/o medical causes
If a pt has a short term substance induced danger what can be done?
metabolization to freedom
What is metabolization to freedom
letting the patient wear off the drug until they become self-aware
Under emergency detention how long is the pt detained?
48hrs
Cooperative psych pts can be given?
oral meds
Non- cooperative psych pt can be given?
intramuscular: Haldol, Lorazepam, Benadryl
