Approach to the Undifferentiated Patient Flashcards
Studies have shown that what percent of patients who present to the ED require hospital admission?
12%
Although patients at Children’s are triaged by number, there are two other systems common elsewhere: _______________.
color (ROYGB with red as 1 and B as 5) and descriptor (critical, emergent, urgent, minor, very minor)
In an emergency department, the absolute first thing a physician should assess is ____________.
the ABCs:
• Airway: does the patient have a compromised airway (evidenced by audible breathing, traumatic obstruction, or patient choking among many others)?
•Breathing: is the patient breathing normally?
•Circulation: feel the patient’s pulse and observe for signs of impaired circulation (like mottling or pallor).
This should be done in the first 60 seconds and if any are in doubt they should be addressed before anything else occurs.
What is the AMPLE mnemonic in assessing an undifferentiated patient?
AMPLE stands for the first things to assess in a critically ill patient:
•Allergies: what is the patient allergic to?
•Medications: what medications is the patient taking?
•Past medical history
• Last meal: when did the patient last eat?
• Events: what events (briefly!) led to their presentation?
Say you go into a room and see a toxic appearing patient in acute distress. You’re unsure of the cause or details of the illness. What three things should you do while you ask the patient/family/nurse questions?
- Establish an IV
- Administer supplemental oxygen if needed
- Connect the patient to a monitor that records vitals
These things are needed in all acutely ill patients, so while you’re interviewing the patient or performing a more detailed physical exam you can order these from RNs, RTs, residents, etc.
Describe the terms primary and secondary survey.
- Primary surveys are the immediate things done by an ED physician in assessing a patient. They include ABCs, AMPLE, and the IV-O2-monitor triad for toxic patients.
- Secondary surveys are for patients deemed “not sick” (i.e., not in need of immediate intervention) and include focused histories and physicals.
What is the term for when another provider’s diagnosis skews your assessment of a patient?
Anchor bias
An often under-utilized step in the management of a patient in the ED is _______________.
simple re-evaluation of the patient; for instance, if there is a change in the patient’s status reported by a nurse, go see the patient before doing anything else!
When discharging a patient, speak as if you are speaking to ____________.
a fourth grader
One clinical pearl from the CDEM patient with suspected gallbladder illness is that _____________ are snapshots of a specific moment.
labs, ECGs, and imaging studies
That is, the patient might have changed because diseases can evolve quickly.
Even in the emergency department, “____________ is often cited as being of higher importance on patient satisfaction surveys than the actual diagnostic and therapeutic accuracy of the physician.” –CDEM
a genuine, caring approach
What percent of non-hospital admissions arrive through the ED?
Slightly over 50%
What are the top five reasons patients go to the ED?
1) Abd pain
2) Chest pain
3) Fever
4) Headache
5) Back symptoms
