ED Intro

Question 1

What is triage

Answer 1

sorting of patients according to urgency

Priority assigned based on fluid process and stability of condition changes over time

Question 2

What are triage goals

Answer 2

identify conditions of immediate threat to life, limb, or vision
treat most ill first

Question 3

What system is efficient in triage

Answer 3

5 level system (accounts for physical, developmental, psych, patient flow, and health care access)
3 level system results in under or over triage (mostly early dc)

Question 4

How do you make a triage decision

Answer 4

A: Do they need immediate live saving intervention (AVPU)
B: Abnormal vital signs or new AMS?
C: Do they need none, one, or many resources?

Question 5

What is the emergency severity index

Answer 5

1. severely unstable (MD) (intervention needed to stabilize)
2. potentially unstable (MD) (labs, radiology, meds, admit)
3. Stable but assess urgently by MD (labs, radiology, meds, discharge)
4. stable, see non-urgently by MD/PA (minimal testing/procedure, discharge)
5. stable. non urgent by MD or PA (no testing/procedure, discharge)

Question 6

When should you initiate treatment

Answer 6

while awaiting diagnostic results if necessary

Question 7

Traditional way to present a case

Answer 7

CC
HPI, ROS, PMH, SH, vitals, PE
differential
plan

Question 8

Problem focused case presentation

Answer 8

Final assessment (diagnosis)
pertinent + and - form H&P to support Dx
pertinent diagnostic results, treatment, and response

Question 9

What is EMTALA

Answer 9

Emergency Medical Treatment and Active Labor Act
1986 by congress- ensures all patients receive a medical screening exam (MSE) regardless of ability to pay
-anti-dumping law

Question 10

What is a Medical Screening Exam

Answer 10

Preformed by a qualified medical person
Treat emergency medical condition until stable, or transfer medical needs not available.
Applies to pregnant and any pt who comes to ED
CANNOT ask a patient their ability to pay until after MSE is complete

Question 11

What is an “emergency medical condition”

Answer 11

condition w/ acute Sx of sufficient severity that in the absence of immediate medical attention can result in placement of health of patient or unborn child in serious jeapordy

Question 12

When can you transfer a patient

Answer 12

At patient written request (w/ consent)
Benefit of transfer>risk
Accepting provider w/ available resources (send copies of dx results)
(stable= not likely to deteriorate while transferring)

Question 13

What is the 250 rule

Answer 13

You must provide care to a patient within 250 yards of ED, hospital, or any office buildings

Question 14

What is the penalty for violating EMTALA

Answer 14

hospital fined 50k
Provider fined 50k (not covered by malpractice)
-Fined if you fail to respond to emergency while on call, don’t preform MSE, or inappropriate transfer

Question 15

What are types of consent

Answer 15

Implied: patient acts is a way that indicated agreement
Expressed: oral or written agreement
Informed: patient notified of reasonable risks and alternatives, use shared decision making

Question 16

Who is unable to consent or refuse treatment

Answer 16

Drugs or alcohol intoxication
severe depression 
AMS
psychosis
injury induced shock
SI
head injury

Question 17

What is AMA

Answer 17

document patient is competent and refuses care

Inform of risks (worsening of condition, delay id dx and tx, lose fx, death)