Intro to EM Flashcards
What does a Level 1 truama center mean
24 hr surgeons in all major subspecialties
24hr neuroradiology
24hr hemodialysis
trauma research program
What is EMTALA
Emergency Medical Treatment and Labor Act
says you must Screen and Stabilize before transferring or discharging a patient
ALL PTS HAVE THE RIGHT TO MEDICAL SCREENING EXAM
Is a women in labor considered stable for transfer
No, women in labor (having contractions) is in an “unstable” condition and cannot be transferred unless pt requests transfer
may not send if there is a risk for problem with mom or fetus in route to accepting facility
What is an Emegency Medicine Screening Exam for EMTALA
may be just H&P
must be same for every patient with same complaint, regardless of social factors
nursing triages is not a medical screening exam
what is a stabilized patient
underlying medical condition does not need to be completely treated, must be able to be dispositioned (discharged, transferred, admitted) without high likelihood of deterioration in an unsafe location
What is included in an appropriate transfer
- pt is stablized to best of current facilities ability
- accepting facility has capability and capacity
- accepting facility agrees to taking the patient
- medical information is sent with patient
- transfer occurs with qualified transfer personnel
what is required of accepting facility with EMTALA
MUST accept patient that their facility has capability of caring for (i.e. Higher level of care or specialty care) and capacity
How can you reduce your risk of litigation
- good introductions
- professional dress
- addressing patient respectfully
- sitting down with them
- discuss expectations
- avoid medical jargon
- give emotional support/empathy
- meet patients during sign-outs
- giv edischarge instructions and answer quesitons
what is the first part of the emergency medical mindset
sick or not sick
run to a sick patient first
are they actively dying?
are they at immediate risk for loss of life or limb?
What is the emergency medicine mindset
ABCDEFGH
A: situational awareness
B: basci measures for life/limb
C: control of threats
D: diagnostics
E: Emergency management
F: Further care
G: Group
H: Highlights and feedback
What are high risk scenarios
your biases
busy department
fatigue
return visits
sign out
vital signs
high risk pt populations
What are the levels of Triage
level 1: immediate: life threatening
level 2: emergency; could become life threatenin
level 3: urgent; not life threatening
level 4: semi urgent; not life threatening
level 5: non-urgent; needs tx when time permits
What are key points for consult
- contact courteously
- orient
- narrow question
- story
- urgency
- later
- thank you
What is important about discharge instructions
MUST align with what you have discussed with the patient
patient MUST understand the instructions
should include:
- clear follow up (with who and when)
- diagnosis (or what its not)
- continue at home care plan
- when to return to the ED
What is SAMPLE history
S: signs and symptoms
A: allergies
M: medications
P: pertinent PMH
L: last oral intake
E: events leading up to episode
