Intro to EM Lecture Powerpoint

Question 1

EMTALA (Emergency Medical Treatment and Labor Act)

Answer 1

Law that states everyone has the right to see medical care within the capabilities of the hospital staff and facilities, cannot be “dumped” if doctor does not want to take patient, if reported to hospital then doctor can face personal fine that is not covered under malpractice

Question 2

General ED principles (5)

Answer 2

• Identify and stabilize life threatening condition***
• find an explanation for condition if possible as well as recognize coexistent pathology
• Determine why patient presented now rather than earlier/later
• Consider the necessity to determine the diagnosis before the patient leaves the ED***
• Document entire visit

Question 3

Foreign body removal in the ER

Answer 3

Don’t always know what it is and sometimes can’t visualize on x ray if not metal, try to remove unless deep, extensive, or cannot be found then need referral to OR for removal

Question 4

Cerumen impaction in the ER

Answer 4

Can try to soften first with water/peroxide 50/50mix or debrox OTC to then follow up with primary care for removal after loosening if cannot remove at the time

Question 5

Lidocaine burns, so go…

Answer 5

….slow with a small bore needle, can buffer with sodium bicarbonate

Question 6

Digital blocks should be done with what anesthetic?

Answer 6

Lidocaine without epi

Question 7

Hematoma block in the ER

Answer 7

Done into hematoma immediately after a fracture to help limit pain before reduction, does not block entire nerve still resulting in pain during reduction but decreases it significantly

Question 8

Irrigation in the ER

Answer 8

Do a ton of it and document the amount in cc’s

Question 9

Field block in the ER

Answer 9

Injection under the skin and around at different sites to numb a site

Question 10

Regional blocks in the ER

Answer 10

Can be done on toes, fingers, ankles, inject around the nerve deep and then superficial but put the entire digit/space to sleep that will last an hour or so but need to do vascular check and motor check beforehand

Question 11

Nail avulsion in the ER

Answer 11

Need to get nail tucked underneath in the matrix to prevent closure of the matrix to allow the nail to continue to grow

Question 12

Joint aspiration in the ER

Answer 12

Can be done on any joint, looking for cultures, crystals, cell counts, gram stains, etc

Question 13

Abscess treatment in the ER

Answer 13

Anesthetize and incise and drain, followed by culture and irrigation, keep open with packing or suture with drain that can be pulled out a few days later upon draining completed

Question 14

Dental repair box

Answer 14

Located in every ER for handling emergency dental repairs when dentists not open or available

Question 15

FAST exam definition

Answer 15

Focused assessment with sonography for trauma exam, diagnostic exam for internal bleeding checking the heart (pericardial), liver/kidney (perihepatic), spleen (perisplenic), and bladder (pelvic) regions