Intro to Emergency Medicine Flashcards
What is the primary mission of emergency medicine?
evaluate, manage and provide medicine to those that PERCEIVE their condition is life threatening
also unexpected illness
what is the #1 goal of ER
See if patient is dying, if not = family care
life or limb threatening condition (need to act quickly)
DO NOT always need to make a diagnosis (instead r/o all things that could be life threatening)
What patients does the ER see?
ALL patients of all ages regardless of CC
what three things are barriers to treatment to ER
time
acuity
resources
Is emergency first come first serve?
No, utilize triage to determine how critical they are (determined by triage nurse)
55 yo with chest pain 2 min > 45 yo with abdominal pain 30 min > 7 yo w/ sore throat
What are the 5 levels of triage
1 = MOST severe and bypass triage
2 - 5 = triage nurse
based on how many resources we think people need
2 = chest pain
3 = adbominal pain
4 = swabs
5 = wound checks / dental pains
2-5 = sitting in waiting room
4-5 will sit in ER for a while
if a patient is unstable, what do we do to stabilize them?
based on their vitals
neuro deficits for stroke (time window is 3 hours)
while stabilizing a patient, what do you do next?
R/o worst case scenarios that can kill the patient first
After r/o worst case scenarios, what do you do next?
Narrow differentials
is diagnosis always important
not for the ER
After stabilized, what do you do?
See if they need to be inpatient or discharged outpatient
Before discharging, what should you do?
ALWAYS
see provider 2-3 days
if symptoms worsen, come back to the ER
also
are they close to an ER/ EMS
do they have support at home (78 yo man that is alone)
ER provider has to feel safe about it
document on discharge papers verbal and written instructions
If some1 does not make it in the ER, what should you do?
Reflect
Think of if condition can cause other people get sick
Autopsy based on medical examiner if sus death
Organ donation
What to do if you need to deliver bad news?
Generally team will
Be straightforward
What is EMTALA
duty to provide emergency care despite ability to pay
if deemed there is not emergency, you do not need to do anything (any facility with Medicare), medical malpractice though
can an unstable patient be transferred?
NO
only can deny transfer if they do not have the bed or specialty
what is informed consent
risk/benefits of ALL options
NEEDED to do this for lawsuits
when is informed consent overwritten
Unconscious with life threatening case
Unconscious with no
who do you obtain informed consent from?
Whoever is doing the procedure
MA, Nurse, PA, NP, or doctor
should avoid blank statement “all risks have been discussed” should instead be specific
Who can give informed consent?
All adults are considered competent unless
what adults cannot give informed consent
not intoxicated patients
in police custody can!
Can a kid seek treatment at ER without parent approval?
Yes - denying care = ANTALA violation
if a psych patient is deemed to be a threat to themselves or others, what needs to happen
psych eval even against will
remember
Are Jehova’s witness parents allowed to deny treatment to kid?
NO
Child can still be given treatment despite parent’s will
What is the most important thing about documentation of ER
Any provider can see why you chose the care you did
Know your audience
What is included in a ER note
time and means of arrival
onset (# of hours or minutes ago rather than clock time like 2:30)
acute distress (need to have intervention, otherwise say appears anxious)
ER care prior to arrival
ER course (patient arrived and this is what I did and how they changed over time)
Medical decision making (document differential and how you worked through the differential to justify it)
Final disposition
Patient condition of discharge
Consultation in ER course
