Intro to Emergency Medicine

Question 1

What is the primary mission of emergency medicine?

Answer 1

evaluate, manage and provide medicine to those that PERCEIVE their condition is life threatening

also unexpected illness

Question 2

what is the #1 goal of ER

Answer 2

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)

Question 3

What patients does the ER see?

Answer 3

ALL patients of all ages regardless of CC

Question 4

what three things are barriers to treatment to ER

Answer 4

time
acuity
resources

Question 5

Is emergency first come first serve?

Answer 5

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

Question 6

What are the 5 levels of triage

Answer 6

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

Question 7

if a patient is unstable, what do we do to stabilize them?

Answer 7

based on their vitals
neuro deficits for stroke (time window is 3 hours)

Question 8

while stabilizing a patient, what do you do next?

Answer 8

R/o worst case scenarios that can kill the patient first

Question 9

After r/o worst case scenarios, what do you do next?

Answer 9

Narrow differentials

Question 10

is diagnosis always important

Answer 10

not for the ER

Question 11

After stabilized, what do you do?

Answer 11

See if they need to be inpatient or discharged outpatient

Question 12

Before discharging, what should you do?

Answer 12

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

Question 13

If some1 does not make it in the ER, what should you do?

Answer 13

Reflect
Think of if condition can cause other people get sick
Autopsy based on medical examiner if sus death
Organ donation

Question 14

What to do if you need to deliver bad news?

Answer 14

Generally team will
Be straightforward

Question 15

What is EMTALA

Answer 15

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

Question 16

can an unstable patient be transferred?

Answer 16

NO
only can deny transfer if they do not have the bed or specialty

Question 17

what is informed consent

Answer 17

risk/benefits of ALL options

NEEDED to do this for lawsuits

Question 18

when is informed consent overwritten

Answer 18

Unconscious with life threatening case
Unconscious with no

Question 19

who do you obtain informed consent from?

Answer 19

Whoever is doing the procedure
MA, Nurse, PA, NP, or doctor

should avoid blank statement “all risks have been discussed” should instead be specific

Question 20

Who can give informed consent?

Answer 20

All adults are considered competent unless

Question 21

what adults cannot give informed consent

Answer 21

not intoxicated patients
in police custody can!

Question 22

Can a kid seek treatment at ER without parent approval?

Answer 22

Yes - denying care = ANTALA violation

Question 23

if a psych patient is deemed to be a threat to themselves or others, what needs to happen

Answer 23

psych eval even against will

remember

Question 24

Are Jehova’s witness parents allowed to deny treatment to kid?

Answer 24

NO
Child can still be given treatment despite parent’s will

Question 25

What is the most important thing about documentation of ER

Answer 25

Any provider can see why you chose the care you did
Know your audience

Question 26

What is included in a ER note

Answer 26

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