Introduction to Emergency Medicine

Question 1

What makes up the emergency medical system?

Answer 1

• Urgent Care
• EMS
• Emergency Department

Question 2

What makes a Level I Truama Center meet the criteria for Level I?

Answer 2

• Specialists available 24 hours
• 24 hour surgeons in all major subspecialties (includes cardiac)
• 24 hour neurodiology and hemodyalysis
• Trauma research program and residency program

Question 3

What is EMTALA?

Answer 3

You MUST SCREEN and STABALIZE before transferring or discharging a patient - may just be an H&P but has to be completed by a provider (not nursing triage)

All patients have the right to a medical screening exam

Federal Law; can’t transfer unstable patient must stabalize prior

Question 4

Is a woman in labor (having contractions) considered stable or unstable?

Can they be transferred?

Answer 4

Unstable

Can not be transferred unless patient requests transfer

Question 5

An appropriate transfer under EMTALA includes:

Answer 5

• Patient is stabalized to best of current facilities ability
• Accepting facility has capability and capacity
• Accepting facility agrees to take pateint
• Medical information is sent with the patient
• Transfer occurs with qualified transfer personnel
• The accepting facility must accept patient and have the capacity

Question 6

What is the first mindset in emergency department?

Answer 6

Sick or Not Sick?

Need to rule out can’t misses first

Question 7

What is included in SAMPLE History?

Answer 7

S: signs and symptoms
A: allergies
M: medications
P: pertinent past medical history
L: last oral intake
E: events leading up to the episode

Question 8

What are the length of ACLS increments?

Answer 8

2 minutes

Question 8

What are shockable rhythms?

Answer 8

V-tach
A-Fib

Question 9

When do you give Amiodarone in ACLS?

What medication is always given?

Answer 9

Only if you are shocking the patient

Epinephrine

Question 10

Who gets lidocaine?

Answer 10

Patients coding in the OR

Question 11

Where does blood hang out in a trauma in the abdomen?

Answer 11

• Pelvis
• Between kidney and spleen
• Between liver and kidney

Question 12

Who gets X-Ray’s in the ED?

Answer 12

• Fracture
• GI obstruction
• Free air
• Pneumonia
• Pneumo
• Cardiomegaly
• Mediastinal widening
• Foreign body (bite wounds)

Question 13

Who gets a CT in the ED?

Answer 13

• Provider discretions
• Concerns for ICH (head trauma)
• Concern for deep space infection
• Vascular obstruction
• Dissection/aneurysm
• Abdominal pain of unclear origin
• Surgical prep

Question 14

Who gets an MRI in the ED?

Answer 14

• Cauda equina
• Pregnant women
• CNS dysfunction (brain and spine)
• Some surgical teams will request

Question 15

What are the dispositions of ED patients?

Answer 15

• Admission
• Observation
• Against medical advice
• Discharge