Introduction to Emergency Medicine

Question 1

Describe the role of a PA in an emergency room setting.

Answer 1

Primary mission = “evaluating, managing, and providing treatment to these patients with unexpected injury and illness.”

Wide skill base to treat variety of illness, ages, biohazard injury. Consider life-threatening pathology without necessarily aiming for a diagnosis. Recognize time constrants.

Question 2

What is the EMTALA law:

Answer 2

The Emergency Medical Treatment and Active Labor Act was created in 1985 to protect the patient from being turned away during a state of emergency.

Question 3

The basics of EMTALA requires the following:

Answer 3

Determining whether or not an ‘‘emergency medical condition’’ exists is by way of the ‘‘appropriate medical screening examination’’. If, after completing an adequate medical screening examination, it is determined that the patient is not suffering from an emergency medical condition, there is no further obligation under the Act on the part of the hospital or physician to that patient.

Question 4

T/F: If there is no emergency medical condition, the Act does not apply. Any patient who is found to have an emergency medical condition must be stabilized.

Answer 4

True

Question 5

T/F: The appropriate on-call physician is not required to be consulted in the administration of necessary stabilizing treatment in emergency situations.

Answer 5

False, If necessary, the appropriate on-call physician must be consulted to administer necessary stabilizing treatment.

Question 6

T/F: Once the patient has been stabilized, the Act no longer applies.

Answer 6

True

Question 7

T/F: If a hospital is un- able to provide the necessary stabilizing treatment, arrangements must be made for an appropriate transfer to a facility with the capacity to provide treatment.

Answer 7

True

Question 8

T/F: A hospital with specialized capabilities or facilities may refuse to accept a transfer of an individual who requires such specialized capabilities or facilities even if the hospital has the capacity to treat the individual.

Answer 8

False, A hospital with specialized capabilities or facilities may not refuse to accept an appropriate transfer of an individual who requires such specialized capabilities or facilities if the hospital has the capacity to treat the individual.

Question 9

T/F: If a woman is in active labor and there is insufficient time to effect an appropriate transfer safely, maternal and newborn care must be provided to the woman and her infant.

Answer 9

True

Question 10

Critical Patients:

Answer 10

Patient has symptoms consistent with life-threatening illness or injury with high probability of death if immediate intervention is not begun.

Question 11

Emergent Patients:

Answer 11

Patient has symptoms of illness or injury that may progress in severity if treatment is not begun quickly.

Question 12

Non-urgent Patients:

Answer 12

Patient has symptoms that have a low probability of progression to a more serious condition.

Question 13

Basic rule of thumb in emergency medicine is:

Answer 13

Look for symptoms of a life-threatening emergency, not a specific disease entity. Anticipate impending life-threatening emergencies in the apparently stable patient.

Question 14

T/F: Small ERs may be staffed by PAs with supervising physician available only by phone

Answer 14

True

Question 15

T/F: Many of the supervising ER physicians are board certified in Emergency Medicine.

Answer 15

False, Many of the supervising ER physicians are actually not board certified in Emergency Medicine

Question 16

What are the triage levels?

Answer 16

Levels 1 – 5, with Level 1 being most acute and Level 5 being least acute.

May change triage level according to vitals (including pain scale)

Question 17

Who determines the triage level?

Answer 17

Triage nurse determines level

Question 18

What do EMTALA Laws determine?

Answer 18

Determines when and how a patient may be:

1. Refused treatment or
2. Transferred from one hospital to another

Question 19

What hospitals are governed by EMTALA laws?

Answer 19

EMTALA applies only to participating hospitals, defined as those that are acceptors of Medicare and/or Medicaid. This excludes Shriners and Military hospitals.

Question 20

What is an emergent condition?

Answer 20

An emergent medical condition manifests itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in: Placing the health of the individual or unborn child in serious jeopardy, Serious impairment to bodily function or Serious dysfunction of any body part or organ.

Question 21

What are exceptions in transferring patients before stabilization?

Answer 21

If a patient requests to be transferred and is fully informed of the consequences of being moved OR If a physician feels that the medical benefits exceed the risk of the transfer.