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Unit 1 Emerg/Surg > L1: Role of PA in ED > Flashcards

L1: Role of PA in ED Flashcards

1
Q

Largest PA specialties

A 
#1 surgery
#2 ER
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2
Q

Physicians to PA ratio in the ED

A

1:3

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3
Q

Top basket crash cart

A

Large gloves
Surgical cone mask
Defibrillator pads
Adult multi-function electrodes

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4
Q

Drawer 1 crash cart

A

Drugs

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5
Q

Drawer 2 crash cart

A

IV Solutions/Pediatric drugs

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6
Q

Drawer 3 crash cart

A

Adult intubation supplies

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7
Q

Drawer 4 crash cart

A

Peds intubation supplies

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8
Q

Drawer 5 crash cart

A

IV start supplies

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9
Q

Drawer 6 crash cart

A

IV supplies and tubing

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10
Q

Drawer 7 crash cart

A

Procedure trays

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11
Q

Bottom basket crash cart

A

Adult BVM+masks
Peds BVM+ #2, 3, 4 masks
5 in 1 connector and O2 tubing

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12
Q

Right side of crash cart

A

sharps container

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13
Q

Left side of crash cart

A

O2 tank + gauge

Adult + pediatric crash cart inventory list Anaphylaxis tx guide

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14
Q

Rear of crash cart

A 
Clipboard: 
procedures sheet
crash cart check off list
pharmacy charge sheet
code blue team sign in sheet
code blue record sheets
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15
Q

3 supervision models for PAs in the ED

A
  1. PA see patients autonomously and consults PRN with supervising physician
  2. PA see patients, physician follows up with each patient as well (for billing purposes 85% → 100%)
  3. Physician sees all patients outside of PA scope and is available for second opinions
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16
Q

Top 10 reasons for ED visits

A 
Abdominal pain
Chest pain
Fever
Cough
Headache
SOB
Back pain
Pain
Laceration
Throat symptoms
17
Q

Warning signs in history

A 
Sudden onset, first episode
Rapid, significant worsening of symptoms
Altered level of consciousness or LOC 
Cardiopulmonary symptoms→ dyspnea, chest pain
Extremes of age: newborns, elderly
Immunocompromised
Poor historian
Frequent, recent ED visits
Unvaccinated/under-vaccinated 
Patient signed off to you at end of shift
18
Q

What might be a sign that a child is dehydrated?

A

Crying without tears

19
Q

4 ED zones a PA might work in

A

Triage
Fast track
Intermediate care/acute care/high acuity care
Trauma

20
Q

PAs in triage are helpful becauses

A

Reduce patients who left without being seen by 80%, wait times by 50%

Aid in compliance with “Emergency Medical Treatment and Labor Act” of 1986

21
Q

Emergency Medical Treatment and Labor Act

A

Regulations for EDs providing medicare/medicaid services

Ensures all individuals access to emergency care, regardless of citizenship, legal status, or ability to pay

May transport patient only if needed

Requires Medical Screening Examination (MSE) by PA/NP/MD/DO

22
Q

Medical Screening Examination

A

Determine if an emergent medical condition exists

PAs can perform MSE as long as written hospital policy specifies

23
Q

Can ED PAs order transfers?

A

PAs can order transfers if: consult SP, SP co-signs order within time frame specified by hospital policy

Some hospital transfers mandate “Doc to Doc” interaction

24
Q

Common chief complaints in fast track

A 
Stable vital signs and minor illness
Lacerations
Minor bites/burns
Abscesses or cellulitis
Rashes
Headaches, migraines (with pt history, not new onset?)
Earaches, sore throats, cough, congestion
Back pain
Dysuria
25
Q

Common chief complaints in Intermediate care/ acute care/ high acuity care

A 
*more advanced illnesses or serious injury*
Deformed extremities
Age <3 months or Elderly
Temperature > 103 F
Abnormal vital signs
O2 saturation <90% on room air
Chest pain
Difficulty breathing
Neuro changes
Abdominal pain/ pelvic pain
Vaginal bleeding
26
Q

Supervision model for Rural EDs and what PAs may do

A

May work alone with satellite physician supervision

May be only resource for healthcare in region

May cover ED alone without consultants available

Might not have skilled help for minor procedures

Stabilize + transfer critical patients to facility with higher level of care

27
Q

Administrative role as lead PA in ED

A 
Education, teaching and administrative functions pertaining to emergency medicine
Scheduling
Hiring and interview of new PAs
Discuss PA issues at board meetings
Can be partners in ED physician groups
Leadership roles in clinical initiatives
28
Q

PA in ED Teaching role

A 
Teaching residents
Precepting PA students
“on-boarding” new PAs
Research
Lectures
29
Q

Pre-hospital ground or air transport of patients

A

Care for patients at scene of call and during transport

Care for patients during transport from one facility to another

Care at events: concerts, sporting

Part of EMS team in rural areas where transport times to ED are longer

Military: transport to medical facilities in combat situations

30
Q

Defenses a PA has against malpractice

A

ED note is the ONLY defense

31
Q

What is the focus of a practitioner in the ED?

A

Think of the worst possible scenario and rule it out

32
Q

How is the level of service for billing purposes supported?

A

ED note

33
Q

What is meant by or included with “Disposition”

A

+/- exact diagnosis (not always possible/necessary)
Sick or not sick?
Where are they going?
Home with follow up vs admission + workup or monitoring?
Discharge, leaving against medical advice
To OR, to observation (24 hours non-cardiac chest pain or asthma)
Admit to med/surg, telemetry, or ICU
Transfer to skilled nursing facility or hospice

34
Q

What should a procedure note include?

A 
Name, DOB, Date/time
Indication, Consent
Description of procedure
Estimated blood loss (EBL)
Complications (if any)
35
Q

What are the goals of informed consent?

A

Support patients to make a decision
give lots of information
offer guidance in weighing goals and possible outcomes
allow autonomous authorization→ patient consent or refusal

36
Q

What are the exceptions to informed consent?

A 
unconscious patient
incapable of consenting
imminent harm from non-treatment
no surrogate available in timely way
→ make sure there is no evidence patient would refuse a specific tx
37
Q

ADC VANDISMAL acronym for admission notes

A

Admit: floor, ICU, telemetry

Diagnosis: primary diagnosis at time of admission

Condition: stable vs unstable

Vitals: frequency, continuous pulse ox? when to call?

Allergies: foods and medications

Nursing: pressure dressings, neuro checks, etc

Diet: normal, low sodium, NPO?

IV fluids: maintenance, bolus

Specials: DVT prophylaxis

Meds: pre-hospital AND new medications

Activity: ad lib, fall risk, etc

Labs: CBC, CMP, q am

38
Q

Leaving Against Medical advice note needs to address 3 broad areas:

A

Review: current medical condition, specific risks and benefits of treatments and alternatives, specific consequences of leaving

Assess mental capacity of patient: understands proposed tx, understands consequences, reasoning for refusal of tx/admission

Follow-up: advise when to seek medical attention, arrangement with social services, family members, etc.

39
Q

Discharge note should include 5 components

A

Discharge diagnosis: cannot be a sign or symptom

Secondary diagnosis: regardless of when diagnosed

Discharge medications: all meds, doses, route, frequency

Discharge instructions: activity level, diet, wound care, return to ER

Follow-up: name of doctor, specialty, appointment location and time. Include timeframe if the patient is scheduling the appointment.

Unit 1 Emerg/Surg (10 decks)

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