Principles of Emergency Medicine Flashcards
What is the primary mission of emergency medicine?
- Manage patients with perceived emergency condition
- Manage unexpected injury or illness requiring immediate medical or surgical evaluation and treatment
What are roles of emergency medicine providers?
- Determine if patient has life or limb threatening problem (not neccessarily about making diagnosis)
- Provide care to patients of all ages
- Make medical decisions with limited time (acuity and severity of patient illness) and information (labs/imaging may be limited due to availability or patient stability) in fast paced environment
- Act as patient advocate (ie consult with specialist, ensure follow up, compliance, consult CPS/APS)
What is the order of seeing patients in emergency medicne?
- Triage and see patients who are about to die first followed by emergent (illness may progress) followed by nonurgent
What questions should be asked in order to provide emergency care?
- Is the patient going to die? Stabilize!
- What steps need to be undertaken to stabilize patient? (ABCs, neuro deficits –> stroke)DO NOT DELAY for tests
- What are the diseases most likely to be the cause of the patient’s presentation? Top differential - worst case scenario, what will kill this patient the quickest
- Could there be multiple causes of the patient’s presentation?
- Can a treatment assist in the diagnosis in an otherwise undifferentiated illness? (ex administration of naloxone)
- Is a diagnosis mandatory or even possible? (accept the possibility of treating their symptoms and excluding emergency conditions without making diagnosis)
- Does this patient need admitted to the hospital? Are you comfortable discharging this patient home?
- If the patient is not admitted, is the disposition safe and adequate for the patient? (be thorough with verbal and written discharge instructions, follow up, when to return to ED, etc.)
What are considerations if patients die?
- Debrief
- Why did they die?
- Will the illness have an impact on survivors?
- Does the illness put health care workers/society at risk?
- Should an autopsy be performed for medical or legal reasons?
- Does the family desire organ donation?
What are guidelines to delivering bad news in emergency medicine?
- Be straightforward but empathetic in verbage
- Have security close by and leave door open due to occassional violent reactions from survivors
The number of ED malpractice claims and the size of malpractice judgements are ……., which has lead to the practice of ………. leading to a ………
increasing, defensive medicine, higher overall cost of healthcare
What is EMTALA?
- Duty to provide emergency care regardless of payment
- Applies to any facility that has medicare contract and receives payment from medicare or medicaid
- Requires that any patient with emergency medical condition must be appropriately and sufficiently examined and evaluated
What happens under EMTALA if an emergent condition is ruled out?
Duty to the patient under EMTALA ends
would still be medical malpractice though
If an emergency condition exists what is duty under EMTALA? How is EMTALA related to a receiving facility?`
- Stabilize the patient and either admit or transfer
- Receiving hospital may not refuse appropriate transfer unless they do not have the capacity or there is another facility to manage patient
What is the effect of EMTALA on the ED?
- ED = routine source of healthcare for uninsured, even for non-emergent conditions
- Leads to patient crowding and longer wait times
- Puts financial strain on hospitals and physicians –> difficulty obtaining specialty physician consults/referrals
What is informed consent?
Process providing patient with adequate information about proposed diagnostic or therapeutic procedure in order to make informed decision about his/her own body
What are components of informed consent?
- Patient’s diagnosis
- Purpose of the treatment
- Risks and expected outcomes of treatment
- Alternative treatments and their risks
- Consequences of no treatment
What are exceptions to informed consent?
- Medical emergencies in which patient is unable to communicate, there is no one available to make decisions, or there is no time to obtain consent
- When patient receives recurrent treatment (ie dialysis)
- When patient waives right to be informed
- Doctrine of therapeutic privilege
What is the doctrine of therapeutic privilege?
Can be invoked (rarely) when patient is so anxious or fragile that full disclosure might cause serious emotional or physical harm
