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Surgery and Emergency Med > Role of PA in ER > Flashcards

Role of PA in ER Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

top basket of crash cart

A

large gloves

surgical cone mask

defibrillator pads

adult multi-function electrodes

pediatric multi-function electrodes

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2
Q

bottom basket of crash cart

A

adult BVM with adult masks

peds BVM with #2,3,4 masks

5 in 1 connector and O2 tubing

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3
Q

where is sharps container

A

right side of crash cart

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4
Q

what is on left side of cart

A

O2 tank and gauge

adult and pediatric crash cart inventory list

anaphylaxis tx guide

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5
Q

what things are included on clipboard on back of cart

A

procedures sheet

crash cart check off list

pharmacy charge sheet

code blue team sign-in sheet

code blue record sheets

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6
Q

first drawer of crash cart

A

drugs for adults

alcohol swabs

blank labels

the drugs are all preloaded and measured

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7
Q

2nd drawer of crash cart

A

pediatric medications

IV solutions too - NaCl 100mL, Dextrose, NaCl 1000mL

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8
Q

3rd drawer of crash cart

A

adult intubation supplies

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9
Q

4th drawer of crash cart

A

peds intubation supplies

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10
Q

5th drawer of crash cart

A

IV start supplies

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11
Q

6th drawer of crash cart

A

IV supplies and tubing

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12
Q

7th drawer of crash cart

A

procedure trays

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13
Q

supervision models in ER

A

PA sees pts autonomously and consults PRN with physician

PA sees pts, physician follows up with each pt too

Physician sees all patients outside of PA scope and available for second opinions

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14
Q

Parameters that determine scope of practice:

A

state laws and regulations

facility/institution policies

experience/expertise of the PA

supervising physician delegation

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15
Q

top ten reasons for ED visits

A
  1. abdominal pain
  2. chest pain
  3. fever
  4. cough
  5. headache
  6. SOB
  7. Back pain
  8. Pain (other)
  9. laceration
  10. throat symptoms
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16
Q

What are the warning signs in a pt’s history that makes you have heightened awareness

A

sudden onset (especially first episode)

rapid, significant worsening of symptoms

altered level of consciousness or loss of consciousness

cardiopulmonary symptoms

extremes of age

immunocompromised

poor historian

frequent recent ER visits (drug seeking)

unvaccinated or under-vaccinated

patient signed off to you at the end of shift (YOU NEED TO DO OWN EVALUATION)

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17
Q

why is general appearance so important?

A

look to see if they’re uncomfortable

what is their social interaction like (can tell you about domestic violence)

hydration status (peds - crying but minimal tear production)

lethargy

diaphoresis

skin changes (pallor, jaundice)

18
Q

how often should you re-evaluate a pt in the ED

A

regularly - review vitals, appearance, pain level, and response to intervention

19
Q

what should you do prior to discharge

A

recheck vitals

clear discharge instructions

ask pt if they have questions

20
Q

what is EMTALA?

A

federal regulation for EDs providing medicare/medicaid services:

cannot turn away pt based on ability to pay, legal status, citizenships status

may only transport pt to another facility only if needed

21
Q

what must occur with EMTALA

A

medical screening examination – must be done by PA, NP, physician

this determines if an emergency condition exists?

22
Q

can PAs order hospital transfers?

A

yes as long as consult with SP first and SP cosigns order within timeframe specified by hospital

Some hospital transfers mandate doc to doc interaction

23
Q

what will you see in fast track

A

stable vital signs + minor illness

lacerations

minor bites/burns

abscesses and cellulitis

rashes

headaches (but have hx of them)

earaches, sore throats, cough, congestion

back pain

dysuria without fever

24
Q

high acuity care examples

A

deformed extremities

age less than 3 mos

temp over 103

abnormal vital signs

O2 sat less than 90% on room air

chest pain, difficulty breathing, neurologic changes, abdominal pain, pelvic pain, vaginal bleeding

elderly

25
Q

can PAs hold administrative role and what do they do

A

yes

scheduling

interviewing/hiring

board meetings

can be partners

taking leadership roles

teaching

on-boarding

research

lectures

26
Q

documentation in ER

A

ED note

informed consent

procedure note

admission note

discharge note

leaving AMA note

27
Q

what is your ONLY defense against malpractice

A

YOUR ED NOTE

must be thorough and complete

reflects credibility and competency

used to support billing processes

use to prove/disprove something and then document it

28
Q

what portion of ED note is different than most other notes

A

disposition - where are they being discharged

29
Q

is exact dx always needed and possible

A

NO

30
Q

if discharged to OR, who writes admit note

A

surgeon

31
Q

can you ask for consults if you’re not admitting

A

YES - sometimes you will discharge them with a consult at the doctor’s office in two hours

32
Q

what are the goals of informed consent

A

support pts to make their own decision

give info - more than we think we need to give

make info understandable

offer guidance to help weigh goals and possible outcomes

allow autonomous authorization - consent or refuse

33
Q

exceptions to informed consent

A

unconscious patient

incapable of consenting

imminent harm from non-treatment

no surrogate available

34
Q

justification of an emergency exception to informed consent - what questions to ask (5)

A

will failure to tx quickly result in serious harm to the pt?

would most capable and reasonable people want tx for this type of injury?

is the pt unable to participate in care decisions ?

can pt preferences be related in a timely way from a surrogate?

is there any evidence that the pt would refuse this specific pt?

35
Q

aspects of procedure note

A

pt name and DOB

date/time

indication

consent

description of procedure

estimated blood loss

complications

36
Q

what do you use to help you remember what to include on admission orders

A

ADC VANDISMAL

37
Q

What needs to be included in admission orders

A

Admit

Diagnosis

Condition

Vitals

Allergies

Nursing

Diet

IV fluids

Specials

Meds

Activity

Labs

38
Q

discharge note - what is important to include

A

list ALL meds –> do they discontinue old ones?? be very specific!

39
Q

what should you review with a pt if they decide to leave AMA

A

current medical condition

specific risks and benefits of proposed tx and alternatives

specific potential consequences of leaving AMA

40
Q

what must you do before pt leaves AMA

A

assess mental capacity of pt: pt understands proposed tx, pt understands consequences of refusing tx, pt’s reason for refusal of continued tx or admission

follow up - advise them when to seek medical attn and arrange with social services and family members

41
Q

3 certifications it is recommended you have if you want to work in ED

A

ACLS - advanced cardiac life support

PALS - advanced pediatric life support

ATLS - advanced trauma life support

Surgery and Emergency Med (6 decks)

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