Role of PA in ER Flashcards
top basket of crash cart
large gloves
surgical cone mask
defibrillator pads
adult multi-function electrodes
pediatric multi-function electrodes
bottom basket of crash cart
adult BVM with adult masks
peds BVM with #2,3,4 masks
5 in 1 connector and O2 tubing
where is sharps container
right side of crash cart
what is on left side of cart
O2 tank and gauge
adult and pediatric crash cart inventory list
anaphylaxis tx guide
what things are included on clipboard on back of cart
procedures sheet
crash cart check off list
pharmacy charge sheet
code blue team sign-in sheet
code blue record sheets
first drawer of crash cart
drugs for adults
alcohol swabs
blank labels
the drugs are all preloaded and measured
2nd drawer of crash cart
pediatric medications
IV solutions too - NaCl 100mL, Dextrose, NaCl 1000mL
3rd drawer of crash cart
adult intubation supplies
4th drawer of crash cart
peds intubation supplies
5th drawer of crash cart
IV start supplies
6th drawer of crash cart
IV supplies and tubing
7th drawer of crash cart
procedure trays
supervision models in ER
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
Parameters that determine scope of practice:
state laws and regulations
facility/institution policies
experience/expertise of the PA
supervising physician delegation
top ten reasons for ED visits
- abdominal pain
- chest pain
- fever
- cough
- headache
- SOB
- Back pain
- Pain (other)
- laceration
- throat symptoms
What are the warning signs in a pt’s history that makes you have heightened awareness
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)
why is general appearance so important?
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)
how often should you re-evaluate a pt in the ED
regularly - review vitals, appearance, pain level, and response to intervention
what should you do prior to discharge
recheck vitals
clear discharge instructions
ask pt if they have questions
what is EMTALA?
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
what must occur with EMTALA
medical screening examination – must be done by PA, NP, physician
this determines if an emergency condition exists?
can PAs order hospital transfers?
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
what will you see in fast track
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
high acuity care examples
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
can PAs hold administrative role and what do they do
yes
scheduling
interviewing/hiring
board meetings
can be partners
taking leadership roles
teaching
on-boarding
research
lectures
documentation in ER
ED note
informed consent
procedure note
admission note
discharge note
leaving AMA note
what is your ONLY defense against malpractice
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
what portion of ED note is different than most other notes
disposition - where are they being discharged
is exact dx always needed and possible
NO
if discharged to OR, who writes admit note
surgeon
can you ask for consults if you’re not admitting
YES - sometimes you will discharge them with a consult at the doctor’s office in two hours
what are the goals of informed consent
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
exceptions to informed consent
unconscious patient
incapable of consenting
imminent harm from non-treatment
no surrogate available
justification of an emergency exception to informed consent - what questions to ask (5)
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?
aspects of procedure note
pt name and DOB
date/time
indication
consent
description of procedure
estimated blood loss
complications
what do you use to help you remember what to include on admission orders
ADC VANDISMAL
What needs to be included in admission orders
Admit
Diagnosis
Condition
Vitals
Allergies
Nursing
Diet
IV fluids
Specials
Meds
Activity
Labs
discharge note - what is important to include
list ALL meds –> do they discontinue old ones?? be very specific!
what should you review with a pt if they decide to leave AMA
current medical condition
specific risks and benefits of proposed tx and alternatives
specific potential consequences of leaving AMA
what must you do before pt leaves AMA
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
3 certifications it is recommended you have if you want to work in ED
ACLS - advanced cardiac life support
PALS - advanced pediatric life support
ATLS - advanced trauma life support
