Emergency Medicine

Objectives

• Acute medical illnesses • Acute surgical illnesses• Acute Obstetrical emergencies• Trauma• Acute mental illnesses• Acute ENT & Ophthalmological emergencies• Environmental hazards

Top Ten Leading Causes of Death

• Heart Disease: 726,974• Cancer: 539,577• Stroke: 159,791• Chronic Obstructive Pulmonary Disease:

109,029• Accidents: 95,644• Pneumonia/Influenza: 86,449• Diabetes: 62,636• Suicide: 30,535• Nephritis, Nephrotic Syndrome, and Nephrosis

25,331• Chronic Liver Disease and Cirrhosis: 25,175

Reception

• 300 – 500 visits per day• Only 20-50 cases require urgent

intervention• Few cases are life-threatening (1-5)

Triage

300300 – – 500500casescases

LifeLife--ThreateningThreatening

UrgentUrgentCasesCases

Non- urgentNon- urgentCasesCases

Triage-OutTriage-Out

Triage ( Categorization)

• Category 1 – 5• 1 : Life-Threatening• 5 : Triage out

Triage

• Physician Triage

• Nurse Triage

• Clark Triage

Life-Threatening Cases ( C.1)

Need immediate intervention• Arrest • Arrhythmias• Hypoxia• Shock• Acute trauma• Siezure• Status Asthmaticus• Anaphylaxis• Chest pain ( STEMI )• Delivery – stage 2

C.2 ( Urgent Cases)

Should be treated within 10 min.

• Acute asthmatic attack

• High Blood Pressure

• Intoxication

• Drowsy patient

• Acute colics

• Fractures

• Burns

C.3 ( Acute Cases )

Should be treated within 30 minutes• Chest Pain ( Non cardiac )• Abdominal pain• Dyspnea• Fever• Old trauma• Gastroeneteritis• Metabolic Derangement• Post ictal state

Cont’d Triage

• C4 : Chronic Abdo pain

Minor trauma

claimed : Fever-Low BP- Fast HR

• C5 : URTI

Long-standing complaints

Meds-Refill

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Appeal of Emergency Medicine

• Make an immediate difference• Life threatening injuries and

illnesses• Undifferentiated patient population• Challenge of “anything” coming in• Emergency / invasive procedures• Safety net of healthcare

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Appeal of Emergency Medicine

• Team approach• Patient advocacy• Open job market• Academic opportunities • Shift work / set hours• Evolving specialty

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Downside to Emergency Medicine

• Interaction with difficult, intoxicated, or violent patients

• Finding follow-up or care for uninsured• Working as a patient advocate• Contract management groups• Malpractice targets

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The Lifestyle:Two Sides of A Coin

• Well defined shifts• Usually not on call• Part time employment possible

• Evenings and nights• Weekends• Holidays

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Subspecialties in Emergency Medicine

• Pediatric Emergency Medicine• Toxicology• Emergency Medical Services• Sports Medicine• Critical Care Medicine

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Upcoming Areas of Emergency Medicine

• Observation units• ED CT

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Research Opportunities

• Broad range of subjects• Limited amount of work published in our

relatively new field

• Limited number of research mentors• Limited number of clinical trials

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What to do to get in to Emergency Medicine ?

• Observe in ED• Summer research projects with EM staff• EM interest group affiliation• Be open to any medical specialty

Trauma

Primary Survey ( A-B-C-D)

Secondary Survey ( Systemic)

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What’s Your Diagnosis ?

OR

Chest pain ( Cardiac )

Chest Pain

Arrhythmias

Low Blood Pressure

• PB = COP * SVR ( 120 / 80 ) mmHg

• COP = SV * HR ( 4- 6 ) 4-6 L/m

• SV = EDV - ESV ( 50 – 100 ) ml

Low Blood Pressure

• Preload• Contractility• Afterload

Dyspnea ( S.O.B)

ABG : 7.35

40

80

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O2 saturation: 99%

Acute Respiratory Failure

• Hypoxemic

• Hypercapnic

Asthma

COPD

Pneumonia

Abdominal Pain ( Medical )

Abdominal Pain ( Surgical )

Fractures

Fractures

Fractures

Laceration

Seizure

Acute Psychiatric Ilnesses

DM

DKA

Skin Rash

THANKS