Emergency Medicine
Transcript of Emergency Medicine
Emergency Medicine Dr. Hossam Hassan Consultant and assistant Prof.
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 few hours (30 m)• 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