Emergency Room

Yi Ping Zhao

Department of Vascular SurgeryRen Ji Hospital

How Emergency Rooms Work

You will learn about

• the normal flow of traffic in an emergency room

• the people involved

• the special techniques used to respond to life-or-death situations

Emergency Room Patients

• Car accidents • Sports injuries • Broken bones and cuts from accidents and falls • Burns • Uncontrolled bleeding • Heart attacks, chest pain • Difficulty breathing, asthma attacks, pneumonia • Strokes, loss of function and/or numbness in arms or legs • Loss of vision, hearing • Unconsciousness

Emergency Room Patients

• Confusion, altered level of consciousness, fainting • Suicidal or homicidal thoughts • Overdoses • Severe abdominal pain, persistent vomiting • Food poisoning • Blood when vomiting, coughing, urinating, or in bowel

movements • Severe allergic reactions from insect bites, foods or

medications • Complications from diseases, high fevers

Understanding the ER Maze

• The classic emergency room scene involves an ambulance screeching to a halt, a gurney hurtling through the hallway and some people frantically working to save a person's life with only seconds to spare.

• This does happen and is not uncommon, • The majority of cases seen in a typical

emergency department aren't quite this dramatic.

Triage

When you arrive at the ER, your first stop is triage. This is the place where each patient's condition is prioritized into three general categories:

• Immediately life threatening • Urgent, but not immediately life

threatening • Less urgent

Triage

The triage nurse records patients vital signs (temperature, pulse, respiratory rate and blood pressure).

She also gets a brief history of patients current medical complaints, past medical problems, medications and allergies.

Registration

• This step is necessary to develop a medical record so that patients medical history, lab tests, X-rays, etc., will all be located on one chart that can be referenced at any time.

• If the patient's condition is life-threatening or if the patient arrives by ambulance, this step may be completed later at the bedside.

Examination Room

• Patients are seen by an ER nurse who obtains more detailed information about patients.

• Once the nurse has finished her tasks, the next visitor is an ER physician. He gets a more detailed medical history about your present illness, past medical problems, family history, social history, and a complete review of all your body systems. He then formulates a list of possible causes of your symptoms.

Diagnostic Tests

Blood tests and a urinalysis are required.

• A complete blood count (CBC)     

• A serum test

• A blood's clotting test

Diagnosis and Treatment

• When the emergency physician has all the information he can obtain, he makes a determination of the most likely diagnosis from his differential diagnosis.

• Alternately, he may decide that he does not have enough information to make a decision and may require more tests. At this point, appropriate consultant is needed.

The ER team

• Emergency Physician

• Emergency Nurse

• Physician Assistant

• Emergency Department Technician

• Unit Secretary

• Physicians in Training

Tools of the Trade

• Emergency Departments are stocked with a huge array of strangely named, oddly shaped, beeping and blinking equipment.

Stethoscope

• A stethoscope lets a nurse or physician listen to heart and respiratory sounds.

• A stethoscope is used to take your blood pressure by listening to the flow of blood through your arteries.

Cardiac Monitor

• A cardiac monitor gives a visual display of the rhythm of patients heart.

• Some monitors also have an automatic blood pressure cuff and a pulse oximeter.

Suture Tray

This tray contains the sterile equipment needed to place stitches in a patient with a laceration.

• needle holder • forceps • sterile towels • scissors• small bowls

Orthopedic Equipment • Most emergency departments have a generous

number of orthopedic devices for many purposes

• plaster and/or fiberglass materials • pre-made splints for specific joints

– knee immobilizers– aluminum finger splints– Velcro wrist splints– shoulder slings– cervical collars

• cast cutters

Crash Cart

A crash cart is a cabinet containing equipment that physicians and nurses need when a cardiac arrest occurs. – Defibrillator – Endotracheal intubation

equipment – Central vein catheters – Cardiac drugs

Defibrillator

Tools used in endotracheal intubation