Definition of Emergency Medicine
Emergency Medicine is a medical specialty which:
• Evaluates & treats unexpected (episodic) illness and injury
• Patient population is largely unknown to the physician
• Encompasses a unique body of knowledge
• Depth and breadth of understanding
• Multi-system illnesses in an unknown patient
• Operates under a paradigm that is different from the “traditional” approach
• Manage “unknown” patients
• Manage multiple patients at once
• Assume the worst and look for the unusual before accepting the probable
• 24 hour operations
• Focus on the immediate – get results now
• Identify correct sequence of priorities.
• Outline primary and secondary surveys.
• Identify and discuss history and injury mechanism.
• Explain treatment guidelines used during resuscitation and definitive care phases.
A safe and reliable method to :
• Assess condition rapidly, accurately.
• Resuscitate/ stabilize via ABC priorities.
• Determine if needs exceed capabilities.
• Arrange for interhospital transfer.
• Assure optimum care is provided.
Goggles, gloves, gown, mask, over shoes, head cover.
Sorting of patients according to ABC and available resources
Triage in medicine
- Field Triage
I) mass casualty or Disaster Triage
II) trauma Triage
- ED Triage
- In-hospital Triage
- On-line Triage…..!?
Triage Priority (for Rx or transport )is dependent upon:
(a) ABDE Priority :
- A irway Compromise +/- management (with C-spine supp )
- B reathing compromise +/- management
- C irculation compromise +/-management
- D isability ; AVPU
- E xposure/ Environment
(b) Severity and/or combination of injuries
(c) Available Resources(manpower, equipments, hospitals level in the area,..etc.
Who can do Triage ?
- Triage Officer
- Triage Nurse
- MD Personnel
To provide the greatest good for the most victims given a certain amount of resources.
FIELD TRIAGE CARD
• Adult / Pediatric priorities
• A- Air way with C- spine control
• B- Breathing
• C- Circulation with hemorrhage control.
• D- Disability: Neurologic status
• E- Exposure / Environment
Assume C-Spine injury
• Multisystem trauma
• Altered level of consciousness
• Blunt injury above clavicle
• Assess Blood Volume loss and Cardiac out put.
• Level of Consciousness.
• Skin Color.
Disability (Neurological Evaluation)
• Level of consciousness.
V- Responds to voice.
P- Responds to pain.
Exposure / Environment
• Undress patient completely
• Protect from hypothermia
• Manage life threatening injuries in sequence.
• Need to transfer.
• Complete History Taking
• Head – to – toe evaluation
• Complete neurologic exam
• Special procedures
• “Tubes and fingers in every orifice”
• Re- evaluation
Complete History Taking
• In Trauma, like other diseases,……………….
An accurate ,complete and correctly interpreted HISTORY “after initial resuscitation” can lead to an indication or suspicion of 90% of a patient injuries.
(This entails :type of accident, estimation of energy exchange and mechanism of impact or colloision)
Types of Motor Vehicle Collisions
- Frontal impact.
- Lateral impact.
- Rotational impact.
- Rear impact.
Deceleration and Acceleration
• Critical Factor
• Increased height + Increased injury
• Type of impact surface increases injury
– Objects struck during fall
– Body part of first impact
• Head Buttocks
Assess body part that impacts first, usually sustains the bulk of injury
Think about the path of energy through body and what other organs/systems could be impacted (index of suspicion)
Yawing and Tumbling Projectiles
- Some projectiles are designed to tumble.
- Tumbling creates greater tissue damage and more tissue destruction.
• A llergies.
• M edication.
• L ast meal.
• E vents / Environment.
Mechanism of injuries
• Hazards to community.
Records and legal considerations
• Concise, chronological documentation.
• Consent for treatment.
• Forensic evidence.
Priorities of trauma management include:
• Primary survey
• Secondary survey
• Definitive care