Emergency Medicine

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  • There is no better job than emergency medicine. We work as the detective to determine the cause of the patients complaints. Patients are not admitted to us with pyelonephritis. They present with an undifferentiated complaint such as back pain and fever. We have to investigate the complaint through history and physical exam, as well as labs and radiographs. We have to work through a very large differential. We see anybody and everybody. We have the chance to make the difference in somebody’s health almost every day. We must be prepared to take care of any emergency that arrives at the ED.
  • Within EM, we work through a team approach with other specialties to arrive at an appropriate diagnosis and treatment plan for the patient. We must stand firm on what is best for the patient even if our consultants would rather not admit them. We work set hours which allows us to better plan our lives. It allows us more time for our families or interests. We know where our work day ends and our private lives begin. The opportunities within academics are huge. You can work in any setting from a community hospital to a level 1 intercity trauma center. Emergency medicine will continue to grow in the future. There are many avenues that we can improve upon and develop.
  • At times, dealing with consultants can be difficult. This is due to the personality of that particular consultant, not the specific specialty. Some patients are under the influence of drugs that cause them to be violent or inappropriate. This should be looked upon as a challenge, not a problem Many patients arrive at the ED without any emergency. Instead they arrive because of convenience for either them or their physician. Although frustrating, it still allows you to practice medicine. There will be times when other specialists look back at your care and determine that it was inappropriate now that they have much more information. Always do the right thing based on what information you have available.
  • Many physicians migrate to EM due to the hours and well defined shifts. However, this must be balanced against the evenings and nights that are part of the career.
  • One can move onto various areas of sub-specialty from the specialty of Emergency Medicine. These are the four areas in which we can become board certified through fellowship training.
  • The future of EM is limitless. We are branching out into various areas of medicine to include these.
  • Research within EM is not yet well established. However, it is limitless. You can pick almost any area of medicine and research it from the emergency department standpoint. As the specialty grows, there are more and more competent and qualified researchers promoting EM. The number of research projects and clinical trials will continue to grow.
  • In order to become more familiar with the field of EM, first and second year students can do many things. Take time to do “shadow shifts” in the ED to see what actually happens. It is not the same as the “ER” television show. Join the EM interest group if you like the field of emergency medicine. It will help you locate others with similar interests and will allow you more time with the EM faculty. At this time in your medical school career, always keep your options open. Look at all areas of medicine before you lock yourself into one area. Take this time to openly investigate any area that interests you.
  • Emergency Medicine

    1. 1. Emergency Medicine Dr. Hossam Hassan Consultant and assistant Prof.
    2. 2. Objectives <ul><li>Acute medical illnesses </li></ul><ul><li>Acute surgical illnesses </li></ul><ul><li>Acute Obstetrical emergencies </li></ul><ul><li>Trauma </li></ul><ul><li>Acute mental illnesses </li></ul><ul><li>Acute ENT & Ophthalmological emergencies </li></ul><ul><li>Environmental hazards </li></ul>
    3. 3. Top Ten Leading Causes of Death <ul><li>Heart Disease: 726,974 </li></ul><ul><li>Cancer: 539,577 </li></ul><ul><li>Stroke: 159,791 </li></ul><ul><li>Chronic Obstructive Pulmonary Disease: 109,029 </li></ul><ul><li>Accidents: 95,644 </li></ul><ul><li>Pneumonia/Influenza: 86,449 </li></ul><ul><li>Diabetes: 62,636 </li></ul><ul><li>Suicide: 30,535 </li></ul><ul><li>Nephritis, Nephrotic Syndrome, and Nephrosis 25,331 </li></ul><ul><li>Chronic Liver Disease and Cirrhosis: 25,175 </li></ul>
    4. 4. Reception <ul><li>300 – 500 visits per day </li></ul><ul><li>Only 20-50 cases require urgent intervention </li></ul><ul><li>Few cases are life-threatening (1-5) </li></ul>
    5. 5. Triage 300 – 500 cases Life- Threatening Urgent Cases Non- urgent Cases Triage-Out
    6. 6. Triage ( Categorization) <ul><li>Category 1 – 5 </li></ul><ul><li>1 : Life-Threatening </li></ul><ul><li>5 : Triage out </li></ul>
    7. 7. Triage <ul><li>Physician Triage </li></ul><ul><li>Nurse Triage </li></ul><ul><li>Clark Triage </li></ul>
    8. 8. Life-Threatening Cases ( C.1) <ul><li>Need immediate intervention </li></ul><ul><li>Arrest </li></ul><ul><li>Arrhythmias </li></ul><ul><li>Hypoxia </li></ul><ul><li>Shock </li></ul><ul><li>Acute trauma </li></ul><ul><li>Siezure </li></ul><ul><li>Status Asthmaticus </li></ul><ul><li>Anaphylaxis </li></ul><ul><li>Chest pain ( STEMI ) </li></ul><ul><li>Delivery – stage 2 </li></ul>
    9. 9. C.2 ( Urgent Cases) <ul><li>Should be treated within 10 min. </li></ul><ul><li>Acute asthmatic attack </li></ul><ul><li>High Blood Pressure </li></ul><ul><li>Intoxication </li></ul><ul><li>Drowsy patient </li></ul><ul><li>Acute colics </li></ul><ul><li>Fractures </li></ul><ul><li>Burns </li></ul>
    10. 10. C.3 ( Acute Cases ) <ul><li>Should be treated within few hours (30 m) </li></ul><ul><li>Chest Pain ( Non cardiac ) </li></ul><ul><li>Abdominal pain </li></ul><ul><li>Dyspnea </li></ul><ul><li>Fever </li></ul><ul><li>Old trauma </li></ul><ul><li>Gastroeneteritis </li></ul><ul><li>Metabolic Derangement </li></ul><ul><li>Post ictal state </li></ul>
    11. 11. Cont’d Triage <ul><li>C4 : Chronic Abdo pain </li></ul><ul><li>Minor trauma </li></ul><ul><li>claimed : Fever-Low BP- Fast HR </li></ul><ul><li>C5 : URTI </li></ul><ul><li>Long-standing complaints </li></ul><ul><li>Meds-Refill </li></ul>
    12. 12. Appeal of Emergency Medicine <ul><li>Make an immediate difference </li></ul><ul><li>Life threatening injuries and illnesses </li></ul><ul><li>Undifferentiated patient population </li></ul><ul><li>Challenge of “anything” coming in </li></ul><ul><li>Emergency / invasive procedures </li></ul><ul><li>Safety net of healthcare </li></ul>
    13. 13. Appeal of Emergency Medicine <ul><li>Team approach </li></ul><ul><li>Patient advocacy </li></ul><ul><li>Open job market </li></ul><ul><li>Academic opportunities </li></ul><ul><li>Shift work / set hours </li></ul><ul><li>Evolving specialty </li></ul>
    14. 14. Downside to Emergency Medicine <ul><li>Interaction with difficult, intoxicated, or violent patients </li></ul><ul><li>Finding follow-up or care for uninsured </li></ul><ul><li>Working as a patient advocate </li></ul><ul><li>Contract management groups </li></ul><ul><li>Malpractice targets </li></ul>
    15. 15. The Lifestyle:Two Sides of A Coin <ul><li>Well defined shifts </li></ul><ul><li>Usually not on call </li></ul><ul><li>Part time employment possible </li></ul><ul><li>Evenings and nights </li></ul><ul><li>Weekends </li></ul><ul><li>Holidays </li></ul>
    16. 16. Subspecialties in Emergency Medicine <ul><li>Pediatric Emergency Medicine </li></ul><ul><li>Toxicology </li></ul><ul><li>Emergency Medical Services </li></ul><ul><li>Sports Medicine </li></ul><ul><li>Critical Care Medicine </li></ul>
    17. 17. Upcoming Areas of Emergency Medicine <ul><li>Observation units </li></ul><ul><li>ED CT </li></ul>
    18. 18. Research Opportunities <ul><li>Broad range of subjects </li></ul><ul><li>Limited amount of work published in our relatively new field </li></ul><ul><li>Limited number of research mentors </li></ul><ul><li>Limited number of clinical trials </li></ul>
    19. 19. What to do to get in to Emergency Medicine ? <ul><li>Observe in ED </li></ul><ul><li>Summer research projects with EM staff </li></ul><ul><li>EM interest group affiliation </li></ul><ul><li>Be open to any medical specialty </li></ul>
    20. 20. Trauma
    21. 21. Primary Survey ( A-B-C-D)
    22. 22. Secondary Survey ( Systemic)
    23. 23. What’s Your Diagnosis ?
    24. 24. OR
    25. 25. Chest pain ( Cardiac )
    26. 26. Chest Pain
    27. 28. Arrhythmias
    28. 29. Low Blood Pressure <ul><li>PB = COP * SVR ( 120 / 80 ) mmHg </li></ul><ul><li>COP = SV * HR ( 4- 6 ) 4-6 L/m </li></ul><ul><li>SV = EDV - ESV ( 50 – 100 ) ml </li></ul>
    29. 30. Low Blood Pressure <ul><li>Preload </li></ul><ul><li>Contractility </li></ul><ul><li>Afterload </li></ul>
    30. 31. Dyspnea ( S.O.B) <ul><li>ABG : 7.35 </li></ul><ul><li>40 </li></ul><ul><li>80 </li></ul><ul><li>23 </li></ul><ul><li>O 2 saturation: 99% </li></ul>
    31. 33. Acute Respiratory Failure <ul><li>Hypoxemic </li></ul><ul><li>Hypercapnic </li></ul>
    32. 34. Asthma
    33. 35. COPD
    34. 36. Pneumonia
    35. 37. Abdominal Pain ( Medical )
    36. 38. Abdominal Pain ( Surgical )
    37. 39. Fractures
    38. 40. Fractures
    39. 41. Fractures
    40. 42. Laceration
    41. 43. Seizure
    42. 44. Acute Psychiatric Ilnesses
    43. 45. DM
    44. 46. DKA
    45. 47. Skin Rash
    46. 48. THANKS

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