3. Presentation Outline
Emergencies in the outpatient clinic setting
Making “quick look” assessments
Triage, treat or transfer approach to the sick
patient
Office staff and practical management of patient
Parent/caregiver in the treatment plan
6. Somewhere in between
Fever
Earaches
Cough
Sore throat
Vomiting
Injury, head, neck or face
Stomach and abdominal
Headache
pain
Facial laceration
Skin rash
National Hospital Ambulatory Medical Care Survey:
2010 Emergency Department Summary Tables
7. What are we talking about then?
Asthma
Fracture
Appendicitis
Seizure
Anaphylaxis
Concussion
Rash
Laceration
Cancer
8.
9. Definitions
What providers perceive
“to become aware of, to know, or identify by means of the senses”
What parents believe
“to have confidence in the truth, the existence, or the reliability of
something, although without absolute proof that one is right in doing
so”
What grandmothers know
“to perceive or understand as fact or truth; to apprehend clearly and
with certainty”
10. Behind door number 1 . . .
Check pulse
Call 911
Remember ABC’s
Direct staff, reassure parents
Make a decision
11. Triage, Treat, or Transfer
Know limits of parents
Know limitations of staff
Know your own limitations
Know your hospital/ER limitations
12.
13. Case #1: Fever
6mo fever to 104 over last two
days. No sick contacts, no
daycare, vaccines UTD
VS: T 101.2
PE: Feeding on bottle, PE wnl
Labs: CBC with WBC 18.7,
57%G, UA not collected
Triage, treat and/or transfer?
PEARL: DON’T FORGET
THE UA
14. Case #2: Fall
4mo unrestrained rolls out of
carrier from counter to tile floor
VS: T 98.2, P 120
PE: Being held by father,
smiling, looking around
Crepitus R parietal skull
Labs/image: None, CT Head
PEARL: BUCKLE UP!
Triage, treat and/or transfer?
15. Case #3: Wheezing
7yo with known h/o wheezing,
fever 101. Had RSV as infant.
VS: T 99, pulse ox 88%
PE: Quiet, retrax present, no
wheezing?
Labs: None, CXR?
Triage, treat and/or transfer?
PEARL: SAY YOUR ABC’s?
16. ICD-10 FOLLIES
W61.92
Z63.1
W45.8XXA
V52.2XXA
V00.32
X92.0
W00.1
V97.33XD
Struck by other birds
Problems in relationship with in-laws
Other foreign body or object entering though
skin, initial encounter
Person on outside of pick-up truck or van
injured in collision with two or three-wheeled
motor vehicle in nontraffic accident
Snow-ski accident
Assault by drowning and submersion while in
bathtub
Fall from stairs and steps due to ice and snow
Sucked into jet engine, subsequent encounter
David Pittman, Med Page Today
17. Case #4: Foreign body
18 mo swallowed a nickel, no
vomiting, no cough
VS: T 98.7
PE: waddling around exam
room, NAD
Labs/image: CXR/KUB
Triage, treat and/or transfer?
PEARL: NICKELS ARE
GOOD, BATTERIES AND
MAGNETS ARE BAD
18. Case #5: Crush injury
2 yo smashed finger in car door
VS: T 99
PE: crying in room,
apprehensive, finger tip and nail
partially avulsed, not actively
bleeding
Labs/image: Xray
Triage, treat and/or transfer?
PEARL: PLASTIC SURGEON
IS YOUR BEST FRIEND
19. Case #6: Nodes
5yo with recurrent fever to 102,
swollen glands, recent dx of
mono after 5 days of fever
VS: T 101.8, P 100
PE: pale, diffuse cervical LAD,
guarding RUQ, bruising
Labs/image: WBC 52K, H/H wnl,
plts 30,000
Triage, treat and/or transfer?
PEARL: BEWARE OF NODES