Successfully reported this slideshow.

Emergency Medicine

9,032 views

Published on

  • Be the first to comment

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

×