INITIAL ASSESSMENT OF TRAUMA PATIENTS....(INSPIRED FROM CTLS AND ATLS GUIDELI...Prerna Biswal
THIS PRESENTATION WAS MADE AT IMA HOUSE IN BHUBANESWAR,ODISHA, BY DR.NIBEDITA PANI,HOD ,DEPT. OF ANAESTHESIOLOGY AND DR.PRERNA BISWAL,PG,ANAESTHESIOLOGY,SCBMCH,CUTTACK,
This presentation on Triage and transport deals with how we should we deal with the patients who are attending the emergency department and to provide best treatment for the needy patients at appropriate time.
I hope this will be helpful to nurses, paramedics, graduate and under graduate students and emergency doctors and team.
PHEM - Pre Hospital Emergency Medicine Guidelines for TrainersEmergency Live
This Guide describes the curriculum, training and assessment processes for Pre-hospital Emergency
Medicine (PHEM) sub-specialty training. It reflects the General Medical Council (GMC) standards and the
uK wide regulations for specialty training (the Gold Guide).1,2 Where there are differences between the four
uK national agencies, the parts of the Gold Guide applicable to these agencies should be regarded as the
definitive guidance.
An Introduction To Pre-Hospital Care in MalaysiaChew Keng Sheng
This lecture was delivered to a group of dental students. As such, in this lecture, this subject was dealt with in an as-objective-as-possible manner, and devoid of much socio-political sentiments associated with the problems of pre-hospital care in Malaysia.
This is a presentation which contains basics of polytrauma management,ATLS, triage, critical decision making skills, application of Glasgow coma scale and complications of different management strategies, if not applied properly.
INITIAL ASSESSMENT OF TRAUMA PATIENTS....(INSPIRED FROM CTLS AND ATLS GUIDELI...Prerna Biswal
THIS PRESENTATION WAS MADE AT IMA HOUSE IN BHUBANESWAR,ODISHA, BY DR.NIBEDITA PANI,HOD ,DEPT. OF ANAESTHESIOLOGY AND DR.PRERNA BISWAL,PG,ANAESTHESIOLOGY,SCBMCH,CUTTACK,
This presentation on Triage and transport deals with how we should we deal with the patients who are attending the emergency department and to provide best treatment for the needy patients at appropriate time.
I hope this will be helpful to nurses, paramedics, graduate and under graduate students and emergency doctors and team.
PHEM - Pre Hospital Emergency Medicine Guidelines for TrainersEmergency Live
This Guide describes the curriculum, training and assessment processes for Pre-hospital Emergency
Medicine (PHEM) sub-specialty training. It reflects the General Medical Council (GMC) standards and the
uK wide regulations for specialty training (the Gold Guide).1,2 Where there are differences between the four
uK national agencies, the parts of the Gold Guide applicable to these agencies should be regarded as the
definitive guidance.
An Introduction To Pre-Hospital Care in MalaysiaChew Keng Sheng
This lecture was delivered to a group of dental students. As such, in this lecture, this subject was dealt with in an as-objective-as-possible manner, and devoid of much socio-political sentiments associated with the problems of pre-hospital care in Malaysia.
This is a presentation which contains basics of polytrauma management,ATLS, triage, critical decision making skills, application of Glasgow coma scale and complications of different management strategies, if not applied properly.
Med i pčelinji proizvodi - prevencija i lekЂорђе Инђић
Upotreba meda i pčelinjih proizvoda iz ugla narodne, tradicionalne, savremene medicine. Karaktreristike različitih vrsta meda i raznolikih pčelinjih proizvoda. Predavanje održano na Festivalu meda u Staroj Pazovi.
Emergency nursing is a nursing specialty in which nurses care for patients in the emergency or critical phase of their illness or injury.
While this is common to many nursing specialties, the key difference is that an emergency nurse is skilled at dealing with people in the phase when a diagnosis has not yet been made and the cause of the problem is not known.
What Does a Medical Assistant Need to Know? Part 2Everest College
In this “part 2” presentation, we continue our overview of the types of classes that students take as part of the medical assistant program at Everest College.
Anatomical difficult airway has been emphasised immensely in poly trauma management . But we very often forgot to look into the correctable physiological airway difficulties ...this presentation is exploring this aspect of airway management .
This session was done in Nepal emergency medicine conference in October 2023 at Kathmandu
This session was done in 2 nd EMS and Industrial Emergency Medicine conference in Ahammadabad in Feb 2020. The presentation explores how to asses the Key Performance in EMS and Ambulance Scenario.
Airway manipulations and intubation are the potential to cause a high level of aerosolization in the emergency department. This presentation is giving an overview of how to perform protected intubation in the emergency department. It has prepared by using the available latest data on COVID 19 protected Intubation
Evidence-based medicine is the cornerstone of quality clinical practice. It is very important that a critical appraisal of a scientific article. This presentation covers a primary survey & Secondary survey approach to select, read and appraise the article
The presentation covers various aspects of DM like the type of disasters, scientific approach, disaster cycle, zones, Incident command, triage, Hospital plan, communication, statutory structure, and support organizations
Prehospital care in trauma is as important as in hospital care. The presentation addresses simple and basic approach to care a polytrauma victim in platinum 10 minutes based on BTLS.
The presentation covers basics of pharmacotherapy involves in advanced life support scenario including peri-arrest situations which have been updated 2019
The presentation covers an easy method to manage acute poisoning in Ed. It elaborates the tox presentations through four toxidromes and an algorithmic approach to solve the puzzle
The presentation covers definitions, identification, Treatment goals, Special situations, Practice points, and cardinal pharmacotherapy. Session presented in NBE learning session
This presentation covers various aspects of OHCA scenarios, including incidence, outcome, challenges, solutions, hen to initiate CPR, protocols, Termination, ECPR, and other issues are covering in details. Explore regional experiences in training and OHCA results as well.
This presentation covers various aspects of OHCA scenarios, including incidence, outcome, challenges, solutions, hen to initiate CPR, protocols, Termination, ECPR, and other issues are covering in details. Explore regional experiences in training and OHCA results as well.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Emergency medicine:The most wanted medical speciality in India
1. Emergency Medicine:
A most wanted specialty in India
Dr.Venugopalan.P.P
DA,DNB,MNAMS,MEM[GWU-US]
Director ,Emergency Medicine
Aster-DM Healthcare –India
Site Director ,MEM program GWU
Deputy Director –MIMS Academy
PG –Teacher Emergency Medicine –
NBE
Founder &Executive Director –
ANGELS
5. Clinical E M
Initial evaluation,
treatment and disposition
of any person at any time
for any symptom, event or
disorder deemed by the
person or someone acting
on his or her behalf to
require expeditious
medical, surgical or
psychiatric attention.
ACEM
6. Emergency
.
Any condition perceived by the
prudent layperson or some one on
his or her behalf as requiring
immediate medical or surgical
evaluation and treatment
7. Emergency
It is a situation or condition having a
high probability of disabling or
immediate life threatening
consequences requiring urgent
intervention including first aid
ACEM
8. ER physician
A specialist who
has been trained to
engage in the
immediate initial
recognition,
evaluation and
disposition of patient
with acute illness
and injury..
9. ER Physicians
•Not provide long
term or continuous
care
•They diagnose a
wide range of
diseases and
perform
interventions to
stabilize the patient
10. ER Physicians • See a large number of
patients, treat their
illness and arrange for
disposition either
admitting them to the
hospital or releasing
them after treatment as
necessary
11. ER physician
Broad field of
knowledge and
advanced procedure
skills including
surgical procedures,
trauma
resuscitation,
advance cardiac life
support advanced
airway management
etc
12. • Good ER physicians
know every single
details of
resuscitation and
treatment methods
of sick and injured
relating to almost
every specialty.
13. Emergency
Medicine
• Demands excellent
communication skills and
knowledge of human
psychology.
• The ED physician has to
deal with as well as
establish rapport with
patient and their
bystanders who are in an
extremely stressful
situation of unexpected
emergencies.
14. Challenges..
•Deal with crying children,
•Child abuse,
•Violent patient attendants
who more often than not think
that the problem is not worth
admitting the patient
16. Other Responsibilities [ACEM]
• Administration, research and teaching of
all aspects of Emergency care.
• Follow up care (observation medicine)
• Provision for emergency care to hospital
patient on request.
• EMS and pre hospital care
17. Other Responsibilities [ACEM]
• Disaster planning and management (both
natural and man made events)
• Toxicology and poisons center development
• Education of Healthcare providers and the
common public
• Preventive care medicine
• Basic and clinical research especially in
resuscitation and acute care.
18. o ED Administrator
o EMS Directors
o EMS and Paramedic
Trainers
• Disaster Planning
Consultants
Opportunities
19. o First Aid trainers for non medical personals
o Best PRO
o Trained appropriately in CPR, Trauma and
Pediatric Resuscitation
o Medico Legal Consultant
Opportunities
21. ER APPROACH
• EM has unique aspects, such as
approach to patient care and decision-
making
Hidden life
threatening issues ..
22. APPROACH
• Comprehensive history,
examinations, routine lab
test, specific diagnosis
procedures and problem
oriented medical record
constitute conventional
methodology, which is
not appropriate in ER.
29. • Vital sign and Chief
complaints, when
used as Triage Tools,
will identify majority of
life threatened
patients.
• Familiarity with
normal vital signs for
all age groups is
essential.
30. Beware of the special
groups
Extremes of Ages
Athletes
Pregnancy
Pacemakers
Beta blockers
31. Approach
The idea of
performing a
'complete'
examination in the
ED is misleading,
because most
frequently a
'complete'
examination is
neither required nor
appropriate.
32. “Do an 'adequate' examination!”
&
“Decide - The patient is stable or unstable”.
33. Once a life threat has
identified
Interven
e to
reverse
the life
threat
36. • The DD must begin with the most serious
condition possible to explain the patient's
presentation
• Not the most common diagnosis
DIFFERENTIAL DIAGNOSIS
37. • It is unreasonable to expect that every patient
evaluated in ED should or must have a
diagnosis made in ED
• Even in specialties sometimes it will take days,
weeks, or months for the final diagnosis to be
made
DIFFERENTIAL DIAGNOSIS
38. DIFFERENTIAL
DIAGNOSIS
“The role of ED
physician is to rule out
serious or life
threatening cause of a
patients presentation.
Not to arrive at the
definitive diagnosis”
40. Focused Tests
•12 lead ECG should
be taken and read
within 10 minutes of
ED arrival – Chest pain
•FAST - Trauma
•CT and MRI – Stroke
/Spinal Cord Injury
•Blood tests and C&S
immediately in sepsis
and septic shock
•Toxicological survey
41. .
No role for X-Ray Chest
to rule out Tension
pneumothorax
43. A patient with recurrent migraine head ache, on
this presentation ERP should rule out the
possibility of Acute subarachnoid bleed .
“What is different
now?”
44. HOSPITAL ADMISSION -
DECISIONS
•Is there a medical
need that can be
fulfilled only by
hospitalization?
•Does the patient
need intravenous
therapy?
45. DECISIONS
•Does the patient
need oxygen
therapy or cardiac
monitoring?
•Whether the
patient can be
safely observed in
outpatient setting?
46. ED DISPOSAL
•Admission to
hospital Wards, I C
U, OT etc
•Observation
•Referral to
specialists
•ED discharge –
with advice or
against medical
advice.
47. ED discharge
• The ED discharge should be with specific
follow up instruction, which include specific
mention of most serious potential
complication of the patient condition.
48. Before discharging the patient from ED
Two Questions should be answered
1.Why did the patient come to the ED?
2.Have I made the patient feel better?
Relieve the Physical,
Physiological and Psychological
Pain before ED disposal
49. MEDICAL
RECORDS
•One should be
able to ascertain
from reading the
chart that the
more serious
diagnosis were
indeed considered.
• Must contain
appropriate follow
up instructions.
50. MEDICO LEGAL RECORDS
Writing proper
Medico legal
Case records,
Intimating
Police, Issuing
wound
certificates are
the primary job
of EPs
51. EMERGENCY MEDICINE
CRITICAL CARE
Both deal with very sick and injured patients
Both require personnel (doctors, nurse,
assistants, etc) who are specifically trained in
these respective specialties.
52. EMERGENCY MEDICINE
CRITICAL CARE
EM personnel are not adequately trained for
ICU work and ICU personnel are not skilled to
function in an emergency department
Procedural skills are the same for both
specialties.
Resuscitations and deaths are common in
both specialties.
54. EM versus CCM
EMERGENCY MEDICINE
Emergency room
Emergency
Physicians
Pre hospital care
Disaster management
CRITICAL CARE
Intensive care units
Intensivists
Not much role
Limited role
55. EM versus CCM
Patients are
unlimited
Short-term
management
Spectrum of
patients and
Problem is vast
Patients limited
by number of
beds
Long-term
management
Spectrum
limited to the
specialty of
Intensive care
Unit
56. EM versus CCM
Diagnosis is
not required
Diagnosis
necessary and
required for
continuation of
treatment
60. When looking back …
Sept. 21, 1979, that
the American Board
of Emergency
Medicine was
recognized as a
conjoint specialty
61. Emergency medicine had
its beginnings as early
as 1961, when four
physicians in Alexandria,
VA, formed the first
group dedicated to
providing care in an
emergency department
setting, which became
known as the Alexandria
Plan.
62. September 21, 1979,
the ABMS Assembly
approved the ABEM as
a conjoint modified
board and included it in
the membership,
recognizing emergency
medicine as the 23rd
medical specialty
66. Scenario
• Dr.Eqbal is fresh graduate scored excellent
rank in NEET exam and he is very much
interested to join MD EM . He seeks a second
opinion with his role model professors.
• Medicine professor advised him “Don’t take
such dirty specialty”.
• Microbiology professor “ What is it…I am not
aware of such specialty “
67. 1# Concept
• What is emergency medicine
• Where exactly the boundaries
• Know your strength and weakness
• Name of the specialty
Casualty
E
M
E
R
G
E
C
Y
M
E
D
I
C
I
N
E
68. Specialty has been recognized by MCI on 21st July 2009
It is not Critical care It is not Anesthesiology
70. Scenario
• Dr.Vineetha knows about the speciality of
Emergency medicine . She also knows some
courses are available.
• She was so much worried about the
placement , job responsibilities payments
,recognition etc…
71. 2# Emergency Physician
• Qualification
• Academics and visibility
• Faculty from other specialties
Involve as much as
72. Emergency Physician
• A specialist who has
been trained to
engage in the
immediate initial
recognition,
evaluation and
disposition of patient
with acute illness and
injury..
73. Emergency Physician
• ER Physicians do not usually provide long
term or continuous care but they diagnose
a wide range of diseases and perform
interventions to stabilize the patient
76. Qualifications
• MD
• MCI recognized other specialists like surgery
anesthesia ; Medicine ; Pulmonologist
• DNB
• MEM
• MCEM;FCEM
• Fellowships
• PGDEM
M
o
R
e
D
E
m
a
N
d
Less people
77. Scenario
• 55years gentle man presented to emergency
department with giddiness and tachypnea at
2 AM. Known case of CAD and APD, had stent
and on anticoagulant
• P A to state transport minister and he was not
even willing to do initial evaluation.
• He want to see his cardiologist .
• Cardiologist is not taking phone
• More than 10 bystanders around
78. 3# People
• They are not much bothered about who you
are !
• 1000 people… more than 10,000 ideas
• Competency and care up to their expectations
• Quality and professionalism
• Ethics , Transparency and Truthfulness
Passionate always
79.
80. Scenario
• 23yr old female brought to ED following RTA.
Had suspected C-spine injury , # Humerus and
# Femur
• Attending did Primary survey and Secondary
survey as per ATLS protocols
• Later new bystanders started agitation and
abusive language for tearing dresses for
exposure in Primary survey
81.
82. #4 Patients
• Have a problem and sometimes many ….
• Distress
• Rewards are …how fast you make them
comfortable
• Need physical , physiological and psychological
resuscitation
• Culture ,Race and Religion
Bystanders are the
real problem ….
83.
84. Scenario
• 25 year old lady present abnormal behavior
and hyperventilation . Case was referred from
rural Kerala. Vitals normal. 12 bystander
crowding around patient. Few of the shouting.
Some are on mobile phone . Chaotic casualty.
85.
86. #5Premise
• ER is the front office
• Good reception lead good care lead to
comfort and confidence
• Plan ,Performance and Perfection
• Implement what exactly you want
Be live …save lives …
93. Scenario
• 5 bedded rural casualty, 1 OT, No CT facility 3
doctors, 6 Nurses ,One ambulance and 2
ambulance assistants
• 8 patients brought to casualty following a
collision of Jeep versus Autorickshaw
• 5 Walking patients , 1 case with fracture femur
of Hypotension, 1 case with facio-maxillary
injury with obstructed airway and one case
fracture dislocation of shoulder
94. #6 Team
• Doctors, Nurses,
Paramedics ,
Ambulance assistants
,Security ….
• Training, modulation
and empowerment
Team work is the success
97. Scenario
• 78 year old lady ,Known case of DM, CKD,CAD
and COPD presented to ED with SOB and Signs
of Sepsis
• Attending EP initiated early stabilization and
contacted different consultants
• Medical ICU beds are full except crash bed
• Consultants are not very keen to take case
98. #7 Destination
• When destination is not clear …
• Overcrowding
• Dumping
• No man area
• Multisystem cases and Poly trauma
Protocol based practice
99.
100.
101. Scenario
• 37 year old gentleman brought to Ed with
shortness of breath , palpitation and dizziness
• Vital Pulse 210 /mt reg. BP 110 ,SpO2 94 RA
• ECG – supra ventricular Tachy
• Not responding to Vagal maneuver and
responds to one dose of adenosine and called
cardiologist for expert opinion
• He shouted to EP like anything and asked to
do the rest of the management as well
102.
103. #8 Consultants
• Supportive
• Incompatible
• Lazy
• Egoistic
• Money
• Over work /Burn out
Evidence based Medicine
Do for the best interest of patient
104.
105. Scenario
• 25 year old male presented with Tachypnea
and pleuritic chest pain. He was just travelled
from Washington yesterday.
• PGY2 order D-Dimer .
• PGY 3 objected and they are in Arguments
106. #9 Academics
• Regular academics
• Multiple levels
• Different modalities
Teaching is the best way to learn
107.
108.
109.
110.
111. Scenario
• A corporate Emergency department claimed
to do good works . They reported the they
treated 65,000 cases per year. Resuscitated
many cases.
• NABH auditors visited in the department
declared that department is not meet the
standards
112. #10 Quality assurance
• Regular follow up
• Documentation
• Know about the errors and its chances
• Fix measurable Parameters , process and
protocol
• Errors
• Audit
Only way to get into next level
115. Acad Emerg Med. 2000 Nov;7(11):1204-22.
Promoting patient safety and preventing medical error in emergency departments.
Schenkel S.
Author information
Abstract
An estimated 108,000 people die each year from potentially preventable iatrogenic injury. One in 50 hospitalized patients experiences a preventable adverse event. Up to 3% of these injuries and
events take place in emergency departments. With long and detailed training, morbidity and mortality conferences, and an emphasis on practitioner responsibility, medicine has traditionally faced the
challenges of medical error and patient safety through an approach focused almost exclusively on individual practitioners. Yet no matter how well trained and how careful health care providers are,
individuals will make mistakes because they are human. In general medicine, the study of adverse drug events has led the way to new methods of error detection and error prevention. A combination
of chart reviews, incident logs, observation, and peer solicitation has provided a quantitative tool to demonstrate the effectiveness of interventions such as computer order entry and pharmacist order
review. In emergency medicine (EM), error detection has focused on subjects of high liability: missed myocardial infarctions, missed appendicitis, and misreading of radiographs. Some system-level
efforts in error prevention have focused on teamwork, on strengthening communication between pharmacists and emergency physicians, on automating drug dosing and distribution, and on
rationalizing shifts. This article reviews the definitions, detection, and presentation of error in medicine and EM. Based on review of the current literature, recommendations are offered to enhance the
likelihood of reduction of error in EM practice.
PMID:
11073469
[PubMed - indexed for MEDLINE]
•108000 preventable deaths from iatrogenic injuries per year
•1 in 50 hospitalized patients experiences preventable adverse events
•3% from ER