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ER protocol.pptx
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- 2. AIMS 1) Good Selectionof emergency cases. 2) Early detection and prioritization of urgent medical conditions in these cases. 3) Qualified dealing with theses conditions . 4) Optimum follow up up to patient condition stabilization and referral to adequate speciality.
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- 4. ER Ticket : Briefhistory: 1)Age. 2)Chronic diseases. (DM, HTN, Cardiac , hepatic, neuro, renal ,etc.) 3) Main complaint + duration : dizziness , dyspnea ,bleeding ,DCL , Headache ,abdominal pain, anuria, chest pain , epigastric pain, palpitation, weakness. 4) vitals:BP,pulse,RR,Temp,so2,RBS
- 5. Selection of ER cases Conscious level GCS>= 10-11 GCS <= 10-11 Vitals BP &HR &RR&Temp RBS &SO2 Resuscitation Room Vitally unstable Vitally stable Observation Room
- 7. Vitals • Temp>37.2 • RR>16 •RR<12 • HR>110 • HR<60 • Hypertension >=180/100 • Hypotension< =90/60 BP HR Temp RR RBS >250 RBS<60 SO2<90-92
- 8. 1)Hypoxia Desaturation: SO2<90-92%. COVID 19 Covid 19 Outpatient clinic Not-COVID 19 1)Resuscitation room 2)CBC,ABG 3)ECG DD.Pulmonary edema vs Acute exacerbation COPD&ASTHMA CT chest
- 9. 2)Hypertensive Emergency >180/100 1)ECG 2)CT brainif there is any sign of lateralization 1)Observation room 2)Nitroderm patch 3)IM consultation
- 10. 3)Hypotension <90/60 1)Adequate assessment of signs ofshock as Tachycardia& Weak pulse volume&hypoxia No signs of shock 1)ECG 2)Fluid resuscitaion then reevaluate. 3)CBC. 1)Resuscitation room 2)ICU consultation
- 11. 4)Tachycardia >100 5)Bradycardia<60 1)Vitals 2)ECG 3)Cardiacconsultation 4)Icu consultation if vitally un stable
- 12. 6)Limb weakness& dysarthria 1)vitals: BP&pulse 2)ECG 3)CTbrain 4)Neuro consultation
- 13. 7)Hypoglycemia <60 mg/dl Asymptomatic conscious 1)Observation Room. 2)Oralfeed trial. 3)Dextrose 10% infusion. 4)internal medicine consultation. Unconscious &FITS 1)Resuscitation Room 2) IV Dextrose 10% 3) ICU consultation
- 14. 8)Hyperglycemia Conscious Asymptomatic 1)Vitals 2)Observation room 3)IM consultation. 4)Urine analysis&ABG 5)Insulinactrapid SC conscious symptomatic: Dyspneic & vomitting 1)Vitals 2)Observation room 3)IM &ICU consultation 4)CBC,s.creat,A BG,Na,K 5)Urine analusis 6)ECG Unconscious 1) Vitals 2)Resusitation room 3) ICU consultation 4)CBC,S.creat,A BG,Na,K 5)Urine analysis 6)ECG
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- 16. 9) Loin Pain& dysuria Urine analysis US Analgesic Anti-spadmodic Urological consultation
- 17. 10)Rt. Hypochondrial pain& +veMurphy's sign (suspected acute cholecystitis) 1) Observation room 2)Analgesic &anti spasmodic. 3)US. 4)Surgical consultation.
- 18. 11) Rt. iliac fossapain Tenderness& rebound tenderness 1)Observation room 2)CBC 3)Urine analysis 4)Surgical consultation. 5)Gynecological consultation (in females)
- 19. (12) Epigastric pain Cardiac ECGto exclude inferior MI Metabolic 1)DKA 2)RF GIT gastritis Antacid+antiemetic
- 20. (13)(Bleeding) Hematemesis & Melena Bleeding per rectum epistaxis Vitallystable 1)Observation room 2)Antibleeding measures 3)CBC,INR. 3)Consultation according to speciality. Vitally unstable 1)Resuscitation room 2)Antibleeding measure 3) Icu consultation 4)CBC&INR
- 21. 14) Hepatic encephalopathy Grade 1-2 1)Vitals 2)Observationroom 3)cbc,s.cr,ABG Grade 3-4 Grade 1-2 with unstable vitals 1)Vitals 2)Icu consultation 3)CBC,s.cr,ABG
- 22. 15)Chest pain Compressing or stapping Referredto lt shoulder with risk factors 1)Vitals 2)ECG 3)Cardiac consultation Stitching & Interfere with inspiration 1)Analgesic +/- chest x-ray 2)Outpatient clinic follow up
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- 25. Role in observationroom 1)Follow up conscious level & vitals. 2)Follow up labs . 3)IF any deterioration occur ,refer to resuscitation room.