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Introduction to emergency 
medicine
Scope 
Approach to the emergency patient 
EMS 
Triage
APPROACH TO THE 
EMERGENCY PATIENT
extremely challenging environment 
available and prepared at any time for 
any patient with any complaint 
unfamiliar
Clinical scope of the problem
Anatomic essentials 
Airway 
Breathing 
Circulation 
Disability 
Exposure
History
Physical examination 
 Temperature 
 HR 
 RR 
 BP 
 O2 sat 
 Pain score 
 GCS
Laboratory studies 
DTX ECG
Radiologic studies 
Bedside ultrasonography
Special patients 
Pediatric 
Broselow resuscitation tape
Disposition 
Consultation 
Serial evaluation 
Admission/discharge
Admission/discharge 
discharge instructions 
1) what to do 
2) what not to do 
3) when (and where) to follow-up 
4) reasons to return to the ED
Pearls, pitfalls and myths 
Always address life-threats first 
An exact diagnosis is not always 
possible in EM, and not always 
necessary. 
elderly patients: uncommon 
presentations 
Never rush a patient out of the ED 
with a condition that may recur
Pearls, pitfalls and myths 
Think about abuse or neglect in every 
case. 
Document appropriate findings in the 
medical record clearly. 
 consultant’s name, service, time you spoke, 
and brief summary of the conversation 
Consider dangerous outcomes or the 
worst-case scenario in every patient.
EMERGENCY MEDICAL 
SERVICES
extension of emergency medical care 
into the prehospital setting
รถปฏิบัติการฉุกเฉิน
Ground transport 
http://www.manafeth.com/index.php/en/products/view/Ambulance-Type-I#
Air transport
มาตรฐานอุปกรณ์ทั่วไป 
อุปกรณ์ที่ใช้ประกอบในพาหนะลาเลียงหรือขนส่ง เพื่อให้ผู้ป่วยได้รับความสะดวก 
สบาย 
หมอน พร้อมปลอกหมอน ผ้าคลุมเตียง 
ผ้าห่ม ผ้าเช็ดตัว 
กระดาษชาระ 
ภาชนะ อุปกรณ์เก็บสิ่งขับถ่าย เช่น Bed pan, Urinal, ถุงจัดเก็บ 
เสมหะหรืออาเจียน 
น้าดื่ม แก้วน้า และน้าสะอาดสาหรับชาระล้าง
อุปกรณ์สารสนเทศและการสื่อสาร
Medical Equipment 
อุปกรณ์ทางการแพทย์พื้นฐาน 
1. อุปกรณ์ขนย้ายลาเลียง 
2. อุปกรณ์เพื่อการตรวจวินิจฉัย 
3. อุปกรณ์ปฐมพยาบาลและทาแผล 
4. อุปกรณ์ช่วยชีวิตขั้นพื้นฐาน
Medical Equipment 
อุปกรณ์ทางการแพทย์เฉพาะด้าน 
1. อุปกรณ์สาหรับทาคลอด 
2. อุปกรณ์สาหรับการช่วยชีวิตขั้นสูง 
3. อุปกรณ์สาหรับการช่วยเหลือที่เกี่ยวกับระบบทางเดินหายใจ 
4. อุปกรณ์สาหรับการช่วยเหลือที่เกี่ยวกับกระดูก 
5. ยาหรือเวชภัณฑ์
Medical Equipment
Medical Equipment
อุปกรณ์เพื่อความปลอดภัยของการปฏิบัติการ 
1. อุปกรณ์ป้องกันตนเอง 
2. อุปกรณ์ป้องกันบริเวณที่ปฏิบัติงาน 
3. อุปกรณ์อื่นเพื่อช่วยเหลือและเพื่อความปลอดภัยของผู้ป่วยฉุกเฉิน
Manpower
Phases of EMS response
TRIAGE
simplest term: the sorting or 
prioritizing of items 
1º operational objectives: time to see 
physician
Assigning Triage 
"usual presentation" 
 not totally dictated by the presenting 
complaint 
vital signs, PEFR, O2 saturation, pain 
scales
Role of Triage Personnel 
triage nurse 
 rapid access 
 be in view of the registration and waiting 
areas at all times 
Accurate: based on 
 Practical knowledge gained through 
experience and training. 
 Correct identification of signs or symptoms. 
 Use of guidelines and triage protocols.
General Triage Guidelines 
dynamic process 
Triage Process: Primary survey vs 
Primary Nursing Assessment
General Triage Guidelines 
1. All patients should be assessed (at 
least visually) within 10 minutes of 
arrival. 
2. Full patient assessments should not 
be done in the triage area
General Triage Guidelines 
3. primary survey 
 level IV and V patients that have been sent 
to the waiting area 
4. The priority for care may change 
5. Level I, II, patients should be in a 
treatment area
The triage assessment 
1. Chief complaint 
2. Subjective 
3. Objective 
4. Additional Information: 
 Allergies 
 Medications
Reassessment 
Objectives for time to Nursing 
reassessment is related to triage level 
exceeded the time objective: up 
triaged
Documentation Standards 
1. Date and time of triage assessment. 
2. Nurse’s name. 
3. Chief complaint or presenting concerns. 
4. Limited subjective history: onset of 
injury/symptoms 
5. Objective observation. 
6. Triage Level 
7. Location in the department. 
8. Report to treatment nurse. 
9. Allergies 
10.Medications 
11.Diagnostic, first aid measures, therapeutic 
interventions. 
12.Reassessment(s).
Protocols 
Emergency Severity Index (ESI©) 
the Canadian Triage Acuity Scale 
(CTAS©) 
the Australian Triage Scale (ARS©) 
the Manchester Triage System 
(MTS©)
Level I Resuscitation 
Conditions that are threats to life or 
limb (or imminent risk of 
deterioration) requiring immediate 
aggressive interventions.
Level II Emergent 
Conditions that are a potential threat 
to life limb or function, requiring 
rapid medical intervention or 
delegated acts.
Level II Emergent
Level III Urgent 
Conditions that could potentially 
progress to a serious problem 
requiring emergency intervention.
Level IV Less Urgent 
(Semi urgent) 
Conditions that related to patient age, 
distress, or potential for deterioration 
or complications would benefit from 
intervention or reassurance within 1- 
2 hours.
Level V Non Urgent 
Conditions that may be acute but non-urgent 
as well as conditions which 
may be part of a chronic problem with 
or without evidence of deterioration.
Australian triage scale
Manchester triage scale
NUH triage
NUH triage
NUH triage
Reference 
An introduction to clinical emergency 
medicine – 2nd ed. 
มาตรฐานและหลักเกณฑ์เกี่ยวกับระบบการแพทย์ฉุกเฉิน พ.ศ. ๒๕๕๒ 
ESI, 2012 edition 
CTAS, 2008 edition 
ATS 
MTS
Take home message 
available and prepared at any time for 
any patient with any complaint 
Always address life-threats first 
Emergency department: EMS + ER 
Triage: sorting or prioritizing
ANY QUESTIONS?
THANK YOU

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Introduction to em

Editor's Notes

  1. Emergency medical technician: EMT
  2. Star of life
  3. Sort: หมวดหมู่ Relevance: การเข้าประเด็น
  4. Dictate: ควบคุม
  5. level IV and V patients that have been sent to the waiting area
  6. May be associated with significant discomfort or affecting ability to function at work or activities of daily living.