Transcript LECTURE2-Emergency Medicine.ppt

Emergency Medicine
Dr. Hossam Hassan
Consultant and
assistant Prof.
Objectives
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Acute medical illnesses
Acute surgical illnesses
Acute Obstetrical emergencies
Trauma
Acute mental illnesses
Acute ENT & Ophthalmological emergencies
Environmental hazards
Top Ten Leading Causes of Death
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Heart Disease: 726,974
Cancer: 539,577
Stroke: 159,791
Chronic Obstructive Pulmonary Disease:
109,029
Accidents: 95,644
Pneumonia/Influenza: 86,449
Diabetes: 62,636
Suicide: 30,535
Nephritis, Nephrotic Syndrome, and Nephrosis
25,331
Chronic Liver Disease and Cirrhosis: 25,175
Reception
• 300 – 500 visits per day
• Only 20-50 cases require urgent
intervention
• Few cases are life-threatening (1-5)
Triage
300 – 500
cases
Triage-Out
LifeThreatening
Urgent
Cases
Non- urgent
Cases
Triage ( Categorization)
• Category 1 – 5
• 1 : Life-Threatening
• 5 : Triage out
Triage
• Physician Triage
• Nurse Triage
• Clark Triage
Life-Threatening Cases
Need immediate intervention
• Arrest
• Arrhythmias
• Hypoxia
• Shock
• Acute trauma
• Siezure
• Status Asthmaticus
• Anaphylaxis
• Chest pain ( STEMI )
• Delivery – stage 2
( C.1)
C.2 ( Urgent Cases)
Should be treated within 10 min.
• Acute asthmatic attack
• High Blood Pressure
• Intoxication
• Drowsy patient
• Acute colics
• Fractures
• Burns
C.3 ( Acute Cases )
Should be treated within 30 minutes
• Chest Pain ( Non cardiac )
• Abdominal pain
• Dyspnea
• Fever
• Old trauma
• Gastroeneteritis
• Metabolic Derangement
• Post ictal state
Cont’d Triage
• C4 :
Chronic Abdo pain
Minor trauma
claimed : FeverLow BP- Fast HR
• C5 : URTI
Long-standing
complaints
Meds-Refill
Appeal of Emergency Medicine
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• Make an immediate difference
• Life threatening injuries and
illnesses
• Undifferentiated patient
population
• Challenge of “anything” coming in
• Emergency / invasive procedures
• Safety net of healthcare
Appeal of Emergency Medicine
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Team approach
Patient advocacy
Open job market
Academic opportunities
Shift work / set hours
Evolving specialty
Downside to Emergency Medicine
• Interaction with difficult, intoxicated, or violent
patients
• Finding follow-up or care for uninsured
• Working as a patient advocate
• Contract management groups
• Malpractice targets
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The Lifestyle:Two Sides of A Coin
• Well defined shifts
• Usually not on call
• Part time employment possible
• Evenings and nights
• Weekends
• Holidays
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Subspecialties in Emergency Medicine
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Pediatric Emergency Medicine
Toxicology
Emergency Medical Services
Sports Medicine
Critical Care Medicine
Upcoming Areas of Emergency
Medicine
• Observation units
• ED CT
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Research Opportunities
• Broad range of subjects
• Limited amount of work published in our
relatively new field
• Limited number of research mentors
• Limited number of clinical trials
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What to do to get in to Emergency
Medicine ?
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Observe in ED
Summer research projects with EM staff
EM interest group affiliation
Be open to any medical specialty
Trauma
Primary Survey ( A-B-C-D)
Secondary Survey ( Systemic)
What’s Your Diagnosis ?
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OR
Chest pain ( Cardiac )
Chest Pain
Arrhythmias
Low Blood Pressure
• PB = COP * SVR
( 120 / 80 ) mmHg
• COP = SV
( 4- 6 ) 4-6 L/m
* HR
• SV = EDV - ESV
( 50 – 100 ) ml
Low Blood Pressure
• Preload
• Contractility
• Afterload
Dyspnea ( S.O.B)
ABG : 7.35
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80
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O2 saturation: 99%
Acute Respiratory Failure
• Hypoxemic
• Hypercapnic
Asthma
COPD
Pneumonia
Abdominal Pain ( Medical )
Abdominal Pain ( Surgical )
Fractures
Fractures
Fractures
Laceration
Seizure
Acute Psychiatric Ilnesses
DM
DKA
Skin Rash
THANKS