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What is Emergency Medicine? How did the field of Emergency Medicine get started? What kind of patients do emergency physicians see? Can I sub-specialize in something or do a fellowship as an emergency physician? Are there any downsides to becoming and emergency physician? Where can I find more info? What is Emergency Medicine? Emergency Medicine a specialty focused on the initial evaluation, resuscitation, and stabilization of the acutely ill or injured patient. Emergency Medicine is the specialty concerned with the stabilization, management, diagnosis, and disposition of individuals with acute illness and injury. It also includes the management of trauma resuscitation, advanced cardiac life support, advanced airway management, poisonings, pre-hospital care and disaster preparedness. Emergency Medicine encompasses a large amount of general medicine but involves the technical and cognitive aspects of virtually all fields of medicine and surgery including the surgical sub-specialties. Emergency physicians require a broad knowledge base and possess the skills of many specialists - the ability to manage a difficult airway (anesthesia), suture a complex laceration (plastic surgery), reduce a fractured bone or dislocated joint (orthopedic surgery), treat a heart attack (internist), delivery a baby (Obstetrics and Gynecology), stop a bad nosebleed (ENT), manage suicide attempts and complex overdoses (Psychiatry & Toxicology), tap a septic joint (Rheumatology), protect an abused child (Pediatrics), and place a chest tube (Cardiothoracic Surgery). Graduates from over 120 Emergency Medicine residency programs in the U.S. and Canada may also complete fellowships that include: Toxicology, Pediatric EM, Sports Medicine, Hyperbaric Medicine, Critical Care, Emergency Medical Services, Research, International EM, and Ultrasound. Of these, the first four offer subspecialty certification. There are approximately 120 million Emergency Department visits per year. In the US, the ED serves as the only access to medical care for millions of people. As a result, in addition to delivering the highest quality of medical care, the emergency physician’s practice includes elements of public health, population health, and prevention. This may include screening, intervention, treatment and referral for a variety of illnesses and behaviors such as substance use disorders, interpersonal violence, depression and other mental health disorders, and undiagnosed illnesses such as hypertension, diabetes, and HIV. In 1979 Emergency Medicine was recognized as the 23rd medical specialty by the American Board of Medical Specialties. The American Board of Emergency Medicine, the independent certifying body for the specialty, was established and the first certification examination was given in 1980. Currently there are 76 full academic Departments of Emergency Medicine at medical schools across the __________. Other universities with academic departments of emergency medicine include Johns Hopkins University, the University of Pennsylvania, Brown University, and the University of California at San Francisco, among others. How did the field of Emergency Medicine get started? Emergency Departments in the 1960s were staffed by physicians (usually residents) of different fields of expertise, but with no specific training in EM. The first Emergency Medicine residency was started at the University of Cincinnati in 1970. The American Board of Medical Specialties recognized EM as a separate specialty in 1979. BMC established the first EM residency program in Boston in 1986. As you can see, EM is a relatively young specialty! Where can I find more info? American Board of Emergency Medicine American College of Emergency Physicians Society for Academic Emergency Medicine American Academy of Emergency Medicine Boston Medical Center Department of Emergency Medicine This chapter will deal with the basic elements of patient assessment (Vital Signs and History Taking.) In those chapters that follow (dealing with patient assessment) the individual components will be expanded and explained. Vital Signs include: (followed by some descriptive classifications) * Respirations (comfortable [eupnea], shallow, deep, labored [dyspnea], agonal, noisy, rapid [tachypnea], slow [bradypnea], absent [apnea], Cheyne-Stokes or Kussmaul patterned) * Pulse (regular, irregular, thready, bounding, absent [peripherally and/or centrally]) * Skin Condition (normal color, pale, red, cyanotic, warm, cool, hot, cold, dry, moist, wet) * Capillary Refill (less than 2 seconds, more than 2 seconds) * Blood Pressure * Level of Consciousness (alert, responds to verbal or painful stimuli, unresponsive, oriented [to time/person and/or place], confused) **AVPU * Breath Sounds (equal, diminished [left/right/bilaterally], rales [location, course, fine], rhonchi [audible, course], wheezing, stridor, absent) * Pupils (equal, unequal, round, not round, reactive to light, non-reactive [fixed], sluggish [left, right, bilaterally], midrange, pinpoint, dilated, left or right fixed gaze) **AVPU * A - Awake and Alert * V - Responsive to Verbal Stimuli * P - Responsive to Painful Stimuli * U - Unresponsive * S - Signs and Symptoms of the event. What signs were collected and what symptoms were reported? When were symptoms first noticed. If "obvious symptoms" are being ignored or denied, so state. * A - Allergies. Is the patient allergic to any medications, food, environmental conditions, or other substances? If so, what reactions resulted? How severe? How long ago? If the patient has no known allergies (nka,) include this information in the history. * M - Medications. What medication is the patient taking. How often and what dosage? Is the patient compliant with the prescribed dosage and frequency? Any over-the-counter drugs taken in the past 12 hours? Note: Some patients do not understand the concept of 'medication' and might deny taking any, but when questioned about what 'pills' they take, suddenly reveal information about their 'blue pill' for the heart, 'yellow pill' for the lungs, 'pink pill' for the ..... If the patient denies taking any medications, ask them if they take any pills....It might just keep you from looking foolish to the care providers next-in-line in the process. * P - Pertinent Past History. Has the patient had any recent surgeries, traumatic events, illnesses, or contacts that might contributed to this present event, or that might impact on the treatment of this present event? * L - Last Oral Intact. When did the patient last eat or drink ANYTHING? What? How much? Did whatever was ingested contribute to this event? If so, what happened the last time this substance/food/fluid was ingested? * E - Events Leading to the Injury or Illness. What happened just prior to the time when the patient first noticed the signs or symptoms. What happened just prior to the injury. Was there something that caused the accident? What has transpired just prior to the emergency care provider's arrival. http://www.emergencymedicaled.com/200Basic%20Life%20Support.htm http://www.ed.bmc.org/applicants-students/faq-about-EM http://medicine.yale.edu/emergencymed/whatis.aspx |