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Emergency Medicine

Transcript: Blood test/culture CT scan X-ray Urinalyisis EKG ABG (arterial blood gas) Chemistry profile Today has been a pretty typical day. There was nothing too serious. The biggest thing we had was a teenage girl complaining about abdominal pain. We decided to do a urinalysis to rule out a UTI, a CBC test to see if her body is fighting an infection, and an abdominal exam to detect inflammation. Those results didn't come back clearly so we took a CT scan. The CT scan showed that she had appendicitis. That meant she needed surgery so we transported her via ambulance to the nearest hospital. Thank You! We focus on acute illness and injury Emergency physician First responders Emergency medical technicians Paramedics Nurses Radiographer (X-ray tech) Lab technicians Community based What do we treat? Equipment Used Urgent Care Facility Staff Lab tests Trauma Sepsis Burns Acute coronary syndrome Poisoning Stroke Broken bones Stethoscope Cardiac monitor Suture tray Orthopedic equipment Otoscope Opthalmoscope Peak flow meter Crash cart Defibrillator IV fluid infusion Laryngoscope Oropharyngeal airway A day at the urgent care facility 62 ECG bpm

Emergency Medicine

Transcript: emergency medicine other locations initial medical treatment of illness takes place lth attention Medical specialty in which physicians [DOs and MDs] students learn the procedures specializes in diseases of the digestive diagnose a variety of care emergency medicine clinicians operate by immediacy rules under large emergency system stabilize undersea wilderness palliative medicine medical attention they diagnose a variety of illnesses they usually provide long term healthcare students pay close attention to emergencies photo credit Nasa / Goddard Space Flight Center / Reto Stöckli (cc) photo by medhead on Flickr sick there are daily lectures and conferences sports medicine disease specializes in diseases hyperboric people with injures need immediate heat undertake acute interventions

Emergency Medicine

Transcript: - sends a shock to the heart that stops it - The benefits of an AED is that the computer makes all the decisions for you, and all someone has to do is follow the directions - an AED is applied when patients are pulseless, not breathing, and unresponsive How to Give CPR CPR Thank You! Acute Myocardial Infarction - Heart Attack - Total and sudden occlusion or blockage of blood blow through a coronary artery to the myocardium -Causes necrosis of the heart tissue - Usually occurs in the left ventricle developed over time by a clot forming - AED and possible CPR is essential Cardiac Emergencies STEPS IN AED USE - Cramping and pain just under the sternum - Radiating pain down the left arm - Indigestion feeling in the upper abdomen - Tightness under the jaw - Shortness of breath 1. BSI 2. Check to see if the scene is safe. If yes enter 3. Decide if it is a life threatening situation. If yes - Call 911 - Get an AED - Gain consent - Control life threatening situations Check CABDS (this is when CPR and AED is in use for cardiac emergencies) Circulation- is there a pulse Airway- is airway open breathing- are they breathing severe bleeding Control other major emergency situations Attempt to find mechanism of injury Take baseline vitals Get Sample history Continue to check vitals every 15 minutes until relieved Types of Cardiac Illness Congestive Heart Failure - Heart is functioning but the myocardium is damaged and can no longer pump adequately to meet the needs of the body - Increases heart rate and enlargement of the left ventricle - Causes a buildup of fluid in the lungs - Severe dyspnea, anxiety, sitting upright, etc. SIGNS OF A HEART ATTACK Steps in an Emergency AED Emergency Medicine: Cardiac Emergencies Cardiac Arrest- occurs when the heart for any reason is not pumping effectively or at all and no pulse can be felt - Brain cells begin to die within 4-6 minutes following Cardiac Arrest -You can increase the survival rate of a cardiac patient by 70% if an AED is applied within 4 minutes of the event - Heart disease is the #1 cause of death in the US - Go through the same steps as any patient, but with the mindset of getting to an AED and being prepared to perform CPR and calling 911 quickly Facts about Cardiac Illness in Emergencies What is an AED Angina Pectoris - Pain in the Chest - Inadequate oxygen supply to the heart usually caused by a blockage in the coronary artery - Pain is described as crushing or squeezing or tightness - Usually occurs during period of stress and can be relieved if the stress is removed - Usually lasts under 10 minutes 1. BSI, scene size- up, medical Direction, AED, CABDS 2. Perform initial assessment 3. Begin or resume CPR as AED is readied 4. ATTACH AED PADS and turn AED Power On 5. Stop CPR and say "Clear" 6. Begin Analysis 7. If AED calls for a shock, then hit the Shock button 8. Repeat for 3 stacked shocks 9. Check patients pulse 10. If no pulse, resume CPR for 1 minute and re- analyze (3x) 1. First Steps (BSI, Size up, Scene Safety) 2. Check to see if the patient is responsive, only perform CPR if the patient isn't breathing or has no pulse. 3. Begin CPR as soon as possible 4. First do 30 chest compressions by putting weak hand in the middle of the chest in between the nipples and the placing the stronger hang over the weak one and interlocking the hands. Straighten arms and lock elbows and compress the chest at least 2 inches since the patient is an adult 5. use the head tilt/ chin lift maneuver by okaying 1 hand on the forehead and 2-3 fingers of the other hand on the bony part of the jaw. lift chin up while tilting head back 6. give 2 rescue breaths by creating a seal around the mouth and pinching the nose 7. Continue 30 compressions and 2 berths for 5 cycles 8. if patent begins to move, maintain airway and place the patient in the recovery position but be prepared to start CPR again 9. Use AED once it arrives 62 ECG bpm

Emergency Medicine

Transcript: 30 - Respirations 2 - Capillary Refill CAN DO - Simple commands bls.gov Basic 18 y.o. Diploma/GED DSHS EMS Course Natl Registry Exam FBI Background Check EMT-P vs LP Ken please come up here Remember "START WHERE YOU STAND" Advanced medical skills Pediatric Cardiac Associates degree in EMS OR Bachelors in any major Virtually Identical 30 2 CAN DO Intermediate TSgt William Cole USAF 13 Years Demo Time All requirements of Basic 1,000+ hours Compromised airways Intraveneous fluids "Triage" French: Trier "Do the most good for the most people" Prioritize If you're not EMS Green- Walking wounded Yellow- Delayed Red- Immediate Black- Another one bites the dust Licensed Paramedic EMT - P EMT - I EMT - B Texas EMS dshs.state.tx.us Emergency Medicine Tagging victims citmt.org

Emergency Medicine

Transcript: Emergency Medical Treatment and Active Labor Act Assess probability of evaluation Patients may be sent to an ER because the case of the patient is too complex. Pediatric Emergency Department Emergency Departments receive the greatest amount of patients within any medical facility. New York University Downtown Community Hospital Define and map the system The Golden Hour Dealing with Psychological Damage Compassion Fatigue Specialty Emergency Departments Over capacity in a primary care unit will result in sending the patients to the emergency room. Charles R. Figley Waiting time is usually more convenient. Obstetric Emergency Department Physicians in the field of emergency deal with a number of challenges throughout their career, but at the end of the day, the career of emergency medicine is extremely rewarding. By: Jessica Smith Identify failure modes Trauma not only affects the patient but the workers in the emergency department as well. If the act is violated, the hospital will be fined $50,000 for each infringement. Chicago Cook County Hospital Assess effects and severity Response Reliability All fifty states abide by the laws of EMTALA. Geriatric Emergency Department EMTALA The International Critical Stress Foundation Emergency Department vs. Primary Care 62 ECG bpm

Emergency Medicine

Transcript: Complete work early Meet every Thursday Gainsville state college Associates in Psychology Transfer Exciting Compose movie Less shy around adults Gather Information Compose a documentary Dads Pager Take a CPR class Kenny Scott Fire Fighter 1,2 EMTI Why It's Relavent The Proccess Post-secondary Many will end up going there A career in medicine Not Pursue a career in this field Reasearch psychology Most F.D. calls are medical Communication Skills All the excitement With more money Why dad became one and why I was considering it The golden hour Level One Trauma Atlanta Medical /Grady Memorial More information Career Feeling good Final Product Three days a week Exciting Issues/Problems Choose a time Reasearch Paper Why it appealed to me Always wanted to be a Fire Fighter Work Habits My Facilitator Scheduling CPR Making movie short Learning curve Thank You Began when I was considering a career Call on scanner Shorter than planned Product

Emergency Medicine

Transcript: FInal Project Patient waiting time decreased significantly. Highly efficient, faster paperwork and results. Decreases amount of patients within the waiting room. Overall patient satisfaction increased significantly. Highly useful for exceedingly hectic days when the waiting room holds more than 20 patients. Physicians given the ability to see and handle more patients within a shift. Patients given the impression that they are given more attention. Consequential patient evaluations boost the Hospital’s overall rating. My Task Dr. Islam’s values taught me efficiency and diligence which stood imperative in order to succeed in any field of work. Fortunately my mentor facilitated the research portion of my project and provided some information and statistics. His major presentation and introduction of the project consisting of initial statistical and overall advantageous goals of placing a Physician in triage. Another major source Dr. Islam provided consisted of a single Patient care statistical chart portraying a definite increase of patient satisfaction for that specific day. Improving the Project Consisted of observing the triage room and surveying the ER staff regarding their experience with Physicians working in triage. As for the product aspect of the project, I generated a brochure evaluating the physician triage project. Project In Detail Neil Albana Dr. Nadim Islam Medical Director of Emergency Medicine The project required not only observation but surveys of staff but and the attendance of staff meetings as well. Consequently, the project generated several challenges that required handling. The first major challenge of the project entailed of surveying the staff of their experience within Physicians in triage. The second issue that incited from the project consisted of attending the staff meetings held early in the morning. Such meetings conflicted with a crucial class. Unfortunately, I attended only a few of these meetings. Patient experience with Physician in triage Dr. islam Recources While discussing my semester project with Dr. Islam, he brought up a new endeavor that the emergency room of Memorial Hermann recently assembled. He delegated me the responsibility to evaluate this new project arranged by the staff of the emergency medicine which consisted of placing a Physician within the triage of the emergency room. Staff of the department of emergency medicine Memorial hermann South east Evaluators Mrs. Nylenn Lessons The majority of my work relied on observation and surveys from the emergency room staff. In the midst of volunteering in the triage room, my learning experience consisted of working efficiently and avoiding any disruption within the work place. The Main objective entailed evaluations of the progress of the Physician in triage project. Product consist of a bochure depicting the benefits, weaknesses, solutions based on observations and staff experience, and comparisons between a triage experience with a Physican and in the absence of. Does the presence of a Physician in triage truly increase patient satisfaction? If so, how will the staff be able to improve the project in order to gain the emergency department the most benefit? I chose to pursue this project in order to facilitate the evaluation process of the ER department's new venture. Triage Discoveries How it came to be For those unfamiliar with the term, triage exists as a room where nurses determine the primacy of a patient’s treatments founded on the severity of their ailment. Patient waits within the waiting room before any initial assessment. After triage, the nurses situate the patient to a designated ER room where he or she waits for subsequent physician assessment. Consequently, Physician confirms diagnosis from assessment and orders necesary medications/ Xrays adding to wait time. Highly time consuming General patient experience in er Special thanks to... Improving the project Essentially Weaknesses: Monetary value of the triage shift of Physician remains questionable. Few Physician assessments in triage are insufficient Some of the nurses and staff are inexperienced of some of the triage tasks. Nurse and Physician assessments overlap. Benefits Solutions: Frequent staff meetings to discuss flaws and possible improvements on the flow in triage. Increase amount of time Physician assesses the patient for adequate assessments. Physician meeting in order to decide the monetary value of the triage shift. A seasoned team is the most effective during the triage shift, therefore train staff members willing to work in the triage shift with the Physician. Completely give assessment task to the Physician while nurses and tech focus on bloodwork and Vital signs. Determine the limited amount of patients within the triage room in order to maintain an easeful environment. Patients enter the emergency room with their own set of high expectations. These experiences remain common among most hospital emergency rooms and prominently influence

Emergency Medicine

Transcript: $400,000 or more Hospitals Emergency What...? Prioritize injuries By Amy Angove University of Pennsylvania Undergraduate- Bachelor, Associate Job Outlook/Earning potential Stanford Los Angeles: $280,639 Texas: $175000 Curriculum Phase I: Human Biology and Disease Curriculum Phase II: Core Clinical Clerkships Curriculum Phase III: 4th Year Colleges Pediatric neonatal intensive care EMS research and analysis Extrication Hazmat handling Pharmacology Emergency cardiology EMS law and legal issues Disaster management Endurance Stressful yet rewarding How Do I get there? 8, 10, 12 hour shifts Paperwork Degrees Multitask Assess Patient Medical Residency Programs Harvard Where can I find one? 23%/ 55,300 jobs Classes Sacramento:$181000 Location +7 years medical training Emergency Medicine American Board of Emergency Medicine recognized in 1979. Physician's License Medical school

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