Transcript: Emergency Medicine The Good, The Bad, The Ugly The Good The Good EM can be very exciting and rewarding You see people often at the worst time in their lives but then when you help you feel like you've made a real difference The variety of work is attractive - you never know what will come through the door "The best 10 minutes of every other specialty" Lots of hands on clinical work and quick thinking required You're never alone, always working in a team The Bad The Bad Shift work and unsociable hours - full time commitment to work High pressure job and environment Challenging patient population Limited space and high volume of patients Misguided patients presenting with non emergencies Pressures to reach unrealistic targets The Ugly The Ugly Seeing patients often at the worst time of their lives you can't save everyone Vulnerable patients Violent or aggressive patients (drugs/alcohol induced) Emotionally challenging High burnout rate
Transcript: Emergency Medicine Emergency medicine care of illnesses or injuries requiring immediate medical attention. Just like in the event of of beloved Scott Sterling, where he likely got a concussion. Emergency Medicine What is it? Different healthcare systems Different methods of Emergency Medicine In the US and the UK, it's typical to see paramedics quickly transfer the injured to hospital, where they're then treated by doctors In France and Germany, paramedics are accompanied by doctors, and often operate on the spot! Therefore, the hospital is literally brought to the patient. Required education to practice Emergency Medicine. Required Education -Bachelor's Degree (4 years). -Has taken the MCAT test (similar to ACT, but allows entry into a medical school). -Completion of Medical School (3 years). -A 4-5 year residency in a hospital, where one is technically a doctor, but is under the guidance of multiple supervisors. Standards History of Emergency Medicine Purpose & Objectives Objectives Material + Equipment Resources References References Procedure & Activities Procedure & Activities Warm-up Activity Warm-up Activity Step 1 Step 1 Step 2 Step 2 Assessment Methods Assessment Methods Assessment Activity 1 Assessment Activity 1 Assessment Activity 2 Assessment Activity 2 Notes Notes
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
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
Transcript: Patient transferred to trauma room Trauma team will evaluate patient while crew gives report to receiving physician transfer equipment and paperwork and radiology studies 8 year old Male had fallen a week prior Uncontrollable seizures and bleeding in the brain Transfer from singing river hospital to USA children and women's Two Types of calls Prevent Hypertension keep head mid line, slightly elevated Neurological evaluation Emergency Medicine Pupils Equal Round and Reactive to light Personnel on Board Layout machines medicines Scene PERRL: Inside of the Helicopter Hospital arrival My Mentor in-flight protocol Tony Fleming er nurse at USA Medical for 9 years currently Clinical base supervisor for life flight for 3 years Air Ambulance Transport Interfacility Transfer closed Head injury transfer Critically ill patients Require Different specialty or procedure Currently 60% of all calls are interfacility ambulance first on scene call made by the ambulance Reasons for scene calls
Transcript: Case 2: Carjacking/Hit & Run - 5 victims 3 children 2 adults Triage Resource Management Stabilization Communicating Bad News A Jack of All Trades and Masters of None? Nope! It's not that bad You can have a life most of the time It's really fun! But you work a lot of weekends Still, it's more flexible than you would think! Thank You! 1. Go to school & Don't do Drugs: Grades, Scores - USMLE STEP 1, Clerkships! --> Recommendations 2. Rotations - how to do a good job 3. Extracurriculars: community service, leadership and creativity 3. EMIG, ACEP/EMRA, AAEM We are experts in resuscitation and Emergency treatment, diagnostics and procedures! We care for the undifferentiated patient better than anyone! How to get into an EM Residency? Emergency Medicine is a backstage pass to the most intense events in the lives of the people of your community. High Energy, Intense, Rewarding. Intubation. Reduction. Defibrillation. Cardioversion. CardiacPacing. CentralIVAccess. Arterial-lines. NerveBlocks. ChestTubes. Thoracotomy. NeedleDecompression. Lateral canthotomy. Joint Aspiration. Lumbar Puncture. Laceration repair. Foreign Body Removal. Not for the Faint at Heart Emergency Medicine: A Resident's perspective Everyday is Entertaining! Teamwork Fun, Energetic Relaxed atmosphere Wear Pajamas to Work First Name Basis Excitement, Variety, Unpredictable, Procedures, Thinking on your feet, Fast Results, Lifestyle, Subspecialities, Teamwork, the People "Emergency Medicine is the most interesting 15 minutes of every other specialty" - Joe Lex Day in the Life of a Resident Linda Sanders Temple University Hospital PGY3 Hot Topics in Emergency Medicine: Sepsis, Ultrasound, Twitter Emergency Medicine Podcasts/Blogs: Skeptics guide to Emergency Medicine, ALIEM, REBELEM, EMBasic, EmCRIT, ERCast, FOAMed We laugh A lot! Tumbleweave. The regular hallway patient. Turkey sandwiches found on physical exam. Crazy traumas. Friday night drunks. Fun images. Foreing bodies Uncertainty Case 1: Food Truck Explosion The People Be an advocate at TCMC Great tool for learning anatomy, procedures Emergency Medicine Uses: Cardiac Arrest, Trauma, Pregnancy, Causes of Dyspnea, Fluid Status, Soft Tissue infection, Kidney stones Do a 4th Year rotation! Free Open Access Medical Education FOAMed EM: The Specialty Why? Procedures Disaster Medicine Making decisions without all of the information. Not knowing the outcome Did you do the right thing for the patient? FISHBOWL EFFECT Lack of gratitude Be comfortable with imperfection in your environment and yourself Ultrasound in Emergency Medicine Sick patients Disaster Medicine Diagnostics --> ActioN! 62 ECG bpm
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
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
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