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  Emergency & First Aid

June 2011
What Happens in an ER?
Dr. Divya Sharma
 
We have seen it in the movies, in the television serials and otherwise – people rushing with their patient to the ER (Emergency Room)… What exactly happens there? Lets find out…

Emergency Medicine is a medical specialty—a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury, affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development.

Emergency Medicine encompasses a large amount of general medicine and surgery including the surgical sub-specialties. Emergency physicians are tasked with seeing a large number of patients, treating their illnesses and arranging for disposition—either admitting them to the hospital or releasing them after treatment as necessary.

The ER or the Emergency department (room) requires doctors with broad field of knowledge and advanced procedural skills, often including surgical procedures, trauma resuscitation, advanced cardiac life support and advanced airway management.

An Emergency is equipped with:
  • Critical Care Medicine:To resuscitate a patient.
     
  • Anaesthesia: To manage a difficult airway.
     
  • Plastic Surgery: To suture a complex laceration.
     
  • Orthopaedics: To reduce (set) a fractured bone or dislocated joint.
     
  • Cardiology: To treat a heart attack or manage heart disease.
     
  • Gynaecology and Obstetrics: To work-up a pregnant patient with vaginal bleeding.
     
  • ENT: To stop a bad nosebleed.
     
  • Cardiothoracic Surgery: To place a chest tube.
     
  • Radiology: To conduct and interpret an ultrasound and different diagnostic tests.
     
  • Neurology: To manage a brain related disorder like stroke.
     
  • Neuro Surgery: To manage brain injuries, brain bleeds.
     
  • Paediatrics: To handle a critical child.
     
  • Endocrinology: To deal with a patient with uncontrolled diabetes.
As patients can present at any time and with any complaint, a key part of the operation of an Emergency department is the prioritization of cases based on clinical need. This is usually achieved though the application of triage.

Triage

Triage is normally the first stage the patient passes through, and most emergency departments have a dedicated area for this to take place, and may have staff dedicated to performing nothing but a triage role.

In most departments, this role is fulfilled by a nurse, although dependant on training levels in the country and area, other health care professionals may perform the triage sorting, including paramedics or doctors.

Most patients will be assessed and then passed to another area of the department, or another area of the hospital, with their waiting time determined by their clinical need. However, some patients may complete their treatment at the triage stage, for instance, if the condition is very minor and can be treated quickly; if only advice is required; or if the emergency department is not a suitable point of care for the patient.

Conversely, patients with evidently serious conditions, such as cardiac arrest, will bypass triage altogether and move straight to the appropriate part of the department. This is the stage where different specialists play their role.

The resuscitation is a crucial area in most departments and serious patients will be dealt with here. The department has the equipment and staff required to deal with life-threatening illnesses and injuries immediately.

Patients whose condition is not life-threatening will be sent to an area suitable to deal with them and these areas might typically be termed as a majors or minors area. Such patients may still have significant problems, including fractures, dislocations, and lacerations requiring suturing. Here an orthopaedic and a plastic surgeon can help.
Children can present particular challenges in treatment and paediatricians are required there. Some departments employ a play therapist whose job is to put children at ease to reduce the anxiety caused by visiting the emergency department, as well as provide distraction therapy for simple procedures.

Many hospitals have a separate area for evaluation of psychiatric problems.  These are often staffed by psychiatrists and mental health nurses and medical social workers.There is typically at least one room for people who are actively a risk to themselves or others (e.g. suicidal).

Dr.DivyaSharma is AIHA in Apollo Health City, Hyderabad.


    
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