Fakulteti i Mjekesise

Dega Mjekesi e pergjithshme - Viti I

Lenda: English Language
L. 13. Emergency medicine

Lecture 13. Emergency medicine

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 behavioral 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.
Dominique Jean Larrey is sometimes called the father of emergency medicine for his
strategies during the French wars. During the French Revolution, after seeing the speed with
which the carriages of the French flying artillery manoeuvred across the battlefields, French
military surgeon Dominique Jean Larrey applied the idea of ambulances, or "flying
carriages", for rapid transport of wounded soldiers to a central place where medical care was
more accessible and effective
Emergency medicine (EM) as a medical specialty is relatively young. Prior to the 1960s and
70s, hospital emergency departments were generally staffed by physicians on staff at the
hospital on a rotating basis, among them general surgeons, internists, psychiatrists,
and dermatologists.
Emergency medicine comprises a large amount of general medicine and surgery including
the surgical sub-specialties. Hospitals around the world always have an emergency room
where patients may receive medical treatment that cannot wait for a scheduled appointment
with a doctor.

 Emergency physicians and other members of the emergency medicine’s team

 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 emergency physician requires a broad field
of knowledge and advanced procedural skills often including surgical procedures, trauma
resuscitation, advanced cardiac life support and advanced airway management. Emergency
physicians must have the skills of many specialists—the ability to resuscitate a patient
(critical care medicine), manage a difficult airway (anaesthesia), suture a complex laceration
(plastic surgery), reduce a fractured bone or dislocated joint (orthopaedic), treat a heart
attack (cardiology), work-up a pregnant patient with vaginal bleeding (Obstetrics and
Gynaecology), stop a bad nosebleed (Otolaryngology or ENT - ear, nose, and throat), place
a chest tube (cardiothoracic surgery), and to conduct and interpret x-rays and ultrasounds
(radiology). Other areas required for a physician specializing in emergency medicine
include: palliative medicine, critical care medicine, medical toxicology, wilderness
medicine, paediatric emergency medicine, sports medicine or emergency medical services.
Among the many people who work in the emergency room are nurses, specialists,
technicians, staff, and at least one emergency room physician.
The job of an emergency room physician is one of the most stressful positions for a doctor,
as there is no way to tell what type of injury or illness will come through the door at any
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 Fakulteti i Mjekesise
Dega Mjekesi e pergjithshme - Viti I
Lenda: English Language
L. 13. Emergency medicine

time. His primary role is to treat patients with a variety of ailments that range from mild to
severe. While the specific medical cases can vary from day to day, the basic duties of an
emergency care physician remain the same. These include quickly diagnosing patients,
stabilizing patients, referring patients to relevant hospital departments and participating in
meetings or conferences.
Hospital emergency rooms may treat everything from a common cold to a life-threatening
bullet wound within the course of a shift. Many hospitals have a policy that no one will be
turned away from the emergency room, which means that, along with life-threatening
emergencies, many uninsured patients or overly-concerned parents with sick children will
also come through the doors of an emergency room. One of the most important jobs of an
emergency room physician is to determine who needs immediate treatment and who can
wait. An emergency room physician must triage the patients who enter the emergency room,
be prepared to treat a broad range of injuries, as well as delegate authority to the nurses and
support staff in the emergency room.
Triage is frequently not as easy of a job as it may seem. While some serious or life-
threatening injuries are obvious, others are not. A gushing bullet wound clearly needs to go
to the head of the triage line, but people are sometimes suffering from internal injuries or
illnesses that are not as visible, yet just as serious. An emergency room physician only has a
few minutes, if that, to determine whether a patient's symptoms require immediate attention
or whether he or she can wait. Once triage has been accomplished, an emergency room
physician must then be prepared to treat the wide range of symptoms he or she sees every
day. Unlike doctors who specialize in a particular area of medicine, an ER doctor must have
a working knowledge of all areas of medicine. An ER doctor must know at least enough to
refer the patient to a specialist if one is needed, which requires a considerable amount of
knowledge about many areas of medicine.
One of the most fundamental duties of an emergency care physician is diagnosing patients.
The types of conditions this physician sees can vary widely, and it's important for him to be
able to quickly and accurately assess the problem. Diagnosis usually involves an evaluation
of each patient to find what the symptoms are. The physician will usually get readings on
the patient's vital signs, and if the patient is able to respond, may ask questions that will help
him with the diagnosis. Performing these tasks successfully requires that the emergency care
physician have a broad knowledge of medical ailments and possess excellent
communication skills.
In many instances, an emergency care physician will also need to stabilize patients. For
example, if a patient is having breathing difficulties, a physician might need to perform
cardiopulmonary resuscitation (CPR). In the case of a patient experiencing cardiac arrest, he
might use an external defibrillator to restore normal heart functioning. This practice requires
an individual to be adept at multiple life saving practices and have the necessary equipment
on hand. After a patient has been diagnosed and stabilized, an emergency care physician
will usually refer the patient to the appropriate hospital department. The speed with which a
patient is referred will typically depend upon the severity of the medical complication and
how busy the hospital is. If a patient has experienced a life-threatening complication, the
patient will be treated right away. When a condition is milder, the patient might have to wait
for a brief period to be treated.

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 Fakulteti i Mjekesise
Dega Mjekesi e pergjithshme - Viti I
Lenda: English Language
L. 13. Emergency medicine

Along with his other duties, an emergency care physician will sometimes need to
participate in meetings or conferences. It's necessary for an emergency care physician to
stay up-to-date on changes in medical science and technology. At these meetings, he might
learn about new methods for treating patients, new equipment and changes in hospital
policy. In some instances, he may be required to travel for meetings.
 An emergency care specialist is usually one of the first points of contact for
individuals seeking treatment for life-threatening injuries or illnesses. Specialists are in
charge of assessing a patient's immediate needs, performing life-sustaining procedures, and
documenting patient information and initial treatment responses. Some types of emergency
care specialists respond to accident and injury scenes, while others respond to patients'
physical and psychological needs in a hospital's emergency room.
Patients utilize emergency care services when they are uncertain of the severity of their
injuries or when they sustain injuries that need immediate treatment. Emergency care
facilities are staffed with physicians, nurses, and technicians who help diagnose and treat
those injuries. The job of an emergency care specialist involves gathering information about
the nature of the illness or injury by means of questions, visual assessments and preliminary
diagnostic tests. The specialist may gather insurance and personal information from those
who are able to think and speak clearly. At times they might gather this information from
other individuals who bring the injured person into the emergency room. Minor procedures
such as wound cleanings, stitches, administering approved medications, and monitoring
vital signs are typically performed by an emergency care specialist. Diagnostic tests such as
collecting fluid samples and oxygen levels may also be administered by those who work in
emergency care. As the specialist gains experience, he might be involved in documenting
and recommending care procedures and protocols. Documenting what care was given to
patients, the types of injuries sustained, and procedures completed to sustain life are part of
the specialist's responsibilities.
Since the specialist may be the first person patients make contact with, he is often
responsible for communicating important details to them. He may attempt to calm them
down and let them know what types of treatments are going to be provided. A specialist will
also inform the patient of any follow-up treatments that might be needed.

 An emergency medical technician (EMT) — one type of emergency care specialist

— is responsible for responding to dispatch calls for emergency services. In most cases, the
dispatch request is made to transfer accident victims or severely ill patients to a nearby
hospital for treatment. When they reach the location of the emergency, EMTs may have to
administer some forms of medical treatment, including CPR, resuscitation, temporary
bandaging, and intravenous fluids. EMTs may communicate and coordinate information
about the patient with law enforcement agencies and other emergency responders.

 Nurses and nursing assistants may perform work as an emergency care specialist
on a rotating basis. They will typically help admit patients to emergency rooms and assess
whether they need further treatment from hospital staff.