EMERGENCY

TREATMENT
 EMERGENCY
5.8 million
eaths/year

10% of worlds deaths

2% more deaths than HIV, TB

Malaria combined
INTRODUCTION

•EMS is an integral part of any hospital

•Microcosm of the hospital as a whole
•“Front door” of the hospital
•Portal of entry that interacts with the
highest volume of patients requiring
critical care
Definitions

• Emergency has been defined as a condition

determined clinically or considered by the patient
or his/her relatives as requiring urgent medical
services, failing which, it could result in loss of life or
limb……………WHO
• Medical emergency is a situation when patient
requires urgent & high quality medical care to
prevent loss of life or limb and/or to initiate action
for the restoration of normal healthy life.
Emergency medicine
Emergency Medicine is one of the most challenging
medical specialties.
Emergency Medicine is a discipline that serves a
whole community of patients both inside and
outside the hospital.
 Emergency Medicine education includes community
outreach, international outreach, EMS, medical
students, residents, and fellowships emphasizing on
acute care of patients with episodic illnesses.
Emergency medicine is a medical specialty involving
care for adult and pediatric patients with acute
illnesses or injuries that require immediate medical
attention.
 Importance
• Public perception & opinion of a hospital is often based on their visit to
the accident & emergency department
• This facility, usually accounts for a significant number of all hospital
admissions
• Effective functional operations in the department are important variables
for staff, patient & visitors satisfaction
 Functions
• Provision of immediate & correct life saving treatment
at all times & for all situations
• Collection of casualties
• Rapid institution of BLS to critically ill at site, en route
& in hospital
• Information centre to render advice on telephone or
in person on simple medical queries
• Capacity & capability to provide effective
management during disaster situations
Functions…..

• Liaison with courts & police in a medico-legal cases

• Provision of ambulance services
• Act as information & communication center especially during
disasters
• To provide education, training & research
Types of A & E Departments

• Type I : Large hospital with all specialists available

round the clock
• Type II : Emergency room physician available round
the clock where specialists on call
• Type III : Standby emergency facilities with
physician & nurse on call
• Type IV : Referral emergency service where only
nurse is available. First aid & refer
Planning

• Location
• Should be loc on the ground floor
• Direct access from the main road
• Separate approach, other than OPD with a spacious parking area
• Loc adjacent to OPD
• Well lighted & boldly sign posted both for day & night
• A helipad is required for major trauma centres, hilly or unapproachable areas
Interrelationship
 Close relationship with:
 OT
 ICU
 Blood bank
 Laboratory
 OPD
 Mortuary
 Some authorities recommend a close relationship with
CCU as well
 Many sub-depts like OT, Diagnostics etc may be required
in the dept itself
Objectives

• Acute medical illnesses

• Acute surgical illnesses
• Acute Obstetrical emergencies
• Trauma
• Acute mental illnesses
• Acute ENT & Ophthalmological emergencies
• Environmental hazards
Triage

500 – 300
cases

Triage-Out

-Life Urgent Non- urgent

Threatening Cases Cases
C.2 ( Urgent Cases)

Should be treated within 10 min.

• Acute asthmatic attack
• High Blood Pressure
• Intoxication
• Drowsy patient
• Acute colics
• Fractures
• Burns
C.3 ( Acute Cases )

Should be treated within few hours (30 m)

 Chest Pain ( Non cardiac )
 Abdominal pain
 Dyspnea
 Fever
 Old trauma
 Gastroeneteritis
 Metabolic Derangement
 Post ictal state
 Cardiac Arrest,
Respiratory Arrest,
Airway Obstruction
Burns
COMMON EMERGENCIES
seizures
Diabetic
Soft-Tissue Injuries
Environmental hazard
CARDIAC ARREST

• Unexpected loss of heart function, breathing and consciousness

• Results from an electrical disturbance in your heart
• Pumping action of the heart is disrupted
• Blood flow to the rest of your body is stopped
SYMPTOMS

 Sudden collapse
 No pulse
 No breathing
 Loss of consciousness
 OTHER SIGNS MAY BE
 Fatigue, fainting, blackouts, chest pain, shortness of breath,
weakness, palpitations or vomiting
 Often occurs with NO warning
TREATMENT

• If you experience any of these signs see a physician immediately

• If you come across someone who is NOT breathing…
– Perform CPR
– Use a portable defibrillator
– Continue this cycle until the patient regains consciousness or emergency
medical technicians take over
RESPIRATORY ARREST

• When a person ceases to breath on their own they enter a state

known as respiratory arrest

• Caused by airway obstruction, respiratory muscle weakness,

decreased respiratory drive

• If respiratory arrest is prolonged, cardiac arrest will quickly follow

SYMPTOMS

• Absence of spontaneous breathing

• Chest does not rise and fall

• Skin color changes due to lack of oxygen

• You will be unable to feel air coming from the mouth or nose
TREATMENT

 Remove any airway obstruction

 Cardiopulmonary resuscitation (CPR)

 Intubation (medical professional)

 Tracheotomy (medical professional)


AIRWAY OBSTRUCTION

• Can be a partial or complete blockage of the breathing passages to

the lungs
• Can become completely obstructed by swollen anatomy or by a
foreign object
• If airway becomes completely blocked, the patient will not be able to
make any sounds, cannot breath and will soon become unconscious
•
TREATMENT

• Encourage victim to cough

• If stop or unable to cough/talk, ask if they are choking and if you can
help them
• If they say yes, perform the Heimlich maneuver
• If unconscious, begin CPR
• Continue cycle until blockage is removed or EMS arrives
BURNS
2nd DEGREE BURNS

• When the first layer of skin is burned through and the second layer is
also burned

• SYMPTOMS
• Blisters
• Skin is intensely reddened and splotchy
• Severe pain and swelling
TREATMENT

• Treatment for 1st and 2nd degree burns

• Cool the burn
• Cover with a sterile bandage
• Take an over-the-counter pain reliever

• WATCH FOR
• Infection, swelling or oozing
• Increased pain
• Redness, fever
 3rd DEGREE BURNS
• Serious burns that involve all layers of the skin and cause permanent
tissue damage
• Spreading wound infection
• Traumatic brain injury
• acute epistaxis
• Spinal disc herniation
• Sudden Sensorineural hearing loss (SSHL, or just SHL, which may
become permanent unless treated promptly.)
 TREATMENT

• Check for signs of circulation

• Elevate burned parts

• Cover the burn

• Call for EMS
SOFT – TISSUE INJURIES

• The damage of muscles, ligaments and tendons throughout the body

• Usually occur from a strain, sprain, contusion (bruise), overuse or

stress injuries
SOFT – TISSUE INJURIES

• Can result in pain, swelling, bruising, and/or temporary loss of

function

• TREATMENT
• R = rest the individual from activity that causes
pain
• I = ice the injury
• C = apply compression to the injury
• E = elevate injured area above the heart
• IF PAIN IS SEVERE CONSULT A PHYSICIAN
AUTOMATED EXTERNAL
DEFIBRILLATOR
(AED)

• A portable electronic device that will automatically diagnose any

potentially life threatening cardiac arrhythmias of ventricular
fibrillation and ventricular tachycardia in a patient
• Treats through defibrillation and allows the heart to reestablish an
effective rhythm
Metabolic
• Diabetic coma,Diabetic ketoacidosis,Hypoglycemic coma
• Electrolyte disturbance, severe (along with dehydration, possible with
severe diarrhea or vomiting, chronic laxative abuse, and severe
burns),Hypercalcemic crisis,Dehydration.
Diabetic Emergencies

• Disorder in which the body’s ability to metabolize glucose in impaired

• Insulin (produced in pancreas) enables glucose to enter the cells- “cellular key”
• Without insulin, glucose remains in blood, causes hyperglycemia (high glucose level)
• Uncontrolled diabetes: (“3 P’s”)
• Polyuria (lots of pee)
• Polydipsia (lots of drinking to satisfy thirst)
• Polyphagia (lots of eating, cells are hungry)
• Type I Diabetes:
• Most patients do not produce insulin at all
• Generally appears early in life, not always
• Need daily injections of insulin (“insulin-dependent”)
• Type II Diabetes:
• Patients produce inadequate amounts of insulin
• Generally appears later in life
• Controlled with diet and oral medications
 Diabetic coma

• Extreme hyperglycemia: high blood glucose

• Not enough insulin
• Signs/Symptoms:
• State of unconsciousness
• Warm, dry skin & sunken eyes
• Sweet, fruity breath
• Rapid, weak pulse
• Kussmaul respirations: deep, rapid breathing
• Treatment:
• Airway
• SAMPLE
• Do they take insulin? did they take their insulin? eaten? excessive exercise?
• Transport (they need insulin)
Seizures
• Caused by:
• Fever
• Infection
• Poisoning
• Hypoglycemia
• Treatment:
• Airway
• Patient on their side
• NPO: Nothing Per Oral
• Anticipate vomiting: suction
Allergic Reactions
 Allergic reaction: exaggerated immune response to any
substance
 Reaction by body’s immune system: releasing chemicals
such as histamines to combat the outside substance or
stimulus
 Anaphylaxis: extreme allergic reaction
 Possible Causes:
 Sting/bite
 Medications (such as penicillin)
 Plants
 Food
 Chemicals
Allergic Reaction
 Signs/Symptoms:
 Tightness in chest or throat
 Weezing (whistling sound from airway)
 Urticaria (hives)
 BP down (vessels are dilating), pulse rate up (initially
compensating)
 Swelling of face, neck, tongue, lips, hands/feet
 Anxiety, sense of impending doom
 Itchy, watery eyes
 Treatment:
 Remove toxin (determine method of entry: skin, inhalation, sting)
 Epinephrine (Epi Pen) if necessary
 Constricts blood vessels: raises BP and pulse
 Inhibits allergic reaction, makes breathing easier
 Oxygen
 SAMPLE
 Monitor vitals
 Monitor for shock
Substance Abuse and Poisoning
 Substance abuse: “the knowing misuse of any substance to produce a
desired effect”
 Can include alcohol, drugs, poisons through ingestion, inhalation,
injection, and absorption
 Goal is to remove as much of the poison as possible
 Treatment:
 Scene safety: avoid poisoning yourself
 Airway
 Remove patient from source of poison
 Remove as much of poison as possible from patient
 Oxygen
 Determine: what, when, how much, what has been done
 Contact poison control if appropriate
 Monitor vitals, monitor for shock
 Transport
Bites, Stings, &
Envenomations
 Spider bites (black widow & brown recluse)
 Snake bites (two small puncture wounds)
 Tick bites: possibly Lyme disease
 Dog bites: possible rabies infection
 Human bites: easily infected (lots of bacteria in human
mouth)

 Treatment:
 Calm patient
 Clean wound, apply sterile dressing, no ice
 Splint extremity
 Monitor vitals, Oxygen if needed
 Transport (if possible, with the spider or snake)
Poisoning
•Food poisoning
•,Venomous animal bite,
•Pharmacological overdose,
•Botanical
)

Ballistic trauma (gunshot wound)

Infections
•Bacterial Meningitis
•Ear infection (can occur with Sudden Sensorineural hearing loss (SSHL, or
just SHL), which may become permanent unless treated promptly
•Thyroid storm
•Hepatic encephalopathy
•Malnutrition and starvation (as in extreme anorexia and bulimia)

• Psychiatric
•Psychotic episode
•Homicidal ideation,Attempted suicide, non-fatal

Acute Prostatitis,Puerperal sepsisObstetrics[edit],Ectopic pregnancy,Eclampsia,

Pre-eclampsia,Fetal distress,Obstetrical hemorrhage,Placental abruption
•Urological, andrological, and gynecologic
•Gynecologic hemorrhage,Ovarian torupture,Sexual assault (rape)
•Ureteric, Urinary retention,Testicular torsion,Testicular infarction.rsion,
 Emergency medicine
Emergency Medicine is the field of practice concerned
with the assessment, stabilization, diagnosis, and
disposition of people with acute illness and injury.
Emergency practitioners treat the full spectrum of
patients using skills ranging from those of a general
practitioner to specialists.
Physicians specializing in Emergency are
palliative medicine, critical-care medicine, medical toxicology,
wilderness medicine, pediatric Emergency Medicine, sports medicine,
disaster medicine, ultrasound, pain medicine, emergency medical
services, and undersea and hyperbaric medicineAdenosine Injection.
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
ng them family physicians, general surgeons, internists, and a variety of other specialists. In many smaller emergency departments, nurses would triage patients and

HISTORY
Developed more than 40 years ago
Emergency medicine as an independent medical specialty is relatively young. 1960s
and 1970s,
Hospital emergency departments (EDs) were generally staffed by physicians on staff at
the hospital on a rotating basis, among them family physicians,( general surgeons,
internists, and a variety of other specialists).
Smaller emergency departments, nurses would triage patients and physicians would be
called in based on the type of injury or illness.
Family physicians were often on call for the emergency department, and recognized the
need for dedicated emergency department coverage.
Many of the pioneers of emergency medicine were family physicians and other
specialists who saw a need for additional training in emergency care.[, it is still one of the
newest medical specialties
During the French Revolution, after seeing the speed with which the carriages of the
French flying artillery maneuvered across the battlefields, French military surgeon
Dominique Jean Larrey 
, Groups of physicians began to emerge who had left
their respective practices in order to devote their work
completely to the ED. In the UK in 1952, Maurice Ellis
was appointed as the first "casualty consultant" at 
Leeds General Infirmary. In 1967, the Casualty
Surgeons Association was established with Maurice Ellis
as its first President.[9] In the US, the first of such groups
was headed by Dr. James DeWitt Mills in 1961 who,
along with four associate physicians; Dr. Chalmers Road
Traffic Accidents are major cause of long term morbidity
and mortality in developing nations 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. 8]
International Emergency Medicine is now its own subspecialty, and focuses not only on the global
practice of emergency medicine but also on efforts to promote the growth of emergency care
throughout the world. This article highlights the development of emergency medicine in the United
States, and includes some aspects of Emergency medicine in other countries. 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. [3]
The field of emergency medicine encompasses care involving the acute care of internal medical
and surgical conditions. In many modern emergency departments, 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 supportand advanced
airway management. They must have the skills of many specialists—the ability to resuscitate a
patient (critical care medicine), manage a difficult airway (anesthesia), suture a complex laceration
(plastic surgery), reduce (set) a fractured bone or dislocated joint (orthopedic surgery), treat a heart
attack (cardiology), manage strokes (neurology), work-up a pregnant patient with vaginal bleeding
(obstetrics and gynecology), stop a severe nosebleed (ENT), place a chest tube (cardiothoracic
surgery), and to conduct and interpret x-rays andultrasounds (radiology). Emergency physicians
also provide episodic primary care to patients during off hours and for those who do not have
primary care providers.
Emergency medicine is distinct from urgent care, which refers to immediate healthcare for less
emergent medical issues. However, many emergency physicians work in urgent care settings,
since there is obvious overlap. Emergency medicine also includes many aspects of acute primary
care, and shares with family medicine the uniqueness of seeing all patients regardless of age,
[4]