Professional Documents
Culture Documents
Lesson 1
Objectives
● Define EM & selected terms used in Emergency
Medicine.
● State the principles of the organization and
management of an Emergency Department.
● List logistic of requirements for emergencies
Definitions
Emergency
is any situation that requires immediate action.
WHO
Medical Disaster
is an occurrence “when the destructive effects of
natural or manmade forces overwhelm the ability
of a given area or community to meet the demand
for health care”.
ACEP
Definitions
● Emergency Medicine (EM) - A branch of
medicine that deals with the appropriate
management of all forms of acute illness
or injury.
● Specialization in EM will lessen unwanted
morbidity or mortality due to a sudden
illness or injury.
● In the British System this is known as
Accident and Emergency (A&E).
Definitions
● Emergency Department (ED) or Emergency
Room (ER) - A unit of the hospital composed of
staff and organized to address management of
acute illness or injury.
● The older terminology "Emergency Room"
is abandoned because the word room is
misleading when compared to the complex
processes and organization of such a hospital
department.
EMS System
Emergency Medical Services
System (EMSS) – The total
system intended to care for a
casualty from the site of incident
to definitive care.
● Triage
● On-site care
● Initial resuscitation and treatment
● Medical transport
● Definitive care or Trauma Center
Early Access
PGH EMS
the ED
●Overcrowding
revised.
● It must be reviewed after each major
emergency.
Prevent unnecessary
mortality and morbidity from
disasters and emergencies
Developing and
implementing plans,
procedures and
training to ensure
that the hospital’s
capacity to respond to
disaster is maximized.
Bombing
Contingency
Planning is the key to the proper
response to a
multiple casualty incident
or disaster.
Operating Theater
● Access to functioning
operating theaters
● Early definitive care
● Minimizes unwanted
morbidity or preventable
mortality.
● Lack of these in the
hospital -- system of
transport and referral is
a must.
Overcrowding
● Overcrowding in the ED - in most Asian & African
countries, state-funded hospitals have
crowded ED’s.
● Survey done of countries in Asia
– lack of resources on a day to day emergency services
already exist even before an actual MCI.
– There was a very rudimentary form of Prehospital
Care
– Much of the modern principles of EMS are
not existent
Airway Devices
oxygen tanks
non-rebreather masks
nasal cannula
oropharyngeal airway devices of different sizes
nasopharyngeal airway devices
Intubation equipment like laryngoscopes
endotracheal tubes
LMA's (laryngeal mask airway)
tracheostomy instruments
tracheostomy tubes and suction machines
Cervical immobilization devices
Endotracheal Intubation
EQUIPMENTS
laryngoscope (F)
endotracheal tube (J/M)
stylet (I)
additional equipment
10 ml syringe (L)
Magill forceps (G)
water-soluble lubricant
L
suction unit
M
Department of Emergency Medicine
UPCM
IV Access Training
Defibrillation
● Automated external defibrillators (AED's)
– Manual defibrillators
● personnel are trained in ACLS and
defibrillation.
● Biphasic defibrillators
● Newer generation cardiac monitors
offer biphasic AED's incorporated into
one machine.
Defibrillator
Monitoring
Critical monitoring devices should include
● pulse oximetry
● non-invasive blood pressure readings,
heart rate and cardiac rhythm
● Point of care testing devices like arterial
blood gas determinations (ABG) and
electrolytes are useful.
● End Tidal carbon dioxide tension (ETCO2) is
also beneficial.
Diagnostics
Emergency Drugs
Scenario
75/M, Known Diabetic & hypertensive
10 mins PTC, found unconscious inside
the bathroom with a 2 cm laceration on
his occiput
Scenario
Young male found unconscious.
Brought in by good samaritans. No
informant.
Emergency
● Medical Situation wherein
– Proposed intervention is deemed necessary
– Delay in treatment may jeopardize life or
result in disfigurement or impaired
faculties
Emergency Medicine
International Federation for Emergency Medicine, 1991
● knowledge and skills required for the prevention,
diagnosis and management of acute and urgent
aspects of illness and injury
● all age groups
● spectrum of episodic undifferentiated physical
and
behavioral disorders
● encompasses pre-hospital and in-hospital
emergency medical systems
Development of EM
Development of EM
Development of EM
● 1991 –Departmentalization of
Emergency Services, Philippine General
Hospital
● 1996 – Setting up of PGH
Emergency Medical Services System
● 1997 – Establishment of Residency Program
at DEMS, PGH
● 2001 – Department of EM established as
Academic unit of UP College of Medicine
Emergency Doctrine
Pillars of EM
● Chain of Survival
● ABCDs . . .
– BLS
– RSI, ACLS
– PALS / NALS
– ATLS
● Pain Management
● EMSS
● High Stress
– Kinds of cases seen
– Kinds of patients seen
– Limited resources
● No Follow-ups
– Do not admit to the hospital
● Prone to Legal & Ethical situations
Characteristics of EM Physicians
● Type A personality
● Adrenaline junky
● Multi-tasker
● Able to make quick decisions
● Willing to work nights, weekends, holidays
Subspecialties
● Pediatric EM
● Toxicology
● Emergency Health
– Emergency Medical Services
– Disaster Medicine and Mass Gatherings
– International EM
– Emergency Public Health information
● ED Administration
● Trauma / Pre-hospital & ED Care
● System Components
– Communications Center
– Personnel
– Patient transport
– Receiving units
● Types of Systems
– Public vs. Private
– Single- vs Multi-Tiered
– Urban vs. Rural
– BLS vs. ALS
Personnel
● First Responder
● EMT-B, EMT-D, EMT-I
● Paramedic
● MD, Medical Direction
Patient Transport
● Star of Life
● Type I – cab & chassis
● Type II – van-type, modified height
● Type III – larger with walk-through passage
● BLS or ALS/ICU
Receiving Units
Directions in EM
Directions in EM
Dissemination
● ED Design
● CQI
Summary
● Defined selected terms used in Trauma
Surgery, Emergency Medicine and
Disaster Medicine.
● Stated the principles of the organization
and management of an Emergency
Department.
● Listed logistic of requirements for emergencies
Conclusion
● The Emergency Department is the frontline
of the hospital response to a disaster.
● The ED plays a critical role in hospital
capacity in MCI
Questions ?