CPR LECTURE SERIES-130911

RESUSCITATION LECTURES:
ACUTE CARE:
EMERGENCY MEDICINE,
ANAESTHESIA,
CRITICAL CARE

DR.ABDUL ALI BIN RAJA MOHAMED, ASA

 ASSOC PROF IN EMERGENCY MEDICINE, FACULTY OF MEDICINE, MAHSA UNIVERSITY.
 PRESIDENT, MEDICALERT FOUNDATION MALAYSIA.
 CHIEF MEDICAL OFFICER, MRCS SELANGOR. MALAYSIA
 MQA, MSQH PANEL MEMBER FOR EMERGENCY MEDICINE
 (1989-2008 : HEAD OF TRAUMA & EMERGENCY CENTRE, UMMC, UNIVERSITY MALAYA)
 (DIRECTOR, ACADEMY OF PARAMEDICAL SCIENCES, CUCMS)
 (PRINCIPAL/CEO, CYBER PUTRA COLLEGE, CYBERJAYA)
 INTL. MEMBER-AMERICAN COLLEGE OF EMERGENCY PHYSICIANS (ACEP)
 INTL. MEMBER- NATIONAL ASSOCIATION OF EMS PHYSICIANS (NAEMSP)
 PREMIUM PROF. MEMBER, COUNCIL ON CARDIOPULMONARY & CRITICAL CARE, AMERICAN HEART ASSOCIATION
 CONTINUUM OF CARE
• IS A CONCEPT INVOLVING AN INTEGRATED
SYSTEM OF CARE THAT GUIDES AND
TRACKS PATIENT OVER TIME THROUGH A
COMPREHENSIVE ARRAY OF HEALTH
SERVICES SPANNING ALL LEVELS OF
INTENSITY OF CARE
• -- (CARE PROVIDED FROM BIRTH TO END OF LIFE)

Evashwick C.
HEALTH MATRIX 1989 SPRING 7(1) 30-9

COPYRIGHT - MEDICALERT
COPYRIGHT - MEDICALERT
COPYRIGHT - MEDICALERT
 TIME

PARENT OR
DAY/NIGHT
GAURDIAN
DOCTOR
&
PATIENT
DRUG THE PLACE

PRAYERS
• TAKE A GOOD HISTORY
• DO A THOROUGH EXAMINATION
• INVESTIGATION
• MAKE DIAGNOSIS
• MANAGEMENT
11-8-2002
COPYRIGHT - MEDICALERT
 CHARACTERISTICS AND CONDITIONS
1 Prenatal Care
2 Genetic birth defects causing pre/post natal morbidity/mortality
3 Genetic anomalies that increase risk of physical or behavioral illness
4 Newborn Care
5 Healthy patient/ Preventive Care
6 Healthy Lifestyle Counselling
7 Healthy Lifestyle/ High Risk factor Care
8 Acute Illness
9 Acute Injury
10 Chronic Illness or Morbid Conditions
11 Recovery from Physical Illness
12 Recovery from Mental Illness or Addiction
13 Rehabilitation of Physical Injury
14 Imminent Death
15 Deceased – Care for the Emotional, Financial and Societal needs of the Family.
Social and Public Health and Research- MEDICALERT
COPYRIGHT
• NO HISTORY
• LIMITED EXAMINATION
• NO INVESTIGATION
• DIAGNOSIS ??????
• MANAGEMENT ?????
FOCUS IS on MAKING A DIAGNOSIS,
DO SOMETHING ABOUT IT….
…MORE… … MORE ….

MORBIDITY &..
MORTALITY….
COPYRIGHT - MEDICALERT
 TIME

PARENT OR
DAY/NIGHT
GAURDIAN
DOCTOR
&
PATIENT
DRUG THE PLACE

PRAYERS
• 84% HAD SHOWN DOCUMENTED EVIDENCE
OF DETERIORATION 8 HOURS BEFORE ARREST.
• 70% HAD SHOWN PHYSIOLOGICAL CHANGES
BEFORE ARREST.
• 70% ADMITTED LATE TO ICU

• THE SYSTEM HAD FAILED!!!!!

Sorry lah.. Sooooo… Not my Fault…

Okkk…. Never Mind laaa… Eeeiii…yessaa

Aahaa… Whatt..Oh.. Noo… So stupid I….

 DEVELOPMENT OF EMERGENCY MEDICAL SERVICES
AROUND THE WORLD
DUE TO / DEPENDED ON:

1. PUBLIC DEMAND FOR BETTER QUALITY CARE

2. EVOLUTION OF SPECIALISTS

3. INCREASED SCIENTIFIC AND TECHNICAL KNOWLEDGE

ROSEN & BARKIN-Emergency Medicine, Concepts and Clinical Practice , 2012

 THE NOBLE QURA’AN -
BENEFIT Surah 41-Fussilat, Ayat-46
TO
OWNSELF
A COMMON MISTAKE IS ASSUMING THAT A PATIENT WHO IS
SITTING UP IN BED AND TALKING CANNOT BE CRITICALLY ILL !!!
 CopyrightThe McGraw-Hill Companies, Inc. Permission required for reproduction or display.

• Levels of Organization:
ACUTE CARE?
EMERGENCY MEDICINE,
ANAESTHESIA,
CRITICAL CARE.
Definition of Emergency Medicine
E.M. encompasses the immediate decision making
and action necessary to prevent death or any further
disability for patients in health crisis. E.M. is practiced
as a patient-demanded and continuously accessible
care. It is the time dependent process of initial
recognition, stabilization, evaluation, treatment and
disposition. The patient population is unrestricted and
presents with a full spectrum of episodic,
undifferentiated, physical and behavioral conditions.
E.M. Is primarily is hospital-based, but with extensive
pre hospital responsibilities.

ACEP 1981.
Accident and Emergency Department
A unique place for student teaching

‘Every medical school graduate should possess

at least a rudimentary competence in the
management of medical and surgical
emergencies. For the most part, this subject is
currently limited to the emergency department.’
1982. Dr.J.B. Henry.
Keynote address:-.
Assoc. Of American Medical Colleges.
 General practitioner
 Hospital
 Ambulance
 House / Office
 Industries
 Street
 Disaster

EMERGENCY MEDICINE

SPECIALITIES
Patient’s come with a….. need
 Alleviation of Illness / Injury

 Motivated by
 loneliness
 Homelessness
 Disability statement
 Work excuse
 Nerve pill
 Antibiotic shot
 Dissuasion to commit suicide
 Does not have cancer
 Still pregnant/Not pregnant
 Permission from an authority figure to make a decision
 Narcotic injection
 Intoxication
 Avoid jail/court
Definition of Emergency Medicine
E.M. Encompasses the immediate decision making
and action necessary to prevent death or any further
disability for patients in health crisis. E.M. Is practiced
as a patient-demanded and continuously accessible
care. It is the time dependant process of initial
recognition, stabilization, evaluation, treatment and
disposition. The patient population is unrestricted and
presents with a full spectrum of episodic,
undifferentiated, physical and behavioral conditions.
E.M. Is primarily is hospital-based, but with extensive
pre hospital responsibilities.

ACEP 1981.
 ACUTE CARE:

• RECOGNIZE CRITICAL ILLNESS

• EARLY INTERVENTION IMPROVES OUTCOME
• DO SIMPLE THINGS WELL
• CLEAR COMMUNICATION VITAL
Objective - 1
To introduce the student to the
clinical practice of emergency
medicine by exposing him to a
wide spectrum of emergency
cases and crisis situations
seen in the trauma and
emergency center.
Objective - 2

To enable the students to

recognize that the patient
defines the emergency and
understands the principles of
triage and correct attitude.
 PUSAT PERUBATAN UNIVERSITI MALAYA
PTJ KECEMASAN DAN TRAUMA
KAEDAH PERGERAKAN RAWATAN PESAKIT

OPERATING THEATER,
RESUSCITATION ROOM .E.M. DOCTOR + I.C.U/C.C.U/WARD/LABOUR
SPECIALIST CARE + NURSING CARE T1 WARD/SCN

BROUGHT IN DEAD. (BID) T5 MORTUARY

PHASE I PHASE II PHASE III PHASE IV

R SPECIALITIES
EMERGENCY
E MEDICINE
MEDICINE DOCTOR
SURGERY
G ACUTE MEDICAL CARE INITIAL
I VITAL SIGNS & NURSING
T2 RECOGNITION
PAEDIATRICS
ORTHOPAEDICS
STABILISATION
TRIAGE S EVALUATION
ENT
T O&G
TREATMENT
ROOM 8 OPHTHALMOLOGY
R
A VITAL SIGNS & NURSING
T3 DISPOSITION
INVESTIGATIONS
PSYCHIATRY
DENTAL SURGERY
BLOOD
T URINE
RADIOLOGY
OB
I FORENSIC PATH
ECG WA
ROOM 8
O
VITAL SIGNS & NURSING
T4 XRAY
N CT SCAN
OTHERS FRACTURE RM
MINOR OT
ASTHMA ROOM 6,7
CASES E.M. DOCTOR + NURSING CARE
T2
Objective -3

To enable the students to

acquire the necessary skills
and proficiency in initializing
and maintaining resuscitation
techniques and safe disposal
of problems.
Objective- 4

To develop the ability to quickly

determine the relevant history and
physical examination with
selective use of ancillary services
to achieve the most efficient and
effective emergency assessment
and management
RESUS 3
CTSCAN 1
Objective -5

To enable the students to

understand the organizational
structure, resources available and
be able to act as an effective team
member. They should understand
their own limitations in such a
setting and be able to make
appropriate referrals
Principles of implementation
 Posting- ‘Round Up”
To work and function in the Trauma
Emergency Department as a team.
 Teaching- Initial assessment and management
- Specific emergency topics not taught
else where in curriculum
-Not on detail management
 Practice- ‘ What should the M.O do in health crisis
before referral’
 Emphasis-‘Knowledge,Skills and Management’
 Concept- ‘Safely function in health crisis for at least
first half hour ’
 Interest- ‘Emergency medicine as a future career’
Components And Process Used In Clinical Decision
Making

PATIENT INFORMATION

MEDICAL KNOWLEDGE

PHYSICIAN EXPERIENCE

ADMINISTRATIVE SKILLS INTERPERSONAL SKILLS

CLINICAL REASONING

DIAGNOSIS/PLAN
 Problem based learning.

What to do?
What? Social crisis

Why? Basic sciences

How? Clinical management

Challenging Questions
1. Is there a life threatening process?
2. What is the most serious disorder?
3. What must be done to stabilize the patient?
4. Is there more than one active pathology?
5. Has the patient progressed with stabilizing process?
6. Is a diagnosis possible?
7. Is hospitalization appropriate?
8. Has the patients expectations been met?
9. Is the discharged disposition adequate?
10. Are the available resources fully utilised?
Hamilton’s Text Book
NO
VITAL SIGNS VALUE RANGE REMARKS
1 PULSE RATE
Infants <160 bpm
Preschool <140 bpm
School <120 bpm
Adult <100 bpm 60 – 80 bpm Volume?
2 RESPIRATION Rate, TV
Infant 25 – 50 bpm
School 15 – 30 bpm
Adult 12 – 20 bpm 12 - 30 bpm <10 , >30
3 TEMPERATURE 37C >38.5C
4 GLASGOW COMA SCALE 3 - 15
5 OXYGEN SAT % > 97% <95% , <90%
6 BLOOD PRESSURE
Infant 70 mm Hg
School 80 (2 age in years)
Adult 120/80 mmHg MAP?
7 PAIN SCALE 0 - 10
Some students comments
 ‘most enjoyable posting’
 ‘loved every minute’
 ‘wish to stay longer’
 ‘resus room was great. Learnt a lot’
 ‘able to do a lot of things,……..more confident ‘
 ‘I stitched!’
 ‘so many acute….. So many things to observe’
 ‘learnt more here than back home’
 ‘loved the teaching’
 ‘good place’
 ‘stressful place…. but OK lah’
 ‘I don’t like resus’
PUBLIC EMERGENCY MEDICAL SERVICE (EMS)
TRAINING PROGRAMMES SINCE 1995
MASTER OF EMERGENCY MEDICINE 2005
GOOD CARE IS as SIMPLE as abc !!!!!!!
Emergency medicine
Functions And Supraspecialties

 Emergency trauma care

 Critical care medicine
 Paediatric emergency medicine
 Toxicological medicine
 Observation medicine
 Disaster medicine
 Telephone medicine
 Telemedicine
 Emergency ultrasound
 Hyperbaric medicine
 Emergency medical service
 Rural emergency medicine
 Injury prevention and Preventive medicine
 International emergency medicine
 …AND IF ANYONE SAVED A LIFE, IT WOULD BE
AS IF HE SAVED THE LIFE OF ALL MANKIND…
THE NOBLE QURAN - S: 5-32

THANK YOU. PLEASE CREATE A PASSION FOR SAVING PRECIOUS LIVES