Emergency Medicine - Clinical Essentials

Introduction:

Any medical condition or injury that requires immediate medical attention, evaluation, and prompt treatment is an emergency. Emergency medicine involves rapid assessment, triage, and immediate treatment of the severely ill or injured by trained frontline healthcare providers. Essential emergency management starts from out-of-hospital care to the emergency department and critical care. Various types of diagnostic technologies and treatment techniques are applied in emergency medicine to ensure patient survival. The emergency services system is also involved in research on acute interventions and resuscitation methods, disaster management, prevention, and public education. The subspecialties in emergency medicine include the following:

1. Pediatric (kids) emergency medicine.

2. The practice of emergency medicine in isolated and rural areas.

3. Prehospital care and emergency services such as ambulances.

4. Initial management and coordination of trauma care.

5. Continued emergency medicine care of critical patients.

6. Research and advancement of emergency medical care.

What Are the Most Common Emergencies?

Health emergencies like acute injuries or illnesses happen every day, everywhere. They affect people of all ages - adults and children alike. Several injuries and illnesses require calling for emergency services or going to the emergency department. The common emergencies include:

1. Heart emergencies such as chest discomfort and pain, heart attacks, cardiac arrest, and heart failure.

2. Lung emergencies that present with difficulty breathing, such as respiratory failure.

3. Severe injuries such as head and brain injuries, burn injuries, multiple trauma, or road traffic accidents.

4. Acute blood loss due to severe bleeding or trauma.

5. Altered mental status.

6. Shock.

7. Health emergencies that result in unconsciousness and severe pain.

8. Poisoning, bites, and stings.

9. Pregnancy complications.

10. Acute complications of chronic diseases such as kidney diseases (that require immediate dialysis).

11. Severe allergies and asthma attacks.

12. Severe dehydration.

What Are the Key Elements of Emergency Medicine?

Emergency medical services and departments provide a coordinated response and patient care for every type of health emergency. The following constitute the key components of emergency medicine:

• First aid, basic and advanced resuscitation procedures.

• Emergency department observation and monitoring.

• Disease or injury identification and diagnosis.

• Prevention of disease or injury progress.

• Triage and focus on the acutely ill or injured.

• Emergency procedures and interventions such as oxygen supply, intubation, intravenous access, or arterial line placement.

• Diagnostic tests and procedures for definitive treatment.

• Treatment coordination with other physicians and health services.

• Transfer to appropriate critical care units for definitive care after emergency management.

What Are the Common Emergency Procedures and Interventions?

1. Incision and Drainage: Any abscess or pus under the skin is incised and drained to provide relief.

2. Arterial Puncture and Arterial Lines: A hollow catheter (tube) or arterial line is placed in an artery (mostly on the wrist). This helps to continuously monitor the patient’s blood pressure and to perform repeated blood draws to monitor levels of oxygen and carbon dioxide in the blood (arterial blood tests).

3. Central Venous Access: A catheter (tube) is placed in the larger important veins of the body (central venous access) for critically ill and injured patients for resuscitation procedures. It is also performed for patients with difficult peripheral intravenous access.

4. Procedural Sedation: Analgesics (numbing agents) or sedatives are administered to decrease the levels of awareness. This ensures patient cooperation for medical procedures that cause discomfort.

5. Lumbar Puncture: A thin needle is inserted into the lower spine to collect cerebrospinal fluid. This is done to diagnose central nervous system infections and bleeding.

6. Wound Closure: Laceration repair or wound closure is done using sutures, staples, or tissue adhesives.

7. Needle and Tube Thoracostomy (Chest Tube Placement): This is an emergency procedure in which a thin tube or needle is inserted into the space between the chest wall and lungs in case of lung-related emergencies. This is used to remove excess fluid or air in the area and to deliver medications.

8. Emergency Ultrasounds: Ultrasound imaging is done at the bedside to diagnose illness and injuries, perform invasive ultrasound-guided procedures, and check the patient’s response to treatment.

9. Airway Management and Intubation: In the case of patients who have stopped breathing or have difficulty breathing, immediate measures are taken to keep the airway open, and breathing assistance is given. Interventions include intubation of the airway (orotracheal or endotracheal tubes) and oxygen supply through masks or tubes. Emergency procedures also include invasive procedures such as making surgical holes in the windpipe to facilitate breathing (tracheostomy).

10. Splinting of Fractures: The fractured bones are splinted to reduce mobility at the fracture site.

11. Blood Loss Management: Low blood pressure, rapid heart rate, and pulse are major blood loss indicators. Active bleeding is one of the major causes of death, and immediate measures are initiated to stop bleeding. Simple measures to control bleeding and fluid resuscitation save lives.

12. Basic and Advanced Life Support: These procedures are used in case of heart emergencies such as cardiac arrest to help the heart to beat normally. Defibrillation and cardiopulmonary resuscitation procedures play a vital role in medical emergencies.

What Are the Common Emergency Types of Equipment Used?

There is a list of emergency equipment provided by the World Health Organization (WHO) to help save lives. These include the following:

1. Resuscitator bag valve and mask (for adults and kids).

2. Oxygen cylinders or concentrators with masks and tubing.

3. Stethoscopes.

4. Suction pump with catheters.

5. Equipment to measure blood pressure.

6. Thermometer to measure body temperature.

7. Scalpels with blades, retractors, and scissors.

8. Oropharyngeal airway equipment.

9. Forceps.

10. Needle holders, needles, and sutures.

11. Sterile gloves and masks, and other personal protective equipment.

12. Sterilizer.

13. Vaginal speculum.

14. Nasogastric tubes.

15. Endotracheal tubes.

16. Intravenous fluid infusion set.

17. Syringes with needles (disposable).

18. Urinary catheters.

19. Tourniquet.

20. Splints for arm and leg.

21. Intravenous infusor bags.

22. Chest tube insertion equipment.

23. Equipment for defibrillation and cardiopulmonary resuscitation.

What Are the Common Life-Saving Medicines?

There is a list of emergency medicines provided by the World Health Organization to help save lives. The most common life-saving ones in case of emergency are:

1. Oxygen: Used in almost all emergencies.

2. Epinephrine: Used commonly in case of severe allergic reactions and asthma attacks. They help to relax the airways to enable breathing.

3. Nitroglycerin: Used in case of chest pain caused by decreased blood flow to the heart.

4. Diphenhydramine: Used in allergic reactions.

5. Albuterol or Salbutamol: Used in asthma attacks.

6. Aspirin: Used in heart problems and heart attacks.

7. Glucose: Used in health emergencies where the patient is unconscious due to low blood sugar.

8. Atropine: Used in health emergencies with slow heart rate and in case of some poisonings.

9. Amiodarone: Used in heart-related emergencies in which the heart beats fast and irregularly.

10. Dopamine: Used in emergencies with low blood pressure, such as heart attack, infection, or trauma.

11. Magnesium Sulfate: Used in heart-related emergencies in which the heart beats irregularly.

What Are the Common Tests Done in the Emergency Department?

Various screening and diagnostic tests are performed in the emergency department to assess the patient’s condition and for definitive treatment. The common tests done include:

1. Complete Blood Count: This test provides information on the white and red blood cells in the body. It helps to identify health issues such as anemia and the presence of infection in the body.

2. Blood Chemistry Profile: This is a comprehensive blood test that assesses various elements, including blood sugar levels, levels of electrolytes such as sodium and potassium, and various enzyme levels that affect the major organs. Medical emergencies such as heart attacks, life-threatening spikes in blood sugar (diabetic ketoacidosis), severe dehydration, and kidney problems can be diagnosed and assessed with these blood tests.

3. Arterial Blood Gas: These are blood tests to assess the level of oxygen and carbon dioxide in the blood. These are essential for diagnosing life-threatening heart and lung problems and drug reactions.

4. Urine Tests: Testing of the urine samples helps to identify various infections and kidney problems.

5. Electrocardiograms (ECG): This test measures the electrical activity of the heart and helps to diagnose heart-related emergencies.

6. Imaging: Various imaging studies such as X-rays, ultrasounds, computed tomography (CT) scans, and others are performed to identify and assess the extent of injuries, fractures, and illness. These help in definitive diagnosis and treatment. The imaging is done based on the patient’s needs.

7. Other Specific Tests: Specific tests are done depending on the patient’s illness or injury.

Conclusion:

Health emergencies can occur to anyone, anywhere, and at any time. Emergency assessment and prompt treatment of medical emergencies ensure survival. The out-of-hospital emergency services and the emergency departments act as frontline warriors for health emergencies. They provide a coordinated response and patient care for every type of health emergency. They use several emergency equipment, drugs, and interventions to manage the critically ill and injured. Simple emergency procedures can save lives when performed on time.