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Lecturer name: Dr. Hossam Hassan Lecture Date:

Learn the essential strategies for handling acute medical conditions in the ER, including trauma, chest pain, and more. Discover the top causes of death, triage procedures, and the appeal and challenges of emergency medicine. Explore the lifestyle, subspecialties, upcoming areas, and research opportunities in this evolving field. Acquire practical skills for diagnosing and treating patients in emergency situations and get insights into the path to pursuing a career in Emergency Medicine.

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Lecturer name: Dr. Hossam Hassan Lecture Date:

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  1. Lecture Title: General objectives of the emergency room management Lecturer name:Dr. Hossam Hassan Lecture Date:

  2. Lecture Objectives..Students at the end of the lecture will be able to: • Recognize and be aware of the basic management of common BLS and ACLS protocols. • Gain experience in the evaluation and management of patients presenting to the ER for acute care. • Developing proficiency with emergency procedures • Expanding the knowledge in acute care medicine to include , Acute Chest pain, Trauma ,and shock management..

  3. Objectives • Acute medical illnesses • Acute surgical illnesses • Acute Obstetrical emergencies • Trauma • Acute mental illnesses • Acute ENT & Ophthalmological emergencies • Environmental hazards

  4. Top Ten Leading Causes of Death • Heart Disease: 726,974 • Cancer: 539,577 • Stroke: 159,791 • Chronic Obstructive Pulmonary Disease: 109,029 • Accidents: 95,644 • Pneumonia/Influenza: 86,449 • Diabetes: 62,636 • Suicide: 30,535 • Nephritis, Nephrotic Syndrome, and Nephrosis25,331 • Chronic Liver Disease and Cirrhosis: 25,175

  5. Reception • 300 – 500 visits per day • Only 20-50 cases require urgent intervention • Few cases are life-threatening (1-5)

  6. Triage

  7. Triage ( Categorization) • Category 1 – 5 • 1 : Life-Threatening • 5 : Triage out

  8. Triage • Physician Triage • Nurse Triage • Clark Triage

  9. Life-Threatening Cases ( C.1) Need immediate intervention • Arrest • Arrhythmias • Hypoxia • Shock • Acute trauma • Siezure • Status Asthmaticus • Anaphylaxis • Chest pain ( STEMI ) • Delivery – stage 2

  10. C.2 ( Urgent Cases) Should be treated within 10 min. • Acute asthmatic attack • High Blood Pressure • Intoxication • Drowsy patient • Acute colics • Fractures • Burns

  11. C.3 ( Acute Cases ) Should be treated within 30 minutes • Chest Pain ( Non cardiac ) • Abdominal pain • Dyspnea • Fever • Old trauma • Gastroeneteritis • Metabolic Derangement • Post ictal state

  12. C4 : Chronic Abdo pain Minor trauma claimed : Fever-Low BP- Fast HR C5 : URTI Long-standing complaints Meds-Refill Cont’d Triage

  13. Appeal of Emergency Medicine • Make an immediate difference • Life threatening injuries and illnesses • Undifferentiated patient population • Challenge of “anything” coming in • Emergency / invasive procedures • Safety net of healthcare

  14. Appeal of Emergency Medicine • Team approach • Patient advocacy • Open job market • Academic opportunities • Shift work / set hours • Evolving specialty

  15. Downside to Emergency Medicine • Interaction with difficult, intoxicated, or violent patients • Finding follow-up or care for uninsured • Working as a patient advocate • Contract management groups • Malpractice targets

  16. The Lifestyle:Two Sides of A Coin • Well defined shifts • Usually not on call • Part time employment possible • Evenings and nights • Weekends • Holidays

  17. Subspecialties in Emergency Medicine • Pediatric Emergency Medicine • Toxicology • Emergency Medical Services • Sports Medicine • Critical Care Medicine

  18. Upcoming Areas of Emergency Medicine • Observation units • ED CT

  19. Research Opportunities • Broad range of subjects • Limited amount of work published in our relatively new field • Limited number of research mentors • Limited number of clinical trials

  20. What to do to get in to Emergency Medicine ? • Observe in ED • Summer research projects with EM staff • EM interest group affiliation • Be open to any medical specialty

  21. Trauma

  22. Primary Survey ( A-B-C-D)

  23. Secondary Survey ( Systemic)

  24. What’s Your Diagnosis ?

  25. OR

  26. Chest pain ( Cardiac )

  27. Chest Pain

  28. Arrhythmias

  29. Low Blood Pressure • PB = COP * SVR ( 120 / 80 ) mmHg • COP = SV * HR ( 4- 6 ) 4-6 L/m • SV = EDV - ESV ( 50 – 100 ) ml

  30. Low Blood Pressure • Preload • Contractility • Afterload

  31. Dyspnea ( S.O.B) ABG : 7.35 40 80 23 O2 saturation: 99%

  32. Acute Respiratory Failure • Hypoxemic • Hypercapnic

  33. Asthma

  34. COPD

  35. Pneumonia

  36. Abdominal Pain ( Medical )

  37. Abdominal Pain ( Surgical )

  38. Fractures

  39. Fractures

  40. Fractures

  41. Laceration

  42. Seizure

  43. Acute Psychiatric Ilnesses

  44. DM

  45. DKA

  46. Skin Rash

  47. Where do you taiage this Pt.? • What information do you need to determine if this Pt. is in shock? • What initial interventions are needed to stabilize that Pt.?

  48. Shock is a syndrome of impaired tissue oxygenation and perfusion due to a variety of etiologies • If left untreated • Irreversible injury ,Organ dysfunction And finally death

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