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Lecturer name: Dr. Hossam Hassan Lecture Date:

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

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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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