Common Problems in the Emergency Department Intern Survival Kit 2013 The Northern Hospital Dr. Phyllis Fu Emergency Physician

The Internship Year “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair…”

“…we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way” - A Tale of Two Cities

Emergency Medicine ‘What is wrong with me, Doctor?’ Discipline which covers ALL facets of Medicine General and Specialty Medicine General and Specialty Surgery Psychiatry O and G Paediatrics Challenging Confronting Consuming

Can you please sign this ECG please??

Common problems in the ED Adults Chest Pain Shortness of Breath Abdominal Pain Headache Dizziness/ Syncope/ Weak, etc! Fever Injuries Acutely unwell psychiatric patient

Children Asthma Fever/ viral illnesses Fractures O and G PV bleed

This is what you are taught in Medical School History Examination Differential Diagnoses Management

“But…You have 20 minutes!” Succinct, targeted history and examination Emergency patient access targets Timely management and disposition of patient

Emergency Medicine… not so hard TIME MANAGEMENT FAIL SAFE MECHANISMS 3 PERTINENT QUESTIONS 1.What is the most likely diagnosis in this patient? 2.What diagnoses, if I miss it, can cause an adverse outcome? 3.Where is the patient going to go?

Common problems in the ED Adults Chest Pain Shortness of Breath Abdominal Pain Headache Dizziness/ Syncope/ Weak, etc! Fever Injuries Acutely unwell psychiatric patient

Children Asthma Fever/ viral illnesses Fractures O and G PV bleed

Tricks in ED Old history recent presentation/ admission, imaging, ECGs, investigations TNH ED Clinical Guidelines Family TEAMWORK in ED Allied health, care coordinators, social workers, etc

REPEAT, REPEAT, REPEAT VITAL SIGNS Chest and abdominal examinations Before and after treatment Before discharge from ED ECG

Why does the patient need to be admitted? Clinical issues Clear diagnosis Persisting symptoms despite treatment Abnormal vital signs +/- investigations Mobility Recurrent presentations Non Clinical issues Social

Documentation History Presentation Past Social Examination Impression Investigations Management Plan progressive medical entries

Documentation Clarity Concise Comprehensive One day it may become a public document Date / Time / Designation - every entry

Emergency Medicine… not so hard TIME MANAGEMENT FAIL SAFE MECHANISMS 3 PERTINENT QUESTIONS 1.What is the most likely diagnosis in this patient? 2.What diagnoses, if I miss it, can cause an adverse outcome? 3.Where is the patient going to go?

Finally… "It is a far, far better thing that I do, than I have ever done; it is a far, far better rest that I go to than I have ever known"

Thank you