Emergency Medicine Dr. Hossam Hassan Consultant and assistant Prof.

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

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 Nephrosis 25,331 Chronic Liver Disease and Cirrhosis: 25,175

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

Triage 300 – 500 cases Life-ThreateningUrgentCases Non- urgent Cases Triage-Out

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

Triage Physician Triage Nurse Triage Clark Triage

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

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

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

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

12 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

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

14 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

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

16 Subspecialties in Emergency Medicine Pediatric Emergency Medicine Toxicology Emergency Medical Services Sports Medicine Critical Care Medicine

17 Upcoming Areas of Emergency Medicine Observation units ED CT

18 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

19 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

Trauma

Primary Survey ( A-B-C-D)

Secondary Survey ( Systemic)

23 What’s Your Diagnosis ?

OR

Chest pain ( Cardiac )

Chest Pain

Arrhythmias

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

Low Blood Pressure Preload Contractility Afterload

Dyspnea ( S.O.B) ABG : O 2 saturation: 99%

Acute Respiratory Failure Hypoxemic Hypercapnic

Asthma

COPD

Pneumonia

Abdominal Pain ( Medical )

Abdominal Pain ( Surgical )

Fractures

Laceration

Seizure

Acute Psychiatric Ilnesses

DM

DKA

Skin Rash

THANKS