1. Dr. Hossam Hassan Consultant and assistant Prof.
Emergency Medicine
Dr. Hossam Hassan
Consultant and assistant Prof.

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

3. 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

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

5. Triage

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

7. Triage
Physician Triage
Nurse Triage
Clark Triage

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

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

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

11. 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
There is no better job than emergency medicine. We work as the detective to determine the cause of the patients complaints. Patients are not admitted to us with pyelonephritis. They present with an undifferentiated complaint such as back pain and fever. We have to investigate the complaint through history and physical exam, as well as labs and radiographs. We have to work through a very large differential.
We see anybody and everybody. We have the chance to make the difference in somebody’s health almost every day. We must be prepared to take care of any emergency that arrives at the ED.

13. Appeal of Emergency Medicine
Team approach
Patient advocacy
Open job market
Academic opportunities
Shift work / set hours
Evolving specialty
Within EM, we work through a team approach with other specialties to arrive at an appropriate diagnosis and treatment plan for the patient. We must stand firm on what is best for the patient even if our consultants would rather not admit them.
We work set hours which allows us to better plan our lives. It allows us more time for our families or interests. We know where our work day ends and our private lives begin.
The opportunities within academics are huge. You can work in any setting from a community hospital to a level 1 intercity trauma center.
Emergency medicine will continue to grow in the future. There are many avenues that we can improve upon and develop.

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
At times, dealing with consultants can be difficult. This is due to the personality of that particular consultant, not the specific specialty.
Some patients are under the influence of drugs that cause them to be violent or inappropriate. This should be looked upon as a challenge, not a problem
Many patients arrive at the ED without any emergency. Instead they arrive because of convenience for either them or their physician. Although frustrating, it still allows you to practice medicine.
There will be times when other specialists look back at your care and determine that it was inappropriate now that they have much more information. Always do the right thing based on what information you have available.

15. The Lifestyle:Two Sides of A Coin
Well defined shifts
Usually not on call
Part time employment possible
Evenings and nights
Weekends
Holidays
Many physicians migrate to EM due to the hours and well defined shifts. However, this must be balanced against the evenings and nights that are part of the career.

16. Subspecialties in Emergency Medicine
Pediatric Emergency Medicine
Toxicology
Emergency Medical Services
Sports Medicine
Critical Care Medicine
One can move onto various areas of sub-specialty from the specialty of Emergency Medicine. These are the four areas in which we can become board certified through fellowship training.

17. Upcoming Areas of Emergency Medicine
Observation units
ED CT
The future of EM is limitless. We are branching out into various areas of medicine to include these.

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
Research within EM is not yet well established. However, it is limitless. You can pick almost any area of medicine and research it from the emergency department standpoint.
As the specialty grows, there are more and more competent and qualified researchers promoting EM. The number of research projects and clinical trials will continue to grow.

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
In order to become more familiar with the field of EM, first and second year students can do many things. Take time to do “shadow shifts” in the ED to see what actually happens. It is not the same as the “ER” television show.
Join the EM interest group if you like the field of emergency medicine. It will help you locate others with similar interests and will allow you more time with the EM faculty.
At this time in your medical school career, always keep your options open. Look at all areas of medicine before you lock yourself into one area. Take this time to openly investigate any area that interests you.

20. Trauma

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

22. Secondary Survey ( Systemic)

23. What’s Your Diagnosis ?

24. OR

25. Chest pain ( Cardiac )

26. 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 : 40 80 23
O2 saturation: 99%

33. Acute Respiratory Failure
Hypoxemic
Hypercapnic

34. Asthma

35. COPD

36. Pneumonia

37. Abdominal Pain ( Medical )

38. Abdominal Pain ( Surgical )

39. Fractures

40. Fractures

41. Fractures

42. Laceration

43. Seizure

44. Acute Psychiatric Ilnesses

45. DM

46. DKA

47. Skin Rash