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Emergency Medicine-General Introduction-Introduction
Mind map of university clinical medicine major - "Emergency Medicine" 01.1 General Introduction to Emergency Medicine - Overview, produced according to the teaching PPT and corresponding textbook ("Emergency Medicine 2nd Edition") during classroom learning, including the definition of emergency medicine, emergency medical service system, characteristics of emergency medicine, etc., with detailed content. It can be used for students in related majors to study and take exams, or for friends who are interested in medicine to understand and refer to. Due to different teaching syllabuses, some content in the textbook has not been produced. Friends who need it can leave a message in the comment area, and updates will be added later. Maps of other courses in the major can be viewed on the homepage after following it. Comments and corrections are welcome. Like, collect and follow to get more information and not get lost. update record: 2023.11.7-Publish works, paid clones
Edited at 2023-11-07 20:02:51
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Emergency Medicine-General Introduction-Introduction
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General Introduction to Emergency Medicine - Introduction
emergency medicine definition
concept
It is a medical specialty whose main task is to evaluate, handle, treat and prevent unpredictable diseases and sudden traumas. It is an emerging edge discipline that spans multiple clinical specialties and is the 23rd specialized discipline of modern medicine.
Differences from other disciplines
Understanding the rules and processing closely revolve around the concept of timeliness and the principle of putting life first
It is required to use the least data, the shortest time and the most effective method to save the patient's life
purpose
Cherish life, protect life, continuously improve the quality of human life, provide patients with urgently needed and convenient medical services, and make emergency treatment decisions and medical actions for critically ill patients to avoid disability and death.
connotation
initial first aid
concept
Refers to the medical theory and skills of using various medical methods to provide emergency treatment to patients in need of emergency treatment so that unstable vital signs can be restored to normal within a short period of time.
main content
On-site first aid, patient transportation, in-hospital emergency treatment
in principle
First "save" and then "send"
Disaster first aid
scope
Natural disasters (earthquakes, floods, typhoons, etc.) and man-made disasters (car accidents, shipwrecks, air crashes, wars)
Purpose
Organize rescue operations effectively and quickly to reduce casualties caused by disasters
Critical Care Care (CCM)
concept
The important core content of emergency medicine refers to the use of advanced diagnostic testing and monitoring technologies to continuously and dynamically collect and evaluate the condition information of high-risk and severely injured patients qualitatively and quantitatively, and provide corresponding vital sign support and comprehensive treatment of the cause of the disease.
Critical illness
It refers to the occurrence of single or multiple important organ failure, accompanied by energy metabolism and oxygen metabolism, in dangerous situations such as trauma, shock, severe infection, large area severe burns, major heart, lung, brain, abdominal and other major surgeries, as well as pathological obstetrics and other dangerous situations. and pathological conditions related to changes in bleeding, coagulation, immune, endocrine and other systems
cardiopulmonary cerebral resuscitation
concept
It is an important part of emergency medicine, focusing on the study of treatment methods and strategies for patients with cardiorespiratory arrest, and the study of tissue and organ hypoxia, post-ischemic pathophysiological changes, and post-reperfusion organ damage related to cardiorespiratory arrest.
three phases
Basic Life Support (BLS)
Including airway control (A), artificial oxygenation and breathing (B), cardiopulmonary resuscitation (C)
Further Life Support (ALS)
Purpose
restore spontaneous circulation
include
Resuscitation drugs and fluid use (D), ECG diagnosis and treatment of arrhythmias (E), electrical defibrillation (F)
Extended Life Support (PLS)
Mainly for brain resuscitation
program
Immediately identify CA and activate first aid system
Perform CPR as early as possible and emphasize chest compressions
chest compressions
Frequency: 100-120 times/min
Compression:relaxation=1:1
Pressing depth＞5cm
Compression location: ½ below sternum
open airway
Forehead pressing and jaw lifting method (mandibular advancement method)
artificial respiration
10-12 times/min
rapid defibrillation
Effective advanced life support
Post-resuscitation supportive care
acute poisoning
scope
Pesticide poisoning, drug (chemical drugs, traditional Chinese medicine) poisoning, rat poison poisoning, gas poisoning
Suicide, accidental ingestion, poisoning
main content
Diagnosis, treatment and prevention of acute poisoning
Trauma first aid
In recent years, it has been included, especially polytrauma and compound injuries as well as group injuries in emergencies.
Treatment is particularly time-dependent and involves many specialties. Treatment by any one specialist may lead to unsystematic treatment, making it difficult to grasp life-threatening vitals, resulting in delays in the initial "golden time"
Trauma patients are uniformly handled by emergency medicine specialists, which is conducive to early diagnosis and timely treatment of the injured.
challenge
Population aging brings new medical problems
The increase in population and social pressure have led to an increase in patients with suicidal poisoning and other suicides.
Increase in emergency trauma injuries caused by industrial, traffic and terrorist incidents
Increased incidence of diseases associated with social undesirable phenomena
Some diseases related to the increase in pet ownership
Emergency Medical Services System (EMSS)
Emphasize the immediacy, continuity, hierarchy and systematicity of emergency care
事故现场或发病初：人群自救互救→急救员和救护组急救→转运，医院急救→重症病房/专科病房
Pre-hospital emergency
concept
broad sense
When the sick or injured become ill or injured, initial first aid is provided by witnesses or medical personnel to maintain basic vital signs and relieve pain.
narrow sense
Specifically refers to a professional first aid institution composed of three elements: communication, transportation and medical care, which provides on-site treatment and en-route monitoring of medical activities before patients arrive at the hospital.
Pre-hospital emergency tasks
On-site first aid
On-site life support, rapid stabilization and safe transport
Maintain respiratory function: inhale oxygen, remove oropharyngeal secretions, apply respiratory stimulants, perform artificial respiration, etc.
Maintain circulatory system function: including chest cardiac compression, ECG monitoring, defibrillation, external cardiac pacing, and treatment of fatal arrhythmias, etc.
Maintain central nervous system function: prevent and treat cerebral edema, reduce intracranial pressure, control epilepsy, etc.
Acute poisoning and accident treatment
Hemostasis, bandaging, fixation, and transportation of trauma to the brain, chest, abdomen, spine, limbs, and other parts of the body
Symptomatic treatment such as analgesia, antiemesis, antiasthma, and hemostasis
Emergency medical rescue for public health emergencies or disasters
Responsible for accident prevention and rescue at major gatherings and events
Information hub for contacting emergency centres, hospitals and administration
Participate in the dissemination and training of first aid knowledge to non-professionals
Rescue on the way
The vehicle is required to have a dedicated team of qualified doctors, nurses and drivers
Oxygen, defibrillator, simple respirator, infusion device, suction device, fixed splint, stretcher, etc.
Pre-hospital emergency management
Pre-hospital first aid
Dispatched and implemented by the emergency center within the jurisdiction
Pre-hospital first aid for disaster victims
The top administrative leader in the jurisdiction is responsible for commanding and implementing
The essential
chain of command
communication system
Mobile phone - address book, constant contact, satellite navigation
ambulance system
Professional staff
Transportation System
Well-equipped ambulance = rescue room, time = life
Pre-hospital first aid evaluation indicators
Pre-hospital emergency time
first aid response time
On-site rescue time
golden 1 hour
In critical polytrauma, severe traumatic or/and hemorrhagic shock patients, within the "golden hour" after injury, if the casualty's bleeding is controlled and treated, preventing suffocation can prevent the death of some saveable patients.
First Aid Platinum 10 Minutes (EP10M)
In an emergency, the first ten minutes or so from the occurrence of the emergency are the key to first aid or treatment. Performing first aid during this period can greatly shorten the rescue time and/or improve the success rate of rescue.
transit time
Pre-hospital first aid effect
Prehospital cardiac arrest resuscitation success rate
For ventricular fibrillation due to emergent cardiac events, approximately 85% of cardiac arrests are ventricular fibrillation or pulseless ventricular tachycardia, and if early (automatic) cardiac defibrillation (AED) is prioritized within 6-10 minutes, many patients may not be spared. Systemic damage, if defibrillation is combined with the comprehensive use of advanced life support, the success rate will be improved
Pre-hospital emergency needs
Hospital emergency
emergency department model
Independent
The medical staff in the emergency department are completely fixed, and all doctors are emergency specialists, responsible for the diagnosis and treatment of all emergency patients.
Semi-independent
The emergency department has some fixed medical staff. Emergency specialists are mainly responsible for rescuing critical and critical patients and managing emergency ICUs and wards. Other doctors rotate regularly and are mainly responsible for the diagnosis and treatment of ordinary emergency patients.
rotation type
There is no fixed doctor in the emergency department. All emergency patients are treated by doctors sent by various specialties who rotate in the emergency room, and then handed over to doctors in each specialist ward for diagnosis and treatment.
Emergency triage (category 5, level)
Category 1, Level: General emergency patients (non-emergency)
Give oral/intramuscular/intravenous drugs: go home after simple and symptomatic treatment
Category II, level: semi-urgent patients
IV Fluids: Going Home After Staying in the Emergency Department for Several Hours
Category III, level: emergency patients
After preliminary examination/diagnosis/treatment, admission to emergency observation area/inpatient ward
Category 4, level: critically ill patients
After emergency treatment, he was admitted to the ICU.
Category 5, level: critical patients
Directly enter the rescue and recovery room/debridement room/operating room/cath lab through the "green channel"
Emergency department division
Diagnosis and treatment area: waiting hall, registration office, triage office, clinic, treatment (injection) room
Rescue area: rescue recovery room, debridement room, operating room
Intensive Care Area【EICU】
Observation area: observation room (ward), infusion center
Special areas: isolation room for infectious patients, fever clinic, isolation room for mental patients, psychological comfort room
Auxiliary areas: chemical laboratory (bedside rapid fluorescence immunoassay tester), imaging examination room (X-ray, CT, MRI), pricing office, emergency pharmacy
Special area for medical staff: office, study, meeting, warehouse, dressing room, duty, dining room
Emergency Department Equipment
Equipped with various emergency operation conditions
Such as electric defibrillation, artificial ventilation, bedside hemodynamic monitoring, ultrasound, temporary pacemaker, intravenous thrombolysis, emergency blood purification, various puncture techniques, various catheter placement, debridement and suturing, blood transfusion /protein/biological products, etc.
Ability to handle critical and severe cases
Such as cardiac and respiratory arrest, acute coronary syndrome, stroke, multiple organ failure syndrome, shock, acute poisoning, trauma, severe infection, water, electrolyte and acid-base imbalance, etc.
Emergency Department Mission
Reception and treatment of common emergency patients (90%)
Rescue and treat urgent, critical, and severe patients (accounting for 5% to 10%)
Formulate emergency rescue implementation plans for various emergencies and major disasters, and conduct command, organization, coordination and arrangements when a large number of injured people receive emergency treatment after accidents and disasters.
Actively carry out teaching and training in emergency medicine and train professional doctors and nurses in emergency medicine
Emergency management and scientific research, such as conducting research on the cause, pathogenesis, course, diagnosis and treatment of emergencies, studying how to optimize the treatment process for emergency patients, how to improve the quality of emergency care and perform quality control, etc.
Intensive Care Unit (ICU)
A medical unit dedicated to treating all kinds of critical and critical patients. In the EICU, patients receive comprehensive and systematic examinations, accurate and meticulous monitoring and care, and timely and precise treatment to maximize the patient's life safety and effectively improve the success rate of rescue.
Not suitable for ICU admission
Patients with acute infectious diseases, patients with definite brain death, patients with chronic diseases without acute deterioration, patients with terminal malignant tumors, mentally ill patients and the elderly in the process of natural death, etc.
Characteristics of emergency medicine and quality of emergency doctors
Characteristics of Emergency Medicine Major
Strong temporal characteristics
Essential attributes of emergency medicine. Emergency medicine deals with emergencies that directly or potentially threaten the patient's life. Quickly correcting hypoxia and shock, and protecting and maintaining the functions of vital organs such as the heart, lungs, and brain are the primary tasks of emergency medicine.
"Time window", the concept of implementing targeted treatment within the time window
The disease spectrum is very broad and the condition is complex and changeable
Emergency diseases involve various systems of the human body, which requires emergency physicians to have extensive basic medical knowledge and basic skills. In my country, due to cultural factors and social factors, a large number of non-emergency patients visit the emergency department, occupying a large number of emergency resources and increasing the complexity of emergency work.
Emphasis on wholeness
The patients faced by emergency medicine are generalized, which is different from other medical specialties.
In the medical treatment of emergency patients, any omission may lead to the failure of the rescue.
Strong social attributes
EMSS goes far beyond the scope of medicine and is closely related to various social factors such as government, police, transportation and citizen quality. It not only reflects the level of emergency medical treatment in a region, but also reflects the social development and civilization of the region.
Emergency working methods
emergency thinking
traditional college
Whether the patient has organic disease
Especially organic diseases within the scope of this professional system
Emphasis on diagnosis: precise location and qualitative use of all possible means, often requiring time
Treatment: Emphasis on targeting the cause
Emergency Specialty
Whether the patient has a life-threatening emergency
rough diagnosis
Take advantage of the easiest, fastest, and most reliable methods possible
Symptoms, medical history, signs, rapid tests, rapid imaging judgment (1) What is most likely (most fatal, most painful), severity (2) Necessity and best method of intervention
aggravating factors - triggers
Emergency procedure
Evaluate
Circulation (C), airway (A), breathing (B), rescue immediately if life is in danger
judge
Regardless of whether a clinical diagnosis can be made immediately
The most important thing is to assess the severity of the condition
rescue
Take appropriate treatment measures according to the condition
re-evaluate
During treatment, continue to observe changes in condition and repeatedly evaluate treatment effects.
in principle
Keeping track of vital signs is always the first priority - save lives first, diagnose the disease later
Is patient A's life in danger?
Critical illness - the patient's life is in danger, and death is extremely likely if urgent intervention is not performed
Common emergencies – the condition will worsen without emergency intervention
Mild patients - the likelihood of the disease getting worse and worse is very small
BDoes vital signs need to be stabilized?
CirculationC, AirwayA, BreathingB, Consciousness disorderD
What is the main reason for patients with C?
Rank the causes of death by asking, "What causes patients to die faster?"
Quickly examine and assess the patient to confirm your suspicions
Are there other reasons for the worsening of D's condition?
Repeatedly ask "Any more questions?"
Ongoing diagnosis and differential diagnosis
Does E require "diagnostic treatment"?
Emergency treatment does not necessarily require first diagnosis and then treatment
Does patient F have to be diagnosed?
Does G require consultation?
Assist in diagnosis, guide treatment, and share risks
Will H treat this disease?
Can I complete the diagnosis and treatment operation?
Does patient G need to be hospitalized?
Is patient H's emergency placement appropriate?
Emergency work skills
All referrals are serious patients, and the out-of-hospital results should be known in detail; Check blood sugar in comatose patients, and the same goes for patients with impaired consciousness; If you have a fever or become comatose in summer, measure your rectal temperature if you suspect heat stroke; Drinking blackouts are common, and the cause isn’t just alcohol; If the headache is severe and unbearable, be alert for arachnoid hemorrhage; If an elderly person living alone suffers a brain injury, he should seek medical treatment; Unexplained cerebral hemorrhage, rat poison warfarin; Ecchymotic rash is difficult to explain, so meningococcal meningitis should be taken seriously. Do not take airway burns lightly; call an anesthetist if you suspect it; Can't drink water, rabies, can't open mouth, tetanus; Glass trauma skin opening, debridement and suture X-ray; Use a tourniquet for trauma, mark the time and read it at any time; Carefully check for wrist injuries and mark tender areas; The chest tube has its own positioning, so do not insert it directly through the wound. When women of childbearing age experience abdominal pain, the first priority is to inquire about menstruation; X-rays for women and children, radiation hazards should be explained.
Emergency risk avoidance
The patient’s relatives should be treated with respect and the patient’s critical condition should be respected When relatives and friends come to see a doctor, they should check carefully and do their best Don’t interrupt patients rashly, listen carefully to the medical history Don’t be annoyed by your picky family members, and be patient when answering inquiries. When seeing a doctor, you should treat the patient as a patient, and you should be cautious when interpreting the results. Discover the essence of representational thinking and find the reason for any abnormality Don’t hope that all patients will be cured, but only seek the best for them Your technical expertise is limited, so don’t take it lightly if you are unable to do so. If you have any questions, please ask your superiors and speak with caution.