Emergency Medicine

1. 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 20-50 cases require urgent
intervention
•Few cases are life-threatening (1-5)

5. Triage
500 – 300500 – 300
casescases
-Life-Life
ThreateningThreatening
UrgentUrgent
CasesCases
Non- urgentNon- urgent
CasesCases
Triage-OutTriage-Out

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

14. 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. 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. 16
Subspecialties in Emergency Medicine
•Pediatric Emergency Medicine
•Toxicology
•Emergency Medical Services
•Sports Medicine
•Critical Care Medicine

17. 17
Upcoming Areas of Emergency
Medicine
•Observation units
•ED CT

18. 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. 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

20. Trauma

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

22. Secondary Survey ( Systemic)

23. 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 : 7.35
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

48. THANKS