Mid 1

• The emergency department (ED) occupies a key position in terms of the interface between primary and secondary care in the hospital.
• Be cautious about accepting telephone advice alone after referral
• An expert cannot usually provide an accurate opinion without seeing the patient
• Many patients attend the ED without referral, but some are referred by general practitioners (GPs), and other medical practitioners.
• The ED manages patients with a huge variety of medical problems.
• Many of the patients who attend the ED have painful and/or distressing disorders of recent origin.
• Priorities in the ED are to make life-saving interventions, provide analgesia, identify relevant issues, investigations, and commence treatment, and decide upon need for admission or discharge.
• ED staff work as a team.
• ED staff include Doctors (permanent and fixed-term), Nurses, Reception and administrative staff, Radiographers, and other specialist staff such as plaster technicians, physiotherapists, paramedic practitioners, physician assistants, occupational therapists.
• Alcohol hand gel can be used if the hands look clean.
• After use, dispose of PPE and wash your hands.
• Use a mask, face shield, and eye protection if blood or body fluids might splash in your eyes or mouth.
• Consent: Use the consent form liberally for anything that is complex, risky, or involves sedation or general anaesthetic (GA). Ensure that the patient understands what is involved in the procedure, together with its potential benefits and risks.
• Referral: Always seek senior help or refer those patients with problems beyond your knowledge or expertise. Record any referral made, together with the name and grade of the doctor referred to, the time it was made, and a summary of the facts communicated.
• Cover broken skin with a waterproof dressing.
• Powered air-purifying respirators should be used for high-risk procedures such as intubating patients with serious viral infections.
• Attitude: Be polite and open with patients. Be as honest as possible in explaining delays/errors.
• Managing blood and bodily fluids: Samples of blood or other body fluids must be handled safely, with care not to contaminate request forms or the outside of the container.
• Safe handling and disposal of sharps: Never re-sheathe needles. Place used needles and blades immediately into a 'sharps bin'.
• Personal protective equipment (PPE): Wear suitable disposable gloves for any contact with blood, body fluids, mucous membranes, or nonintact skin.
• Hands that are visibly dirty must be washed with soap and water, and dried thoroughly.
• Use a disposable plastic apron if there is a risk of blood or body fluids contaminating clothing.
• Documentation: Good notes imply good practice. Keep careful notes, using simple, clear language. Write your name legibly and document the time that you saw the patient. Try to avoid abbreviations, particularly where there is room for confusion.
• Supporting staff in the ED include security, cleaners, and police.
• Note reporting in the ED includes presenting complaint, previous relevant history, current medications, and examination.
• Infection control in the ED involves standard precautions for preventing infection, which include hand hygiene, decontaminating hands before and after every patient contact, and after any activity that might contaminate hands, including removing gloves.
• If not breathing, perform CPR
• Keep the person warm and cover them with a blanket
• Place the person in a semi-prone position
• Remove the person to the hospital as soon as possible
• Monitor breathing and pulse constantly
• If there is no pulse, perform CPR
• Level of consciousness can be determined using the AVPU acronym: A lert, V erbal stimulus response, P ainful stimulus response, U nresponsive
• Conditions compromising breathing: A- pneumothorax, B- Pulmonary contusion
• Excessive movement while establishing airways may cause neurological damage to fractured spine
• Causes of unconsciousness include shock, asphyxia, poisoning, head injury, stroke, epilepsy, hysteria, infantile convulsions, hypothermia or hyperthermia, D.M, and heart attack
• Emergency care for unconscious patients includes removing them from hazards, attention to the spine, loosening tight clothes, checking breathing, and removing airway obstruction
• Circulation can be checked by assessing pulse and capillary refill
• Assessment in the secondary survey includes a head-to-toe evaluation
• Primary survey is a rapid priority at the scene prior to transport, while the secondary survey aims to discover injury-related problems with no immediate threat to survival