Should I go to the ER for an acute exacerbation?
Feb 09, 2010 · In a randomized controlled trial, the addition of high-dose inhaled corticosteroids to a course of oral corticosteroids at discharge was associated with a lower risk of relapse of the asthma exacerbation at 21 days than the use of oral corticosteroids alone. 167 In a recent prospective study of asthma care in the emergency department, the risk of relapse at 28 days …
How do you deal with an abusive patient in the ER?
Mar 26, 2008 · EMTALA imposes the obligation to provide for examination and treatment for emergency medical conditions and women in labor. The first requirement is that of "medical screening".The law requires that, in the case of a hospital that has an emergency room department, if any individual presents themself to the emergency department and a request is ...
What happens to an intoxicated patient in the emergency department (ED)?
No resources would be required. Patient will receive prescriptions for oral antibiotics or pain medications. If the patient is given an IM shot in the emergency room for pain or antibiotics, he would be elevated to ESI level 4. A 79 year old male is brought to the ER with severe abdominal pain which started about 30 minutes prior to arrival.
How is acute asthma treated in the emergency department (ED)?
Emergency Medical Service has brought a 24-year-old man to the ED with gunshot wounds to his abdomen and left groin area. His blood pressure is 84/52 and heart rate is 120 per minute. His skin is diaphoretic, cool, and pale. The treatment the nurse should prepare for is:
How long does it take to get treated in the ER?
Answer. Emergency room patients are supposed to be immediately assessed and treated according to the urgency of their condition. The average ER patient in the U.S. waits around 28 minutes before they are seen by a doctor, but for most women, getting properly diagnosed and treated is more complicated than it should be.Jan 17, 2018
What usually happens after a patient is seen in an emergency department?
After you explain your emergency, a triage nurse will assess your condition. You will be asked to wait or go immediately to an exam room, depending on the severity of your illness or injury. Once inside the exam room, a nurse will ask you a few questions and then fill out paperwork for the doctor to review.
What are the 3 categories of triage?
Triage categoriesImmediate category. These casualties require immediate life-saving treatment.Urgent category. These casualties require significant intervention as soon as possible.Delayed category. These patients will require medical intervention, but not with any urgency.Expectant category.
When a patient arrives in the emergency room?
When a patient first arrives in the emergency room—now typically called the Emergency Department—the first stop is triage. In triage, a nurse typically prioritizes each patient's condition into one of three general categories: Immediately life threatening. Urgent, but not necessarily immediately life threatening.
How do you treat an emergency patient?
Reassure the victim until recovery or medical team arrives. Do not ever delay providing first aid to the victims during medical emergencies. Identify the warning symptoms and provide appropriate and prompt help to save their lives. You can always request for help from others while assisting the victim.
How are ER levels determined?
The assignment of an ED E&M level is based on Nursing and hospital resources used for treating the Patient. The process is to assign a point value to each Nursing service or resource which cannot be separately charged to the Patient, the sum of the point values are then “fitted” to a scale to determine the level.
What is rapid treatment?
A rapid treatment area (RTA) is an identified space, typically close to triage in the emergency department, which is used to help manage patient flow and throughput.Nov 25, 2021
Why is triaging important?
The purpose of triage is to save as many lives as possible. During a severe pandemic, you can expect that the period of time when the need for care will be greater than the resources available will last for weeks or months.
Is triage the same as ER?
A primary ER nurse has to be able to help patients and deal with family members and their questions. All emergency nurses need to be trained to assess patient needs quickly and capably, but a triage nurse is on the front lines.Nov 1, 2015
What are the six basic care guidelines for an emergency?
What are the Six Priorities in an Emergency Situation?Stop to assess the situation – watch out for danger. ... Make sure it is safe to approach the scene. ... Make the area safe. ... Assess the victim. ... Call for help.Resuscitate and treat injuries as necessary.Apr 21, 2019
What happens when you first arrive at hospital?
Arriving at the hospital There, a nurse will take you into a triage room, hook a fetal monitor to your belly to check baby's heart rate, and measure your contractions. If you or the nurses think your water has broken, you might get a swab (yep, down there) that will be used to test if it really is amniotic fluid.
What are 5 emergency situations?
People often wonder whether it's best to call 911 or go straight to the hospital. Five emergency situations include chest pain, choking, stroke, heavy bleeding and severe head injury....Two questions often asked about emergenciesIs it safe to move the person having an emergency? ... Will the ambulance be faster?More items...•Nov 9, 2021
How many categories can a triage nurse sort patients into?
In conclusion, by completing a brief focused assessment, it allows the triage nurse to sort patients into five categories based on the patients need and acuity level. It allows the nurse to quickly and effectively determine which patients must be seen immediately and which patients can wait to be seen.
What is ESI in medical?
ESI is a standardized triage system that is supported by both ENA, and ACEP (American College for Emergency Physicians), and provides validity and consistency of a rating system amongst medical institutions across the United States (Briggs & Grossman, 2006).
What is a triage assessment?
Triage Assessment. Assessment helps the patient care team to understand a situation, in order to identify the problem, the source of the problem, and the consequences of the problem. The purpose of an assessment is not to identify an intervention, but to find out whether an intervention is needed. Triage Assessment, as stated by ...
What is ESI level 3?
ESI level 3. Patient will be worked up for abdominal pain, to include labs, x-rays, medications. Most likely he has constipation. He will need IV access and will receive pain meds and fluids. If a small bowel obstruction or perforated colon were identified, the ESI level would increase to 2.
What is the difference between the front and back of the body?
The front and back of the head and neck equal 9% of the body's surface area. The front and back of each arm and hand equal 9% of the body's surface area. The chest equals 9% and the stomach equals 9% of the body's surface area. The upper back equals 9% and the lower back equals 9% of the body's surface area.
What is the CEN exam?
A nurse who wishes to obtain the Certified Emergency Nurse (CEN) credential must take and pass the CEN exam which is administered by the Board of Certification of Emergency Nursing (BCEN).
What is emergent delivery?
The nurse has assisted in an emergent delivery of an infant in the Emergency Department. The infant was born 2 weeks before the due date and is small for gestational age. The nurse documents a thin upper lip, small eye openings, and a smooth philtrum above the upper lip. This child may be diagnosed with: a.
What is preload in the heart?
The pressure in the arterial system that the heart must overcome to pump the blood. Preload is the volume of blood that enters the right side of the heart. This volume stretches the fibers in the heart prior to contraction. Preload is commonly measured as atrial pressure.
What are the signs of respiratory failure?
d. Nasal flaring and retractions. Nasal flaring and retractions are signs of respiratory distress, not respiratory failure. In respiratory failure, you will see decreased respiratory effort with late bradypnea, diminished air movement, peripheral and central cyanosis, and decreased level of consciousness.
What color is the eardrum?
The normal eardrum is pearly gray in color so this would rule out any of the ear infections. This patient has an extensive dental caries that should be referred to a dentist. The ED provider may prescribe antibiotics and/or pain medications for this patient to clear any infection that may be causing the ear pain.
What is the pain of a 34 week pregnant woman?
She is complaining of intermittent lower abdominal pain. The hospital does not have a labor and delivery unit, but the on-call physician has determined that her cervix is dilated to 3 cm.
Can a pregnant woman be transferred?
According to EMTALA, a pregnant woman cannot be transferred if delivery is imminent. However, in this scenario, the patient is stable, the fetus does not seem to be in distress, and the woman is not in active labor. Therefore, the discharge of the patient is not restricted by the EMTALA statute.
What is hypertensive emergency?
Hypertensive Emergency. Hypertensive emergency means blood pressure is so high that organ damage can occur. Blood pressure must be reduced immediately to prevent imminent organ damage. This is done in an intensive care unit of a hospital. Organ damage associated with hypertensive emergency may include:
How to know if you have hypertension?
Symptoms of a hypertensive emergency include: 1 Headache or blurred vision 2 Increasing confusion 3 Seizure 4 Increasing chest pain 5 Increasing shortness of breath 6 Swelling or edema (fluid buildup in the tissues)
Leadership
- By James R. Hubler, MD, JD, Department of Emergency Medicine, University of Illinois, Peoria, IL; Daniel Sullivan, MD, JD, FACEP, Chairman, Department of Emergency Medicine, Ingalls Memorial Hospital, Harvey, IL; Tim Erickson MD, FACEP, FACMT, Toxicologist, University of Illinois, Department of Emergency Medicine, Chicago, IL.
Criticism
- A review of the literature indicates that there are no clear-cut guidelines for the EPs management of the intoxicated patient. These patients present to the ED with an altered mental status, often express suicidal ideation, and, at times, are belligerent and physically violent. Frequently, police, family, or friends bring these patients into the ED against their wishes, and patients refuse medic…
Safety
- The alcohol impaired patient often lacks insight into his condition; thereby, making it difficult for the physician to accurately diagnose and treat underlying medical illness. EPs must not assume that a \"regular\" patient is simply \"drunk again.\" One must always assume the alcoholic patient is \"hiding\" some potentially life-threatening pathology until proven otherwise. In order to ensur…
Contraindications
- The following issues will be discussed: 1) whether blood alcohol levels are required in all patients; 2) general management of the intoxicated patient; 3) \"against medical advice\" (AMA) in the \"alcohol impaired patient;\" 4) physician use of restraint and forced treatment; 5) clinically clearing patients for discharge; and 6) high-risk cases and risk management.
Side effects
- Ethanol is a selective central nervous system (CNS) depressant at low doses and a general depressant at high doses. At the highest blood alcohol levels, there is loss of protective reflexes, coma, and increased risk of death from respiratory depression.1 There is a narrow margin between the anesthetic and fatal dose; deeply intoxicated patients are near death and must be …
Pharmacology
- A \"standard drink\" (equivalent to a glass of wine, a shot, or a 12 oz. beer) increases the blood alcohol by 25-35 mg/dL. Lethal doses of ethanol are reported to be 5-6 mL/kg in adults and 3 mL/kg for children.4 The LD 50 (the \"lethal dose\" level at which half of those patients with this blood alcohol level would die) in the nonhabituated patient is approximately 500 mg/dL.5 More t…
Treatment
- Ethanol is a dialyzable substance in cases of potentially lethal ingestion.8 There is no antagonist to alcohol currently available. Neither naloxone or flumazenil have been shown to reduce the effects of alcohol. There is a new direct alcohol dehydrogenase inhibitor, 4-methyl pyrazole (4-MP), that may soon be available for toxic ingestions of methanol or ethylene glycol. Studies hav…
Management
- General Management of the Intoxicated Patient Physicians must not assume that intoxication is the etiology of a patients altered mental status. There is little debate about the management of the patient with a severely altered level of consciousness or in a comatose state. Attention to the ABCs (i.e., airway, breathing, and circulation) is the first priority. If the airway is occluded, unprot…
Diagnosis
- In comatose patients or those patients with severely altered mental status, blood alcohol level should be performed to determine if alcohol intoxication is the likely etiology of the altered mental status. The blood alcohol level should roughly correlate with the level of consciousness. Physicians must be aware that coma due to ethanol alone is rare at blood levels less than 300 m…
Prognosis
- In general, based on the biomechanics of alcohol degradation, the patients clinical condition should begin to improve in a three- to six-hour time frame. Some authors have recommended a longer time frame prior to physician re-evaluation.12 Whatever the time frame, further investigation is indicated if the patients mental status does not improve over a reasonable perio…
Purpose
- The frequent use of the breath analyzer, even if a blood alcohol level was previously obtained, offers the physician a convenient and rapid determination of alcohol level to determine if alcohol content is rising or falling. Although rising ethanol levels are uncommon, this may occur if the patient has a recent large ingestion of alcohol prior to the ED visit with ongoing gastric absorptio…
Recording
- The level obtained by breath analysis should be documented in the chart. If the breathalizer is capable of printing, the printed number should be attached to the chart. If a printed copy is not available, then the physician or those delegated to administer the test should document the time and the level obtained.
Risks
- The alcohol impaired individual who refuses treatment is often not capable of understanding the risks, benefits, and alternatives of treatment; therefore, an informed decision cannot be made. An analysis of state legislation and case law strongly suggests that the EP may err well on the side of caution and restrain and treat when necessary. However, intoxication is not synonymous with in…
Security
- Although this is a complex problem, there is clearly a duty to protect patients who cannot make an informed decision and may be a danger to themselves or others. From a legal standpoint, it is better to err on the side of paternalism. In some states, the EP may also have a legal duty to protect third parties, outside of the patient-physician relationship. (See ED Legal Letter 1995;6:9…
Background
- In states without such statutes, case law supports the underlying philosophy that intoxicated patients are incapable of giving consent. In Miller v. Rhode Island Hospital,19 the Rhode Island Supreme Court held that a patients intoxication may render him incapable of giving informed consent and, in emergency situations, that consent may be waived. In this case the plaintiff, Mill…
Controversy
- In summary, these cases and statutes demonstrate support physicians in treating intoxicated patients without their consent. Their documented inability to understand the risks, benefits, and alternatives of treatment creates a presumption of incompetence in regard to making medical decisions. Physicians who render reasonable care to intoxicated patients have historically been …
Issues
- The medical, legal, and social issues related to discharge are complex. The EP has to consider the patients clinical condition and conduct following discharge; the patients support network of family or friends; community resources for follow-up care; the potential for injury to third parties exposed to the patient post discharge; and other issues. A few case examples are illustrative.
Facts
- The patient was in his 20s when he suffered blunt head injury during an assault. He was found by police and taken to the defendant hospitals ED. The plaintiff was uncooperative and initially refused treatment but eventually consented to an X-ray of the skull. The X-ray was read as normal by the EP. The patient was released to the custody of the sheriffs department, AMA. The defend…
Significance
- This injury was probably caused by the blow itself, and any delay in treatment was inconsequential. Therefore, this case should have failed on the causation issue. Causation is one of the essential elements of a medical malpractice action. The plaintiff must prove that a breach in a standard of care caused the patients injury. If the injury occurred unrelated to a breach in a s…
Assessment
- A review of recent AMA cases indicates that the AMA defense is an extremely strong defense when used in the appropriate circumstances. (See ED Legal Letter 1996;7.) If a patient has a normal mental status, and makes an informed refusal of care, then the AMA defense wins in almost every case. Although these issues must go to a jury, the jury tends to support the emerge…
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