CURRENT Diagnosis & Treatment Emergency Medicine 7th Edition 2020 PDF

 Preface

An emergency is commonly defined as any condition per-
ceived by the prudent layperson—or someone on his or

her behalf—as requiring immediate medical or surgical
evaluation and treatment. On the basis of this definition,
the American College of Emergency Physicians states that
the practice of emergency medicine has the primary mission
of evaluating, managing, and providing treatment to these
patients with unexpected injury and illness.
So what does an emergency physician (EP) do? He or she

routinely provides care and makes medical treatment deci-
sions based on real-time evaluation of a patient’s history;

physical findings; and many diagnostic studies, including

multiple imaging modalities, laboratory tests, and electro-
cardiograms. The EP needs an amalgam of skills to treat

a wide variety of injuries and illnesses, ranging from the
diagnosis of an upper respiratory infection or dermatologic
condition to resuscitation and stabilization of the multiple
trauma patient. Furthermore, these physicians must be able
to practice emergency medicine on patients of all ages. It

has been said that EPs are masters and mistresses of negoti-
ation, creativity, and disposition. Clinical emergency medi-
cine may be practiced in emergency departments (EDs),

both rural and urban; urgent care clinics; and other settings
such as at mass gathering incidents, through emergency
medical services (EMS), and in hazardous material and
bioterrorism situations.
Emergency medicine serves as the US health care safety
net. It provides valuable clinical and administrative services
to the health care delivery system, including care for the
indigent and others who lack access to health care, and
What Is Emergency Medicine?
Unique Aspects of Emergency Medicine Practice

Principles of Emergency Medicine
Conclusion

1 Approach to the Emergency

Department Patient

T. Russell Jones, MD, Mdiv

has evolved as the most visible and vital component of a
patchwork of health care providers and facilities. EDs have
become the routine, and often the only, source of care for
many of the uninsured, thereby acting as a critical safety net
for our fragmented health care delivery system.
Finally, EDs are the only element of the health care system
whose function has been delineated by federal law. Initially
authorized in 1986, the Emergency Medical Treatment and
Active Labor Act mandates that all EDs provide screening,
stabilization, and appropriate transfer to all patients with
any medical condition. Emergency medicine is often the last
resort for many patients and frequently the access point for
competent, comprehensive, and efficient medical care.

 An EP faces numerous challenges. The first and most dis-
tinctive challenge is that of limited time. Time constraints

occur because of the severity and acuity of the illness and
also because of the ever-present worry that someone else will
need the physician’s attention. The second challenge for the

EP is that he or she needs to quickly assess and make thera-
peutic decisions on the basis of limited information. The EP

may also be providing medical control for patients in the
prehospital environment. In addition, the EP also will need
to determine what care was given prior to arrival and what
impact the intervention made. History may be provided

from bystanders or EMS providers and given to the physi-
cian second hand.

The EP has a different mindset than other specialties. The
main concern of the EP is not necessarily the diagnosis, but aprocess of thinking aimed at ruling in or out serious pathol-
ogy that is life- or limb-threatening. The classic model of

history taking followed by a physical examination and then
diagnostic testing must often be compressed and conducted
simultaneously when time is of the essence and the patient’s
life is threatened.
The evaluation of patients should proceed in a parallel
fashion rather than the time-honored serial method. The
mindset that patients must be triaged and registered in the

waiting room when there are beds available must be aban-
doned. Patients should be taken straight away to any avail-
able room where the physician and nurse assess the patient

and get the history while the patient is simultaneously having
an intravenous line with blood work drawn and registration
occurring in the room. The single intervention of in-room
registration can decrease the length of stay of the patient by
an average of 15 minutes.
The ED is a unique environment in that hospital EDs are
required by federal law to evaluate patients without regard to
ability to pay. In 2005, there were an estimated 45–48 million
Americans without health insurance. This puts financial
strains on both hospitals and physicians. In addition,
patients with nonurgent health problems use the ED for a
variety of reasons. Studies have found that the majority of
patients were not aware of other places to go for their care.
When an ED reaches 140% of its capacity, the number of
patients leaving without being seen will increase. This leads
to patient dissatisfaction and an increased risk of litigation,
not to mention the potential that the patient is leaving with
a potential life threat that has not been identified.