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UNIVERSITY of SZEGED Basics of Emergency Medicine

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UNIVERSITY of SZEGED Basics of Emergency Medicine UNIVERSITY OF SZEGED Basics of Emergency Medicine Edited by Dr. Pető Zoltán (University of Szeged, Albert Szent-Györgyi Health Center, Department of Emergency Medicine) Authors from the University of Szeged, Albert Szent-Györgyi Health Center: Dr. Boros István (Department of Emergency Medicine) Dr. Börcsök Éva (Department of Emergency Medicine) Dr. Cserjés Andrea (Department of Emergency Medicine) Dr. Hankovszky Péter (Department of Anaesthesiology and Intensive Therapy) Dr. Molnár Anna (Department of Anaesthesiology and Intensive Therapy) Prof. Dr. Molnár Zsolt (Department of Anaesthesiology and Intensive Therapy) Dr. Pető Zoltán (Department of Emergency Medicine) Prof. Dr. Rudas László (Department of Anaesthesiology and Intensive Therapy) Dr. Schneider Erzsébet (Department of Emergency Medicine) Dr. Simon Marianna (Department of Emergency Medicine) Tóth Lajos (Department of Emergency Medicine) Proof Readers: Dr. Lőrincz István (University of Debrecen Faculty of Medicine Institute of Internal Medicine Department of Emergency Medicine) Dr. Pető Zoltán (University of Szeged, Albert Szent-Györgyi Health Center, Department of Emergency Medicine) Dr. Szabó Zoltán (University of Debrecen Clinical Center Institution of Internal Medicine Department of Emergency Medicine) Dr. Szok Délia (University of Szeged, Albert Szent-Györgyi Health Center, Department of Neurology) Szeged, 2015. This teaching material is created under the project TÁMOP-4.1.1.C-13/1/KONV-2014- 0001”Coordinated, practice-oriented, student -friendly modernization of biomedical education in three Hungarian universities (Pécs, Debrecen, Szeged), with focus on the strengthening of international competitiveness.” supported by the European Union and financed by the European Social Fund You must not circulatte this teaching material in any form! Tartalomjegyzék Abbreviations .............................................................................................................................. 3 1. The Basics of Physical Examination and Documentation in the ED byDr.PetőZoltán .......... 8 2. BLS – Basic Life Support by Dr. Cserjés Andrea ................................................................. 12 3. ALS – Advanced Life Support by Dr. Cserjés Andrea .......................................................... 18 4. Levels and Priorities of Emergency Care and the Rights of the Patient by Dr. Simon Marianna ................................................................................................................................... 21 5. Triage in the EDby Tóth Lajos .............................................................................................. 26 6. Management of Chest Pain in the ED by. Prof.Dr.RudasLászló ........................................... 39 7. Management of Sepsis in the ED by Prof.Dr.MolnárZsolt ................................................... 50 8. Management of Neuroemergency in the ED by Dr.BorosIstván .......................................... 52 9. Management of Abdominal Pain in the ED by. Dr. Schneider Erzsébet ............................... 57 10. Management of Gastrointestinal Bleeding in the ED by. Dr. Schneider Erzsébet .............. 63 11. Metabolic Crisis in the ED by Dr. Börcsök Éva ................................................................. 66 12. Management of Intoxication in the ED by Dr.Hankovszy Péter ......................................... 81 13. Analgesia, Anaesthesia and Sedation in the ED by Dr.Molnár Anna ............................... 100 14. Laboratory tests in the EDbyDr.BorosIstván .................................................................... 105 2 Abbreviations ACS Acute Coronary Syndrome ACCP/SCCM American College of Chest Physicians/Society of Critical Care Medicine ADORA Antidepressant Overdose Risk Assessment AED Automatic External Defibrillator AF Atrial Fibrillation AIDS Acquired Immune Deficiency Syndrome ALS Advanced Life Support AMI Acute Myocardial Infarct AMP Adenosine Monophosphate APTT Activated Partial Thromboplastin Time ARDS Adult (Acute) Respiratory Distress Syndrome ASY Asystole AV Atrial - ventricular BE Base Excess BLS Basic Life Support BZD Benzodiazepine CABG Coronary Artery Bypass Graft CAMP Cyclic Adenosine Monophosphate CBF Cerebral Blood Flow CEDIS Canadian Emergency Department Information Systems CK Creatinine kinase CNS Central nervous system CO Cardiac output CoHb Carboxyhaemoglobin COPD Chronic Obstructive Pulmonary Disease COX Cyclooxygenase CPP Cerebral Perfusion Pressure CPR Cardio-Pulmonary Resuscitation CRP C-reactive Protein CRT Capillary Refill Time CSF Cerebrospinal Fluid CT Computer Tomography CTAS Canadian Triage and Acuity Scale CVI Cerebrovascular Insult CVP Central Venous Pressure DAMP Damage Associated Molecular Pattern DBP Diastolic Blood Pressure DIC Disseminated Intravascular Coagulation DNOC Dinitroorto Cresol EDTA Ethylenediaminetetraacetic Acid EKG Electrocardiograph ERCP Endoscopic retrograde cholangio-pancreatography 3 ES Extrasystole ETI Endotracheal Intubation ET Endotracheal Tube FFA Free Fatty Acid FFP Fresh Frozen Plasma. FiO2 Fraction of inspired O2 GABA Gamma Amino Butyric Acid GCS Glasgow Coma Scale GFR Glomerular Filtration Rate GI Gastrointestinal GM Grand mal GOT Glutamate Oxaloacetate GPT Glutamate Pyruvate Transaminase GRACE Global Registry of Acute Coronary Events hCG Human Chorionic Gonadotropin Htc Haematocrit Hgb Haemoglobin HHS Hyperglycaemic Hyperosmolar State Haemoglobin A1c HgA1c HTAS Hungarian Triage and Acuity Scale IABP Intra-aortic Balloon Pump IBD Irritable Bowel Syndrome ICD Implantable Cardioverter Defibrillator ICH Intracerebral Haemorrhage ICP Intracranial Pressure INH Isonicotinic Acid Hydrazide IPAT Initial Pain Assessment Tool ICU Intensive Care Unit LBBB Left Bundle Branch Block LD Lethal Dose LF Liver Function LMA Laryngeal Mask Airway LMWH Low Molecular Weight Heparin LSD Lysergic Acid Diethylamide MAP Mean Arterial Pressure MICU Mobile Intensive Care Unit MRI Magnetic Resonance Imaging MOF Multi Organ Failure MSOF Multiple System Organ Failure NAPQI N-acetyl-para-benzoquinone-imine NIBP Non-invasive Blood Pressure NO Nitric Oxide NSAID Nonsteroidal Anti-inflammatory Drugs NSTE-ACS Non-ST Elevation Myocardial Infarction Acute Coronary Syndrome NSTEMI Non-ST Elevation Myocardial Infarction PAD Public Access Defibrillator 4 PAMP Pathogen Associated Molecular Pattern PCI Percutaneous Coronary Intervention PCP Phencyclidine PCT Procalcitonin PEA Pulseless Electrical Activity PoCT Point of Care Testing POSS Prehospital Cincinnati Stroke Scale PT Prothrombin time PTX pneumothorax PVT Pulseless Ventricular Tachycardia RBC Red Blood Cell RDE Rectal Digital Examination ROSC Return of Spontaneous Circulation ROTEM Rotational Thromboelastography RR Respiratory Rate RSI Rapid Sequence Induction SAH Subarachnoid Haemorrhage SBP Systolic Blood Pressure SIADH Syndrome of Inadequate Antidiuretic Hormone Secretion SIRS Systemic Inflammatory Response Syndrome STEMI ST Elevation Myocardial Infarction SVPT Supraventricular Paroxysmal Tachycardia TAI Thrombocyte Aggregation Inhibitor TAT Turnaround Time TB Tuberculosis TBI Thyroxin Binding Index TCA Tricyclic Antidepressant TCT Thrombocyte TEE Transoesophageal Echocardiography TI Thrombin Time TIVA Total Intravenous Anaesthesia TNF Tumour Necrosis Factor TP Total Protein TTE Transthoracic Echocardiography US Ultrasound VCI Vena Cava Inferior VES Ventricular Extrasystole VF Ventricular Fibrillation VT Ventricular tachycardia WBC White Blood Cell WHO World Health Organisation 5 1. The Basics of Physical Examination and Documentation in the ED byDr.PetőZoltán Working as an emergency physician means a challenging job for the ones who can cope with unpredictable situations under always changing circumstances. Lots of personal skills are needed to become a good emergency physician. For most of the patients contact healthcare professionals first in the ED, it is essential to build a good rapport with them. Because of crowded waiting rooms and misconceptions about the ED’s function people might get angry with the medical staff. To prevent conflicts excellent communication skills, well-organised protocols and evidence based treatment strategies are required. NB: Always treat the patient as you would want to be treated! The ABCDE of Patient examination: A: Airway B: Breathing C: Circulation D: Disability E: Environment, Anything Else NB: Always insist to ABCDE, which focuses on the most life-threatening conditions! Before examination always make sure, that the patient’s dignity is preserved. Medical condition of the patient is always confidential. Introduction is the simplest way to start building a good rapport, defusing a volatile situation and evaluating the patient’s condition at the same time. The patient who can response in whole detailed sentences no serious ABCD problem is probable. During examination all of the senses are used. It is extremely important to search for the absence of normal and the presence of not normal. Note keeping is indispensable. It is essential to record the patient’s history, every symptoms and as much objective parameters as you can to help documenting what happened to the patient. It gives also a good basis to explain the therapeutic decisions, what have been made. But keep in mind write nothing judgemental what might stigmatise the patient (body habitus, clothing, appearance, illicit drug use if there is no consequence for the recent condition). Do 6 not write either critics about other healthcare providers, or messages for them.
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