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EmergencyRoomYiPingZhaoDepartmentofVascularSurgeryRenJiHospitalHowEmergencyRoomsWorkYouwilllearnabout•thenormalflowoftrafficinanemergencyroom•thepeopleinvolved•thespecialtechniquesusedtorespondtolife-or-deathsituationsEmergencyRoomPatients•Caraccidents•Sportsinjuries•Brokenbonesandcutsfromaccidentsandfalls•Burns•Uncontrolledbleeding•Heartattacks,chestpain•Difficultybreathing,asthmaattacks,pneumonia•Strokes,lossoffunctionand/ornumbnessinarmsorlegs•Lossofvision,hearing•UnconsciousnessEmergencyRoomPatients•Confusion,alteredlevelofconsciousness,fainting•Suicidalorhomicidalthoughts•Overdoses•Severeabdominalpain,persistentvomiting•Foodpoisoning•Bloodwhenvomiting,coughing,urinating,orinbowelmovements•Severeallergicreactionsfrominsectbites,foodsormedications•Complicationsfromdiseases,highfeversUnderstandingtheERMaze•Theclassicemergencyroomsceneinvolvesanambulancescreechingtoahalt,agurneyhurtlingthroughthehallwayandsomepeoplefranticallyworkingtosaveaperson'slifewithonlysecondstospare.•Thisdoeshappenandisnotuncommon,•Themajorityofcasesseeninatypicalemergencydepartmentaren'tquitethisdramatic.TriageWhenyouarriveattheER,yourfirststopistriage.Thisistheplacewhereeachpatient'sconditionisprioritizedintothreegeneralcategories:•Immediatelylifethreatening•Urgent,butnotimmediatelylifethreatening•LessurgentTriageThetriagenurserecordspatientsvitalsigns(temperature,pulse,respiratoryrateandbloodpressure).Shealsogetsabriefhistoryofpatientscurrentmedicalcomplaints,pastmedicalproblems,medicationsandallergies.Registration•Thisstepisnecessarytodevelopamedicalrecordsothatpatientsmedicalhistory,labtests,X-rays,etc.,willallbelocatedononechartthatcanbereferencedatanytime.•Ifthepatient'sconditionislife-threateningorifthepatientarrivesbyambulance,thisstepmaybecompletedlateratthebedside.ExaminationRoom•PatientsareseenbyanERnursewhoobtainsmoredetailedinformationaboutpatients.•Oncethenursehasfinishedhertasks,thenextvisitorisanERphysician.Hegetsamoredetailedmedicalhistoryaboutyourpresentillness,pastmedicalproblems,familyhistory,socialhistory,andacompletereviewofallyourbodysystems.Hethenformulatesalistofpossiblecausesofyoursymptoms.DiagnosticTestsBloodtestsandaurinalysisarerequired.•Acompletebloodcount(CBC)•Aserumtest•Ablood'sclottingtestDiagnosisandTreatment•Whentheemergencyphysicianhasalltheinformationhecanobtain,hemakesadeterminationofthemostlikelydiagnosisfromhisdifferentialdiagnosis.•Alternately,hemaydecidethathedoesnothaveenoughinformationtomakeadecisionandmayrequiremoretests.Atthispoint,appropriateconsultantisneeded.TheERteam•EmergencyPhysician•EmergencyNurse•PhysicianAssistant•EmergencyDepartmentTechnician•UnitSecretary•PhysiciansinTrainingToolsoftheTrade•EmergencyDepartmentsarestockedwithahugearrayofstrangelynamed,oddlyshaped,beepingandblinkingequipment.Stethoscope•Astethoscopeletsanurseorphysicianlistentoheartandrespiratorysounds.•Astethoscopeisusedtotakeyourbloodpressurebylisteningtotheflowofbloodthroughyourarteries.CardiacMonitor•Acardiacmonitorgivesavisualdisplayoftherhythmofpatientsheart.•Somemonitorsalsohaveanautomaticbloodpressurecuffandapulseoximeter.SutureTrayThistraycontainsthesterileequipmentneededtoplacestitchesinapatientwithalaceration.•needleholder•forceps•steriletowels•scissors•smallbowlsOrthopedicEquipment•Mostemergencydepartmentshaveagenerousnumberoforthopedicdevicesformanypurposes•plasterand/orfiberglassmaterials•pre-madesplintsforspecificjoints–kneeimmobilizers–aluminumfingersplints–Velcrowristsplints–shoulderslings–cervicalcollars•castcuttersCrashCartAcrashcartisacabinetcontainingequipmentthatphysiciansandnursesneedwhenacardiacarrestoccurs.–Defibrillator–Endotrachealintubationequipment–Centralveincatheters–CardiacdrugsDefibrillatorToolsusedinendotrachealintubation