Introduc*on

to Emergency Medicine

Prof. Dr Ismail Mohd. Saiboon

MBBS(Mal) MS Orth (UKM), Emerg. Med (NSR), AMM
Professor & Senior Consultant in Emergency Medicine ,
& Head
Dept of Emergency Medicine UKMMC
 Learning objec*ve
At the end of this session you should be able to:
Understand the dierent terminology use to iden*fy the eld
of emergency medicine
Understand the principles of emergency medicine
Describe the process of pa*ent evalua*on, diagnosis,
treatment and disposi*on.
Relate the work process in ED towards its principles
Understand principles of resuscita*on & stabiliza*on
EP contribu*on to health care service system.
 What are they?
Emergency Medicine (EM)
Emergency Medical and Trauma Services (EMTS)
Emergency Department (ED)
Emergency Physician (EP)
Accident & Emergency (A&E)
Casualty
 Emergency Medicine
Emergency medicine is the medical specialty dedicated
to the diagnosis and treatment of unforeseen
illness or injury.

It encompasses a unique body of knowledge as set
forth in the "Model of the Clinical Prac*ce of
Emergency Medicine.

The prac*ce of emergency medicine includes the ini*al
evalua*on, diagnosis, treatment, and disposi*on of
any pa*ent requiring expedi*ous medical, surgical, or
psychiatric care.

Emergency medicine may be prac*ced in a hospital-
based or freestanding emergency department (ED), in
an urgent care clinic, in an emergency medical
response vehicle or at a disaster site.


(American College of Emergency Physicians 2008)
 Emergency Medicine
EM is a specialty that cut across all specialty
that caters undieren*ated emergent cases or
condi*ons which are possible to cause life,
limb or system threat that need to be handle
immediately at any*me, anywhere, and on
anyone.

Ismail M. Saiboon, 2010

 Our Philosophy

Trust in God and evidence-based knowledge,

as well as the consolidation of theory and practice,
form the basic foundation of provision of
immediate care in situations of
medical emergencies.
 Principles in Emergency Medicine
Ini*al evalua*on
Triage
Primary & Secondary Survey
Diagnosis
Working Diagnosis
Treatment
Resuscita*on & stabiliza*on
Disposi*on
Home, ward, mortuary
Administra*ve du*es in healthcare delivery system
Human resource, Equipments, System , Infrastructures, Finance,
Prehospital care,
 Principles in Emergency Medicine
Ini*al evalua*on
Triage
Primary & Secondary Survey
Diagnosis
Working Diagnosis
Treatment
Resuscita*on & stabiliza*on
Disposi*on
Home, ward, mortuary
Administra*ve du*es in healthcare delivery system
Human resource, Equipments, System , Infrastructures, Finance,
Prehospital care,
 Ini*al evalua*on: Triage

Process of sor*ng out pa*ent - need for

treatment.
Originate from French word trier
All pa*ents
Aim: Look for immediate major life threat
Tiers in triage: single or mul*ple- Primary;
secondary; ter*ary
 Triage

How is it done: Triage protocols vs most

experience
Pre-hospital triage
In-hospital triage
Triage categories
Red Priority 1 P1 Triage 1
Yellow Priority 2 P2 Triage 2
Green Priority 3 P3 Triage 3
Black - Priority 4 - P4 Triage 4
 Pre-hospital triage
START system
Simple Triage And Rapid Transport
Yes
Call out Green
No
> 29/min
Respiration Red
No Radial pulse not felt

Circulation
Black
Not follow command

Mentation Yellow
follow command
 In-Hospital Triage categories (UKMMC)
Triage Priority Categories Sample Target
Time
1 Immediate Resuscitation Collapse
Polytrauma 0 MIN
Unconscious
2A Emergency Unstable vitals Acute M I
Danger signs + Severe Asthma < 3 min
Major trauma
2B Urgent Stable vitals Mod. Trauma
Danger signs +/- High grade fever < 30 min
need urgent attention Dengue HF

3 Delayed Stable vitals Minor trauma

No danger signs Acute Appendicitis < 120
No urgent attention min
4 Non-urgent Cold case URTI
Can treat by GP MC <240 min
Chr. rashes
 Triage 1
RESUSCITATION ROOM Immediate problem
Collapse
with:
Resuscitate & Stabilize
Airway,
History
Breathing,
Registration
Circulation
Investigations
 Triage 2A & @
2B
EMERGENCY ROOM (ER)
Acute problem Vital Signs unstable: HR, RR, BP,SpO2, Temp
with dangerous/ serious ECG, PEFR
threat to life Initial Mx O2, 12-lead ECG, GTN, Aspirin,
Bronchodilators
Stabilize
History
Registration
Investigation
Disposition
 Triage 3
Problem is acute but Register
stable and no immediate History
Life-threat Examination
Investigation
(NB. Fast Tracking)
Treatment
Disposition
 Triage 4
Chronic problem History (Chronic/Cold cases)
non acute Examination (Normal vital signs)
response Triage-away to GP
Trivial ?Investigation
Not life threat Treatment

M.C.!
 Principles in Emergency Medicine
Ini*al evalua*on
Triage
Primary & Secondary Survey
Diagnosis
Working Diagnosis
Treatment
Resuscita*on & stabiliza*on
Disposi*on
Home, ward, mortuary
Administra*ve du*es
Human resource, equipments, system , infrastructures, nance
 Evalua*on: Primary and Secondary
surveys

Assessment of the pa*ents looking for

immediate (primary) and poten*al life
threatening (secondary) condi*ons.
A systema*c approach from (ABCD) Airway,
Breathing, Circula*on, Disability (CNS) and
Head-to-Toe examina*on.
Done this way in order to avoid or minimized
misses.
 Principles in Emergency Medicine
Ini*al evalua*on
Triage
Primary & Secondary Survey
Diagnosis
Working Diagnosis
Treatment
Resuscita*on & stabiliza*on
Disposi*on
Home, ward, mortuary
Administra*ve du*es in healthcare delivery system
Human resource, Equipments, System , Infrastructures, Finance,
Prehospital care,
 Diagnosis
A very important part in the management of
any pa*ents or cases.
A correct diagnosis will lead to beeer
treatment op*ons and outcome.
Important to have working diagnosis and
managed the pa*ent accordingly.
Some*me not easy to make a deni*ve
diagnosis on certain case
In certain cases or situa*on EM treatment
might come before a deni*ve diagnosis have
 History

Bedside Ix &
Assessment
POCT
findings
-ECG

Diagnosis
-USG
-Glucometer
-POCT options

Algorithm/ CDR Radiological Ix

Ottawa
Nexus

Lab Ix
 Principles in Emergency Medicine
Ini*al evalua*on
Triage
Primary & Secondary Survey
Diagnosis
Working Diagnosis
Treatment
Resuscita*on & stabiliza*on
Treatment
Disposi*on
Home, ward, mortuary
Administra*ve du*es in healthcare delivery system
Human resource, Equipments, System , Infrastructures, Finance, Prehospital
care,
 2. Resuscita*on & stabiliza*on
Immediate threat to Airway (A), Breathing(B), Circula*on (C),
neurologic Disability (D)
Aim: To stabilize the pts A,B,C,D
Basic resuscita*on vs Advance resuscita*on (emergency cri*cal
care)
Immediate life saving procedures
Need immediate decision and ac*on
Trauma and Non-trauma resuscita*on
Resuscita*on Team Leader
 Resuscita*on & Stabiliza*on
Intuba*on
CPR/Debrilla*on
Ven*latory process- NIV, IPPV
Hemorrhage stabiliza*on
FAST & E-FAST
Thoracocentesis
Thrombolisa*on
Emergency Surgical procedures
etc
 Treatment of non-resuscita*on
case
Treat pa*ent acute problem or presen*ng
problems
Other associated problem are treated
accordingly or refer for further treatment.
Pain allevia*on is the most common
treatment
Oxygena*on, ven*la*on and nebuliza*on
Decompression of symptoms
Reduc*on of fracture or disloca*on
 Principles in Emergency Medicine
Ini*al evalua*on
Triage
Primary & Secondary Survey
Diagnosis
Working Diagnosis
Treatment
Resuscita*on & stabiliza*on
Disposi*on
Home, ward, mortuary
Administra*ve du*es in healthcare delivery system
Human resource, Equipments, System , Infrastructures, Finance,
Prehospital care,
 Disposi*on
A process of discharging or sending the
pa*ent to another place from ED
Crucial to have proper and correct disposi*on
Wrong disposi*on can lead to fatal error.
Disposi*on to:
Admission: Ward, OT, Cri*cal Care,
Home,
Mortuary
 Disposi*on transfer process
Before disposi*on transfer we should ensure
pa*ent are adequately stabilized.
During disposi*on transfer we must ensure
that the pa*ent are op*mally monitored.
Proper hand-over to the appropriate
personally also equally important to ensure
pa*ent received op*mal con*nues care.
 Important ques*ons to be ask
Why do this pa*ent come to ED today?
Is there any life-threatening problems?
Is there any serious problems?
Have I seele this pa*ent acute problems?
Can this pa*ent be safely discharge home?
Does this pa*ent need to be seen again?
 Principles in Emergency Medicine
Ini*al evalua*on
Triage
Primary & Secondary Survey
Diagnosis
Working Diagnosis
Treatment
Resuscita*on & stabiliza*on
Disposi*on
Home, ward, mortuary
Administra*ve du*es in healthcare delivery system
Human resource, Equipments, System , Infrastructures, Finance,
Prehospital care,
 Emergency Medicine
The EPs also provide valuable clinical and administra*ve services
to the ED and other sectors of the health care delivery system.
These may include and are not limited to:

1. Pre-hospital emergency medical response
2. Out-of-hospital medical control
3. Community disaster preparedness
4. ED leadership and medical direc*on
5. Organized ED pa*ent intake process
6. Plan & approve of ED equipment and physical layout

(American College of Emergency Physicians

2008)

6. Planning for ED stang levels

7. Approval of ED policies and procedures

8. Ac*ve par*cipa*on in the ED budgetary process

9. ED sta con*nuing educa*on

10.Oversight of ED pa*ent disposi*on

11.The coordina*on of ED pa*ent care among mul*ple

providers and healthcare facili*es
 The coordination of out-of-hospital emergency
medical response
Out-of-hospital medical control system
authorization
Par*cipa*ng in community disaster preparedness
Par*cipa*ng in community disaster
preparedness
 Emergency department leadership and medical direc*on
 Patient intake process

People must be alert & ready all times

Equipment are ready and functional all times


Equipment and physical plant

Easy Access
Easy Egress
Security
Coordination patient care among multiple
providers and healthcare facilities
 Department policies and procedures
 Department policies and procedures

Dedicated area for

treatment
According to
priority
 Department policies and procedures

Asthma area
 Con*nuing sta educa*on

Training BTC, Aquatic Rescue, EMT, Mass CPR

Planning of ED staffing levels
 Emergency Medicine
It s the only popula*on-based specialty
Its has a unique prac*ce-
undieren*ated,
*me-sensi*ve illness,
high sensi*vity for any illness,
integra*ve
It is a management specialty.
Skills for every environment.
Judith E. Tin*nalli
 Thank You
Terima Kasih
Shukran
Please visit this website for questions, comments and discussion
http://padlet.com/Mael/EMedCUCMS2014