common situations encountered in emergency room

[vintageRXL]

hi guys, just wanna ask what are the most common situations encountered in the ER, and usual management of these situations including drugs.. I am graduating this year and Im tryin to learn as much as i can especially in the ER. I find ER interesting cause youll never know what youre gonna get.. also how do you manage your charting in ER.. Im guessing, charting is done after the patient is stabilized.. i would appreciate your replies very much... thanks...

[Susie2310]

As other posters have said, you should invest in either a pocket resource or text to get the information that you need as there is far too much information to impart here. But I think that most nurses would agree there some presentations that are more common than others, the thing you need to remember is that we are in the business of ruling out life-threatening diagnoses a good deal of the time, rather than actually making a diagnosis, a substantial amount of patients go home knowing what they don't have, rather than what they do have. So, in critical cases, the idea is to rule out obvious causes (from a physicians point of view).

RESUSCITATION/CARDIAC ARREST = The four H's and the four T's. Identify correctible causes.

Hypo / hyperthermia

Hypo / hyperkalaemia

Hypoxia

Hypotension

Tension Pneumothorax

Thrombus (PE)

Toxins

Tamponade.

Common ED presentations that may evolve to the above problems.

Gastrointestinal: Abdo pain + or - vomiting / diahrroea / haematemesis / malena.

Gynaecological: PV bleeding and lower abdo pain.

Cardiovascular: Chest pain, ischaemic limbs and syncope amongst other things.

Trauma - any kind.

Neurological: ALOC, suspicious headaches, seizures, CVA.

Toxins: Usually prescription medication or illicit drugs.

Potential airway compromise (even from a boring sore throat).

Septicaemia.

Respiratory compromise- asthma, COPD etc.

Psychiatric presentations, from deliberate self-harm to florid psychosis.

Emergency medicine focuses on ruling out life-threatening illness and identifying diseases in early stages to intervene. Chest pain is the bane of my existence. Get that TNI and a reassuring ECG as soon as possible. Abdo pain, especially non-specific abdo pain, annoying and often nothing to worry about. Elderly people are always sicker than you think they are and young people compensate well when they are really sick so their numbers don't reflect it. Generally the patients who look sick, are. Most of the time we can establish fairly quickly whether to worry or not. The trick is to rule out the big stuff first, and often the look and vital signs of a patient will determine this early in the piece. ABC PAIN. In the meantime, we treat the symptoms. A pocket guide will often list off the common causes of most presenting complaints and the routine investigations necessary. The important thing to remember is that although we expend huge resources ruling out illnesses that turn out to be nothing, every once in a while, that 28 year old man who suffered epigastric pain while doing his situps after lunch, will have an aortic dissection and if we didn't do that chest xray he would be dead. Grab an ED medicine guide and start reading!

Thank you for a very helpful post.

[nurse2033, MSN, RN]

Yeah, prepare for everything and be ready for anything. You can't possibly answer such a general question with a specific answer.