General Technique TO THE EMERGENCY patient
The traditional approach to affected person problems entails taking a cautious history, appearing a cautious examination and acquiring laboratory, radiological and other diagnostic effects to result in proof of a selected analysis. This technique does not paintings properly inside the emergency branch, due to the fact the on the spot hassle does now not contain reaching a particular ailment prognosis however instead influencing a final not unusual pathway of patho-physiological derangement that can be same for lots specific sicknesses. for example, breathing failure is not any different if as a result of pneumonia, or fatigue in a affected person with allergies. The emergency medical doctor must make a diagnosis if feasible and if beneficial, but the emergency team has greater critical priorities than setting up a precise diagnosis.
the primary duty is to determine which emergency affected person is maximum sick. patients must be assessed by way of someone who isn't always best professional in the popularity of significant however subtle ailments, but who additionally has the potential to keep away from becoming involved with the info of care. This assessment has become referred to as TRIAGE.
the next step is to assign the affected person to a bodily region in the branch. Emergency employees should analyze and relearn that putting the affected person in a room commonly assigned to trivial troubles does no longer suggest that the patient can't harbour extreme disease. unfortunately, as soon as a hassle is labelled as trivial, re-questioning the case in a greater critical fashion is hard. but, every member of the emergency branch need to constantly re-evaluate sufferers to gather multiple point on the curve in their contamination.
the following is an instance of a Triage Scale:
the primary duty is to determine which emergency affected person is maximum sick. patients must be assessed by way of someone who isn't always best professional in the popularity of significant however subtle ailments, but who additionally has the potential to keep away from becoming involved with the info of care. This assessment has become referred to as TRIAGE.
the next step is to assign the affected person to a bodily region in the branch. Emergency employees should analyze and relearn that putting the affected person in a room commonly assigned to trivial troubles does no longer suggest that the patient can't harbour extreme disease. unfortunately, as soon as a hassle is labelled as trivial, re-questioning the case in a greater critical fashion is hard. but, every member of the emergency branch need to constantly re-evaluate sufferers to gather multiple point on the curve in their contamination.
the following is an instance of a Triage Scale:
CATEGORY
|
DESCRIPTION
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TO BE SEEN BY DOCTOR WITHIN
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1
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Resuscitation
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Immediately
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2
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Emergency
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10 minutes
|
3
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Urgent
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30 minutes
|
4
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Semi-urgent
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60 minutes
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5
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Non-Urgent
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2 hours
|
Three components are essential for triage and identity of the existence-threatened patient.
a) a major grievance
b) A whole set of crucial signs inside the area and in the emergency department
c) An opportunity to visualise, touch, and auscultate the patient
The chief criticism, which on occasion can not be obtained immediately from the affected person however have to be acquired from family individuals and others, will help categorize the overall kind of hassle (e.g. cardiac, demanding, respiration and so on).
important signs and symptoms are the most reliable, objective facts which can be immediately to be had to emergency department employees. essential symptoms and the chief grievance, when used as triage tools, will become aware of most people of lifestyles threatened patients. it's miles important to be completely acquainted with ordinary vital signs and symptoms for all age companies. Age, underlying physical situation, scientific issues and present day medicines (e.g. beta blockers) are critical considerations in figuring out normal important signs for a affected person. as an example, a properly conditioned younger athlete who has simply sustained foremost trauma and arrives with a resting, supine pulse of 80 ought to be presumed to have large blood loss due to the fact his ordinary pulse might be in the 40-50 variety.
most pre-medical institution care systems with a level of care beyond primary shipping additionally offer therapy to patients. due to the fact this remedy generally makes effective changes to the affected person's condition, the affected person may look deceptively well on arrival in the emergency department. for instance, a 20 12 months old girl with acute onset of left lower quadrant belly pain, who's located to be cool and clammy, with a pule price of 116 and a blood strain of seventy eight palpable and who receives 1500 cc of fluid en path to the emergency branch, may additionally arrive with regular vital symptoms and no pores and skin changes. If one does no longer examine or pay attention to the paramedic's description of the affected person and the preliminary critical signs and symptoms, the presumption could be made that every one is properly.
from time to time regular critical signs aren't everyday. as an instance, a 20 year old asthmatic patient has a respiration rate of 14. An asthmatic patient who is dyspnoeic and wheezing
have to have a respiration rate of as a minimum 20-30/min. The "ordinary" breathing price of 14 on this placing suggests that the affected person is in respiration failure. that is a classic instance of in which regular isn't regular.
Visualizing, touching and auscultating helps to become aware of the danger to life i.e. is it the top airway, decrease airway or circulate? Touching the pores and skin is crucial to determine whether or not surprise is associated with vasoconstriction (hypovolaemic or cardiogenic) or with vasodilatation (septic, neurogenic or anaphylactic). Auscultation will perceive threats associated with lower airway (eg. bronchospasm, anxiety peumothorax).
In conclusion, gain the important signs and symptoms on each patient with out exception. It can't be pressured enough the want for accurate temperature willpower specifically in younger youngsters. doctors frequently neglect temperature determination in adults, ensuing in postpone in perceiving the significance of issues or in beginning suitable interventions. it's miles tough to understand why such a lot of medical doctors pay little interest to critical signs and then face the unhappy mission of seeking to explain away abnormalities that must have provided clues to the seriousness of the patient's problems. even though a patient can be seriously unwell with what seems to be normal vital signs and may not be seriously unwell with abnormalities of the identical, it's far first-rate to consider odd important signs in patients who seem ill, because modifications in crucial signs might also provide clues to worsening in a patient's condition.
a) a major grievance
b) A whole set of crucial signs inside the area and in the emergency department
c) An opportunity to visualise, touch, and auscultate the patient
The chief criticism, which on occasion can not be obtained immediately from the affected person however have to be acquired from family individuals and others, will help categorize the overall kind of hassle (e.g. cardiac, demanding, respiration and so on).
important signs and symptoms are the most reliable, objective facts which can be immediately to be had to emergency department employees. essential symptoms and the chief grievance, when used as triage tools, will become aware of most people of lifestyles threatened patients. it's miles important to be completely acquainted with ordinary vital signs and symptoms for all age companies. Age, underlying physical situation, scientific issues and present day medicines (e.g. beta blockers) are critical considerations in figuring out normal important signs for a affected person. as an example, a properly conditioned younger athlete who has simply sustained foremost trauma and arrives with a resting, supine pulse of 80 ought to be presumed to have large blood loss due to the fact his ordinary pulse might be in the 40-50 variety.
most pre-medical institution care systems with a level of care beyond primary shipping additionally offer therapy to patients. due to the fact this remedy generally makes effective changes to the affected person's condition, the affected person may look deceptively well on arrival in the emergency department. for instance, a 20 12 months old girl with acute onset of left lower quadrant belly pain, who's located to be cool and clammy, with a pule price of 116 and a blood strain of seventy eight palpable and who receives 1500 cc of fluid en path to the emergency branch, may additionally arrive with regular vital symptoms and no pores and skin changes. If one does no longer examine or pay attention to the paramedic's description of the affected person and the preliminary critical signs and symptoms, the presumption could be made that every one is properly.
from time to time regular critical signs aren't everyday. as an instance, a 20 year old asthmatic patient has a respiration rate of 14. An asthmatic patient who is dyspnoeic and wheezing
have to have a respiration rate of as a minimum 20-30/min. The "ordinary" breathing price of 14 on this placing suggests that the affected person is in respiration failure. that is a classic instance of in which regular isn't regular.
Visualizing, touching and auscultating helps to become aware of the danger to life i.e. is it the top airway, decrease airway or circulate? Touching the pores and skin is crucial to determine whether or not surprise is associated with vasoconstriction (hypovolaemic or cardiogenic) or with vasodilatation (septic, neurogenic or anaphylactic). Auscultation will perceive threats associated with lower airway (eg. bronchospasm, anxiety peumothorax).
In conclusion, gain the important signs and symptoms on each patient with out exception. It can't be pressured enough the want for accurate temperature willpower specifically in younger youngsters. doctors frequently neglect temperature determination in adults, ensuing in postpone in perceiving the significance of issues or in beginning suitable interventions. it's miles tough to understand why such a lot of medical doctors pay little interest to critical signs and then face the unhappy mission of seeking to explain away abnormalities that must have provided clues to the seriousness of the patient's problems. even though a patient can be seriously unwell with what seems to be normal vital signs and may not be seriously unwell with abnormalities of the identical, it's far first-rate to consider odd important signs in patients who seem ill, because modifications in crucial signs might also provide clues to worsening in a patient's condition.
ALLGEMEINER ANSATZ ZUM NOTFALL
AnfangsschwerpunkteDer konventionelle Ansatz für Patientenprobleme beinhaltet eine sorgfältige Geschichte, eine sorgfältige Untersuchung durchzuführen und Laboratorien, radiologische und andere diagnostische Ergebnisse zu erhalten, um zu einer bestimmten Diagnose zu führen. Dieser Ansatz funktioniert in der Notfallabteilung nicht gut, denn das unmittelbare Problem besteht nicht darin, eine spezifische Krankheitsdiagnose zu erreichen, sondern einen endgültigen gemeinsamen Weg patho-physiologischer Störung zu beeinflussen, der für viele verschiedene Krankheiten identisch sein kann. Zum Beispiel ist das Atemversagen nicht anders, wenn es durch eine Pneumonie oder eine Ermüdung bei einem Patienten mit Asthma verursacht wird. Der Notarzt sollte möglichst eine Diagnose machen und wenn nötig, aber das Notfallteam hat wichtige Prioritäten als eine präzise Diagnose.Die erste Verantwortung ist, zu bestimmen, welcher Notfallpatient am kranksten ist. Die Patienten müssen von jemandem beurteilt werden, der nicht nur in der Anerkennung von ernsthaften, sondern subtilen Erkrankungen geschult ist, sondern auch die Fähigkeit hat, sich nicht mit den Details der Pflege zu beschäftigen. Diese Bewertung wurde als TRIAGE bekannt.Der nächste Schritt ist, den Patienten einem physischen Standort innerhalb der Abteilung zuzuordnen. Notfallpersonal muss lernen und neu lernen, dass die Platzierung des Patienten in einem Raum, der gewöhnlich trivialen Problemen zugeordnet ist, bedeutet nicht, dass der Patient keine ernste Krankheit bekämpfen kann. Leider, sobald ein Problem als trivial markiert ist, ist das Überdenken des Falles in einer ernsteren Weise schwierig. Jedoch muss jedes Mitglied der Notfallabteilung ständig die Patienten neu beurteilen, um mehr als einen Punkt auf der Kurve ihrer Krankheit zu erwerben.Das folgende ist ein Beispiel für eine Triage-Skala:KATEGORIEBESCHREIBUNGZU SEHEN DURCH DOCTOR INNERHALB1ReanimationSofort2Notfall10 Minuten3Dringend30 Minuten4Halb dringend60 Minuten5Nicht dringend2 StundenFür die Triage und Identifizierung des lebensbedrohlichen Patienten sind drei Komponenten erforderlich.A) Eine HauptbeschwerdeB) Ein vollständiger Satz von Vitalzeichen im Feld und in der NotfallabteilungC) Eine Gelegenheit, den Patienten zu visualisieren, zu berühren und zu auskultierenDie Hauptbeschwerde, die man manchmal nicht direkt vom Patienten erhalten kann, sondern von Familienmitgliedern und anderen erhalten werden muss, wird dazu beitragen, die allgemeine Art des Problems (z. B. Herz, traumatisch, respiratorisch usw.) zu kategorisieren.Vitalzeichen sind die zuverlässigsten, objektiven Daten, die dem Notfallpersonal sofort zur Verfügung stehen. Vitalzeichen und die Hauptbeschwerde, wenn sie als Triage-Werkzeuge verwendet werden, werden die Mehrheit der lebensbedrohten Patienten identifizieren. Es ist wichtig, mit normalen Vitalzeichen für alle Altersgruppen völlig vertraut zu sein. Alter, zugrunde liegende körperliche Verfassung, medizinische Probleme und aktuelle Medikamente (z. B. Beta-Blocker) sind wichtige Überlegungen bei der Bestimmung normaler Vitalzeichen für einen Patienten. Zum Beispiel muss ein gut konditionierter junger Sportler, der gerade ein großes Trauma erlitten hat und mit einem ruhenden, Rückenpuls von 80 ankommt, vermutlich einen bedeutenden Blutverlust haben, weil sein normaler Puls wahrscheinlich im 40-50-Bereich liegt.Die meisten Vor-Krankenhaus-Betreuungssysteme mit einem Niveau der Pflege über den Grundtransport hinaus bieten auch Therapie für Patienten. Da diese Therapie in der Regel positive Veränderungen in den Zustand des Patienten vornimmt, kann der Patient bei der Ankunft in der Notfallabteilung treffend gut aussehen. Zum Beispiel, eine 20-jährige Frau mit akuten Beginn der linken unteren Quadranten Bauchschmerzen, die gefunden wird, um cool und clammy, mit einer Pulsrate von 116 und einem Blutdruck von 78 palpable und wer erhält 1500 cc Flüssigkeit auf dem Weg zu Die Notfallabteilung, kann mit normalen Vitalzeichen und ohne Hautveränderungen ankommen. Wenn man nicht auf die Beschreibung des Patienten und die anfänglichen Vitalzeichen des Sanitäters aufmerksam macht oder darauf achtet, könnte man vermuten, daß alles gut ist.Manchmal sind normale Vitalzeichen nicht normal. Zum Beispiel hat ein 20-jähriger asthmatischer Patient eine Atemfrequenz von 14. Ein asthmatischer Patient, der dyspnoeisch und keuchen istSollte eine Atemfrequenz von mindestens 20-30 / min haben. Die "normale" Atemfrequenz von 14 in dieser Einstellung zeigt an, dass der Patient in Atemnot ist. Dies ist ein klassisches Beispiel dafür wo normal normal ist.Visualisierung, Berührung und Auskultivierung hilft, die Bedrohung des Lebens zu identifizieren, d.h. ist es die obere Atemwege, die untere Atemwege oder die Zirkulation? Berührung der Haut ist wichtig zu bestimmen, ob Schock mit Vasokonstriktion (hypovolämische oder kardiogene) oder mit Vasodilatation (septisch, neurogene oder anaphylaktische) assoziiert ist. Auskultation identifiziert Bedrohungen, die mit dem unteren Atemweg verbunden sind (z. B. Bronchospasmus, Spannung peumothorax).Abschließend, erhalten Sie die Vitalzeichen für jeden Patienten ohne Ausnahme. Es kann nicht genug betont werden die Notwendigkeit für eine genaue Temperaturbestimmung vor allem bei kleinen Kindern. Ärzte oft übersehen Temperaturbestimmung bei Erwachsenen
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