ER team managing urgent patient
Emergency medicine is a “sexy” specialty* focused on the acute care of medical and surgical conditions in patients with a vast range of illnesses and personal sense of urgency. Emergency room physicians in the Anglo-American model, which is followed in North America, the UK and former Commonwealth countries, and many developing nations, undergo formal training in emergency medicine in a hospital residency or as registrars. Less commonly, ER physicians are specialized in other fields–e.g., anesthesiology or general surgery and not permanently appointed to a particular ER/A&E.
*Recall George, the silver fox, Clooney, was an ER doc, not a rheumatologist or geriatrician
With few exceptions, patients are triaged on arrival by the ER staff as the first step towards managing their presenting complaints. Triaging, from the French trier, to sort or select, is a process attributed to Dominic Jean Larrey (1766-1842), a military surgeon in Napoleon’s Grand Armée, whose other innovations included the use of ambulances to retrieve the wounded on a battlefield and take them to a centralized field hospital, making him the de facto father of emergency medicine.
At triage (see schematic below), a patient’s condition is stratified into one of four groups:
schematic, triage priorities
Expectant/black The patient’s injuries are such* that he or she is expected to die shortly, regardless of the treatment given and the most that ER staff can offer is comfort (palliative) care. In mass disasters, expectant patients are among the last transported away from the scene.
*Examples of expectant patients are those with large third-degree burns, severe trauma, lethal doses of radiation, non-response to prolonged CPR, septic shock, non-responsive suicidal patient with stomach full of well-digested pills–e.g., acetaminophen/paracetamol
Immediate/red The goal is that the patient is seen within 10 to 15 minutes. They require immediate transport if in the field and immediate surgery or medical management*. With appropriate care, they are expected to live
*Examples of immediate care patients are those with transected arteries, internal haemorrhage, head trauma, and carotid or coronary thrombosis
Urgent/yellow The goal is that the patient is seen within 30 minutes. They require rapid transport if in the field, constant observation, and rapid treatment*.
*Examples of urgent care patients are those with flesh wounds, fractures and dislocations.
Less urgent/green The goal is that the patient is seen within 60 minutes. Transport if required, treatment* if practical and discharge ASAP.
*Examples of non-urgent patients are those with lacerations, sprains and abrasions.
This website, www.newmedicalterms.com is the front end of The Modern Medical Dictionary (MMD), a rapidly expanding database with 190,761 entries (compared to the 124,000 found in the Dorland’s Illustrated Medical Dictionary). From its inception in 1984, the MMD’s raison d’être has been to catalog terminology used in the working medical parlance–e.g., door-to-drug interval, road rash, blue light emergency services, which are rarely found in traditional medical dictionaries (TMDs), if at all.
With the able help of Kent Hummel, webmaster extraordinaire and database guru, we have begun releasing portions of the MMD. We released the first subdatabase, Medical Abbreviations and Acronyms, a compilation of nearly 20,000 abbreviations with over 100,000 translations, in May (2017). It’s free. The second subdatabase, Genes, contains succinct information on over 8,000 genes. We believe this subdatabase will prove useful to our target demographic (other physicians, medical students and advanced health professional). It’ll cost you five bucks.
Over time, the MMD will continue to spread its net and include terminology found in TMDs, but that day is two or three years in the future.
We have a very ambitious schedule of beta products in the pipeline. Check back often