Welcome to the Accident and Emergency Department, also called the Casualty unit.
So what happens in an Emergency department?
Meet our Patient:
Mr. X, a 21-year-old man who just sustained a gunshot wound to his left leg. The story according to an eyewitness was that the victim had a heated argument with some guys at a local pub and after being dismissed by the patron of the pub, one of the guys allegedly shot him in a nearby alley. The gunman with his fellow conspirators immediately absconded, leaving Mr. X in a pool of blood.
A random stranger was kind enough to contact the services of the Emergency department.
The Emergency Medical dispatch team is quickly mobilized and off they go.
15 minutes later, the sound of the siren is heard as the Ambulance arrives.
The scuffling of feet as nurses and orderlies rush to bring in the semiconscious patient on a stretcher.
The alertness of the Doctor-in-charge and every other member of the team as the Patient is brought into the resuscitation room.
Like in any Emergency setting, the ABC rule is applied:
A- Secure the Patient’s Airway
B- Check for adequate Breathing
C- Monitor the Circulation status
All hands are on deck, and every second counts. Based on the suspected amount of blood loss from the patient, it’s only a thin line between life and death. Will the patient survive or not?
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I happened to resume in the department on no other day than my birthday, the 15th of December. I had mixed feelings that morning because I didn’t really know what to expect. Thankfully the day went well and I was able to have a nice time with a couple of friends later that evening.
My first lesson in A&E: Every case in the Emergency room is a matter of TRIAGE. We had different color-coded Admission cards to put patients into groups based on the apparent priority of their presenting complaints.
RED CARDS: Emergent life/limb threatening conditions such as Major Trauma (MVA, Gunshot wounds etc), Myocardial Infarction, Significant Burn Injuries, Severe Respiratory Distress etc
BLUE CARDS: Urgent but relatively non-life threatening conditions such as Abdominal pain, Lacerations, Acute Asthma attacks etc
YELLOW CARDS: Non-life threatening conditions such as Chronic headache, cold symptoms, minor cuts etc
I can understand the frustration of some patients who complain that they do not get attended to at the Emergency unit on time. The Emergency unit where I worked has a written policy that all non-emergent cases would only be attended to after 4 p.m. on weekdays at the discretion of the Emergency unit staff. Some patients actually leave in anger after waiting endlessly.
Many factors come to mind; the department somewhat doesn’t seem to have sufficient hands, so it takes a considerable amount of time for a nurse to be available to assess a patient, and much more for the doctor to examine such.
Each patient is attended to in the unit as the case demands. Some patients require intensive work-up including labs, X-rays, EKG or even emergency surgical consult. Other patients only require the doctor’s reassurance and can follow-up in the outpatient setting. A number of patients are transferred to other departments (e.g. Surgical Ward) for inpatient management while others are treated and discharged accordingly.
That said, not much happened during the early part of the day at the Emergency department where I worked. Most of the trauma cases presented from late afternoon till evening, so I missed out on some interesting cases.
Nevertheless, we had a good number of stab injuries, asthma exacerbations, some trauma cases, burn injuries, and lots of acute pain presentations.
I recall the funny incident of a patient who came with “fish-bone” stuck to her throat. She was a pleasant-looking elderly woman and just wanted to get the bone out of the way. It took the Doctor attending to her some effort but she succeeded, and the woman was so relieved. She kept thanking and blessing us with her prayers.
It was in A and E unit I began to get a good hang of the History taking and Physical examination, as well as the attempt to draw blood samples from patients.
I really did more of watching and learning from the variety of Doctors that worked in the unit.
PS: New Year’s Eve was unexpectedly calm. No one seemed to want to spend the last day of the year in the casualty unit.
My Preceptor, Dr. Adams, a humorous but goal-oriented personality, taught us the importance of inspiring confidence in each patient that presents. He also emphasized on the need for efficiency as the unit demanded being kept on one’s toes. He was the first doctor to actually drill my presentation skills. He expected his students to be apt and concise at all times.
In conclusion, the Emergency unit is a WORLD of its own. Anyone willing to work there must have an inner sense of peace despite the craziness and uncertainty each case might bring. As for me, I wouldn’t even dare.
Here’s to all the brave ER doctors and staff, keep doing what you know how to do best…xoxo!
Thank you for reading!