MN Healthcare News May 2016

Page 10


Emergency department care James R. Miner, MD, FACEP Dr. Miner is chief of the Department of Emergency Medicine at Hennepin County Medical Center (HCMC) and professor of Emergency Medicine at the University of Minnesota. What are the most common reasons people go to the emergency department (ED)? Generally, it’s because something about their health has changed suddenly and they don’t know why. The three most common causes are chest pain, back pain, and headache. These are followed closely by trauma, which can range from minor falls and abrasions to major car accidents. What factors affect volume? The two big determinants are time of year and weather. In Minnesota, we see a huge increase in the summer, starting the first weekend in April that’s over 70 degrees, peaking the weekend closest to July 4th, and then starting to slow down after the first fall frost. The other busy time is the six weeks of flu season, which is usually around January. Busy holidays include St. Patrick’s Day, Memorial Day weekend, July 4th, Labor Day weekend, Halloween, and New Year’s Eve. Other holidays, like Christmas and Thanksgiving, tend to be pretty slow. As it gets hotter, we also get busier, and the bigger the change, the larger the increase. This is true whether the temperature is going from 0 to 30 degrees, or from 60 to 90 degrees. Volumes decrease when it gets colder, unless we have icy roads at rush hour. How does emergency training differ from other medical specialties? Emergency physicians complete a three- or four-year residency after medical school, focusing specifically on emergency patient care. This includes resuscitation of cardiac arrest, stabilization of critically ill and injured patients, and evaluation of acute and unstable conditions. The training is very rigorous and challenging, but ensures the broad skill set necessary to address any imaginable emergency. Specific skills include endotracheal intubation, wound repair, fracture management, and vascular access. Far more difficult, however, is developing the decision-making



skills necessary to make the best decisions possible despite the limited information and time available during emergencies. Resident physicians develop these skills alongside experienced emergency physicians, and their responsibilities gradually increase as they develop technical and decision-making skills. What other kinds of professionals are involved? The ED requires many skilled professionals. Firstline paramedics are specifically trained in the rescue and initial stabilization necessary to transport patients with emergencies, and work closely with the emergency medical services director to develop protocols for pre-hospital care. The largest single group of professionals are the emergency nurses, who are generally very experienced in critical care skills. Emergency physicians are trained to take care of any medical condition the moment the patient arrives, but complex medical conditions require specialized medical care. As emergency physicians stabilize and diagnose the patient, they also determine whether the patient will require specialized care, and assess how to get them to that care at the right time. Trauma surgeons are usually in the hospital or close by. Sometimes they are called to the bedside even before the patient arrives, if we know that the patient is injured badly. Interventional cardiologists and cardiac catheterization lab teams—usually in the hospital or close by— can be called when paramedics see the first EKG and recognize a heart attack. Neurologists are also in the hospital or close by to treat stroke patients, who, like heart attack patients, are treated more often in the ED than they were a decade ago. Other surgical specialists, such as orthopedic surgeons; ear, nose, and throat surgeons; oral surgeons; urologists; Ob/Gyn physicians; cardiothoracic surgeons; and neurosurgeons are frequently called to provide expert care. Emergency physicians interact most with the radiologist, who interprets images performed during the diagnostic evaluation of emergency patients and works with them to determine a patient’s diagnosis. The radiologist is a critical part of emergency care. Patients rarely get to meet them (unless they need treatment from an interventional radiologist) but as many as 50 percent of patients require a test that they interpret.

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