When was the first emergency room


Now it is time! What you previously only knew from television has now become your reality. You are the master of the "Emergency Room"! This is a welcome challenge, but it can also create a few anxieties. Of course you have to have the medicine on it. So that you can concentrate fully on the problems of your patients, I would like to give you a few tips here so that your work goes smoothly and you become part of the emergency room team.

"And where were the crushing bowls again?"

1. Form and lead a team

An emergency room can only be managed together. No matter how big it is. You work there with at least one caregiver and they usually have a few years of experience. You are probably the one who is supposed to run this shop now, but you are well advised to seek advice from the nurses or medical colleagues trained here. Ask about the usual work processes and which “route” the patient takes from the emergency room to the ward.
But even if you are the beginner, you may also be the only doctor and that means that the responsibility lies with you. If you take advice from the nurses, it's still your decision to stand by, even if it was the wrong one. But you have to make decisions, because that's your job now.
In this way you will also earn the respect of your colleagues.

2. Look for orientation

On the first day (or better before) you should have all the rooms and, above all, the contents of the cupboards shown to you. If you think now: "What I need, the nurses will get me when I need it", then I unfortunately have to tell you that there are times when you are alone and then you are happy when You can find your way around.
Inquire about the special and emergencies that require specific management. What do you do if you suspect a heart attack or an announced multiple trauma?
There are often defined processes that you should be familiar with.

So better ask yourself beforehand ...

A colleague of mine was confronted with a multiple trauma on duty alone at night and just worked as he was used to. First examine everything, take x-rays and then call the senior physician with the finished diagnosis. He had kept the ambulance there for support. What he did not know and then learned from the senior physician was: "If you are informed of a multiple trauma, you must immediately call your senior physician into the house, inform the anesthetist, the CT, the laboratory, the intensive care unit and the surgical team who are then all go to the emergency room! "
Fortunately, it wasn't really a multiple trauma, but no one had explained this pattern to my colleague beforehand. So better ask yourself beforehand about these and similar emergencies and their special management!

3. Organize work processes

But even the small work processes can be a big hurdle at the beginning. You should clarify the following and similar questions beforehand: How is an X-ray examination arranged? How does the patient get to the X-ray department? Do I do ultrasound examinations myself or do my colleagues from radiology do it? Where is the Sono device anyway? How does it work? Where do I enter the findings? How do I arrange laboratory results? How does the blood get into the laboratory? And much more...

You see, it no longer has so much to do with medicine, but with good organization. The freestyle comes when the famous "bus" has pulled up in front of the emergency room and has brought you a double-digit number of patients. Now it is a matter of organizing the individual work processes in such a way that everything is done as quickly as possible. If you simply examine each patient one after the other, take a blood sample, wait for the result, then take an X-ray and wait for the results and finally maybe add an ultrasound examination and then turn to the next patient again, it will take a long time You left the emergency room empty.

Always think about what will take a long time and how can I fill any waiting times sensibly. Ask the receiving nurses what the individual patients are complaining about and then sort the patients in a meaningful order. Real emergencies and children in pain always have priority, of course. Afterwards, you can, for example, briefly examine all patients who are suspected of having a fracture and then arrange for the necessary X-rays. While they are busy, you look at the patient with abdominal pain and take blood. While you are waiting for the laboratory values, you send him for an ultrasound examination and sew the patient with the cut. While the nurse is putting on a bandage here, you write the doctor's letter and look at the first x-rays that come back. You now have a plaster cast applied to one patient, while the other is given a bandage and you write the doctor's letters. And so on ...

Always think about what only you can do and what the nursing staff can do. Then hand in these tasks so that you can do everything that comes up together as a team. It makes little sense if you do everything and the nurse is bored while the patients wait in the waiting room. Perhaps the nurses may also take blood from you.
But don't be too bad if the nurses have their hands full because they have to tame a drunk, and quickly bring the blood to the laboratory yourself or help them. So at the end of your work you can proudly look back on what you have mastered together as a team.

4. Understand the patient's fears and ignorance

While the colleagues in the "Emergency Room" on TV almost always have to deal with real emergencies, you will meet many patients in your emergency room where you seriously ask yourself why they come to you in the first place.
Keep this question to yourself and approach them with understanding for their fears. So you start your careful examination (which doesn't always have to include an X-ray if you can't find any evidence of a possible fracture) and then try to relieve the patient of their fears.

After all, only you are the doctor and a layperson can be very worried about even the smallest problems.

Explanations are better here ...

A typical example are parents who come to the emergency room with their children, including their grandparents or neighbors. Then just go to the examination room with the parents and the child and show a lot of commitment and care.
You then experience strange things, such as the young mother who came to us with her toddler. She sat down and the child scurried happily through the examination room. It laughed and ran from one corner to the next. It tried to open cupboards and babbled to itself. So I asked what the reason for your visit was.

"The little one fell off the sofa and immediately screamed - about five minutes!" Replied the mother. I thought perfect (and of course didn't say it). She then described the height of the sofa as about 30 cm and you are worried that something could be broken or there was a concussion. So I examined the child.
A small bump on the forehead, otherwise apparently no pain when I knocked on the head (next to the bump!). The pupils reacted properly on both sides and, with the best will in the world, I could not see any restriction in the movement of the locomotor system. The child could not tell me about pain, but it would certainly not “heat” the examination room like that.
And I could also rule out nausea, since the child was now suckling on a bottle.

Now it was a matter of convincing the mother and it doesn't help at all if you downplay your fears or ask why she came to the hospital for "something like that" in the first place. Explanations that make parents feel like they are being taken seriously are better here.
In such cases I usually start with the sentence: “Well, here I can take your worries away!” And then I explain understandingly why nothing can be broken and there can be no concussion, since the child screamed immediately! People with a real concussion are at least briefly unconscious. Then I explain that she can of course come back at any time if the child starts to vomit or becomes cloudy, so that she knows that you are still there for her.
And then you often hear: "I actually didn't want to come either, but my neighbor said ..."

(Inexperienced) parents constantly have the feeling that they are doing something wrong with their child and if the environment also stirs up these doubts, they are quickly in the hospital, because they do not want to be "bad parents" either. Many then also lack the experienced grandmother who takes these worries away and can assess the whole thing a little better. Now you have to be that grandma and help the parents come to terms with these and similar situations.

5. Just think logically and improvise

And where we are right now with logical thinking. This is also required of you here. You can also outgrow yourself a little, because not everything is in the textbooks.
Life still has a few surprises in store for you. And then you can improvise sometimes ...

that's not in any textbook ...

One day a mother came very excited with a toddler who had pushed a “fries” into its right nostril. The pediatrician had already tried unsuccessfully to remove them, so he sent them both to the hospital. The fact that I was only an assistant doctor in training to become a surgeon and not an ENT doctor probably didn't matter to anyone involved, because I was supposed to help now.
What can I say, the "fries" were deep and had already been canceled by the pediatrician. In addition, it was so softened by all the slime that I could only grab small chunks with the tweezers. To make matters worse, the child screamed incessantly and struggled as best he could. The screaming was only interrupted by the child's gasping, hasty inhalation. Then the idea came to me: at the end of the next breath I closed the child's second nostril and mouth and when he wanted to scream again, the “french fries” were squeezed out of the nose in a high arc and flew straight into the sister's face! The patient was cured and the mother was overjoyed, which I couldn't necessarily say about the sister ...

6. Little wisdom from surgery

And here's a little tip in case you work in the surgical emergency room. Then it will often be part of your tasks to examine x-rays and decide whether something is broken or not or whether a patient may even have to be admitted to the hospital. As they say in law: “In case of doubt, for the accused”.
Before you have your specialist title, the following applies: “In case of doubt, for the admission or the plaster cast”.
If you are not sure, both can be justified with the severe pain, which can be treated better in an inpatient setting or, even in the case of a sprain, can be resolved more quickly through consistent immobilization. I have never seen a senior or chief physician complain about it. You can also explain to the patient that it is used to relieve pain and that a specialist will look at everything again on the next day at the latest during the visit or the plaster cast check.

If a patient rejects the admission or the plaster cast, then you get him to sign it and he acts on his own responsibility, even though you have described the risks to him. In particular, if you are assigned a patient by a resident specialist with a referral certificate, you should insist on admission and only let the patient go with a signature and after detailed explanation. Find out more in the chapter "Good patient education"
Finally, a specialist was of the opinion that inpatient treatment was necessary. As a “not” specialist, it is better to obey this in order not to expose yourself to reproaches later.

“There has to be order! Because after the game is before the game! "

So have fun as the master of the "Emergency Room"! Also think of the tips about the first ward, etc., which you can also use here in the emergency room.

Your dr. Felix Resourceful