Emergency Medicine - Patient Assessment and Management

Introduction:

Acute illnesses, injuries, and other health emergencies occur almost on a daily basis throughout the world. People of all ages (children and adults) are affected alike. Emergency medical services attend to emergencies such as major injuries and infections, strokes and heart attacks, and acute complications of chronic health conditions. The initial assessment of acutely ill or injured patients involves identifying the life-threatening problems on first contact with the patient. Quick medical treatment and management can help save lives if a grave injury or condition is identified. It is vital to carry out the initial assessments systematically and logically. Initial assessments by the emergency personnel also help to detect problems that can become life-threatening if neglected.

What Are the Major Life-Threatening Problems in Health Emergencies?

The potential life-threatening conditions can be caused by medical issues, infection, or injury. In some cases, the diagnosis is known, while others need intervention before the diagnosis due to the acuity of the condition. The most common potential life-threatening presentations that require immediate medical management include:

1. Difficulty in breathing.

2. Severe trauma.

3. Loss of blood due to severe bleeding.

4. Shock.

5. Altered mental status.

6. Severe pain with unknown cause.

7. Chest discomfort.

8. Poisoning, bites, and stings.

9. Pregnancy complications.

What Is the ABCDE Approach?

To effectively manage health emergencies, quick interventions are to be initiated based on the signs and symptoms presented by the patient. The ABCDE approach is the systematic approach followed to assess the patients and initiate interventions for life threats rapidly. The approach must be performed in the first five minutes of first contact with the patient and must be repeated if the patient's condition worsens. It ensures that the patient has a clear airway and can breathe. It aims to maintain adequate blood flow through the body (circulation) to provide sufficient oxygen to all parts of the body, including the brain and heart. The ABCDE approach is a step-wise approach designed to ensure that all life threats are identified and treated in the order of priority. The key elements of the ABCDE approach are:

1. A - Airway: The emergency personnel checks for and corrects any obstruction to air movement into the lungs. The goal is to ensure the patient's airway is clear. Endotracheal tube (airway) tube insertion, administration of oxygen, and other life-saving procedures are performed to keep the airway patent.

2. B - Breathing: The emergency personnel assess the patient’s breathing and identify the issues in spontaneous breathing, breathing rate, and other signs of pathology and address it immediately. They ensure that there is an adequate movement of air into the patient's lungs. They promptly assess the warning signs of serious life-threatening illnesses and initiate corrective measures (including immediate ventilator support if needed).

3. C - Circulation: The patient’s condition is evaluated to see if the blood flow is adequate and oxygen is supplied to all body parts. Issues in blood circulation in the body, such as blood volume, cardiac output, and bleeding problems, are assessed and identified. The patient's consciousness level, skin color, and irregularities in pulse indicate the issues in circulation. If a person has low blood pressure, rapid pulse, and heart rate, it could indicate major blood loss. As active bleeding is a major contributor to death, immediate measures are initiated to stop the bleeding. Thus, simple steps, when done on time, such as bleeding control, and fluid resuscitation, can help save lives.

4. D - Disabilities: The goal is to assess and protect spine and brain function. A rapid neurologic evaluation (Glasgow coma score - GCS) establishes a patient's consciousness level. The patients are checked for the presence of other disabilities, and prompt measures are initiated to stop their progress.

5. E - Environment or Exposure: The signs of concern on or around the patient (environmental threats) have to be promptly identified and managed. For example, warm blankets or a warming device can be used to restore temperature if the patient’s body temperature is below normal. The entire body is examined for hidden rashes, injuries, serious allergies, or bites.

How Is Patient History Gathered in Case of Emergencies?

The standard way of gathering the key history of the patient regarding the illness or injuries is using the SAMPLE approach. The sources of information include the injured or ill person and their family members. In addition, information can be obtained from bystanders or previous doctors. The elements of the SAMPLE approach include:

1. Signs and symptoms of the health emergency.

2. Allergies that the patient might have.

3. Medications that the patient is routinely taking.

4. Patient's medical history, including chronic conditions and surgeries.

5. Last oral intake of food and liquid.

6. Events surrounding the illness or injury.

What Are the Key Life-Saving Interventions During the Initial Assessment?

Life-saving measures and interventions must be immediately initiated to ensure the patient's survival. The important life-saving interventions include the following:

1. In case of unconsciousness or suspected spine injury, the head and neck have to be immediately stabilized, and cervical immobilization has to be performed.

2. The patient is positioned appropriately depending on the type of medical problem or injury.

3. In case of airway obstruction, the airway is kept open (oro- or nasopharyngeal airway insertion), and cardiopulmonary resuscitation is also done when required.

4. Airway maneuvers like head tilt, chin lift, and jaw thrust are performed.

5. In case of breathing difficulties, measures are taken to rescue breathing, and supplemental oxygen is provided. Bag-valve-mask ventilation, chest compressions, and cardiopulmonary resuscitation protocols rescue breathing.

6. In case of cardiac arrest, relevant cardiopulmonary resuscitation protocols are performed.

7. Advanced life support, defibrillation, and endotracheal intubation are provided wherever required.

8. Measures are taken to control and stabilize bleeding, and fluid resuscitation is initiated.

9. Appropriate emergency medications can be administered to save lives.

10. In cases of disabilities like fractures or paralysis, interventions, like splinting of bone fractures and spinal immobilization, are performed.

11. Patients with acute illness have difficulty regulating body temperature. If the patient’s temperature is below normal, a warming device is used to restore the temperature, as it can be potentially life-threatening.

12. Monitoring blood glucose levels and glucose administration.

13. Monitoring the patient’s vital signs (pulse, respiration, blood pressure, pupils and skin color, and temperature) and appropriate interventions to stabilize the patient.

14. Wound management.

Conclusion:

A systematical and logistic approach to health emergencies ensures that all the life threats are identified and treated in the order of priority. The initial assessment and management of patients in health emergencies using the ABCDE approach improves survival. It helps determine the severity of the injury or illness and aims to manage the patient in step-by-step manner. In case of health emergencies, quick assessment and prompt interventions can save lives.