View Full Version : Emergency Room Procedure

01-15-2007, 06:39 AM
Suppose a patient arrives at an emergency room via ambulance from the scene of a car wreck. They are unconscious and have lost a lot of blood through a laceration on the forehead. Paramedics have already verified a pulse (irregular) and the patient is still breathing.

What should the doctor do?

01-15-2007, 06:57 AM
Check to see if they have insurance.

September skies
01-15-2007, 07:05 AM
stop the bleeding would be number one -- the patient would come in wearing a cervical collar (neck brace) and would be on a backboard -- precautionary measures to avoid paralyzing the person. With the irregular pulse, they would probably connect him to a heart monitor to keep an eye on the pulse. He would already have either lactated Ringers solution going or D5W -- if bleeding is under control. Lactated Ringers solution if the individual has lost a lot of blood and needs fluid replacement.
Other than that, they would probably just send him in for a CAT scan and other xrays, once that is cleared, they remove the brace and board -- if he has had a concussion, they admit the person overnight for observation (and most likely even without since the person is unconscious)

01-15-2007, 07:10 AM
The Mneumonic is ABC

Airway (open airway)
Breathing (see if breathing, give puff if no breath)
Check pulse (begin cpr if no pulse)

Once that's handled, stop any bleeding, splint bones, etc.

All stages are to be aware of possible spine injury.

01-15-2007, 07:34 AM
Thank you, September skies, that sounds like exactly what I needed to know.

Thanks also to Greg, the paramedics in my story will take care of that as soon as they arrive on the scene of the accident.

01-15-2007, 08:10 AM
I agree with the other posters but add that, if the person is truly unconscious (google Glasgow Coma Scale/Score), unable to respond to commands, the paramedics usually intubate the trachea with an endotracheal tube to secure the airway. If the person awakens in the ED, the tube can be removed. GCS of < 8 usually gets a tube at the scene.

ETA: The AVPU score is also common: Awake, responds to Verbal stimulus, responds only to Pain, Unresponsive. AVPU of P or U gets a tube most times.

01-15-2007, 08:25 AM
first responders will administer oxygen as soon as they can. Though they won't wait for teh tanks to do CPR if needed.

I dont know or remember the exact protocol for Paramedics but they may hook up an intravenous to put some fluids back in tocompensate for blood loss. EMT's don't do IV's. At least they didn't. That may be changing.

Probably one of the things the doc will do once the patient is examined and considered stable might be to do an head xray or cat scan or something given a big gash on teh forehead. Patient is breathing and has a pulse and is unconscious, then it might be a head injury, concussion, etc.

01-15-2007, 08:35 AM
PM me if you have specific questions. I do this for a living.

01-15-2007, 09:37 AM
Thanks everyone, thanks to your input, I've finished the scene in question.

Now, another question related to medicine, for the same story: is there a special web directory that doctors can use to track down information on rare or possibly unprecedented medical conditions? I know there are several resources like this available to physicians with specializations (for instance, treating AIDS patients) but I can't find any information on a network like this for obscure diseases.

Is there some repository for all medicine related journal articles online that a physician would have access to?

01-15-2007, 07:24 PM
The old grand-daddy is National Library of Medicine (http://www.nlm.nih.gov). It's a great site and is available to anyone. Each journal also generally has its own website and many of these link to others. These days most of us just use Google.

ETA: You can tell the how old NLM is: the name of its search engine, which actually pre-dates the web, is Grateful Med. I don't know if Jerry Garcia ever got any money out of that.