Hospital Emergency Rooms: A quick guide

Try to get registration done as early as possible
Apr 25, 2019
People who have road traffic accidents, falls, workplace injuries, heart problems or are victims of violence all commonly end up going to the casualty or emergency wards of hospitals. Here are a few key things to remember while going through this experience either as a patient or as an attendant going with them. The intention of putting this information here is to make readers aware of how important it is to seek information themselves to make the best decisions in a medical emergency. Triage The first place you might come to when approaching a hospital in an emergency is the Triage Zone. This may not be a specific place in a hospital, but a process that takes place often in the outer-most area of the Emergency Room or near the ambulance area. This is where the patient’s initial evaluation takes place to determine where they should be sent next. The doctor or nurse may ask you questions like: Do you have any health problems? Are you taking any medicines? How did this emergency happen? Stay calm and give them the exact information to the best of your ability. Registration After triage it is crucial to go through registration. This is very important for a patient’s registration and medical documentation to begin. This is what will get them into the hospital system. Do not leave the patient unregistered and ask the staff to process the registration as soon as possible. This will help protect and your patient from legalities and delays. Treatment Every patient who comes to the Emergency will often receive a first check-up from a mid-level doctor (physician). Allow the nurse to put an IV line in your arm or upper surface of your hand. This will allow any medicine to be infused immediately. The nurse may also use some gadgets to monitor the vitals (like blood pressure, heartbeat) of the patient. A patient’s age and medication history and the presence of any systemic disease can affect their vitals. If the patient is a child, someone who has a psychiatric condition or is elderly, the ER visit can be more difficult. Know that the elderly are twice as likely to have more complex health conditions and poor outcomes, so it certainly helps if the attendant with them has enough knowledge about their conditions so they can be separated from the complaint with which they came to the ER in the first place. It always helps to keep a list of medication for an elderly patient. Medication & injections These are the most common reasons, but not all, that a patient is given medicine in the ER: Trauma due to violence and road traffic accidents Ischemic heart disease (cardiac arrest or angina/chest pain) Cerebrovascular disease (stroke) Respiratory illness Abdominal or stomach pain In each case, the medicine is given according to the condition. For pain, commonly anti-narcotics and sometime opioid injections are given depending on the intensity. These are medications give short-term relief from pain and may have side-effects so ask if that is the case. For simple pain, paracetamol, diclofenac or brufen can be given. If the patient is given antibiotics such Augmentin, Cefixime or Rocephin, one must be cautious as it must be assessed if the patient is allergic to them and they must be injected slowly. Generally speaking, these medicines can be given if the patient has some sort of infection. Morphine, oxygen, Nitroglycerin (a tablet under the tongue) and aspirin are common medicines given for a patient who shows symptoms of a cardiac arrest. If a patient is given expired medicine by mistake, it only means that it will be less effective. It does not mean it will be a cause of death. In some cases such as liquid antibiotics and insulin, they can be less effective if expired or not refrigerated properly. In all cases, doctors must take permission from you before giving you any treatment. However, in emergency cases, a healthcare providing person may not need consent if the patient shows mental health conditions, is severely ill or is unconscious. For the treatment of children, a physician will generally take consent from the guardian. Watch out for these hazards and red flags: Any self-prescribed injections, used injection needles, having injections administered by unregistered physician and nurses, unsealed injection liquid, fake medicine from unregistered companies among other things. Testing & diagnosis Often a patient may need further diagnostic investigations such a blood or urine test or an x-ray etc. Ask the doctor which test is required and what they are suspecting. This will help you understand the condition of the patient and why there may be a delay on sending them to another ward. Sometimes the physician will ask a consultant to come and see the patient to gain a better diagnosis from a specialist doctor. You can always ask a nurse if you would like to understand more of what is being said and decided if the doctor is unable to convey it immediately. Please keep in mind that doctors in the Emergency are generally rushed and busy. You can ask about the vitals of your patient, but try to wait and not interrupt the nurse too much as they go about tending to the patient. You may ask if the blood pressure is stable or dropping? Is the patient breathing well or shallow? Is the patient’s temperature too high or normal? Sometimes the nurse will also monitor their blood oxygen levels; if oxygen saturation is below 89%, they may put a mask on the patient’s face to help them breathe better. Discharging If the patient is allowed to be discharged to go home you must ask the physician which medicines have been prescribed and why, if at all. You can ask if there are any side-effects. You can ask if you need to bring the patient back for a follow-up. Tips: 1. If the patient has collapsed or is not conscious do not give them any food or drink. 2. The position of the patient’s head is important. The basic rule is to keep the head in a position which lets the patient breathe easily. 3. If the patient is bleeding from the mouth, lay them sidewise so they don’t choke. Try engaging with the patient until emergency care arrives. Identifying the severity and intensity of a medical emergency and stabilizing a life-threatening condition of a patient’s life demands a high level of competency skills, teamwork and focus. This is where quick and critical decisions are made by physicians in an ER. Emotional disturbances like panic, anxiety and rage are commonly expressed by a patient’s attendants. Everyone understands that taking a patient or going to the ER in an emergency is a frightening and stressful experience. But it is helpful to remember that turning violent, swearing, making threats or verbal abuse towards hospital staff or another patient, relative or staff member makes matter worse. Please note, this article provides information for general awareness and is not medical advice. Always consult a medical provider or doctor for diagnosis and treatment and before taking any medication. This information is based on the opinion of the author and is intended to motivate readers to make their own inquiries in a medical emergency so they are able to make informed decisions for themselves or the patient. This article does not provide an exhaustive list regarding medical emergencies. Dr Saad Ahmed Khan, PhD, is a clinician, public health specialist and a medical scientist.  He tweets at @drsaadkhanz

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