Emergency Medicine

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Emergency Medicine Essay

The History of Emergency Medicine

The history of Emergency Medicine is an inexact study. The actual beginning date is unknown. This paper attempts to combine the facts given from many different sources into one single overview of known history from approximate known dates.
It should also be stated that although Emergency Medicine Services, as a system exists all over the United States, it is in no way uniform. The laws governing emergency medical personnel and their actions differ greatly from state to state. This paper, when stating current Emergency Medicine Services conditions, will be referring to California for the most part.Emergency Medicine Essay

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Starting in the early 1960’s, many states passed legislation that protected individuals who stopped to…show more content…
The goal of the Department of Transportation was to package all the information gained from military experience of medical care in the field into a system able to be used in the private sector. This system must be able to train personnel who could provide field intervention medicine, or technical intervention that quickly turned near death victims into surviving patients (Department of Transportation, I-8). In 1967 one of the first such systems was set up in Pittsburgh. “Unemployables” of the black ghetto were trained in basic life support for pre-hospital, ambulance use. For these individuals, who were not accustomed to the medical profession, the world of emergency care was a shock. Special stresses and constraints existed when rendering CPR in a crowded restaurant, childbirth in a city park, or patient care through the window of a wrecked automobile (Caroline, ix). In California the Wedworth-Townsend Paramedic Act, passed in 1970, it provided permission for certain counties to establish experimental programs to test the use of Paramedics for emergency care in the field. It not only established advanced life support as the scope of practice for Paramedics, but also introduced the idea of a MICN. A Mobile Intensive Care Nurse, or MICN, is a registered nurse licensed by the county health department to provide emergency medical care or to give instructions. Emergency Medicine Essay

Emergency room physicians are on the front lines in a crisis, caring for everyone from trauma victims to sick kids. An ability to think quickly and care for a wide variety of patients makes them valuable assets at every hospital. It also brings some perks. When sudden illness or acute injury strikes, patients turn to hospital emergency rooms for immediate medical assistance. An ER doctor, or emergency medicine specialist, is a physician who diagnoses and treats illnesses and injuries in a hospital emergency room or other urgent care setting. Emergency medicine is a financially rewarding career, and it also comes with the reward of saving lives. ER doctors require intensive training to know how to shoulder their intensive responsibilities.
To qualify for Medical school you have to complete all the pre-med classes(How to Become an ER Doctor). You have to complete one year of a biology class with a lab(How to Become an ER Doctor). Biology classes vary a lot. You can take courses such as plant biology, ecology, and on infectious disease(How to Become an ER Doctor). You also have to take a general chemistry class with lab and an organic chemistry with a lab(How to Become an ER Doctor). The difference between them is that organic chemistry has to do with the environment and general can be any chemistry course. You also have to complete a physicist’s class(How to Become an ER Doctor). The last class you have to complete is en English class(How to Become an ER Doctor). After completing your four years at an under graduate collage then you have to qualify for medical school(How to Become an ER Doctor). To even be considered competitive you have to have at least an A average and get at least 35 out of 45 the average score is only a thirty(How to Become an ER Doctor). If you get into a medical school like at the same place you were to complete your under graduate classes then you won’t have that much of a change, but if you want to change school then it will be a bigger change. If you were to go to Stanford, which is one of the most prestigious university’s in America, then you would have a better chance at getting into a residency program. Emergency Medicine Essay

Everyone dreads getting injured. When someone injures himself or is not feeling well, he goes to the emergency room (ER). While in tremendous pain, he is caught up in the chaos of the ER where he must wait, sometimes for hours, for an emergency physician. Emergency physicians try their best to help patients feel better, ordering numerous tests that help them determine what’s wrong. Eventually, patients all leave the hospital, feeling much better than when they came. Emergency Physicians provide primary care to a host of patients entering hospital ERs with illnesses and injuries covering a broad spectrum, from acute infections to life-threatening conditions.
In order to become an emergency physician, one begins by getting an undergraduate degree from an accredited college (“Emergency Room Physician Salary”). During college, most people major in either biology or chemistry, but it is not necessary for students to follow a pre-medical course of study in college. Nevertheless, students will need to take all the required sciences, including organic and inorganic chemistry, biology, microbiology, and anatomy. Another requirement for entering medical school is taking the MCAT, which students often take during their third year of undergraduate study (“Emergency Room Doctors”).
Only a fraction of the tens of thousands of applicants who apply to American medical schools are accepted. In addition to academics, medical schools are looking for people that are diverse and well rounded. The first two years of medical school are devoted to classroom and laboratory work. Students study more science while taking classes in psychology, medical ethics, and law.Emergency Medicine Essay

This post is based on one of the most interesting articles I have ever read in EM. The article written by Dr. Peter Rosen in 1979 and published in The Journal of the American College of Emergency Physicians (later become Annals of Emergency Medicine) is a landmark piece. It defines the specialty with so much precision that even contemporary authors find very little discrepancy of what Dr. Rosen wrote and the state of EM in present time.

There is a very clear opinion of what Dr. Rosen believed the unique biology of EM should be. He explains the birth of EM, which was not validated by other specialties in the house of medicine. It was more a reaction from multiple factors, which included financial incentives, growth of urban centers, need of a doctor in a geographic region, and the decreased numbers of physicians house calls.Emergency Medicine Essay

One of my favorite sections in the article is when he writes “Defining The Specialty.” He states that the responsibilities of the emergency physician (EP) entails differentiating the sick from the non-sick patient, handling multiple patients at the same time, and instituting life/limb saving interventions. He uses the analogy of a climber who for whatever reason has fallen from a precipice and the job of the EP is to get the climber to a much safer place as possible, assuming 100% safety is not attainable.

Interesting enough, he also states that prehospital care should also be managed by the EP. This is an aspect of EM in which EPs are more directly involved. In Dr. Rosen’s opinion, the hardest task of an EP is sending home a patient with a potentially life-threatening diagnosis when the patient presents with nonspecific signs or symptoms.Emergency Medicine Essay

I have worked with some amazing clinicians, and their diagnostic skills are impressively accurate. They arrive at the correct diagnosis with very little information due to the patient’s altered mental status, his/her being a poor historian, or even how atypical the disease is presenting.
In the essay, he states that stabilization takes priority over diagnosis. This contrasts medical school teachings where the emphasis of education is on primary care. Consequently, the priority is to take a history, do a physical exam, and then treat the patient– in that order.Emergency Medicine Essay

This statement reminds me of a web search that I did last year on how to think like an EP. I came across Dr. Reuben Strayer’s (@emupdates) 30-minute video “How to Think Like an Emergency Physician” delineating how an EP should go about seeing patients in the ED. I think this is what Dr. Rosen envisioned the specialty should focus on. Treat the patient first when indicated, and then do a history and physical.
The hardest thing to teach residents, according to Dr. Rosen, is to “assume the worst even if statistically improbable”. I believe that Dr. Amal Mattu (@amalmattu) refers to this as a “healthy paranoia”. This means that we still need to rule out life threatening diagnoses for seemingly non-emergent patients. We must also have enough knowledge of NON-life threatening diagnoses in order to address these in the ED, if possible. If we feel confident that the patient has no life threatening diagnoses and can be discharged the patient home, then we should ensure appropriate follow up.

In tomorrow’s post (part 2), we will look at how Dr. Rosen categorized ED patient visits and his views on EM administration and research.Emergency Medicine Essay

It is said that the best healers are the wounded ones. I didn’t understand what that meant until I became wounded, myself.

My passion for emergency medicine goes way back to my own personal crisis. I remember the time when my father went into cardiac arrest—right while he was driving. He was rushed to nearest hospital, where he and emergency personnel fought an uphill battle to save his life.

I had never seen so many syringes before. One after another, the nurse was pumping their contents into the IV connected to my father’s arm. I was captivated by this unfamiliar, frantic, yet flawlessly organized environment: the Emergency Room. Amidst the organized chaos, we hoped and prayed that God would heal him and spare his life.

God had other plans. Dad passed away later that night, and my entire world turned upside down.

Amidst the turmoil, however, I calmly remembered a vivid memory that had a lasting effect on me: It was the caring and methodical way in which the doctors handled every diligent step in attending to my father, and to us, his family. I only realized the full impact of this event long after the dust had settled.Emergency Medicine Essay

I began to ask myself the critical question that all wounded people asked. What if I could offer other desperate people that very same sincerity and compassion during critical times? That became my urgent sense of purpose. Since then, I resolved to become an emergency medicine doctor, and my resolve has only grown stronger over time.

I knew what I wanted, so I dove right into training. A few years later, at seventeen years of age, I was again exposed to this environment. I volunteered at the Thomason Hospital ER in my local hometown. The circumstances were less trying this time, but no less meaningful—I could better appreciate the efficiency of the fast paced ED.Emergency Medicine Essay

I remember one ER physician, Dr. Bhagat, whose passion for teaching stood out above all. He took me under his wing and introduced me to the field of Emergency medicine. He was a very patient mentor; he took his time to answer my questions, explain the disease processes, and gave me a firsthand look at many heartbreaking and uplifting moments he shared with his patients. I was enthralled by the wide breadth of his medical knowledge. I absorbed the notion of how EM doctors calmly and confidently rule out life threatening conditions while simultaneously trying to ascertain the most probable diagnosis. They are the front line workers with regard to influencing the patient’s treatment plan, many times without the luxury of medical records and just the raw clinical picture in front of them. Dr. B served as a shining example of everything I aspired to become as a physician and he naturally became my role model.

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My own personal tragedy coupled with Dr. B’s training only further steeled my purpose. They drove me to serve in other volunteer capacities: volunteering at Brackenridge ED, working as an Emergency department technician at Dell Children’s Medical Center during College and shadowing the head of the department of Trauma Surgery at Vanderbilt during a summer medical internship. I practically lived and breathed Emergency Medicine.Emergency Medicine Essay

Starting in 2005 I traveled abroad to Panama, Costa Rica, Mexico and Nicaragua to serve and to learn about medicine in areas of great medical need. With a colleague, I founded Longhorns without Borders, an organization that continues to grow to this day. Here we trained students on proper History and Physical Exam Skills and allowed young aspiring doctors to interact directly with and be involved in the care of patients. During Medical School at UTSW, I continued these trips that allowed me to monitor my own growth. I volunteered as a translator for the Monday Clinic as well as the Spanish Interpreter Apprenticeship program where we taught students medical Spanish. I often participated in the EM shadowing program and EMSA workshops as well.Emergency Medicine Essay

My desire to bring together multiple facets of various medical specialties and apply everything I learned in medical school drives my passion for EM. It also helps me balance my critical thinking skills and hands-on experience. During a single shift, one can perform a wide variety of procedures ranging from surgical laceration repairs to orthopedic cast placements to assessing new trauma patients. The vast array of patients and the unique presentation of the same diseases presented to the ER really challenge one to recognize atypical presentations, and most importantly, to watch for possible life threatening conditions.Emergency Medicine Essay

It is only in Emergency Medicine that I find myself dealing with numerous possibilities of clinical exposure to human disease. Due to the critical nature of human condition in the ED, I find the very best opportunities for human connection and positive influence. During my EM clerkship, I gained the greatest sense of fulfillment and reward during times when I clenched the diagnosis, intervened effectively and saw my patients improve right before my eyes! I recognize fully that language barriers, communication skills, and various unimaginable circumstances can factor into a patient’s state of mind when they enter the ER. Nevertheless, their smile of gratitude or the sight of someone finally being able to breathe or to experience relief from pain invariably makes up for the frustration that permeates the ER before the patient is seen.Emergency Medicine Essay

I also understand that the doctor/patient relationship in Emergency Care is often fleeting and short-lived, and while that is a challenge for me, it is what compels me to want to make the most of the few precious moments I have with each one of my patients. An academic teaching center is ideal for me because it is an environment oriented to evidence-based medicine—it is a place where I can constantly learn and grow from the best, fulfill my love of lifelong learning, and influence and mentor future generations of doctors. It also supports my interest in international medical mission trips, Disaster Medicine and Critical Care.

I aspire to become the kind of doctor who thinks on his feet, yet remains thorough enough to communicate effectively with his patients. I desire to be a healer who remains sensitive to his patients’ emotional needs while keeping his composure in moments of extreme pressure. My goal is to become a medical professional who is always responsible for improving the quality of life for each of his patients. With God’s help, I will become the kind of EM doctor who is on the front line above all. Emergency Medicine Essay