You’ve watched the scene unfold on TV: ambulance rushing in, paramedics
running a stretcher inside, doctors and nurses flocking to the patient
to try to save a life. While the majority of cases seen in an emergency
department aren't always so dramatic, when you’re the patient,
it’s intense, and you might not feel as in control as you’d
like to be. Sometimes, just knowing what to expect can help.
Let's look at a typical case to see a simplified breakdown of the flow
through an ER. The scenario: It’s the middle of the night, and you
wake up with excruciating pain in your stomach. Something is definitely
not right, so you decide to head to the ER in your own vehicle.
Stop 1: Triage
When you arrive, the first stop is triage. Here, each patient’s condition
is prioritized, typically by a nurse, into three general categories: immediately
life-threatening, urgent but not immediately life-threatening, and less
urgent. At the same time, a registration clerk will get the basics --
name and date of birth – as the first step in creating your medical record.
The triage nurse records vital signs -- temperature, pulse, respiratory
rate and blood pressure – and gets a brief rundown of your current
issue and your medical history, including medications and allergies. Here
you find out that your temperature is 100.4.
Stop 2: Physician Exam
If your condition is not immediately life-threatening, you’ll be
brought to the triage physician who will perform a basic exam, and enter
diagnostic orders (blood work, urinalysis, x-ray, CT, EKG etc.) and medicine
orders to expedite your treatment.
Full registration happens at some point during your visit after the physician
sees you. Documenting your vital statistics and insurance information
is not exciting, but it’s an important step in creating a medical
record. That way, your medical history and any tests like labs or X-rays
will all be in one spot. Your bill will also be generated from the information
in your medical record.
If you had arrived by ambulance, when you are registered could fluctuate
and would depend on your condition.
Let’s stop the ER flow to talk about driving to the ER versus calling
911. Take heart attacks as an example. If you have symptoms like chest
pain, shortness of breath, nausea or dizziness, sweating, or discomfort
in your arms, neck or jaw, you could be having a heart attack. And when
it comes to surviving a heart attack, every second counts. Patients who
call 911 receive treatment an average of 20 minutes faster than those
who drive themselves to the hospital because paramedics will begin treating
you immediately, relaying your condition to the heart team at the hospital.
Stop 3: Examination Room
Next you are brought to the exam room. There, you vomit blood on the floor
which could be a sign of a GI bleed. An ER nurse will perform an assessment,
getting more details from you as well as any blood or urine samples that
weren’t already collected. The nurse will also administer any ordered
medications and get you a gown in preparation for the exam.
While in the exam room, you’ll see an emergency medicine physician,
who will get even further into the details of your issue and history,
and perform a general assessment of all your body systems, focusing even
more on the area of you chief complaint. After taking into account your
symptoms, a physical exam and test results, the physician may make a diagnosis
or order some tests to help determine a diagnosis.
Stop 4: Diagnostic Tests
Some common diagnostic tests performed in the ER are blood tests like CBC
(complete blood count), urine analysis, EKG, X-rays and CT scans. In our
example, the physician ordered blood tests, urinalysis and a CT scan.
Stop 5: Diagnosis and Treatment
When the physician has all the information at hand, he or she can determine
the most likely diagnosis, or decide that they don’t have enough
information to make a decision and may require even more tests. At this
point, the physician speaks to a gastroenterologist, the appropriate specialist
in this case. The gastroenterologist comes to see you and performs a thorough
history, physical exam and review of your lab data. He or she examines
your symptoms, and these all point to a GI bleed. The treatment for a
GI bleed is an EGD/colonoscopy. The gastroenterologist explains the procedure,
including the risks and benefits. If necessary, you then sign a consent
form to document this and permit her to operate on you.
Stop 6: End Game
Depending on your condition, the physician will either admit you to the
hospital, discharge you, or transfer you to a more appropriate facility.
(For example, a transplant patient would need to be in the care of transplant surgeons)
If you are discharged, you will receive instructions that explain your
medications and other treatments. If medications are prescribed, you may
receive a beginning dose. You will also be referred for follow-up care
should your condition continue or worsen.