Emergency Department Notes
ER Triage Levels
Triage nurses are important in establishing the level!
There’s a giant ER board that people look at. This is not the only way in which Nurses → Doctors on whom to attend to. In a very serious case they can just notify the doctors.
Note that H&P details might be sparse in an ER. You can have Jane Does that pass out from booze every weekend; you gather information after they’re stable/OK.
Doctors generally get ER and general life-support training.
People will use the ER system for their primary care. Think Medicare.
The principle of double effect is a set of ethical criteria which Christian philosophers have advocated for evaluating the permissibility of acting when one’s otherwise legitimate act may also cause an effect one would otherwise be obliged to avoid. The first known example of double-effect reasoning is Thomas Aquinas’ treatment of homicidal self-defense, in his work Summa Theologica.
What if EHR goes down?
Lots of research on what to do during downtimes.
You use paper. These days things are all electronic so this creates a big point of failure. Nurses are trained to use old/manual ways.
You need a “Downtime Toolkit”. Informaticians are very important here.
- Real-only downtime viewer for meds, allergies, problem list, recent notes.
- Paper tracking board.
- Printed protocols.
- Updated backup on-call list.
- Downtime huddle with explicit role assignment.
- Checklist (!) for high-risk ED presentations: head trauma, chest pain, sepsis, stroke.
The Pitt S1E8. CyberAttack! Consternation on the young ones’ faces. Lazy writing with the genius with photographic memory. People coming together in a crisis. FAX MACHINES! ❤️ Asking patient questions while they’re doing the exam. Papers can be misclassified physically. People can lean on the board and erase it. Lots of frenetic activity; lots of split-seocnd decisions. Felt-tip pen won’t go through the copies (lol). Princess is the chart nurse. Facemask for kit to prevent contamination of swabs.