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Emergency Room
Yi Ping Zhao
Department of Vascular Surgery
Ren Ji Hospital
How Emergency Rooms Work
You will learn about
• the normal flow of traffic in an
emergency room
• the people involved
• the special techniques used to
respond to life-or-death situations
Emergency Room Patients
Car accidents
Sports injuries
Broken bones and cuts from accidents and falls
Uncontrolled bleeding
Heart attacks, chest pain
Difficulty breathing, asthma attacks, pneumonia
Strokes, loss of function and/or numbness in arms or legs
Loss of vision, hearing
Emergency Room Patients
Confusion, altered level of consciousness, fainting
Suicidal or homicidal thoughts
Severe abdominal pain, persistent vomiting
Food poisoning
Blood when vomiting, coughing, urinating, or in bowel
• Severe allergic reactions from insect bites, foods or
• Complications from diseases, high fevers
Understanding the ER Maze
• The classic emergency room scene involves an
ambulance screeching to a halt, a gurney hurtling
through the hallway and some people frantically
working to save a person's life with only seconds
to spare.
• This does happen and is not uncommon,
• The majority of cases seen in a typical
emergency department aren't quite this dramatic.
When you arrive at the ER, your first
stop is triage. This is the place where
each patient's condition is prioritized
into three general categories:
• Immediately life threatening
• Urgent, but not immediately life
• Less urgent
The triage nurse records patients vital
signs (temperature, pulse,
respiratory rate and blood pressure).
She also gets a brief history of patients
current medical complaints, past
medical problems, medications and
• This step is necessary to develop a
medical record so that patients medical
history, lab tests, X-rays, etc., will all be
located on one chart that can be
referenced at any time.
• If the patient's condition is life-threatening
or if the patient arrives by ambulance, this
step may be completed later at the
Examination Room
• Patients are seen by an ER nurse who
obtains more detailed information about
• Once the nurse has finished her tasks, the
next visitor is an ER physician. He gets a
more detailed medical history about your
present illness, past medical problems,
family history, social history, and a
complete review of all your body systems.
He then formulates a list of possible
causes of your symptoms.
Diagnostic Tests
Blood tests and a urinalysis are
• A complete blood count (CBC)
• A serum test
• A blood's clotting test
Diagnosis and Treatment
• When the emergency physician has all the
information he can obtain, he makes a
determination of the most likely diagnosis
from his differential diagnosis.
• Alternately, he may decide that he does
not have enough information to make a
decision and may require more tests. At
this point, appropriate consultant is
The ER team
Emergency Physician
Emergency Nurse
Physician Assistant
Emergency Department Technician
Unit Secretary
Physicians in Training
Tools of the Trade
• Emergency Departments are stocked
with a huge array of strangely named,
oddly shaped, beeping and blinking
• A stethoscope lets a nurse or physician
listen to heart and respiratory sounds.
• A stethoscope is used to take your blood
pressure by listening to the flow of blood
through your arteries.
Cardiac Monitor
• A cardiac monitor gives a visual
display of the rhythm of patients
• Some monitors also have an
automatic blood pressure cuff and a
pulse oximeter.
Suture Tray
This tray contains the sterile equipment needed to
place stitches in a patient with a laceration.
• needle holder
• forceps
• sterile towels
• scissors
• small bowls
Orthopedic Equipment
• Most emergency departments have a
generous number of orthopedic devices
for many purposes
• plaster and/or fiberglass materials
• pre-made splints for specific joints
knee immobilizers
aluminum finger splints
Velcro wrist splints
shoulder slings
cervical collars
• cast cutters
Crash Cart
A crash cart is a cabinet containing
equipment that physicians and nurses
need when a cardiac arrest occurs.
– Defibrillator
– Endotracheal intubation
– Central vein catheters
– Cardiac drugs
Tools used in endotracheal intubation