The Approach to the emergency patient

The approach towards an emergency patient is much different than that adopted by other specialties, and is more or less same as that adopted by the various life support courses. It includes:

• The Primary Survey (ABCDE)

1. Airway (with cervical spine control in trauma victims)
2. Breathing and Oxygenation)
3. Circulation (and control of hemorrhage)
4. Disability (neurology)
5. Exposure and environment.

• Resuscitation and control of threats
• Secondary Survey: History & Head to Toe Examination
• Emergency Treatment & Investigations
• Disposition and definitive Care

Remember to "Treat First that Kills First"

Key Points:

• Treat life-threatening problems problems first
• Treatment can proceed initially without a diagnosis
• Use appropriate tests, always have a pre-test probability for the diagnosis under consideration
• Be cautious with the high risk groups (Elderly and very young)
• Perform a focussed examination quickly (detailed examination may be required)
• Review all available and relevant documents (paramedic, nurses, previous hospitalization records, nurses notes)
• Think of abuse and violence
• Document things clearly
• Practice within your abilities, and seek help (expert opinion) when needed.

(Source: Atkinson, Kendall, & Rensburg, 2010)