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Encyclopedia > Emergency medicine

Emergency Medicine is a speciality of medicine that focuses on diagnosis and treatment of acute illnesses and injuries that require immediate medical attention. While not usually providing long-term or continuous care, emergency medicine physicians diagnose a wide array of pathology and undertake acute interventions to stabilize the patient. These professionals practice in hospital emergency departments, in the prehospital setting via emergency medical service and other locations where initial medical treatment of illness takes place. Just as clinicians operate by immediacy rules under large emergency systems, emergency practioniers aim to diagnose emergent conditions and stabilize the patient for definitive care. Image File history File links Question_book-3. ... For the chemical substances known as medicines, see medication. ... In general, diagnosis (plural diagnoses) has two distinct dictionary definitions. ... For the town in the Republic of Ireland, see Hospital, County Limerick. ... The emergency room is the American English term for a room, or group of rooms, within a hospital that is designed for the treatment of urgent and medical emergencies. ... Emergency medical service (known by the acronym of EMS in the USA and Canada) is a branch of medicine that is performed in the field, pre-hospital, (i. ...


Urgent Care Centers are often staffed by physicians, physician assistants, nurses and nurse practitioners who may or may not be formally trained in emergency medicine. They offer primary care treatment to patients who desire or require immediate care, but who do not reach the acuity that requires care in an emergency department or admission to a hospital.


Emergency Medicine encompasses a large amount of general medicine but involves virtually all fields of medicine and surgery including the surgical sub-specialties. Emergency physicians are tasked with seeing a large number of patients, treating their illnesses and arranging for disposition - either admitting them to the hospital or releasing them after treatment as necessary. The emergency physician requires a broad field of knowledge and advanced procedural skills often including surgical procedures, trauma resuscitation, advanced cardiac life support and advanced airway management. Emergency physicians ideally have the skills of many specialists - the ability to manage a difficult airway (anesthesia), suture a complex laceration (plastic surgery), reduce (set) a fractured bone or dislocated joint (orthopedic surgery), treat a heart attack (internist), work-up a pregnant patient with vaginal bleeding (Obstetrics and Gynecology), and stop a bad nosebleed (ENT). Anesthesia or anaesthesia (see spelling differences) has traditionally meant the condition of having the perception of pain and other sensations blocked. ... For the album by The Huntingtons, see Plastic Surgery (album). ... This fracture of the lower cervical vertebrae, known as a teardrop fracture is one of the conditions treated by orthopaedic surgeons. ... Internal medicine is concerned with the diagnosis and treatment of internal diseases, that is, those that affect internal organs or the body as a whole. ... Obstetrics and gynaecology (often abbreviated Ob-Gyn in the US and O&G elsewhere) form a single medical specialty and have a combined postgraduate training program. ... Otolaryngology is the branch of medicine that specializes in the diagnosis and treatment of ear, nose, throat, and head & neck disorders. ...

Contents

Definition

"Emergency medicine is a medical specialty -- a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioral disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development."


International Federation for Emergency Medicine 1991


History

During the French Revolution, after seeing the speed with which the carriages of the French flying artillery maneuvered across the battlefields, French military surgeon Dominique Jean Larrey applied the idea of Ambulances, or "Flying Carriages", for rapid transport of wounded soldiers to a central place where medical care was more accessible and effective. Larrey manned Ambulances with trained crews of drivers, corpsmen and litter-bearers and had them bring the wounded to centralized field hospitals, effectively creating a forerunner of the modern MASH units. Dominique Jean Larrey is sometimes called the father of Emergency Medicine for his strategies during the French wars. The French Revolution (1789–1815) was a period of political and social upheaval in the political history of France and Europe as a whole, during which the French governmental structure, previously an absolute monarchy with feudal privileges for the aristocracy and Catholic clergy, underwent radical change to forms based on... Dominique Jean Larrey, portrait by Anne-Louis Girodet de Roussy-Trioson, beginning of 19th century. ... The Mobile Army Surgical hospital (MASH) refers to a United States Army medical unit serving as a fully functional hospital in a combat area of operations. ... Dominique Jean Larrey, portrait by Anne-Louis Girodet de Roussy-Trioson, beginning of 19th century. ...


Emergency Medicine (EM) as a medical specialty is relatively young. Prior to the 1960's and 70's, hospital "emergency rooms" were generally staffed by physicians on staff at the hospital on a rotating basis, among them general surgeons, internists, psychiatrists, and dermatologists. Physicians in training (interns and residents), foreign medical graduates and sometimes nurses also staffed the ED. EM was born as a specialty in order to fill the time commitment required by physicians on staff to work in the increasingly chaotic emergency departments (EDs) of the time. During this period, groups of physicians began to emerge who had left their respective practices in order to devote their work completely to the ED. The first of such groups was headed by Dr. James DeWitt Mills who, along with four associate physicians at Alexandria Hospital, VA established 24/7 year round emergency care which became known as the "Alexandria Plan". Soon, the problem of the "ER", propagated by published reports and media coverage of the poor state of affairs for emergency medical care had culminated with the establishment of the first emergency medicine training program at Cincinnati General Hospital, with Bruce Janiak, M.D. being the first emergency medicine resident in 1970. During the 1970's, several other residency programs developed throughout the country. At this time, EM was not yet a recognized specialty and hence had no primary board certification exam. It was not until the establishment of ACEP, the recognition of emergency medicine training programs by the AMA and the AOA, and in 1979 a historical vote by the American Board of Medical Specialties that EM became a recognized medical specialty. Dermatology is a branch of medicine dealing with the skin, its structure, functions, and diseases (from Greek derma, skin), as well as its appendages (nails, hair, sweat glands). ... The American College of Emergency Physicians (ACEP) is the largest organization of emergency physicians in the United States. ... Please wikify (format) this article as suggested in the Guide to layout and the Manual of Style. ...


Organizations around the world

In the United Kingdom and Ireland, the College of Emergency Medicine sets the examinations that trainees in Emergency Medicine take in order to become consultants (fully-trained emergency physicians). The British Association for Emergency Medicine is the member organization in the UK. In 2005 , the two organizations initiated steps, and have applied for a royal seal, to merge as the Royal College of Emergency Medicine. The College of Emergency Medicine is planned to come into existence on 1st January, 2006. ... An emergency physician is a physician who works at an emergency department to care for acutely ill patients. ... The British Association for Emergency Medicine (BAEM) is the representative body for Emergency Physicians in the United Kingdom. ...


In Australia and New Zealand, advanced training in Emergency Medicine is overseen by the Australasian College for Emergency Medicine (ACEM). The Australasian College for Emergency Medicine is an institution whose prime objective is the training and examination of emergency physicians for Australia and New Zealand. ...


In Canada, there are two routes to practice emergency medicine. More than two thirds of physicians currently practicing emergency medicine across the Canadian nation have no specific emergency medicine residency training. Emergency physicians who tend to work in more community-based settings complete a residency specializing in Family Medicine and then proceed to obtain an additional year of training of special competence on Emergency Medicine from the College of Family Physicians of Canada (CCFP-EM). Physicians practicing in major urban/tertiary care hospitals will often pursue a 5 year specialist residency in Emergency Medicine, certified by the Royal College of Physicians and Surgeons of Canada. These members typically spend a great deal of time in academic and leadership roles within emergency medicine, EMS, research, and other avenues. There is no significant difference in remuneration or clinical practice type between physicians certified via either route. A general practitioner (GP) or family physician (FP) is a physician who provides primary care. ... The Royal College of Physicians and Surgeons of Canada, (RCPSC) is a national, private, nonprofit organization established in 1929 by a special Act of Parliament to oversee the medical education of specialists in Canada. ...


In the United States, there are many member organizations for emergency physicians:

  • The American College of Emergency Physicians (ACEP) is presently the largest member organization of emergency physicians, and Active membership is open to all physicians that have completed an emergency medicine residency approved by the Accreditation Council on Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA), or are certified by any emergency medicine certifying body recognized by ACEP. Physicians engaged in the practice of emergency medicine prior to 2000 also qualify for membership under a grandfather clause. Originally founded in 1968, ACEP was the first Emergency Medicine society formed in the United States. Fellows use the designation FACEP. As of 2006, ACEP had about 25,000 members.[1][2]
  • The American Academy of Emergency Medicine (AAEM) was formed in 1993 and has been the subject of some controversy due to its traditional position statements concerning board certification, resident "moonlighting", and the practice of "corporate medicine". Nevertheless, AAEM has worked cooperatively alongside the ACEP and the ACOEP when the interests of emergency medicine have called for a united front. Active membership is open to all physicians who have completed an emergency medicine residency approved by either ACGME or the AOA. Fellows use the designation FAAEM. As of 2007, the AAEM had about 5,000 members.
  • The American College of Osteopathic Emergency Physicians (ACOEP) was founded seven years later in 1975.[3] Active membership is open only to osteopathic (D.O.) medical physicians who have practiced emergency medicine for the past three years and/or have completed an emergency medicine residency approved by the AOA or ACGME. Fellows use the designation FACOEP. As of 2006, ACOEP enrolled about 2,300 members
  • The Association of Emergency Physicians (AEP), which was founded in 1991, distinguishes itself by offering membership to any practicing emergency physician regardless of training.[4] By so doing, the AEP acknowledges that more than half of practicing emergency physicians in the United States, much like their colleagues in other countries, completed residencies in other related specialties that included training in the practice of emergency medicine. Currently, this organization is the only US organization that admits non-specialty trained physicians. AEP has members in 45 states.[4]
  • The American Board of Emergency Medicine (ABEM) provides board certification to emergency physicians. Although ABEM now requires successful completion of an ACGME-approved residency in emergency medicine followed by completion of an additional year of practice before taking the exam, currently half of the emergency physicians currently holding ABEM certification were "grandfathered" in to certification eligibility via the practice track by training in another specialty, practicing emergency medicine, and then passing the ABEM certification exam.
  • The American Osteopathic Board of Emergency Medicine (AOBEM) provides board certification to osteopathic (D.O.) emergency physicians who have successfully completed an AOA-approved residency in emergency medicine, completed two years of practice, passed a written exam, and passed an oral exam. Like ABEM, the AOBEM at one time offered certification eligibility via a practice track, allowing training in another specialty, practicing emergency medicine, and then passing the AOBEM certification exam.
  • The Board of Certification in Emergency Medicine (BCEM) provides board certification to both physicians who have completed an emergency medicine or primary care residency and performed five years of emergency medicine practice, followed by a written and oral examination process. Many of the above-mentioned legacy, or "grandfathered," physicians are certified via this pathway.
  • Also, EM doctors who do not qualify for ABEM or AOBEM under the grandfather clause can apply and get boarded via AAPS. The board is being accepted more by hospitals, although it does not carry nearly the weight of ABEM. Furthermore, many emergency departments in the US insist on residency-trained ABEM emergency medicine physicians only.

The American College of Emergency Physicians is the largest organization of emergency medicine physicians in the United States. ... American Osteopathic Association Founded in 1898 in Kirksville, MO, the American Osteopathic Association (AOA) is the representative organization for osteopathic physicians in the United States. ... A grandfather clause is an exception that allows an old rule to continue to apply to some existing situations, when a new rule will apply to all future situations. ...

Education

In the US, Emergency Medicine is a moderately competitive specialty for medical graduates to enter, ranking 7 of 16 specialties in terms of percentage of U.S. graduates whose applications are successful. However, over 90% of applicants from US medical schools to US Emergency Medicine residencies are successful. [5] Allopathic (MD,MBBS,MBChB) emergency medicine residencies can be three or four years in length, depending on the training institution, while all osteopathic (DO) residencies are four years in length, the first being a one-year traditional rotating internship. In addition to the didactic exposure, much of an emergency medicine residency involves rotating through other specialties with a majority of such rotations through the emergency department itself. By the end of their training, emergency physicians are expected to handle a vast field of medical, surgical, and psychiatric emergencies, and are considered specialists in the stabilization and treatment of emergent condition. Emergency physicians are therefore both clinical generalists and well-rounded diagnosticians. Image File history File links Question_book-3. ... Emergency psychiatry is a branch of psychiatry and emergency medicine designed to respond to emergencies requiring psychiatric intervention. ...


A number of fellowships are available for emergency medicine graduates including prehospital medicine (emergency medical services), toxicology, sports medicine, ultrasound, and pediatric emergency medicine. An Emergency medical service (abbreviated to initialism EMS in many countries) is a service providing out-of-hospital acute care and transport to definitive care, to patients with illnesses and injuries which the patient believes constitutes a medical emergency. ...


Working

The employment arrangement of emergency physician practices are either private (a democratic group of EPs staff an ED under contract), institutional (EPs with an independent contractor relationship with the hospital), corporate (EPs with an independent contractor relationship with a third party staffing company that services multiple emergency departments) or governmental (employed by the US armed forces, the US public health service, the Veteran's Administration or other government agency).


Most emergency physicians staff hospital emergency departments in shifts, a job structure necessitated by the 24/7 nature of the emergency department.


Patients being served by the emergency medicine unit often proceed to intensive care medicine, which often is closely related to emergency medicine. “Intensive Care” redirects here. ...


References

2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 128th day of the year (129th in leap years) in the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance to the Gregorian calendar. ... is the 128th day of the year (129th in leap years) in the Gregorian calendar. ...

See also

{{Otheruses4|the medical term|the Australian television series|Medical Emergenc an immediate threat to a persons life or long term health. ... First aid is a series of simple, life-saving medical techniques that a non-doctor or layman can be trained to perform. ... Emergency medical service (known by the acronym of EMS in the USA and Canada) is a branch of medicine that is performed in the field, pre-hospital, (i. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... The Star of Life, a global symbol for medical service EMTs loading an injured skier into an ambulance An Emergency Medical Technician (EMT) is an emergency responder trained to provide emergency medical services to the critically ill and injured. ... The Star of Life, a globally recognized symbol for Emergency medical services. ... CPR redirects here. ... A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, totally occluding the artery and preventing blood flow downstream. ... In emergency medicine the golden hour is the first sixty minutes after the occurrence of multi-system trauma. ... Toxicology (from the Greek words toxicos and logos [1]) is the study of the adverse effects of chemicals on living organisms [2]. It is the study of symptoms, mechanisms, treatments and detection of poisoning, especially the poisoning of people. ... Traumatology (from Greek Trauma meaning injury or wound) is the study of wounds and injuries caused by accidents or violence to a person, and the surgical treatment and repair of the damage. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ...

External links

Health Sciences are the group of disciplines of applied science dealing with human and animal health. ... For the chemical substances known as medicines, see medication. ... Advanced cardiac life support or (ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions. ... Advanced Life Support (ALS) is a treatment consensus for cardiopulmonary resuscitation in cardiac arrest and related medical problems, as agreed in Europe by the European Resuscitation Council, most recently in 2005. ... Advanced Trauma Life Support is a training program in acute management of trauma cases, developed in 1976 by the American College of Surgeons. ... Basic life support (BLS) is a specific level of prehospital medical care provided by trained responders, including emergency medical technicians, in the absence of advanced medical care. ... CPR redirects here. ... First aid is a series of simple, life-saving medical techniques that a non-doctor or layman can be trained to perform. ... Pediatric Advanced Life Support (PALS) is a system of Advanced Life Support applied to infants and children. ... An ambulance in San Jose del Cabo, Mexico A Helicopter used as an Ambulance. ... A disposable BVM Resuscitator A bag valve mask (also known as a BVM or Ambu bag) is a hand-held device used to provide ventilation to a patient who is not breathing or who is breathing inadequately. ... A chest tube or chest drain is a flexible plastic tube that is inserted through the side of the chest into the pleural space. ... Typical view of defibrillation in progress, with the operator at the head, but clear of contact with the patient Defibrillation is the definitive treatment for the life-threatening cardiac arrhythmias ventricular fibrillation and pulseless ventricular tachycardia. ... An automated external defibrillator, open and ready for pads to be attached An Automated External Defibrillator or AED is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient,[1] and is able to treat them by application... ICD An implantable cardioverter-defibrillator (ICD), also known as an automated implantable cardioverter-defibrillator (AICD), is a small battery powered electrical impulse generator which is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation. ... “QRS” redirects here. ... Intraosseous infusion is the process of injection directly into the marrow of the bone. ... Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein. ... This article or section needs copy editing for grammar, style, cohesion, tone and/or spelling. ... In medicine, a nasopharyngeal airway, also known as a nasal trumpet because of its flared end, is a tube that is designed to be inserted into the nasal passageway to secure an open airway. ... An oropharyngeal airway inserted into a mans throat An oropharyngeal airway or (OPA) is a medical device used to maintain a patent (open) airway. ... This article or section does not cite any references or sources. ... The Star of Life, a global symbol for medical service EMTs loading an injured skier into an ambulance An Emergency Medical Technician (EMT) is an emergency responder trained to provide emergency medical services to the critically ill and injured. ... The Star of Life, a globally recognized symbol for Emergency medical services. ... An emergency physician is a physician who works at an emergency department to care for acutely ill patients. ... Atropine is a tropane alkaloid extracted from the deadly nightshade (Atropa belladonna) and other plants of the family Solanaceae. ... Amiodarone belongs to a class of drugs called Vaughan-Williams Class III antiarrhythmic agent. ... Epinephrine (INN) or adrenaline (BAN) is a hormone and a neurotransmitter. ... General Name, symbol, number magnesium, Mg, 12 Chemical series alkaline earth metals Group, period, block 2, 3, s Appearance silvery white solid at room temp Standard atomic weight 24. ... For baking soda, see Sodium bicarbonate In inorganic chemistry, a bicarbonate (IUPAC-recommended nomenclature: hydrogencarbonate) is an intermediate form in the deprotonation of carbonic acid. ... In emergency medicine the golden hour is the first sixty minutes after the occurrence of multi-system trauma. ... The emergency department (ED), sometimes termed the emergency room (ER), emergency ward (EW), accident & emergency (A&E) department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and... An Emergency medical service (abbreviated to initialism EMS in many countries) is a service providing out-of-hospital acute care and transport to definitive care, to patients with illnesses and injuries which the patient believes constitutes a medical emergency. ... Emergency psychiatry is a branch of psychiatry and emergency medicine designed to respond to emergencies requiring psychiatric intervention. ... {{Otheruses4|the medical term|the Australian television series|Medical Emergenc an immediate threat to a persons life or long term health. ... A trauma center is a hospital equipped to perform as a casualty receiving station for the emergency medical services by providing the best possible medical care for traumatic injuries 24 hours a day, 365 days per year. ... Typical triage tag used for emergency mass casualty decontamination. ...

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