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 

ThS.BS Nguyễn Hồng Trường

 1961: bottom of the medical prestige ladder

 24 hours a day, 365 days a year

 1968: formation of the American College of Emergency

Physicians

 2000: top three specialty choices

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 Objects:
o General Internal

o Surgery

o Injury

o Mental, behavior

o Poison

Complete
history

Exam

Differential
Diagnosis

Labs test,
Imaging Treatment
Diagnosis

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 Comprehensive knowledge

 Life threatening

 Cooperation of patient

 Information

 Time

 Primary complaint vs Disease

 Stability vs Complete History

 Exclude vs Definitive Diagnosis

 Chicken or Egg?

 Oriented Trial vs Specific Treatment

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 Initial impression and resuscitation

 Primary assessment and intervene

 Secondary assessment and treatment

 Reassessment

 Definitive care

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 From the door:

o Conscious and responsive?

o Efforts to breathe?

o Skin color?

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 Identify and treat any life threatening conditions

o A Airway: looking, listening, feeling

o B Breathing: rate, pattern, expansion, air, sound, saturation

o C Circulation: Rhythm, rate, pulse, CRT, BP, skin

o D Disability: consciousness (AVPU, GCS), pupil, blood glucose

o E Exposure: T°, rash, petechieae, injury, bruises

 Brief history and exam: chief complaint

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 Starts once the vital functions have been stabilised and

immediately life threatening conditions have been treated

 Directed by the history and primary assessment findings

 History: (PHRASED, SAMPLE)

o P Problem

o H History of presenting problem

o R Relevant medical history

o A Allergies

o S Systems review

o E Essential family and social history

o D Drugs (actually taking, doses, changes)

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 System review:
o Focused body system

o Always examine:

• Vital signs

• General appearance

• Heart and lungs

 Diagnostics: lab, radiology, …

 Protocol, pathway: dynamic

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 Problems

 Changes, Trends

 Include threats to life

 A definitive diagnosis may not be reached

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 Discharge vs Admit

 Safe at home?

 Following treatment plan

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