Accident and Emergency Department Elective

Emergency Department

Recently I was assigned to Accidental and Emergency Department (AE) for my 2 months elective course. In Jordan, AE is nit provided as one of the subjects in medical school. Thus, I took this opportunity to observe and learn how the department works and also to cover some subjects that I feel inadequate like Orthopedics.

AE literally accepts cases that involving traumas or acute (less than 3 days) cases that need rapid monitoring, stabilization, and rapid diagnosis to avoid worst case scenario.  Those that are not included will be referred to medical centre. The duty in AE is shift based literally 9am-2pm and 2pm-9pm including oncall.

The most important part in AE is triage. In this part, the patients who come will be analyse and sort out according to the zone. We have three zones, red, yellow, green, and blue based on severity. Red zone is for the critical cases, yellow zone is for those who might have complication from the complain acutely, green zone for mild cases which is not deteriotating the patients and blue zone is for observation post-treatment.  In this stage too, vital signs will be obtained for the reference of the doctors afterward.

Let's discuss about the blue zone first. So as I said the blue zone is prepared for monitoring the patients after they pass the critical phase. We monitor them to identify which could be discharged and which need to be admitted to the wards. Blue zone is not triaged from the start. Usually it's the course from the other zones. There are terms of uptriage which mean a patient is bring forward to critical zone like from green to yellow ir yellow to green. Another term is downtriage which is from red to blue or anywhere below it. This is to ensure the condition of the patient could be maintained.

Next is the green zone. Mainly this is for all the cases in which the patients could tolerate and the complain is not affecting the vitals of the patient like fever ( suspecting dengue), swelling of the limbs, fractures ( depending) and ecentera. Green zone is very important zone because it's very vague. We could not discharge the patient if we are not confirmed that what the patient is having is not serious and we need to diagnose the complain in a quick response since AE is an overwhelmed department where there are always a lot of patients lining up. Any wrong diagnosis the doctors will be held responsible. 

Yellow zone is for those who could not tolerating the complain like fatigue, pain, shortness of breath, or being aggressive. However, they are still concious, mainly dependent on Glascow Coma Scale (GSC) here it's mandatory to know GCS by heart. Red Zone is similar to Yellow zone besides that it's mainly those coming unconcious or in acute emergency like serious motor vehicle accident, myocardial infarction, pneumothorax, ectopic pregnancy, or those fainted,  unconcious.

Those who work in this environment will know the term code blue which is a condition a person need cardiac pulmonary resuscitation (CPR) whom lose pulse and need rapid management to ensure survival.

I manage to see few cases if CPR unfortunately none of them survive. The maximum limit of CPR is 30 minutes which after that we will stop doing CPR.

There are also addition of rooms that supports the zones like Procedure Room which mainly involve hand-ons treatment like suturing, toileting, dressing, eye irrigation, insertion of cannula, taking blood sample, etc. 

One unique room in AE is One Stop Crisis Centre which commonly cases involving police. It is held in private environment to ensure confidentiality. Like for example domestic violence, drug addict.

In conclusion, AE is a branch that ensure the stability if the patient when they first arrived before they are referred to other department. AE is important and vital and should be held in acuity to avoid error which will affect the survival of the patient. It is interesting environment to pursue to. 

This entry is written by one of our writer, Solahuddanne.

She completed her medical elective posting in Malaysia.