Decision Making in Emergency Medicine

1. Is there anything unique about emergency medicine?
Although there is significant crossover between emergency medicine and all other clinical specialties, emergency medicine has unique aspects, such as the approach to patient care and the decision-making process.

2. Describe the conventional method of evaluating a patient.
A comprehensive history, physical examination, "routine" laboratory diagnostic studies, special diagnostic procedures, and the formulation of a problem-oriented medical record and rational course of therapy constitute the "ideal" approach to patient care because it is so comprehensive.

3. Why is the conventional methodology not ideal for use in the emergency department (ED)?
Even though in retrospect only 10-20% of patients presenting to an ED truly have emergent problems, it must be presumed that every patient who comes to an ED has an emergent condition.

Therefore, the first and most important question that must be answered is, What is the life threat? The conventional approach does not ensure an expeditious answer to this question. Time constraints also impede the use of conventional methodology in the ED.

4. How do I identify the life-threatened patient?
Three components are necessary to quickly identify the life-threatened patient:
1. A chief complaint and a brief, focused history relevant to the chief complaint
2. A complete and accurate set of vital signs in the field and in the ED
3. An opportunity to visualize, auscultate, and touch the patient