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Conduta médica na unidade de emergência

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Conduta médica na unidade de emergência

  1. 1. Unidade de emergência pediátrica Conduta médica geral Antonio Souto Médico coordenador Unidade de Medicina Intensiva Pediátrica Unidade de Medicina Intensiva Neonatal Hospital Padre Albino Professor de Pediatria nível II Faculdades Integradas Padre Albino Catanduva / SP 2011
  2. 2. Patient care is always our number one priority.
  3. 3. Time and Attendance1. You should be on timefor your shift.This is not just an expectation, but also a common courtesy to your co-workers.
  4. 4. Personal Business on Work Time1.Everyone should focus on their assigned dutieswhile on their shift.2. Reading of medical relatedmaterial is allowed if there areno patients in the department.
  5. 5. Personal Phone Calls Gener1.At no time should calls interfere withpatient care or the flow of patientsthrough the department.At no time should a patient or familymember know that a Team Member isreceiving a personal call
  6. 6. Food in the Department/ Breaks and Meals1.Food is prohibited in the patient care areas.2. Food should be kept out of the view of all patientsand families.Sorry, unless your institutionprovides them, there are no freemeals.
  7. 7. Professional Appearance1.Please ensure all clothing isprofessional and appropriate for thework environment. We expect housestaff to be dressed in neat clothes or clean scrubs and a white coat. No T-shirts, sweatshirts, jeans, or sandals.
  8. 8. Professional Appearance2. Ensure that the clothing and shoes worn provideprotection in accordance with hospital, departmental,and infection control policies.2. Applying of cosmetics or contactlenses within patient careenvironment is prohibited.
  9. 9. Professional AppearanceA norma NR 32 – SEGURANÇA E SAÚDE NO TRABALHOEM SERVIÇOS DE SAÚDE (Portaria TEM no 485, de 11de novembro de 2005), seguida no HPA, determina noitem item E (32.2 DOS RISCOS BIOLÓGICOS)que “É PROIBIDO O USO DE CALÇADOS ABERTOS”, oque deve ser seguido em todas as unidades dohospital.
  10. 10. Professional AppearanceYour primary institutionphoto ED badge anda Children’s ID badgemust be worn atall times whileon the CHHC campus.
  11. 11. Potato Chip is a trained therapydog. Check out her hospital ID...
  12. 12. Professional Behavior1.Our patients and families arevaluable to us.
  13. 13. Professional Behavior2. When parents are driven with anxiety our goal willbe to help them feel more comfortable and educatethem on what is happening to their child.a) Treat every interaction with patientsand families as you would expect to betreated.b) Do not judge parents. Educate them on the reasonsto start treatment early.c) Assist in helping parents that are upset.
  14. 14. Professional BehaviorCommunicate with both patients and familiesregarding what to expect, why things are happeningthe way they are, what procedures are going to beperformed, and why the procedures are necessaryto help decrease their anxiety.d) Assist with other patients in the emergencydepartment.e) All patients and visitors are to betreated with respect at all times.
  15. 15. Professional BehaviorCommunicate with both patients and familiesregarding what to expect, why things are happeningthe way they are, what procedures are going to beperformed, and why the procedures are necessaryto help decrease their anxiety.d) Assist with other patients in the emergencydepartment.e) All patients and visitors are to betreated with respect at all times.
  16. 16. Quality of Care and Teamwork1.Always place high quality care as the toppriority.2. Always view all the patients in the department as “our”patients, not “my patients and your patients.”3. Offer to take patients or assist others as appropriate.4. Everyone’sworkload should always beequal. Never sit or stall while otherscarry the load.
  17. 17. Departmental Cleanliness1.The cleanliness of the department is theresponsibility of the TEAM. The impressionthat our environment makes to our familiesand patients is very important in helping toinstill confidence in the quality of care thatwe provide.
  18. 18. When you start your shift, introduceyourself to the charge nurse and theattending if you have not met.
  19. 19. Don’t recap needles!
  20. 20. Topic ReviewAdmissionTry to decide as early as possiblewhether your patient will requireadmission.
  21. 21. ChartsAll ED charts must bedictated beforeyou go home.Your help to keep the chart in therack when not in use will increase theefficiency of the ED.
  22. 22. follow-upAs a general rulewe do not perform follow-upvisits on our patients.Special exceptions include patients who requireurgent follow-up that do not have a regular physicianor do not go to a particular clinicEvery patient should have a follow-up appointmentmade or advised at time of discharge.
  23. 23. Medical students1. Patients should be screened initially, to see if theyare appropriate for the medical student.2. All orders, charts, and discharge instructions mustbe cosigned by a licensed physician.3. Attendings will review each case with the medicalstudent.
  24. 24. 4. Students should identify themselves asstudent doctors or medical students (theword student must be audibly detected bythe parent) . Name-tags must be worn.
  25. 25. General Objectives1.Develop a logical, efficient approachto the assessment of the ill pediatric patient.2. Put into practice the rapid cardiopulmonaryassessment learned in PALS.3. Learn to prioritize and triage patient care.4. Become adept at procedures necessary toresuscitate and stabilize pediatric patients.
  26. 26. 5. Build and expand knowledge base andtechnical skills regarding pediatricemergencies in a ‘hands on’ environment.6. Learn how to deal with families, patients, andmedical staff under acute stress.7. Learn good charting and documentation.8. Learn the ‘safety net’ method of the earlyevaluation and treatment of sick children (i.e., IV, ECG,and Ox monitor and oxygen).
  27. 27. 9. Learn how to decide when certain pediatricproblems should be admitted and when they can besafely sent home and managed at home.
  28. 28. Objectives:Other Rotating Residents1. Develop skills of pediatric emergency assessmentand management through direct patient care.2. Learn to obtain a problem-oriented history andphysical appropriate for the PED.3. Expand knowledge through seeing as many patientsas possible.4. Become more comfortable in dealing with familiesand ill children.
  29. 29. 5. Get a sense of the difference between pediatric andadult ED patients.6. Get experience taking care of difficult children withlots of medical problems that you may not see oftenin your residency training.7. Learn as much as you can about pediatric painmanagement and sedation, trauma management, andhow and why we manage febrile patients the way wedo.
  30. 30. Selected Caveats forEmergency Medicine:A Grief Reduction SyllabusJohn T. Kanegaye, MDGENERAL1. ALWAYS introduce yourself (name, title) to thepatient/family (consider brief apology if family hasbeen waiting long).2. Make a point of letting the patient see you washyour hands before exam.
  31. 31. 3. DO try to sit when taking the history(proven to convince families that you’rebeing thoughtful and taking plenty of time with them).4. ALWAYS convey your orders and general plan to theassigned RN.5. NEVER forget to address the patient (and not justthe parent).6. Keep families updated through the ED course, evenif only waiting for labs
  32. 32. Re-examinefrequently.
  33. 33. ATTENDINGS IN THE ED (a strange beast)1. What they want to know:a. General appearanceb. Vitalsc. Pertinent positives and negatives
  34. 34. 2. What they don’t need to know:a. Extensive birth history in reasonably well or olderkids (>3-4 mo).b. Social/Family history or race, except as extremelypertinent (e.g. NAT, RAD, SS dis)3. Talk to them before gettingconsults, tests.
  35. 35. LABORATORY1. Before ordering any test:a. Know the likelihood of a clinically significantabnormality.b. Understand how or if the result will influencemanagement.c. Be certain that meaningful follow-up of results canoccur.
  36. 36. LEGAL ISSUES1. Beware change of shift!a. Reassess patients signed out to you, and documentb. Every patient needs a note, even if all you did wasto check labs and discharge.2. When in doubt, consult. Document it (even phonecalls or failed phone contact).3. Document discussion of risks/benefits/alternativesand consent/patient assent—BEFORE the procedure.
  37. 37. LEGAL ISSUESDocument