Tuesday, 29 July 2008

Accident and Emergency Posting

Short but more interesting posting compare with Neuro posting..kalo ikut post yang lepas..i said that Neuro posting is the best..tapi posting A&E ni lagi best..

even the doctors are bz..but still they spend their time for the students...teach us, laugh with us and answering us..memang best la..

Specialist yang sehebat mana pun, very kind, ada sense of humor..so, dalam kelas, jarang-jarang je ngantuk..(means, ngantuk jugak tp xseteruk posting lain la..)..

pendek kata: boleh berbual macam kawan la..kalo takut dengan specialist..something wrong somewhere tu..

Di HUSM, A&E adalah the busiest department..di mana almost all patient (admitted or not) akan datang dengan pelbagai ragam..ada yang sakit betul-betul...and ada yang tak kecemasan pun tapi still datang A&E..kat KB ni, dah jadi macam rutin plak..rasa nak jumpa doctor jer,datang A&E..klinik harian USM pun ada...tapi bila patient dah datang, takkan a kita nak halau balik..

I prefer one doctor ni..dia akan treat patient dia yang 'non-emergency' case..tapi at the same time, she told the patient that A&E is not a right place for diseases yang 'non-life-threathening' or 'non emergency' la..yang boleh tahan..xserius, gi je klinik...

Contoh non-emergency cases yang I lihat : hair loss, panau, demam sehari with body temperature 37 degree and etc..

Emergency cases yang lain banyak la..i will share some of them later..

before that, let's get to know the system in HUSM..


First, when a patient arrive at the A&E, they have to register at the counter by showing the staff their IC and treatment card (if any, will be provided later).


After that, a staff nurse or Medical Assistant (MA) or even medical students will call their name and sit on a chair besides them for ur vital signs asssessment : Blood Pressure, SpO2 (saturation of oxygen in the blood), Heart rate, Respiratory rate and general conditions of the patient.

At the same time, some hostory and complaint of the patient will be hear. From the history and Vital signs, the patient will be categirized into three group. This is called TRIAGING. They got three colour code: Green, Yellow and Red

Green: patient will be seen by the doctors within 2 hours

Yellow: around half-1 hour

Red: within 10 minutes


Green Zone:

Name will be call..and inside, a doctor-in-charge will take further history and physical examnation..thorough only..then, carried out some investigation if needed such as blood test ect.

If need to be admit, Intravenous cannula will be attached, as needed..only.. tak sakit pun.

Sesaper pun akan tolong doctor untuk carriend out investigation such as Capillary Blood Sugar, other blood test such as Full Blood Count (FBC), Blood Urea Serum Electrolyte (BUSE) and etc..kalo ada student, kami lah yang akan ambik...hehehe..best..

After that, medication and some advice will be delivered..then discharge the patient if appropriate.

Yellow Zone

Asthma falls into this zone..immediately will be call and some nebulizer of medication will be given for symptomatic relief. Usual medication used : Salbutamol, Adrenaline and Ipratropium Bromide.

Acute abdominal pain such as appendicitis, diarrhea and fever more than 40 degree Celcius will be treat in this zone..

not much difference from the Green Zone..

Red Zone

Life-Threatening conditions such as angina (chest pain cardiac origin), severe shortness of breath such as in Acute Pulmonary Oedema (APO), head injury, unconscious patient and massive hemorrhage.

Some procedures includes : Cardipulmonary Resuscitation, Fluid Resuscitation, Central line insertion and monitoring may be carried out depends on patient's problems.

In this zone, relatives are not allowed to be with the patient especially during the resuscitation.

The ethics behind this is : the resuscitation procedure might seem very invasive and 'ganas' and painful..so, to avoid some emotional factors from the family members, which later may influence the decision of treatment, they have to stay outside the zone..or outside the curtain...this happen especially when the family members are closed-minded or didn't have any medical background..


and patient in this zone came out with variety of outcome and prognosis..

That's A&E..the first place where the patient seen by the doctors before other department (Medical, Surgery, Orthopaedics and ect) take over the case...

Next time, i'll story about A&E in the view of medical student and what we learn...

and also some cases..

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