Video 4: Emergency Department Patient Care

Dr. Nelson (00:00):

I am Dr. Nelson. We are taking care of our virtual emergency department patients using the software Full Code. Hope you had a chance to talk about what it’s like to work in a team environment in the emergency department and who gets seen first. As you probably spoke, it’s the most critically ill or injured patient that’s determined by the triage nurse.

Let’s continue forward with our patient. Initially, what we tend to do as emergency department physician is take a patient history, but if our patient is not able to respond or communicate with us, we are unable to do that.

So what we’ll do is intervene with some stabilizing interventions. In this case, I would ask the nursing staff to start an IV, attach them to the cardiac monitor to watch their electrical activity and increase the amount of supplemental oxygen, such as using a non-rebreather mask as our nasal cannula.

Dr. Nelson (01:07):

The oxygen did not respond well enough with our oxygen saturation. I would also start to give some IV fluids, a liter of normal saline, and we could do some additional interventions if needed. 

Let’s say if we had to defibrillate a patient that’s in ventricular fibrillation or do some cardiac pacing, other emergent interventions such as a central line, or we could do a endotracheal tube in the patient’s airway for definitive airway placement. Other sources of information are friends or family members or a patient’s medical record. So there’s many options that we try to get the patient’s history from. 

If the patient is awake and able to interact with us, then we’re going to ask them several different things. One is your past medical history, do you have a history of heart conditions or kidney problems? Do you take any medications? Are you allergic to any medications? Have you had any surgical procedures?

Dr. Nelson (02:16):

Then we’ll ask them their social history. Do you smoke cigarettes? Do you drink alcohol? Do you take illicit drugs? What kind of work do you do? Are you in any danger at work? Then we’ll do a family history, sometimes are there any family history of heart problems, kidney problems, cancer? 

Then, we’ll do what we call a review of systems where we ask, do you currently have any symptoms regarding your nose or throat, or are you having problems breathing or stomach issues? 

Looking at our AAMC competencies list, it would appear that several different competencies are relative to this interpersonal skills, demonstrating awareness, how social and behavioral cues affect people’s interactions and behaviors. Oral communication affecting only conveying information to others using spoken words and sentences, other ones that would work here. Empathy and compassion. Cultural humility seeks out, engages diverse and divergent perspectives with a desire to understand and willingness to adjust one’s mindset. 

I want you to stop the video now and think about what would you do if you’re trying to speak to a patient, communicate with them, get their history when they might not always be able to answer you and what you would do in that situation. 

How would you use your resources of friends and family medical records? I also want you to talk about what it means to communicate and cultural awareness and how you would work on those skills to become a competent emergency department physician.

• 📝 Recall what answer(s) you had for this question from Video 2: “[B]rainstorm together and make a list of…what questions we could ask Randy and his family” (Video 2).
  
  How might you approach talking to Randy’s family members with your Video 2 questions? What issues might arise? What might you need to consider before or while speaking with them?
  
  
• One key skill of healthcare workers is being able to actively listen and communicate well with patients, other healthcare workers, and many others.
  
  
  • Why do you think that cultural competency and having experience serving diverse communities may help healthcare workers effectively communicate and listen to all patients? Give at least one example.
    
  • How would you draw on these skills with patients?
    
    
• In your opinion, what makes a great physician and/or healthcare worker?