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Another Day In The Emergency Room

By EmpowHER December 10, 2010 - 3:25pm

Written by: Dr. James Kelley

Each day in the emergency room brings together unique patient problems and situations. As an emergency physician, each day is made more difficult by trying to obtain information on patients who can’t provide information.

A typical scenario could involve an older man with Alzheimer’s dementia who arrives from a personal care home with no available information. He displays altered mental status, likely from a combination of an overwhelming infection and his underlying dementia. It takes some time for family to arrive and communicate his advance directives. The directives state that no advanced life support measures should be taken. In the absence of these directives, emergency personnel are obligated to proceed with aggressive care. Compounding matters, the patient arrives with no records and hasn’t been seen previously in this hospital. Paramedics provide what little information they have, but treatment choices are impacted by the lack of information.

Another similar patient could be a woman with difficulty speaking (aphasia), a history of stroke, and new stroke symptoms. The dilemma is that the patient has never been seen in this hospital and cannot verbally communicate in clear detail which of her symptoms are new and which were old. As well, she cannot clearly describe any additional medical problems she possesses. In such cases after hours and multiple phone calls, some portions of the records arrive from another hospital.

In both cases, typical of any emergency department, better communication and information availability would have made treatment more accurate, patient specific, and timely. Everyone should carry some basic medical information to include: emergency contact, power of attorney, medical conditions, surgeries, allergies, medications.