Accident & Emergency


An Emergency Department (ED), also known as an Accident & Emergency Department (A&E), Emergency Room (ER) or Casualty Department, is a medical treatment facility specializing in emergency medicine, the acute care of patients who present without prior appointment; either by their own means or by that of an ambulance. 

Due to the unplanned nature of patient attendance, the department must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention. In some countries, emergency departments have become important entry points for those without other means of access to medical care.

The emergency departments of most hospitals operate 24 hours a day, although staffing levels may be varied in an attempt to reflect patient volume. Critical conditions handled Cardiac arrest Cardiac arrest may occur in the ED/A&E or a patient may be transported by ambulance to the emergency department already in this state. Treatment is basic life support and advanced life support as taught in advanced life support and advanced cardiac life support courses. This is an immediately life-threatening condition which requires immediate action in salvageable cases. Heart attack Myocardial infarction Patients arriving to the emergency department with a myocardial infarction (heart attack) are likely to be triaged to the resuscitation area. They will receive oxygen and monitoring and have an early ECG; aspirin will be given if not contraindicated or not already administered by the ambulance team; morphine or diamorphine will be given for pain; sub lingual (under the tongue) or buccal (between cheek and upper gum) glyceryl trinitrate (nitroglycerin) (GTN or NTG) will be given, unless contraindicated by the presence of other drugs, such as drugs that treat erectile dysfunction. An ECG that reveals ST segment elevation or new left bundle branch block suggests complete blockage of one of the main coronary arteries. These patients require immediate reperfusion (re-opening) of the occluded vessel. This can be achieved in two ways: thrombolysis (clot-busting medication) or percutaneous transluminal coronary angioplasty (PTCA). Both of these are effective in reducing significantly the mortality of myocardial infarction.


Many centers are now moving to the use of PTCA as it is somewhat more effective than thrombolysis if it can be administered early. This may involve transfer to a nearby facility with facilities for angioplasty. Trauma Physical trauma Major trauma, the term for patients with multiple injuries, often from a road traffic accident or a major fall, is initially handled in the Emergency Department.

However, trauma is a separate (surgical) specialty from emergency medicine (which is a medical specialty, and has certifications in the United States from the American Board of Emergency Medicine). Trauma is treated by a trauma team who have been trained using the principles taught in the internationally recognized Advanced Trauma Life Support (ATLS) course of the American College of Surgeons. Some other international training bodies have started to run similar courses based on the same principles. The services that are provided in an emergency department can range from x-rays and the setting of broken bones to those of a full-scale trauma centre.


A patient's chance of survival is greatly improved if the patient receives definitive treatment (i.e. surgery or reperfusion) within one hour of an accident (such as a car accident) or onset of acute illness (such as a heart attack). This critical time frame is commonly known as the "golden hour". Some emergency departments in smaller hospitals are located near a helipad which is used by helicopters to transport a patient to a trauma centre. This inter-hospital transfer is often done when a patient requires advanced medical care unavailable at the local facility. In such cases the emergency department can only stabilize the patient for transport. Mental illness Some patients arrive at an emergency department for a complaint of mental illness.

In many jurisdictions (including many US states), patients who appear to be mentally ill and to present a danger to themselves or others may be brought against their will to an emergency department by law enforcement officers for psychiatric examination. The emergency department conducts medical clearance rather than treats acute behavioral disorders. From the emergency department, patients with significant mental illness may be transferred to a psychiatric unit (in many cases involuntarily). Asthma and COPD Acute exacerbations of chronic respiratory diseases, mainly asthma and chronic obstructive pulmonary disease (COPD), are assessed as emergencies and treated with oxygen therapy, bronchodilators, steroids or theophylline, have an urgent chest X-ray and arterial blood gases and are referred for intensive care if necessary. Noninvasive ventilation in the ED has reduced the requirement for tracheal intubation in many cases of severe exacerbations of COPD.

INTERESTING FACT
HISTORICAL TERMINOLOGY STILL EXISTS ACROSS THE ENGLISH-SPEAKING WORLD, ESPECIALLY IN VERNACULAR USAGE. THE PREVIOUSLY ACCEPTED FORMAL TERM "ACCIDENT AND EMERGENCY" OR "A&E" IS STILL THE ACCEPTED TERM IN THE UNITED KINGDOM, COMMONWEALTH COUNTRIES AND THE REPUBLIC OF IRELAND, AS ARE EARLIER TERMS SUCH AS "CASUALTY" OR "CASUALTY WARD", WHICH CONTINUE TO BE USED INFORMALLY. THE SAME APPLIES TO "EMERGENCY ROOM" OR "ER" IN NORTH AMERICA, ORIGINATING WHEN EMERGENCY FACILITIES WERE PROVIDED IN A SINGLE ROOM OF THE HOSPITAL BY THE DEPARTMENT OF SURGERY....Read More