At 8 pm, Xiao Li finally got off work. Remembering that I caught a cold these two days and didn't have time to go to work during the day, I went to a big hospital near my home to hang up an emergency and prescribed some medicine. As a result, I waited for more than two hours without seeing a doctor. He also found that patients who arrived later than him always saw it first.
Xiao Li stormed into the consulting room: "I just caught a cold and waited for more than 2 hours!" " Your shady story is too obvious! They came so much later than me, why are they all in front of me? Do you want to come first? ! "
Lao Li, who rushed to the emergency department soon, bent over and walked into the consulting room with an unhappy face to help him: "Yes, I have been here for almost half an hour, and I will see him soon. As a result, the man was called in to see a doctor as soon as he arrived. I have diarrhea all night and it hurts badly. Are you responsible for the delay? ! "
Dr. Zhang, who was on duty that night, explained to Lao Li and Xiao Li while giving the patient an electrocardiogram: "I'm sorry to have kept you waiting." As we all know, whether in work or in life, we all pay attention to a priority, not necessarily in the order of things. Now this patient, when he came, his blood pressure was over 200 and he had severe chest pain. He has to look at it first, and check the critical illness that is life-threatening at any time. "
Just then, the electrocardiogram was printed. When Dr. Zhang saw the typical electrocardiogram, he immediately diagnosed whether the patient was an acute myocardial infarction or an immediately life-threatening type. He immediately escorted the patient to the emergency room and issued a series of instructions (medical advice). "This patient needs to be rescued, immediately monitored, taking antiplatelet drugs, contacting the catheter room, taking blood tests according to the requirements of the green channel, establishing venous access, and explaining the patient's situation ..." At the same time, he "looked around and talked in all directions" and turned around and said, "Wait a minute, the patient in the clinic, this is the rescue. Take it easy, you two. Let's talk about it later. "
Lao Li saw the patient sweating, pale and miserable. Then he looked at the medical staff who had just worked step by step. The pace, words and rhythm all seem to be dead. He immediately felt as if his stomach hurt less. He and Xiao Li quietly returned to the hall and continued to wait.
Jumping in line is allowed to save lives.
Finally, the intense rescue came to an end, and Lao Li and Xiao Li also finished seeing the disease. While there were few people, Dr. Zhang began to chat with them, and the patients and their families who had not left around also gathered around to listen to the explanation and queue up to see the emergency department. Why not pay attention to first come, then come? The following is dr. zhang's conversation with them.
"It's just that in everyone's work and life, the priorities of things determine the order of things. The same is true of emergency medical care. The most fundamental purpose is to enable truly critical patients to get effective treatment immediately. Just like the patient in front, it is a very dangerous acute myocardial infarction, and sudden death is possible at any time. Every second counts, so you should see it immediately when you come to the emergency room. Don't say this patient has nothing to do with me. This condition has nothing to do with me and must be treated immediately. " After listening to Dr. Zhang, everyone nodded frequently.
Dr. Zhang turned to Lao Li and said, "Your blood pressure is stable and your condition is stable. Although I feel very uncomfortable, patients with stomachache and diarrhea are generally not life-threatening immediately as long as they are not seriously dehydrated, so they need to wait. Where is Xiao Li? You don't need to see an emergency department for a cold. You see, you came to the hospital voluntarily after work. In fact, you agree that this is not an acute disease, right? A real emergency patient' cutting in line' to the front may save a life a few minutes in advance. Like Xiao Li, just prescribe some cold medicine, you can not come to the emergency department, or you can choose another hospital. In short, in the emergency department, the priority is that the condition is king, seriously ill patients can see first, mild patients can wait, and patients with the same disease can see a doctor in a first-come-first-served order. "
If you are seriously ill, who will be responsible?
Then how to judge the condition? Who will judge? What is the standard?
Usually, there is a triage desk in a prominent position in the emergency department, where patients can measure blood pressure, heart rate, oxygen saturation and respiratory frequency (as the case may be), and each patient should measure these indicators at the triage desk before seeing a doctor. Input indicators, symptoms and other information into the special triage system, and the computer will automatically judge the patient's condition classification according to a series of objective standards.
The person in charge of judging the condition is called a triage nurse. They are all senior nurses trained in the emergency department. They have a keen observation of critically ill patients. In addition to the objective indicators in the computer system, they will also invite emergency doctors to evaluate patients who are uncertain or may have an immediate deterioration.
The standard of triage is summed up after years of practice.
1 grade patients are the most serious. They are in critical condition and their lives may be in danger at any time. They need to enter the resuscitation room or rescue room immediately for rescue, such as cardiac arrest, shock and definite myocardial infarction. You don't even need to register. These procedures will be supplemented later.
Grade 2 patients whose condition is critical or rapidly deteriorating and life-threatening should also enter the rescue room for treatment in a short time, such as severe dyspnea, lethargy and acute stroke.
Grade 3 patients are in urgent condition and have potential life threats, so they should be given priority over grade 4 non-emergency patients for diagnosis and treatment, such as acute asthma, foreign body inhalation, persistent vomiting, chest and abdominal pain, mild and moderate trauma, etc.
Grade 4 patients do not belong to the emergency department, and the degree of illness is general, such as mild pain and minor abrasions, which do not need to be sutured. Patients in stable recovery period will be returned to the clinic and only medical certificates will be issued. Mild patients see a doctor according to the guiding order, which also means that non-emergency patients will wait longer to go to the emergency room. Xiao Li mentioned above is a typical case.
Leave emergency resources to those who really need them.
Are these standards reliable? What should I do if the patient is "well" waiting for his condition to deteriorate when he first comes?
This standard is summed up after years of practice, and can identify most critically ill patients. Moreover, based on the principle of "rather wrong than leaking", the criteria for triage of severe cases are relatively loose. Once in doubt, patients who can be classified as 1 will not be classified as Grade 2, and critically ill patients will not be missed. It is also the characteristic of emergency work to check the critical illness first-to reduce the ladder thinking. Patients will also dynamically evaluate their condition after triage, which is not static. If the condition changes, you can re-evaluate the grading and deal with it in time.
Finally, Dr. Zhang said: "The emergency department should be the last solid line of defense for critically ill patients and their lifeline. However, for various reasons, emergency resources are occupied by non-emergency patients. It is quite common to see emergency patients for non-emergency diseases. I hope that everyone will leave first-aid resources to emergency patients who really need them. " Xiao Li scratched his head embarrassedly after hearing this, saying that he would not casually see the emergency department in the future.
Authors: Zhang Xiangyang, Deputy Director of Emergency Department of Tsinghua Chang Gung Hospital.
Text arrangement: Ma Shicheng
Audit experts: experts from the national health science expert database.
Wang Chuanlin, Director of Emergency Surgery/Deputy Director of Trauma Treatment Center, Peking University People's Hospital.
Planning: Tan Jia