Role of PA in ER

Question 1

top basket of crash cart

Answer 1

large gloves

surgical cone mask

defibrillator pads

adult multi-function electrodes

pediatric multi-function electrodes

Question 2

bottom basket of crash cart

Answer 2

adult BVM with adult masks

peds BVM with #2,3,4 masks

5 in 1 connector and O2 tubing

Question 3

where is sharps container

Answer 3

right side of crash cart

Question 4

what is on left side of cart

Answer 4

O2 tank and gauge

adult and pediatric crash cart inventory list

anaphylaxis tx guide

Question 5

what things are included on clipboard on back of cart

Answer 5

procedures sheet

crash cart check off list

pharmacy charge sheet

code blue team sign-in sheet

code blue record sheets

Question 6

first drawer of crash cart

Answer 6

drugs for adults

alcohol swabs

blank labels

the drugs are all preloaded and measured

Question 7

2nd drawer of crash cart

Answer 7

pediatric medications

IV solutions too - NaCl 100mL, Dextrose, NaCl 1000mL

Question 8

3rd drawer of crash cart

Answer 8

adult intubation supplies

Question 9

4th drawer of crash cart

Answer 9

peds intubation supplies

Question 10

5th drawer of crash cart

Answer 10

IV start supplies

Question 11

6th drawer of crash cart

Answer 11

IV supplies and tubing

Question 12

7th drawer of crash cart

Answer 12

procedure trays

Question 13

supervision models in ER

Answer 13

PA sees pts autonomously and consults PRN with physician

PA sees pts, physician follows up with each pt too

Physician sees all patients outside of PA scope and available for second opinions

Question 14

Parameters that determine scope of practice:

Answer 14

state laws and regulations

facility/institution policies

experience/expertise of the PA

supervising physician delegation

Question 15

top ten reasons for ED visits

Answer 15

1. abdominal pain
2. chest pain
3. fever
4. cough
5. headache
6. SOB
7. Back pain
8. Pain (other)
9. laceration
10. throat symptoms

Question 16

What are the warning signs in a pt’s history that makes you have heightened awareness

Answer 16

sudden onset (especially first episode)

rapid, significant worsening of symptoms

altered level of consciousness or loss of consciousness

cardiopulmonary symptoms

extremes of age

immunocompromised

poor historian

frequent recent ER visits (drug seeking)

unvaccinated or under-vaccinated

patient signed off to you at the end of shift (YOU NEED TO DO OWN EVALUATION)

Question 17

why is general appearance so important?

Answer 17

look to see if they’re uncomfortable

what is their social interaction like (can tell you about domestic violence)

hydration status (peds - crying but minimal tear production)

lethargy

diaphoresis

skin changes (pallor, jaundice)

Question 18

how often should you re-evaluate a pt in the ED

Answer 18

regularly - review vitals, appearance, pain level, and response to intervention

Question 19

what should you do prior to discharge

Answer 19

recheck vitals

clear discharge instructions

ask pt if they have questions

Question 20

what is EMTALA?

Answer 20

federal regulation for EDs providing medicare/medicaid services:

cannot turn away pt based on ability to pay, legal status, citizenships status

may only transport pt to another facility only if needed

Question 21

what must occur with EMTALA

Answer 21

medical screening examination – must be done by PA, NP, physician

this determines if an emergency condition exists?

Question 22

can PAs order hospital transfers?

Answer 22

yes as long as consult with SP first and SP cosigns order within timeframe specified by hospital

Some hospital transfers mandate doc to doc interaction

Question 23

what will you see in fast track

Answer 23

stable vital signs + minor illness

lacerations

minor bites/burns

abscesses and cellulitis

rashes

headaches (but have hx of them)

earaches, sore throats, cough, congestion

back pain

dysuria without fever

Question 24

high acuity care examples

Answer 24

deformed extremities

age less than 3 mos

temp over 103

abnormal vital signs

O2 sat less than 90% on room air

chest pain, difficulty breathing, neurologic changes, abdominal pain, pelvic pain, vaginal bleeding

elderly

Question 25

can PAs hold administrative role and what do they do

Answer 25

yes scheduling interviewing/hiring board meetings can be partners taking leadership roles teaching on-boarding research lectures

Question 26

documentation in ER

Answer 26

ED note informed consent procedure note admission note discharge note leaving AMA note

Question 27

what is your ONLY defense against malpractice

Answer 27

YOUR ED NOTE must be thorough and complete reflects credibility and competency used to support billing processes use to prove/disprove something and then document it

Question 28

what portion of ED note is different than most other notes

Answer 28

disposition - where are they being discharged

Question 29

is exact dx always needed and possible

Answer 29

NO

Question 30

if discharged to OR, who writes admit note

Answer 30

surgeon

Question 31

can you ask for consults if you're not admitting

Answer 31

YES - sometimes you will discharge them with a consult at the doctor's office in two hours

Question 32

what are the goals of informed consent

Answer 32

support pts to make their own decision give info - more than we think we need to give make info understandable offer guidance to help weigh goals and possible outcomes allow autonomous authorization - consent or refuse

Question 33

exceptions to informed consent

Answer 33

unconscious patient incapable of consenting imminent harm from non-treatment no surrogate available

Question 34

justification of an emergency exception to informed consent - what questions to ask (5)

Answer 34

will failure to tx quickly result in serious harm to the pt? would most capable and reasonable people want tx for this type of injury? is the pt unable to participate in care decisions ? can pt preferences be related in a timely way from a surrogate? is there any evidence that the pt would refuse this specific pt?

Question 35

aspects of procedure note

Answer 35

pt name and DOB date/time indication consent description of procedure estimated blood loss complications

Question 36

what do you use to help you remember what to include on admission orders

Answer 36

ADC VANDISMAL

Question 37

What needs to be included in admission orders

Answer 37

Admit Diagnosis Condition Vitals Allergies Nursing Diet IV fluids Specials Meds Activity Labs

Question 38

discharge note - what is important to include

Answer 38

list ALL meds --> do they discontinue old ones?? be very specific!

Question 39

what should you review with a pt if they decide to leave AMA

Answer 39

current medical condition specific risks and benefits of proposed tx and alternatives specific potential consequences of leaving AMA

Question 40

what must you do before pt leaves AMA

Answer 40

assess mental capacity of pt: pt understands proposed tx, pt understands consequences of refusing tx, pt's reason for refusal of continued tx or admission follow up - advise them when to seek medical attn and arrange with social services and family members

Question 41

3 certifications it is recommended you have if you want to work in ED

Answer 41

ACLS - advanced cardiac life support PALS - advanced pediatric life support ATLS - advanced trauma life support