How An ER WorksSep 24, 2013
Dr. Troy Madsen: I'm Dr. Troy Madsen, emergency physician at the University of Utah hospital, today how the ER works.
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Dr. Troy Madsen: So one of the questions I get asked a lot as an ER doctor, is how does and ER work? Well the biggest thing to keep in mind, is when you go in the ER, number one, you're seeing an emergency physician. So we're the doctors that work in the ER, that's what we do on a day-to-day basis. We work there, we treat patients, and if anyone would ask what is our specialty, it's treating emergent conditions. So I know a little bit about a lot of things, and in another sense, I don't know a lot about a few things. So it's kind of a trade-off, but that's who you're seeing. So I'll come in the room, I'll see you as an emergency physician, and then we'll go through, what are you here for? Are you having abdominal pain, chest pain, have you been injured? And then kind of sort through it from there. And once we get some test results back, if we find something that's concerning, that's when we get specialists involved.
So in a sense, you know we do kind of triage things, you hear about triage nurses, who kind of distill things down or sort through things, and decide what's really serious and what's not. That's kind of what were doing as ER doctors is sorting through, okay what you have wrong, who we need to get involved? If you come in with the abdominal pain, and we do a CT scan and you have appendicitis, I'll call the surgeon once we get the results back. Now let's say you have an arm that's injured or it looks like it's broken, we'll get the x-rays, once we know it's broken we'll call the orthopedic surgeons. So in that sense, you're coming in the ER, you're seeing us, then we're bringing the other people down to get you the help you need. There are a lot of other people you see on the way there, we have nurses that will see you, sometimes you'll see a triage nurse at the front desk.
In our emergency department we actually have one of the doctors that sits out front, so we can see you more quickly, and try and get you treatment more quickly as well. But you may see EMTs, these are technicians in the ER who may start your IV, you may see radiology technicians, who are taking you to x-rays. So there's a lot of support staff their, but we're all kind of working toward that same goal, under the guidance of the emergency physician, try to figure out what's wrong, is it something we can treat in the ER and send you home, or is it something that we need to get someone else involved. So nurses are absolutely integral part of the emergency department. And I can tell you, having worked a lot of different places, what a huge difference great emergency department nurses make. And I can say in our emergency department they truly are the best nurses I've ever worked with, and we're really fortunate to have them.
The nurses are really responsible, they're kind of my eyes and ears in the ER. I may be taking care 15 different patients at once, I may be stuck in a trauma, I really rely on these nurses to come to me and say, hey this patient in bed ten, is really sick, we need you in there right now. The nurses are the ones that are at the bedside, who know what's going on with the patient, they're starting the IV, giving them medication, sending off the laboratory results, giving really the treatment these patients need, under my direction, and they really are the key to a successful emergency department.
So a lot of people wonder just how hectic is the ER. I think some people think of the ER, kind of like the show ER, from the late 90s, and it seemed like every episode there was a helicopter crashing outside the door, or you know, multiple people coming in with things sticking out of their chest that they've been impaled with.
So it's not always like that in ER. Some days are like that, some days it's absolutely insane, where we may have multiple trauma patients coming in, multiple injured patients, heart attack, stroke were treating at the same. Other days you look around and it kind of scares you just how quiet it is. Just before I came here, I walked through the ER, and it was amazing, there just were not a lot of people there. There's no rhyme or reason to it, but the kind of taboo thing to do, is to actually say it's quiet, you don't want to do that, because, then you sort of jinx it, but it really varies. So there are certain days of the year when I know it's going to be crazy. One day which is notoriously bad, is Easter weekend. For whatever reason, it's that weekend everyone takes off on vacation, and a lot of people go down to the Little Sahara.
These are the sand dunes, down in southeastern Utah, and we actually station one of our helicopters there, and they just fly back and forth all weekend, bringing patients to the ER who have been severely injured from ATV accidents. So that's always a bad day.
The other bad day is July 4, that night. Usually the evening isn't too bad, but it's that night that all the burns start to come in. A lot of patients who have been injured by fireworks. I've seen fingers blown off, severe injuries to hands, to eyes, all sorts of different things that number one, were seeing come directly to the ER, and number two is a burn center that will get transferred to us from all over the Inter mountain region. So those days are usually pretty bad. Some of the holidays, like Christmas, is notoriously work... it's known to be quite usually a quiet day, at least in the morning. New Year's Eve, can get a little crazy at night.
So there are at least some days during year, usually are surrounding holidays, sometimes also associated with University of Utah football games, that can be pretty crazy in the ER.
The thing I really love about what I do is, I really like to feel like I can take care of whatever comes in the door. Sort of being a jack of all trades. I grew up in eastern Utah in a little town called Price, and it's a mining community and during college I did a history project where I interviewed some of the doctors that worked in these mining towns back in the 1920s and 30s, and they would tell me stories of the stuff they cared for, and all these crazy things, and to me, I just, I loved that, and that's what the ER is to me, you take care of everything.
Someone comes in, you got one patient in one room who has a severe head injury you are taking care of, you've got a pregnant patient in another room, someone else with a stroke, someone with chest pain, abdominal pain, you've got kids, adults. I think that's really what makes my job fun, and kind of what keeps you coming back.
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