Shades of Gray: What should you expect if you take a sick relative to the ER?
It is Sunday evening and your father or close relative is having some serious looking medical problem. You have to take him to an emergency in the nearby large hospital. You are pretty sure that there will be some young doctor available to attend to your relative. Thoughts in your head swing between optimism and pessimism in the light of the events that have happened recently in India.
What should you reasonably expect in the ER and the subsequent hours? What should be your role in the event? This blog aims to provide that information for you and is a series of questions that you have to ask yourself and also the doctor and get appropriate information.
# 1. Is the patient at risk of death? This is the first question to be asked. If you take the patient to the hospital in an unconscious state (not responding to call), in shock (No recordable BP) and feeble pulses and very low oxygen in the blood (measured by a pulse oximeter), the patient is at high risk of death. Stabilisation of the patient with securing of the airway, restoring oxygenation by supplemental oxygen along with mechanical ventilation (breathing machine) and supportive IV fluids and medications. Stat tests (done at the bedside with immediate results) are ECG, blood glucose and ABG. If you go through this process, the rough cost will be Rs. 15, 000 - 20, 000 within 1 hour.
The reaction time required for this is very small - drop in oxygenation to critical levels can damage the brain in about 5 minutes. So when you go to the ER, it is good to be prepared for this if you find any of the above described symptoms. This is the first medical intervention a junior doctor does in the ER.
If you have reached on time and the patient responds to the treatment given, we can proceed to the next step. Your role is to give the doctor, time to stabilise the patient without any interference and also be ready financially for tests and medications required for stabilisation.
# 2. What caused the problem? Establishing what caused the problem (the medical term for this is diagnosis) follows after stabilisation of the clinical condition especially with regard to breathing and circulation.
Doctors do this by asking a series of questions and analysing the answers given. Honest answers will give the doctor a clue to your illness and he or she will examine the patient and look again for clues to the problem.
Most of the time, the doctor's suspicion will have to be confirmed by tests. Once the diagnosis is established, definitive treatment begins.
# 3. What kind of treatment is needed and where should it be provided? There are only 2 broad categories of treatment - medical treatment and surgical treatment. There are 2 broad places to treat you in the hospital - the intensive care unit and the ward. The choice of treatment will vary with the diagnosis and I am sure, the doctor will explain this to you.
ICU care is given to patients who require minute by minute monitoring so that complications can be identified. It is also given to patients who are on medications whose effect changes in minutes. Nurses are available at the bedside to identify and relay information to the doctor. ICU care is also given to patients who require some kind of device to treat the failed organs which is best centralised in the hospital.
# 4. When is the projected recovery of the patient? Knowing the course of the illness in a broad way is a sign of expertise in your doctor. If he knows the illness enough to treat you well, he will also tell you how the treatment will happen and how the disease will respond. Over my 20 years of working as a surgeon, I find this as an product of knowing well. I look for this whenever I take my relatives to the hospital to treat an illness that does not fall into my expertise. Most of the junior doctors and inexperienced ones will give vague remarks like - "we will see after 48 hours".
#5. What if nothing can be done? What do you do if the nature of the illness is severe enough that the patient is hurtling towards death? Presence of more than 3 organ failures leads to death in everyone. There are a 2 key decisions that you must take and clearly express to the doctor - what is the end of life care that you expect for your loved one and if they are brain dead, would they qualify to be an organ donor.
Most of the medical team would address your concerns and issues. Alway talk about the last point with the senior member of the medical team and request to talk to them. Most of the junior medical and surgical team will focus on the altered physiology, but these kind of decision require a wisdom that you would mostly find in senior physicians and surgeons.
What should you reasonably expect in the ER and the subsequent hours? What should be your role in the event? This blog aims to provide that information for you and is a series of questions that you have to ask yourself and also the doctor and get appropriate information.
# 1. Is the patient at risk of death? This is the first question to be asked. If you take the patient to the hospital in an unconscious state (not responding to call), in shock (No recordable BP) and feeble pulses and very low oxygen in the blood (measured by a pulse oximeter), the patient is at high risk of death. Stabilisation of the patient with securing of the airway, restoring oxygenation by supplemental oxygen along with mechanical ventilation (breathing machine) and supportive IV fluids and medications. Stat tests (done at the bedside with immediate results) are ECG, blood glucose and ABG. If you go through this process, the rough cost will be Rs. 15, 000 - 20, 000 within 1 hour.
The reaction time required for this is very small - drop in oxygenation to critical levels can damage the brain in about 5 minutes. So when you go to the ER, it is good to be prepared for this if you find any of the above described symptoms. This is the first medical intervention a junior doctor does in the ER.
If you have reached on time and the patient responds to the treatment given, we can proceed to the next step. Your role is to give the doctor, time to stabilise the patient without any interference and also be ready financially for tests and medications required for stabilisation.
# 2. What caused the problem? Establishing what caused the problem (the medical term for this is diagnosis) follows after stabilisation of the clinical condition especially with regard to breathing and circulation.
Doctors do this by asking a series of questions and analysing the answers given. Honest answers will give the doctor a clue to your illness and he or she will examine the patient and look again for clues to the problem.
Most of the time, the doctor's suspicion will have to be confirmed by tests. Once the diagnosis is established, definitive treatment begins.
# 3. What kind of treatment is needed and where should it be provided? There are only 2 broad categories of treatment - medical treatment and surgical treatment. There are 2 broad places to treat you in the hospital - the intensive care unit and the ward. The choice of treatment will vary with the diagnosis and I am sure, the doctor will explain this to you.
ICU care is given to patients who require minute by minute monitoring so that complications can be identified. It is also given to patients who are on medications whose effect changes in minutes. Nurses are available at the bedside to identify and relay information to the doctor. ICU care is also given to patients who require some kind of device to treat the failed organs which is best centralised in the hospital.
# 4. When is the projected recovery of the patient? Knowing the course of the illness in a broad way is a sign of expertise in your doctor. If he knows the illness enough to treat you well, he will also tell you how the treatment will happen and how the disease will respond. Over my 20 years of working as a surgeon, I find this as an product of knowing well. I look for this whenever I take my relatives to the hospital to treat an illness that does not fall into my expertise. Most of the junior doctors and inexperienced ones will give vague remarks like - "we will see after 48 hours".
#5. What if nothing can be done? What do you do if the nature of the illness is severe enough that the patient is hurtling towards death? Presence of more than 3 organ failures leads to death in everyone. There are a 2 key decisions that you must take and clearly express to the doctor - what is the end of life care that you expect for your loved one and if they are brain dead, would they qualify to be an organ donor.
Most of the medical team would address your concerns and issues. Alway talk about the last point with the senior member of the medical team and request to talk to them. Most of the junior medical and surgical team will focus on the altered physiology, but these kind of decision require a wisdom that you would mostly find in senior physicians and surgeons.
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