Emergency medicine: objectives, exams, techniques, important concepts

By Cristiano Antonino On Mar 30, 2023

Emergency medicine is the specific medical discipline that deals with emergencies or urgencies and operates in internal hospital services (Emergency Room) or services outside the hospital, such as Emergency Number

History of Emergency Medicine

Emergency medicine (and the very concept of “first aid”) has historically experienced strong developments coinciding with major war events (in particular the First and Second World War) and is still very important today especially in those places where there are wars going on.

Historically, the modern concept of emergency medicine dates back to the French Revolution, thanks to the contribution of the surgeon Dominique Jean Larrey (Beaudéan, France, July 8, 1766 – Lyon, July 25, 1842), who first conceived the concept of a specifically equipped ambulance for the rapid transport of wounded soldiers from the front to the field infirmaries and for this reason he is considered the “father” of emergency medicine.

The history of the ambulance is actually more articulated and earlier, but undoubtedly Larrey’s idea is considered a cardinal point in the history of rescue, albeit not the only one.

Main objectives of Emergency Medicine

Emergency medicine deals transversally with a series of clinical topics usually pertaining to many other medical-surgical specializations, such as neurology, cardiology, surgery, pulmonology, anesthesia and resuscitation, but which are specifically declined within the ambit of intervention on acute events and in patients in critical conditions, for example polytraumatized, with amputations, with head trauma, internal bleeding.

A specific application of emergency medicine is intervention in areas of maxi-emergency, such as in disaster medicine. (aircraft accidents, railway accidents, major fires, explosions, earthquakes…).

Quickness

In emergency medicine one of the most important components is the speed in reaching the diagnosis in order to be able to start the therapy as soon as possible: in emergency medicine the concept of golden hour is more important than in all areas of medical specialization and one minute more or less often makes the difference between life and death for the patient.

Anamnesis and physical examination must be extremely rapid and this is often difficult and not always possible, given that seriously ill patients who arrive at the emergency room are frequently unconscious and alone, therefore without relatives or friends to ask for medical information.

In emergency medicine, the majority of tests (such as laboratory and imaging diagnostics) are carried out in extremely short times because any small delay decreases the chances of recovery of the seriously ill patient.

Laboratory tests

There are numerous laboratory tests that can be performed directly in an emergency:

Emergency Medicine and Imaging Diagnostics

One of the most important components in emergency medicine diagnosis is diagnostic imaging.

The exams are carried out in a very short time and are mainly:

traditional radiology (for example in fractures and thoracic and abdominal pathologies in general);
TAC (very useful in head trauma);
nuclear magnetic resonance (very useful in spine traumatology);
ultrasound (extremely useful in case of damage to the abdomen).

Ultrasound

Ultrasound, initially considered the exclusive competence of the radiologist and now widespread in other specializations (for example in cardiology and gynecology), has numerous applications in emergencies.

Ultrasound is a quick, painless, non-invasive, inexpensive examination that can be performed on pregnant women.

One of the few “defects” of ultrasound devices is that they are “operator dependent”: the doctor must be very good at using the probe in order to find exactly the problem and this can be difficult in the hectic moments of rescue in multiple-traumatized patients.

In addition to the now “classic” applications in the field of trauma (FAST ultrasound: Focused Abdominal Sonography for Trauma), ultrasound in the course of abdominal pain, echocardioscopy (synthetic and essential evaluation of cardiac function) and chest ultrasound.

Electrocardiogram

In emergency medicine, great importance lies in the electrocardiogram: a quick, safe, cheap test that provides very useful information to the emergency doctor.

An electrocardiagram, often associated with a cardiac ultrasound with color Doppler, provides valuable information on the electrical activity of the heart, its morphology and the movement of blood inside it.

Techniques, devices and important concepts in emergency medicine and first aid in general are:

Characteristics of the emergency doctor

The “ideal” emergency doctor must be an expert in various health fields: internal medicine, emergency sedation, use of electronic equipment for diagnostics in critical situations, intubation, cardiac massage, oxygen therapy, cardiopulmonary resuscitation and minor surgical operations performed at the time of emergency, ranging from a few stitches used to suture small wounds, to tracheostomy in case of upper airway obstruction that prevents normal breathing.

The “ideal” emergency-urgency doctor, based on our experience, has courage, rapidity of thought and action, rationality, coldness, maximum knowledge of the entire human organism (both anatomy and pathophysiology), extreme resistance psycho-physical to prolonged stressful events, ability to switch from rest to frenetic action in a few moments.