,
,Golden rules of Emergency Medicine
There are exceptions to every rule, but think very carefully before breaking
the following:
General Rules
• Turn up on time for every shift
• ED staff work as a team—thank members appropriately
• Always listen to nagging doubts
• Do not work beyond your expertise: when in doubt, seek senior advice
• If someone gives you advice, record what it was and who gave it
• Referral means referral and is usually a one-way process
• When making notes, write legibly, record times and print your name
• Always record what explanation and advice you give
• Avoid giving an opinion outside your expertise
• Always re-check drug doses (especially in children)
Rules and your patient
• Allow patients to ‘tell their story’ or at least a summary of it
• Beware patients who are ‘handed over’ to you
• Treat patients as you would want to be treated
• Treat the patient (not just the investigation result)
• Do not bring patients back for a second opinion—get a first opinion
• Discuss with a senior if contemplating breaking patient confidentiality
• If a patient has d GCS, check BMG
• Glass + skin wound = X-ray
• Beware using tourniquets on digits and limbs
• Check visual acuity for all eye problems
• X-ray high velocity eye injuries (eg hammering)
• Always check/document anatomical snuffbox tenderness in wrist injuries
• ‘Worst headache ever’ mandates exclusion of subarachnoid haemorrhage
• Call an anaesthetist early in possible airway burns
• Never assume d GCS is due to alcohol alone (especially with head injury)
• Admit patients with even minor head injury and no one at home
• CT scan patients with head injury if they take anticoagulants
• Bleeding disorder + injury = discuss with a haematologist
• Do not place chest tubes through stab or bullet wounds
• Take it seriously if a parent says their baby (or child) is simply ‘not right’
• Consider meningococcal disease with unexplained skin rashes
• Consider NAI in atypical paediatric presentations
• If NAI is a possibility, inform a senior and/or specialist at once
• Do not try to age bruises
• Ask about allergies before giving drugs
Rules and you
• Ensure each shift contains regular refreshment breaks
• Do not try to ‘work through’ illness
• If you feel yourself becoming angry, take a deep breath and a short break
• If a fellow professional is rude, it may reflect stress on their part
• Each time you see a new condition, read up about it
, OXFORD MEDICAL PUBLICATIONS
Oxford Handbook of
Emergency Medicine
,Golden rules of Emergency Medicine
There are exceptions to every rule, but think very carefully before breaking
the following:
General Rules
• Turn up on time for every shift
• ED staff work as a team—thank members appropriately
• Always listen to nagging doubts
• Do not work beyond your expertise: when in doubt, seek senior advice
• If someone gives you advice, record what it was and who gave it
• Referral means referral and is usually a one-way process
• When making notes, write legibly, record times and print your name
• Always record what explanation and advice you give
• Avoid giving an opinion outside your expertise
• Always re-check drug doses (especially in children)
Rules and your patient
• Allow patients to ‘tell their story’ or at least a summary of it
• Beware patients who are ‘handed over’ to you
• Treat patients as you would want to be treated
• Treat the patient (not just the investigation result)
• Do not bring patients back for a second opinion—get a first opinion
• Discuss with a senior if contemplating breaking patient confidentiality
• If a patient has d GCS, check BMG
• Glass + skin wound = X-ray
• Beware using tourniquets on digits and limbs
• Check visual acuity for all eye problems
• X-ray high velocity eye injuries (eg hammering)
• Always check/document anatomical snuffbox tenderness in wrist injuries
• ‘Worst headache ever’ mandates exclusion of subarachnoid haemorrhage
• Call an anaesthetist early in possible airway burns
• Never assume d GCS is due to alcohol alone (especially with head injury)
• Admit patients with even minor head injury and no one at home
• CT scan patients with head injury if they take anticoagulants
• Bleeding disorder + injury = discuss with a haematologist
• Do not place chest tubes through stab or bullet wounds
• Take it seriously if a parent says their baby (or child) is simply ‘not right’
• Consider meningococcal disease with unexplained skin rashes
• Consider NAI in atypical paediatric presentations
• If NAI is a possibility, inform a senior and/or specialist at once
• Do not try to age bruises
• Ask about allergies before giving drugs
Rules and you
• Ensure each shift contains regular refreshment breaks
• Do not try to ‘work through’ illness
• If you feel yourself becoming angry, take a deep breath and a short break
• If a fellow professional is rude, it may reflect stress on their part
• Each time you see a new condition, read up about it
, OXFORD MEDICAL PUBLICATIONS
Oxford Handbook of
Emergency Medicine
