Mount Auburn Healthcare Connection

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A successful emergency department is like a well-oiled machine, with each part doing its specific job efficiently so that it doesn’t break down and will keep running smoothly. At Mount Auburn Hospital, the emergency department runs smoothly because its staff members understand and carry out their roles in a variety of situations, some of which are life-threatening.

Todd Thomsen, M.D., emergency medicine physician at Mount Auburn Hospital, says, “At Mount Auburn Hospital, we have established well-understood emergency procedures to make sure we handle each specific situation in the most effective way possible.”

The injuries and conditions that are handled in emergency departments are extremely varied. Some kinds of problems are seen on an almost daily basis while others are much less common. The key is for emergency department personnel to know what to do in each situation.

For instance, one of the most common procedures handled in emergency departments is treating cuts or lacerations. These injuries can be as simple as a small cut on the eyebrow to a deeper laceration on the leg that penetrates multiple layers of tissue. Dr. Thomsen says, “Everyone in our emergency department knows the procedure for handling a laceration and it’s more complicated than knowing how to place a suture in the skin and tie the knot.”

According to Dr. Thomsen, while every wound is somewhat different, there are certain basic steps that should always be taken with every laceration. One of the first steps is to assess exactly what kind of injury has taken place, which requires a good understanding of the many different laceration types. It’s important to determine if the injured person has any additional injuries that may not be initially obvious, such as a brain injury, a fracture, or some kind of deeper wound to blood vessels, muscles, nerves or tendons that needs to be repaired before the laceration is closed.

Before a wound is closed, it’s also essential to make sure that no foreign body has been introduced into the area, so the wound needs to be explored and completely cleaned out to ensure that it is absolutely sterile—a step that is necessary to prevent an infection after the laceration has healed. In addition, emergency physicians need to consider other factors that might affect the patient’s treatment, such as the patient’s age and medical history. Also, certain medications may interfere with the healing process. All these factors need to be considered before proceeding with treatment.

“Once we’ve decided on a treatment plan,” says Dr. Thomsen, “it’s very important to properly explain the procedure to the patient. We never want the patient to be surprised by what takes place.” Various personality factors also need to be considered before treatment begins. For example, if the patient is particularly anxious this might help determine the kind of anesthesia used during treatment.

Dealing with children is a special challenge, but emergency physicians have specific training in pediatrics and understand that a screaming three-year-old may need to be handled with different procedures than a relatively calm forty-year-old. Dr. Thomsen has found that in some situations it’s best for parents to stay with children and in other situations parents may be adding to the child’s anxiety and might be better off in the waiting room during the procedure.

Other common situations where there are clearly established procedures involve broken and dislocated bones. For instance, emergency personnel understand that dislocations need to be handled fairly quickly because there is always the possibility of losing the blood supply to the joint or cutting off a nerve, risking vascular or neurological complications. Also, the longer a joint remains dislocated, the harder it may be to put back in place because muscles tend to constrict as each minute goes by.

The number of conditions and procedures that emergency medicine personnel need to understand is substantial. While most situations seen in an emergency department may seem relatively minor and easily treatable, other conditions require that emergency physicians know how to immediately activate life-saving procedures. For instance, sometimes a physician must put a central venous line into a patient who needs an immediate infusion of blood or other fluid. This procedure is much more complicated than inserting a typical intravenous line and takes significant training and skill, as does diagnosing and providing immediate treatment for a heart attack or stroke.

Having skilled physicians and other emergency department personnel is essential in order to implement the most appropriate procedures and take good care of patients. All the emergency department physicians at Mount Auburn Hospital are residency-trained in emergency medicine and board-certified. While these emergency department physicians can handle most conditions and procedures themselves, they also know when it’s appropriate to consult with specialists or bring in specialists to help treat a patient.

Dr. Thomsen points out that emergency medicine is unique in many ways. It is a very broad-based specialty that requires a wide-ranging knowledge of many facets of medicine. The emergency department is also a unique part of a hospital because it is open 24 hours a day, seven days a week, and is ready to handle any patient who walks in the door with a medical complaint.

“The emergency department is the front door of the hospital to many patients,” says Dr. Thomsen. “More than 60 percent of the patients who are admitted to Mount Auburn Hospital come in through the emergency department. A patient’s first experience in the hospital may be the emergency department. Consequently, we work very hard to follow procedures that will make patients comfortable, provide the correct diagnosis, and alter the course of their injury or disease, whether they are admitted to the hospital or not. It’s important for the public to know that in Mount Auburn Hospital’s emergency department, they can be assured that the physicians and other staff members caring for them are well trained and have the ability to provide at least the initial care for whatever problem they may have.”