Hospital Emergency Department

Emergency medicine is the only medical specialty defined by the area in which it is practicedi.e., the hospital emergency department (8:22). It is there that hospital personnel interact with police, firefighters, and paramedics to provide prehospital care (8:2). It is also where an increasing number of people with a broadening array of medical needs come for initial treatment. It involves a population of patients whichlike the sands of an hourglassconverges on the hospital and then diverges with each patient eventually departing to his or her final functional destination (8:23). Emergency medicine is a highly technical and continuously evolving specialty. It can resemble a playing field where well trained personnel act as a coordinated team, their efforts directed towards a common goal. That goal is to prevent the deterioration of life and limb and to provide relief from suffering (8:2).

For the physician, the first priority in emergency medicine is to determine which patient is most ill (7:3). This initial assessment is known as triage (7:4). A concept which originated on the battlefields of France, triage involves sorting patients on the basis of need. It requires that the physician set priorities in a manner that ensures the best possible outcome of events (8:2). Furthermore, this responsibility must often be executed with a sense of urgency. Not only is the hourglass an appropriate metaphor for patient flow through the emergency department, but it also

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doses and its alpha1adrenergic effects cause vasoconstriction at higher doses (6:51). Furthermore, in addition to being effective against cardiogenic shock, the drug is a good firstline vasopressor for reversing hypotension in cases of septic and neurogenic shock (6:60). Another drug that is useful in cardiac emergencies is dobutamine hydrochloride (6:79). A synthetic catecholamine with beta1receptor, peripheral beta2 and alphareceptor activity, it is given to patients with congestive heart failure to increase cardiac contractility and decrease left ventricular filling pressures. In addition, in cases of cardiogenic shock, dobutamine is one of the safest beta1adrenergic agents for initial therapy (6:51). This is due to the fact that it causes minimal changes in blood pressure and heart rate; very rarely, is the drug associated with tachyarrhythmias (6:51). Yet another cardiac medication, digoxin, is a commonly used inotropic agent (6:412). Its direct effects include increasing myocardial contractility, increasing the refractory period of the AV node, and increasing total peripheral resistance (6:412). At higher doses, however, toxic sympathomimetic effects become important (6:412). Finally, verapamil is a ca

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