What is emergency medicine?

From the Guidelines

Emergency medicine is a high-stakes field that requires physicians to embody virtues like courage, justice, vigilance, impartiality, trustworthiness, and resilience to provide optimal care for patients in crisis situations. According to the code of ethics for emergency physicians 1, these virtues are essential for emergency medical practice, as they enable physicians to navigate complex and unpredictable situations while prioritizing patient well-being.

Key Virtues in Emergency Medicine

• Courage: the ability to carry out one's obligations despite personal risk or danger, such as advocating for patients against managed care gatekeepers or providing care for violent or infected patients 1
• Justice: the disposition to give each person what is due to them, ensuring that resources are allocated fairly and that all patients receive a basic level of care 1
• Vigilance: the ability to be alert and prepared to meet unpredictable demands, despite circadian disharmony and personal wellness threats 1
• Impartiality: giving emergency patients an unconditional positive regard and treating them in an unbiased, unprejudiced way, regardless of their background or circumstances 1
• Trustworthiness: protecting patients' interests through competence, informed consent, truthfulness, and confidentiality, and maintaining the trust of patient-subjects in clinical investigations 1
• Resilience: remaining composed, flexible, and competent in the midst of clinical chaos, and facilitating the ability to recover undaunted from change or misfortune 1

Clinical Applications

Emergency physicians must apply these virtues in their daily practice, making quick decisions with limited information, utilizing resources efficiently, and communicating effectively with patients and healthcare teams. This requires a deep understanding of emergency medical procedures, such as intubation, central line placement, wound management, and cardioversion, as well as the ability to prioritize patients based on acuity and provide 24/7 access to care regardless of a patient's ability to pay. By embodying these virtues, emergency physicians can provide high-quality care for patients in crisis situations, ultimately reducing morbidity, mortality, and improving quality of life.

From the Research

Emergency Medicine Overview

• Emergency medicine encompasses a wide range of medical specialties and subspecialties that deal with emergency situations, including cardiopulmonary arrest, acute coronary syndrome, and other life-threatening conditions.
• The primary goal of emergency medicine is to provide rapid and effective treatment to patients in emergency situations, with the aim of preventing long-term damage and improving outcomes.

Resuscitation Techniques

• The Airway, Breathing, and Circulation (ABC) approach is a widely accepted method for emergency resuscitation, which involves stabilizing the airway, breathing, and circulation to maintain cerebral perfusion 2.
• The ABCDE approach, which includes Disability and Exposure, is also applicable in all clinical emergencies for immediate assessment and treatment 3.
• High-quality cardiopulmonary resuscitation is necessary to reduce the duration of cerebral anoxia and improve outcomes in cardiac arrest patients 2.

Antithrombotic Therapy

• Antithrombotic therapy is critical in patients with acute coronary syndrome, particularly those with cardiogenic shock or out-of-hospital cardiac arrest 4.
• The choice of antithrombotic agent, route of administration, and therapeutic drug monitoring are crucial in minimizing the risk of thrombosis and bleeding 4.
• Antiplatelet and anticoagulant agents, such as aspirin, clopidogrel, and bivalirudin, are commonly used in the treatment of acute coronary syndromes 5, 6.
• The combination of aspirin, clopidogrel, and low-dose rivaroxaban has been approved for secondary prevention after acute coronary syndrome 5.

Clinical Application

• The ABC and ABCDE approaches are widely accepted and applicable in all clinical emergencies, including cardiac arrest, acute coronary syndrome, and other life-threatening conditions 2, 3.
• Antithrombotic therapy should be carefully considered and individualized based on the patient's risk factors, medical history, and current clinical condition 4, 5, 6.