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  3. Emergency Rooms Millions of Americans visit an emergency room each year. Millions more have seen the hit TV show "ER". This

Emergency Rooms Millions of Americans visit an emergency room each year. Millions more have seen the hit TV show "ER". This

admin2013-06-25  83
问题                             Emergency Rooms
    Millions of Americans visit an emergency room each year. Millions more have seen the hit TV show "ER". This has sparked a great interest in the fascinating, 24-hour-a-day, non-stop world of emergency medicine.
    A visit to the emergency room can be a stressful, scary event. Why is it so scary? First of all, there is the fear of not knowing what is wrong with you. There is the fear of having to visit an unfamiliar place filled with people you have never met. Also, you may have to undergo tests that you do not understand at a pace that discourages questions and comprehensions.
    In this article, we lead you through a complete behind-the-scenes tour of a typical emergency room. You will learn about the normal flow of traffic in an emergency room, the people involved and the special techniques used to respond to life-or-death situations. If you yourself find the need to visit an emergency room, this article will make it less stressful by revealing what will happen and why things happen the way they do in an emergency department.
    Understanding the ER Maze
    The classic emergency room scene involves an ambulance screeching a halt, a gurney hurtling through the hallway and five people frantically working to save a person’s life with only seconds to spare. This does happen and is not uncommon, but the majority of cases seen in a typical emergency department aren’t quite this dramatic. Let’s look at a typical case to see to the normal flow of an emergency room works.
    Imagine that it’s 2 a.m. , and you’re dreaming about whatever it is that you dream about. Suddenly you wake up because your abdomen hurts — a lot. This seems like something out of the ordinary, so you call your regular doctor. He tells you to go to your local hospital’s emergency department: He is concerned about appendicitis (阑尾炎) because your pain is located in the right, lower abdomen.
    When you arrive at the emergency department, your first stop is triage (医疗鉴别分类). This is the place where each patient’s condition is prioritized, typically by a nurse, into three general categories. The categories are immediately life threatening; urgent, but not immediately life threatening; and less urgent.
    This categorization is necessary so that someone with a life-threatening condition is not kept waiting because they arrive a few minutes later than someone with a more routine problem. The triage nurse records your vital signs (temperature, pulse, respiratory rate and blood pressure). She also gets a brief history of your current medical complaints, past medical problems, medications and allergies so that she can determine the appropriate triage category. Here you find out that your temperature is 101 degrees F.
    What’s next? You need to register.
    Registration
    After triage, the next step is registration — not very exciting and rarely seen on TV. Here they obtain your vital statistics. You may also provide them with your insurance information, Medicare, Medicaid or Health Maintenance Organization card. This step is necessary to develop a medical record so that your medical history, lab tests, X-rays, etc. , will all be located on the chart that can be referenced at any time. The bill will also be generated from this information.
    If the patient’s condition is life-threatening or if the patient arrives by ambulance, this step may be completed later at the bedside.
    Examination Room
    Now you are brought to the exam room. You promptly throw up in the bathroom, which may be more evidence of appendicitis; you are seen by an emergency department nurse who obtains more detailed information about you. The nurse gets you settled into a patient gown so that you can be examined properly and perhaps obtain a urine (尿) specimen at this time.
    Some emergency departments have been subdivided into separate areas in order to better serve their patients. These separate areas can include a pediatric FR, a chest-pain ER, a fast track (for minor injuries and illnesses), trauma center (usually for severely injured patients) and an observation unit (for patients who do not require hospital admission but do require prolonged treatment or many diagnostic tests).
    Once the nurse has finished her tasks, the next visitor is an emergency-medicine physician. He gets a more detailed medical history about your present illness, past medical problems, family history, and a complete review of all your body systems. He then formulates a list of possible of your symptoms; this list is called a differential diagnosis. The most likely diagnosis is then determined by the patient’s symptoms and physical examination, if this is inadequate to determine the diagnosis, then diagnostic tests are required.
    Diagnostic Tests
    When the tricky diagnosis of appendicitis is considered, blood tests and a urinalysis are required.
    The patient’s blood is put into different colored tubes, each with its own additive depending on the test being performed:
    AA purple-top tube is used for a complete blood count (CBC). A CBC measures:
    1. The adequacy of your red blood cells, to see if you are anemic (贫血的)
    2. The number and type of white blood cells (WBCs), to determine the presence of infection
    3. A platelet count (platelets are a blood component necessary for clotting)
    A red-top tube is used to test the serum (the liquid or non-cellular half of your blood).
    A blue-top tube is used to test your blood’s clotting.
    The tests in your case indicate that you have an elevated WBC count. This is a sign of a bacterial infection, and bacterial infections are commonly associated with appendicitis.
    At this point, the emergency physician may request that you not eat or drink anything. The reason is that appendicitis is treated by surgery, and an empty stomach is desirable to prevent some compilations of anesthesia (麻醉).
    Diagnosis and Treatment
    When the emergency physician has all the information he can obtain, he makes a determination of the most likely diagnosis from his differential diagnosis.
    Alternately, he may decide that he does not have enough information to make a decision and may require more tests. At this point, he speaks to a general surgeon the appropriate consultant in this case. The surgeon comes to see you and performs a thorough history, physical exam, and review of your lab data. She examines your symptoms: pain and tenderness in the right, lower abdomen, vomiting, low-grade fever and elevated WBC count. These symptoms all point to appendicitis. The treatment of appendicitis is removal of the appendix, or an appendectomy. The surgeon explains the procedure, including the risks and benefits. You then sign a consent form to document this and permit her to operate on you.
    Disposition
    Depending on a patient’s specific medical condition, physicians will admit the patient to the hospital, discharge the patient, or transfer the patient to a more appropriate medical facility.
    If you are discharged, you will receive discharge instructions (either written specifically for you or pre-printed) that explain your medications and other treatments. If medications are prescribed, you may receive a beginning dose if there are no drug stores open in your area at that particular time. You will also be referred for follow-up care should your condition continue or worsen.
    You may need to be transferred if your condition is better treated at another institution. You may have to sign a consent form if your condition or mental state allows.
    The modern emergency department performs an important role in our society; it really is a marvelous invention that has saved countless lives. Hopefully, the information in this article will help ease your fears should you need the services of an emergency department in the future.
According to the actual situation of the patients and the arrival time, nurses decide who comes into the emergency room.
选项 A、Y
B、N
C、NG
答案B
解析 原文定位中提到在急诊室就诊时需要考虑病人的危重程度，而题干中涉及就诊先后顺序的是病人的病情和病人到达急诊室的时间，和原文的陈述不一致，故选择N。
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