The conservative emergency room - care of acutely critically ill non-trauma patients

Abstract

Treatment of critically ill non-trauma patients is challenging, due to the broad spectrum of underlying diseases in this clinical setting. It has been shown that outcome in these patients is poor due to high age, comorbidities and severeness of acute disease. In most cases it is crucial to establish diagnosis and start specific treatment immediately to improve patients' outcome. In contrast to the management of severely injured patients, general guidelines for the initial diagnostic and therapeutic approaches in these patients have been lacking until now. As a consequence, little is known about both: patients' characteristics and outcome. This article provides an overview of the current information available on this group of patients.All critically ill patients should first be managed in the resuscitation room, as it is necessary to provide the optimal infrastructure, including material and personal resources, to maintain high quality care. For non-trauma patients, indication can be defined using the ABCDE approach. Expertise in emergency ultrasound as a key diagnostic tool, profound knowledge of intensive care treatment and of diagnostic and therapeutic approaches according to current specific guidelines are required. These requirements can be implemented by assembling nursery and medical staff trained in emergency care, supported by accredited continued professional development and regular simulation trainings.The best transition from preclinical to in-hospital care is achieved through detailed preparation and the use of standardized handover tools. Subsequent patient management can be organized using the primary and secondary survey. These aim to detect and treat life threatening pathologies first and, within a second step, to expand the diagnosis and therapy according to the individual case. Special focus should be put on communication, using crew resource management training, and on the provision on an open and constructive approach to making mistakes.