Definition of Emergency Medicine
La medicina de emergencia es definida por un sistema complejo que incluye necesidades del paciente y recursos hospitalarios y prehospitalarios. Adoptada por la AMA en 1975, esta definición guía la formación de residencia y resalta la responsabilidad del médico de emergencia en el reconocimiento inmediato, estabilización, evaluación, tratamiento y disposición de pacientes con enfermedades y lesiones agudas.
La práctica clínica en medicina de emergencia implica una atención accesible las 24 horas del día, basada en intervenciones inmediatas y manejo de múltiples pacientes con condiciones físicas y conductuales diversas. Además, los médicos de emergencia tienen responsabilidades prehospitalarias y deben gestionar aspectos médicos y administrativos del sistema de servicios médicos de emergencia.
La certificación en esta especialidad es crucial para garantizar que los médicos estén adecuadamente preparados para ofrecer atención de emergencia de alta calidad.
The Biology of Emergency Medicine (Traducción)
Es hora de que aceptemos nuestro papel en la medicina sin disculpas y con la confianza de que podemos hacer el trabajo bien sin pedir ayuda hasta la próxima fase de atención por la especialidad apropiada. Los días en que el médico de emergencia funcionaba como un secretario de referencia y pedía permiso antes de intervenir en una amenaza de vida del paciente, deben, deberían y llegarán a su fin.
The Biology of Emergency Medicine (Texto Original)
The Biology of Emergency Medicine Peter Rosen, MD Denver, Colorado INTRODUCTION Aristotle has often been misquoted as stating that all things must have a beginning, middle, and end. What he actually said was, «A whole is that which has a beginning, middle, and end.» I think it might be instructive to analyze emergency medicine as a whole to present my vision of the specialness of emergency medicine. THE WHOLE The BEGINNING «that which is not itself necessarily after anything else, and which has naturally something else after it…» The history of emergency medicine is not yet written. But less important than who were the first physicians to restrict their practice to emergency medicine are the reasons for the appearance of the specialty. It is hard to comprehend why it took so long for attention to be paid to the demands of the specialty. Certainly, since man took his first steps, there have been accidents and ailments that struck him down unawares. Doubtless, it takes a certain technology and willingness to intervene in natural disasters by an emergency response. Nevertheless, it is still an unaccountably late development in modern medicine. The beginning cannot, therefore, be the onset of those medical conditions that would mandate a professional emergency response. In fact, when one analyzes emergency medicine in terms of its case load, one is quickly struck by the fact that true emergencies, i.e., the life or limb threat, are not what has produced the beginning of the field. Even the urgent cases (nonlife or limb threat but requiring a response to prevent deterioration into true emergency) probably would not have produced the field. In fact, I believe that two events coincided to produce the beginning: first was increasing numbers of nonemergency patients in the emergency department; second, the initial financial support for these cases in the emergency department. The cause of the increased workloads is multifactorial: the disappearance of primary physicians; the demise of the housecall; the growth of urban populations; the increased expectations of the public («If you can put a man on the moon, why can’t you cure my cold?»); the initial willingness of third-party carriers to pay for emergency department visits but not office calls, and last, but not least, the captive presence of a physician in a predictable geographic area when the patient wanted to be seen: the interface with the medical delivery system. I’m sure that many other factors can be offered to explain this onset, but whatever the conglomeration of sociologic, technologic and medical events, in the late 1960s the crisis became ubiquitous, and the response produced emergency medicine. The MIDDLE «that which is by nature after one thing, and has also another after it…» It is hardly arguable that emergency medicine evolved along the only possible path or even that what we recognize as emergency medicine today is the form that it will assume over the next several decades. But as we all struggle to define our roles and responsibilities, it is worthwhile to pause and ask: Is there anything unique about emergency medicine that we can see in our struggle to define it as a special entity? That this was not done before the specialty had its beginning is not unique. While one can clearly distinguish between the allergist and the vascular surgeon, and readily understand the intellectual and technical concerns that separate them, the epistemological waters become very murky when trying to decide to whom to refer the facial fracture – oral, plastic surgeon, or otolaryngologist. DEFINING THE SPECIALTY Webster’s Dictionary defines a specialty as: «A branch of knowledge, science, art or business to which one devotes oneself whether as an avocation or a profession, and usually to the partial or total exclusion of related matters.» What is there to emergency medicine to justify this definition? First, there is the workload in and of itself. Not only did it produce the economic incentive for people to «exclude totally or partially related matters,» but its logistics began to shape the specialness of emergency medicine. One of the specialty’s responsibilities is not only to separate the sicker from the less sick but to juggle several patients simultaneously. The emergency physician does not have the luxury of devoting all of his energy to a single case at a time. To return to the separation of emergency, urgent, and nonemergency, clearly many of us choose emergency medicine because of the life or limb threat. The «cowboy case» makes our adrenaline flow and combating death is the intellectual and emotional challenge we sought in becoming physicians. But, in fact, as we examine our response to the emergency, our responsibilities are defined less by the definition of the disease state than by the level of life threat. As an analogy, the role of emergency medicine is to catch the climber who is falling from a precipice and return him to as much safety as can be readily achieved, but not necessarily to get him all the way back down to the valley. Nor does it matter how he fell. The life threat of the fall must be overcome before determining that his rope broke or that he was pushed by a jilted lover. At times, that intervention can be lifesaving; at times, merely stabilizing as in volume replacement in the hemorrhaging patient. And as we define our responsibilities, we get caught up in the uniqueness of our specialty. The dying organism behaves differently. Where we intervene in that death threat, in fact, sets the limits of our field. Let us examine the dying patient. Despite the etiology, there are only a small, finite number of pathways to death: failure of respiration, failure of circulation – either via the pump or via the volume of the system, failure of the brain, or failure of metabolism. Although specific interventions must be made for specific causes – the response to the care coronary is different than to the respiratory failure from drug overdose – our specialty establishes adequate oxygenation, and does