Goals in the ED

When I walk into a patient's room in the emergency department (ED) I have 3 questions in my mind. 1) What diseases / pathology can kill this patient given their presentation? 2) What can I do for this patient while here in the ED? 3) Where is this patient going, following my treatment? 

It is important to make sure that I do not miss something that could kill the patient if missed. Fortunately I have lots of back up at this point in my training to make sure I do not miss something. In order to rule out things that may kill the patient I may need to do a thorough history and physical exam. I may also need to order certain imaging and lab studies. Eventually when I have ruled out things that could kill the patient and in the process narrowed down their diagnosis I can start a treatment plan. Finally I figure out where the patient needs to go. I could discharge the patient home, admit for observation, admit to the ICU, send the patient to the OR for surgery or several other options. Then I need to make this happen which may include getting a specialist involved or talking to the patients family. 

This is a very basic outline of some of the ED physician responsibilities. It can be easy to assume the patient is fine and just discharge the patient without worrying about some of the other things but this is a rookie mistake and will eventually get the ED doctor in trouble. 

These are just a few of the thoughts that go through my head as I meet a new patient and their family.