Emergency medicine is a vital component of the health care system. The average ER nurse or doctor is tasked with handling a broad array of maladies, from life-threatening catastrophes to vague and mysterious aches and pains that could be any one of a hundred possibilities. So what are the most common complaints seen in emergency departments? A 2011 study of the most frequently entered emergency department codes (conducted by the American College of Emergency Physicians) came up with some results that might surprise you. (1)
1) Level IV Examinations
The top three codes entered by emergency departments are, not surprisingly, those for the general exams required to diagnose a health problem. There are five levels of emergency examination, with Level I generally being the lowest in complexity and seriousness and Level V being the highest. (2)
Level IV exams include preparation for x-rays of multiple body areas, preparation for special imaging (such as CT or MRI), cardiac monitoring, and tube placement. Level IV is also the first level at which sexual assault examinations are performed. Some of the symptoms that precipitate a Level IV exam are blunt or penetrating trauma, headache with nausea or vomiting, dehydration or vomiting requiring treatment, chest or abdominal pain with limited diagnostic testing, non-menstrual vaginal bleeding, or signs of psychosis.
2) Level III Examinations
Symptoms that will prompt a Level III exam include minor trauma that can potentially cause complications, headache with no other symptoms, head injuries without neurological symptoms, eye pain and mild dyspnea. Care at this level might consist of lab testing, x-rays of only one area, routine mental health treatment, or administration of a catheter. The reason why it most likely sits so high on the list is that the code is also applied automatically when the patient arrives in an ambulance.
3) Level V Examinations
The most serious grouping of conditions short of critical care, a Level V exam might consist of frequent and continuous monitoring of vital signs, preparation for three or more diagnostic tests, blood transfusion, moderate sedation, a sexual assualt exam with specimen collection, physical or chemical restraints, or a suicide watch. If treatment at the level of critical care occurs for less than 30 minutes, the emergency medicine department will code it as a Level V exam instead.
4) EKG Rhythm Interpretation
EKG, also known as electrocardiography or ECG, is simply the monitoring of the heartbeat. A high incidence of complaints of unspecified chest pain likely contributes to the use of EKG being so common in emergency medicine. EKGs are also sometimes used to determine if drugs are interfering with or having any effect on heart rhythms.
5) Level II Examinations
Level II exams are not particularly serious. Common problems that patients will present with at this level are skin lesions, sunburns, rashes, painless eye or ear discharges, minor viral infections, or simple trauma that doesn’t require x-rays. A Level II exam might consist of visual acuity tests, urine or stool samples, or application of a sling or wrap.
6) Lacerations up to 2.5cm in size
The next two most frequently entered codes combined cover small to moderate lacerations at just about any point on the surface of the body. These lacerations may be small and shallow enough that they do not require stitches. In the case of these less serious lacerations, the wound may simply be cleaned with antiseptic and have a bandage applied to it. So why would people not do that themselves at home with some peroxide and a band-aid? Many of the less serious lacerations seen in emergency rooms are on children whose parents are nervous about the wound and don’t want to take any chances. People also worry about even small lacerations on the face or other sensitive areas possibly leaving permanent scarring.
7) Critical Care 1st Hour
If critical care exceeds 30 minutes of total time, this code is automatically applied. Critical care mandates the impairment of “one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient’s condition.” Some of the symptoms that mandate critical care are comas, burns threatening to life or limb, multiple trauma, shock, drug overdoses, strokes, acute failure of an organ, heart attacks or serious envenomation by a snake.
8) Lacerations between 2.6cm and 7.5 cm on the trunk, neck, scalp or genitalia
Large lacerations to most of the body surface are not uncommon in an emergency room. Lacerations of this size are generally treated with sutures, tissue adhesives, skin-closure tapes or staples. Local anesthesia may be applied.
Very deep wounds, such as a stab wound, may be bad enough to put a patient into critical care. If the wound is in a non-vital area and not too deep, however, it may fall under this treatment code. In the case of stab wounds a check with ultrasound may be performed to see if underlying tissues have been damaged or infected.
9) Application of Finger Splint
Perhaps not surprisingly, broken fingers are often seen in the emergency room. While not life-threatening, these injuries prevent people from going about many aspects of their daily life and they generally want to have them treated immediately. Sprains may also require a finger splint.
10) Application of Forearm Splint
The forearm splint covers the area from the forearm to the hand excluding the fingers. As with broken fingers, a broken wrist or arm is a painful malady that can prevent a person from doing many of the things they routinely do.
These are some of the maladies that a front-line ER nurse, doctor, technician or nursing student will frequently encounter while working the emergency department. It’s quite a broad range! Professionals working the emergency room need to have a diverse medical skill set. Nursing students preparing for their clinical trials in the emergency department may find this information particularly helpful.