आकस्मिक चिकित्सा

नेपाली विकिपीडियाबाट
यसमा जानुहोस्: परिचालन, खोज्नुहोस्


आकस्मिक चिकित्सा चिकित्साको एउटा हाँगा हो। यो हाँगा अस्पतालको इमर्जेन्सी विभाग, फिल्डमा (इमर्जेन्सी मेडिकल सर्भिसको रूपमा), र प्रारम्भिक चिकित्सा हुने अन्य स्थानमा प्रयोग गरिन्छ।

Emergency medicine focuses on diagnosis र treatment of acute illnesses र injuries that require immediate care. While not usually providing long-term care, EM physicians र pre-hospital personnel still provide care with the aim of improving long-term patient outcome. In the United States, some people use the emergency department for outpatient care that could be provided at a doctor's office. As a result, much of emergency room care is general practice (coughs, colds, aches, pains).

A variant of an Emergency Department is an Urgent Care Center, often staffed by non-Emergency Medicine trained physicians and/or nurses, which treats patients who desire or require immediate care, but do not reach the acuity that requires care in an emergency department.

Emergency Medicine involves a large amount of general medicine but involves all fields of medicine including the surgical sub-specialties. Emergency Physicians are tasked with seeing a large number of patients, treating their illnesses र admitting them to the hospital as necessary. The field requires a broad field of knowledge र requires advance procedural skills often including surgical procedures, trauma resuscitation, advance cardiac life support र advanced airway management.

Definition[सम्पादन गर्ने]

"Emergency medicine is a field of practice based on the knowledge र skills required for the prevention, diagnosis र management of acute र urgent aspects of illness र injury affecting patients of all age groups with a full spectrum of undifferentiated physical र behavioural disorders. It further encompasses an understanding of the development of pre-hospital र in-hospital emergency medical systems र the skills necessary for this development."

International Federation for Emergency Medicine १९९१

History[सम्पादन गर्ने]

Emergency Medicine as a standalone medical specialty is relatively young. Prior to the १९६०'s र ७०'s, hospital emergency rooms were generally staffed by doctors trained in other specialties, such as internal medicine र primary care. However, during this time period, groups of physicians mostly located in the midwestern United States (notably Cincinnati, Ohio, र Denver, Colorado) recognized the need, र the niche, for physicians specifically trained to handle acute medical emergencies.

Organizations around the world[सम्पादन गर्ने]

In the United States, the American College of Emergency Physicians (ACEP) is presently the largest member organization of emergency physicians (EPs), र is open to most physicians who practice in an Emergency Department. Originally founded in १९६८, it was the first Emergency Medicine society formed in the United States. Fellows use the designation FACEP.

The American College of Osteopathic Emergency Physicians (ACOEP) was founded seven years later in १९७५. Membership is open to both osteopathic (D.O.) र allopathic (M.D.) physicians who practice emergency medicine. Fellows use the designation FACOEP.

The American Academy of Emergency Medicine (AAEM) is another specialty society of Emergency Medicine. It was formed after ACEP र ACOEP र is considered a rival organization although both organizations have cooperated in the past. Members must be board certified in Emergency Medicine. Fellows use the designation FAAEM.

The American College of Veterinary Emergency र Critical Care (ACVECC) is the governing body that offers board-certification to veterinarians who have completed an accredited residency program र passed a rigorous written, practical र oral certification examination. Specialists are known as criticalists, र most are employed in referral practice or academic institutions. It is a rapidly expanding field of veterinary medicine. Specialists are given the desgination of DACVECC after becoming certified for Diplomate of the American College of Veterinary Emergency र Critical Care.

The American Board of Emergency Medicine (ABEM) provides board certification to allopathic (M.D.) emergency physicians who have successfully completed a residency in emergency medicine, completed an additional year of practice, passed a written exam, र then an oral exam.

The American Osteopathic Board of Emergency Medicine (AOBEM) provides board certification to osteopathic (D.O.) emergency physicians who have successfully completed a residency in emergency medicine, completed an additional two years of practice, passed a written exam, र passed an oral exam.

The American Board of Physician Specialties (ABPS) also offers Board Certification in Emergency Medicine (BCEM). This certification is offered to experienced physicians who have completed residency training in related primary care fields, who have more than ५ years of full-time emergency medicine experience, are certified in ACLS/PALS/ATLS courses, provide letters of recommendation, र file १० case reports - all required prior to passing both written र oral tests. The ABPS certification is more widely recognized in rural र suburban hospitals. The 'grandfathering-in' of other experienced non-residency trained physicians practicing emergency medicine was closed off from ABEM र AOBEM several years ago, likewise from BCEM if the doctor has not completed a residency. Currently (as of ७/०६), only the state of Florida has recognized BCEM at the state medical board level, but many hospitals across the country do recognize BCEM.

Board certification is maintained through annual testing over required reading lists र a more extensive written exam every १० years (for ABEM), every ८ years for BCEM.

Many types of physicians may practice in an Emerency Department; however, only those who have successfully passed the board certification process are considered "Emergency Medicine Specialists". Currently the ABEM र AOBEM require a number of years of residency training after medical school, followed by comprehensive written र oral examinations. The BCEM requires (in addition to passing written र oral examinations) completion of an ACGME approved residency in an approved specialty such as Family Medicine or Internal Medicine, ५ years of the practice of emergency medicine, १० Peer reviewed case reports, current ATLS/PALS/ACLS certification र ३ letters of recommendation from peers.

A sudden surge of interest in the specialty in the late १९९०s was due to the popularity of the American TV series ER. Showcasing the function of a Chicago Emergency Department (loosely based on Cook County Hospital) र its many characters, the show introduced a large number of people to the specialty.

In the United KingdomIreland, the College of Emergency Medicine sets the examinations that trainees in Emergency Medicine take in order to become consultants (fully-trained emergency physicians). The British Association for Emergency Medicine is the member organization in the UK. In 2005, the two organisations initiated steps to merge as the College of Emergency Medicine.

In AustraliaNew Zealand, advanced training in Emergency Medicine is overseen by the Australasian College for Emergency Medicine (ACEM).

In Canada, there are two routes to practice emergency medicine. More than two thirds of physicians currently practicing emergency medicine across the nation have no specific emergency medicine residency training. Emergency physicians who tend to work in more community-based settings complete a residency specializing in Family Medicine र then proceed to obtain an additional year of training of special competence on Emergency Medicine from the College of Family Physicians of Canada (CCFP-EM). Physicians practicing in major urban/tertiary care hospitals will often pursue a ५ year specialist residency in Emergency Medicine, certified by the Royal College of Physicians र Surgeons of Canada. These members typically spend a great deal of time in academic र leadership roles within emergency medicine, EMS, research, र other avenues. There is no significant difference in remuneration or clinical practice type between physicians certified by either route.

See medical emergency for specific lists of medical emergencies र how best to respond.

Practice[सम्पादन गर्ने]

In the US, Emergency Medicine is one of the more competitive specialties to get into, र residency programs generally select physicians from the top of their medical school class. There are usually many physicians competing for each residency spot.

Allopathic (M.D.) emergency medicine residencies can be ३ or ४ years in length, combining both the internship र residency into one program or "१+३," utilizing a separate internship followed by ३ years of Emergency Medicine. Osteopathic (D.O.) residencies are four years in length, requiring a one year traditional rotating internship followed by a three-year emergency medicine residency. In addition to the didactic exposure, much of an emergency medicine residency involves rotating through other specialties with a majority of such rotations through the emergency department itself. By the end of their training, EPs are expected to handle a vast field of medical, surgical, र psychiatric emergencies. EPs are therefore both clinical generalists र well-rounded diagnosticians. EPs are considered specialists in advance cardiac life support protocols ('codes') र airway management.

The employment arrangement of emergency physician practices are either private (a democratic group of EPs staff an ED under contract), institutional (EPs with an independent contractor relationship with the hospital), or corporate (EPs with an independent contractor relationship with a third party staffing company that services multiple emergency departments).

Most emergency physicians staff hospital emergency departments in shifts, a job structure necessitated by the २४/७ nature of the emergency department.

See also[सम्पादन गर्ने]

External links[सम्पादन गर्ने]


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