What to Expect from Local Emergency Care [Dr. Adrian Dreessen]

I'm Dr. Adrian Dreessen. I've been an emergency physician practicing for just over 21 years, and I've been an emergency doctor here at Brookings Health.

When possible, what should patients bring with them to the ER?

They have some form of identification, some...maybe a list of past medical problems or at least medicines. It's helpful to know allergies, and then it's also helpful to have somebody with you that you trust and can be, like, your memory or your...like memory from the past, or memory from instructions going forward to help with the visit.

What is triage?

Triage is a way of sorting kind of a... sorting is the best way to put it. So, we use patient's presentation, their presenting complaint, say, chest pain, short of breath, abdominal pain, and then combine that with vital signs meaning temperature, heart rate, rest rate, oxygen, and blood pressure to help decide who's the sickest and probably should be attended more quickly and who's not. Also, I guess to put in there there's trauma, but that's another entity on itself.

What are the first steps in ER treatment?

If you have visited an emergency often, you have to tell your story multiple times. So, often it's the intake nurse who gets those things, chief complaint, vital signs, and maybe a little history on what's going on. And unfortunately, often, the provider may come in and do those same questions. Sometimes people get frustrated by that, but it's usually just somebody who's trying to get a story about what exactly is going on. They expand on one point, may, you know, not be as interested in another point, and it just kind of leads to exactly what's going on with the current medical problem.

Why does registration take place after the initial assessment?

Both being courteous, meaning trying to help the patient get their medical problem checked out first. I think we also follow EMTALA obligations where anybody can present, if they believe they have a medical emergency, they need to be seen by somebody, and taken care of, and then we worry about the money, insurance stuff later.

How do you assess a patient?

What we try to do is put together a picture about a patient's health. And so, it could be, you know...even on-site, you may see somebody who's pale or, you know, what we call cyanotic meaning blue discoloration because a lack of oxygen. It could be they're cool or clammy often. People that are sweaty, that may lead to there's an underlying problem that can't be seen from the outside so far. So, I think we combine our vital signs, our gestalt about what we're seeing and feeling on a physical exam plus tests to help decide what the patient needs most appropriately next.

How do you determine treatment?

Depends on the patient's, you know, age, what they're there for, vital signs, and what appropriate treatment needs to happen whether it be no test, diagnostic tests such as labs, X-rays, CT scans, even up to the level of needing to see a specialist where then someone may be transferred to another hospital in order to get that care.

What happens at discharge?

It's a cumulative story about what happened with the patient's visit, what the results are, what we think is happening, and then what we expect to happen going forward, and whether that includes prescriptions or a follow-up with a doctor or whatever that entails. We try to go through that verbally, which is why I think it's important for somebody to come with somebody who can have a memory of that with them. But also, we have discharge instructions to try to get patients to reiterate what we have talked about.

What should patients do if their conditions worsen after leaving the ER?

I think that depends on what it is exactly such as pain if it's unbearable and they don't have the right treatment plan or medicines to take care of it. They may need to be reseen. I believe our discharge instructions have our emergency number, department number, and so, somebody is welcome to call back. I think that they can also speak to another doctor, whoever's on call, to get a call back and help decide what's the right next plan for them.

What makes Brookings Health System a good place to receive emergency care?

I think we have great, trained providers, nursing staff, and also ancillary staff such as lab, X-ray, CT techs to pretty much take care of anything on the front end. I have some data that say that within about a 75-mile radius around our facility, we have some of the fastest throughput times getting the patient from the front door all the way to discharge or admission. We also, I think community-wise, I think the whole community comes together to take care of our emergency patients. And so, I think it's helpful to have those other staff that are available in case something's needed to take care of.