1. What is the purpose of the Emergency Medicine Department?

    The Emergency Medicine Department (ED) serves two primary functions:

1. Initial Stabilisation – Achieved through Primary assessment (ABCD approach, vital signs evaluation, and critical actions). This must be performed in a time-bound, structured manner, much like mastering a typewriter—where repetitive training ensures swift, accurate, and efficient execution. The primary assessment helps to identify life-threatening conditions.

2. Initiation of Definitive Care – Requires diagnostic acumen and the ability to initiate appropriate treatment. This step demands not just knowledge alone but wisdom too. Wisdom: the logical application of knowledge gained through reading and experience. To filter and apply knowledge effectively, one must cultivate the right attitude. A brain grows only if it maintains a learning attitude, best summarized as: "Stay hungry stay foolish"

2. What is the "Slogan" in the ED?

"Swift Pace & Accuracy."

This reflects the time-bound nature of emergency care and the focused approach required to identify and manage life-threatening conditions efficiently. 

3. What is Professionalism in the ED?

Professionalism is doing what is required in a given situation, in the expected manner, regardless of one's emotional state. It demands:

• Emotional Stability – Remaining calm in a high-emotion environment.

• Clear Vision Amidst Chaos – While the ED may appear chaotic to outsiders, professionals inside operate with structured protocols and a clear-cut vision, minimising stress.

4. What is the Behavior of ED Professionals?

Due to the fast-paced environment, ED professionals naturally develop a degree of assertiveness and decisiveness. This is not aggressiveness but a necessary adaptation to high-pressure decision-making.

5. What is Busy Shift in ED means?

Just as light is relevant only in darkness, the term "busy" is outdated for ED professionals—they are trained to function effectively under high-pressure conditions through triage systems, teamwork, and discipline. ensuring this through

• Every role is clearly defined.

• Professionals remain less stressed due to streamlined workflows.

• Training is designed to handle volume efficiently, making the term "busy" an outsider’s perspective rather than a reality for trained ED personnel.

6. What is Stress in the ED?

Stress in the ED primarily arises when a doctor is stuck at any stage of patient management—diagnosis, investigation, treatment, or disposition. However, stress can be minimised because:

• The department is equipped with 24×7 senior consultants for support.

• Ego is the real cause of stress—some junior doctors may have an ego of knowledge, hesitating to discuss cases with seniors, which leads to unnecessary pressure.

7. What Determines the Outcome (Efficiency) of the ED?

The ED efficiency is dictated by preparedness and teamwork:

• Preparedness: Preparedness isn't just about having resources—it’s about training the team to function under stress, think critically, execute protocols with precision and use common sense.

• Teamwork: Defined by:

1. Clear Roles & Accountability – Every team member must understand their critical responsibilities.

2. Recognising Limitations 

3. Effective Communication – This includes: 

   1. • Clear, concise messaging.

      • Mutual respect among colleagues.

      • Closed-loop communication—verifying that instructions are understood and followed.

8. What is a positive Attitude?

A positive attitude doesn’t mean you are always happy. Instead, it means:

• Finding opportunities to learn in every situation—even negative incidents become valuable lessons.

• Having an optimistic mindset—focusing on solutions rather than problems.

• Understanding others before criticising—empathy is key to teamwork and growth.

In the fast-paced, high-stakes ED environment, attitude determines whether a doctor learns and grows or stagnates and burns out.

9. Who is a Leader?

A leader is not just someone with authority or influence—everyone is a leader in their own capacity. Some lead large teams, while others lead their family, colleagues, or even themselves. Leadership is about responsibility, decision-making, and growth, not just position or power.

There is a fundamental difference between a manager and a leader:

• A manager runs the already established system, ensuring smooth day-to-day operations.

• A leader takes the team to the next level, driving progress, innovation, and change.

Leadership naturally faces resistance, much like Newton’s First Law—systems in motion tend to resist change. Because of this, a leader is often less popular than a manager. Remember "If you want to make everyone happy, sell ice cream." Being a leader means making decisions that may not always be popular, but they drive growth and improvement.

A leader is defined by honesty and vision—the ability to see beyond the present and guide the team toward continuous improvement. The two immovable pillars of leadership scaffolding are

• Honesty (attitude): forms an attitude of trustworthiness and integrity.

• Vision (clarity and direction): Provide direction, purpose, and momentum. 

Everything else -skills, communication, strength can be drawn from the team. Without honesty and vision leadership collapses. A leader in the ED does not seek comfort but embraces challenges, ensuring the team evolves into a high-functioning, disciplined, and prepared unit.

Leadership vs. Influence

• Influence is about persuading others, but it does not necessarily mean leading them in the right direction.

• Leadership is about taking the right decisions, even when they are tough or unpopular. 

Respected, Not Just Liked – A leader earns respect through integrity, strength, and wisdom, not by seeking approval. 

Two stories that define Leadership

1. Crossing the river: The selection test

A group needs to cross a river. Only two people know how to cross. who becomes the leader?

• The one who is honest (won't mislead)

• The one who know the way (has a vision)

Not the strongest swimmer. Not the loudest voice. Leadership here is earned by character and clarity, not charisma.

2. The Lion: Attitude is everything

Why is the lion the king of the jungle? Not the fastest (cheetah), not the biggest (elephant), not the smartest (owl). The lion is king because of its attitude. It sees itself as a leader, acts like one. "When the lion see an elephant, he thinks lunch. when an elephant sees a lion, he thinks run." - Attitude defines altitude.

10. What are the Levels of Leadership?

Leadership is a mindset- rooted in honesty, shaped by attitude, and powered by vision. Influence and effectiveness are the external progression, but true leadership begins within. The progression of influence and effectiveness, a functional classification of leadership, is outlined in the levels below. 

• Level 1: Position (Rights) - People follow because they have to. Leadership is granted by position or job title (the keyword is "title"). The limitation is low commitment and minimal impact.

• Level 2: Permission (Relationships). People follow you because they want to (the keyword is "trust"). Based on relationships, leaders listen well, observe, and serve. Strength: Boosts morale and loyalty. Remember, "respect" is the cornerstone of any relationship.

• Level 3: Production (Results). People follow because of what you’ve done for the organisation (the keyword is "results"). This level is about achieving results, solving problems, and driving success. Impact: Increases credibility and momentum.

• Level 4: People Development (Reproduction). People follow because of what you’ve done for them. Focuses on mentoring and developing others into leaders (the keyword is "reproduction"). Benefit: Multiplies influence and legacy.

• Level 5: Pinnacle (Respect). People follow because of who you are and what you represent. The keyword is "Legacy"

11.  What is Respect in the ED?

In the ED, respect is about respecting the system by: Following protocols to maintain efficiency and upholding discipline, particularly in communication and teamwork. The three non-negotiable rules in ED are:

1. Never compromise initial stabilisation.

2. Never violate infection control practices.

3. Never break ED discipline—communication, teamwork, and patient care ethics must be upheld.

12. What is the importance of practicing Code Green protocol– The Mass Casualty Protocol

It tests the ED system’s resilience under surge conditions. Clear roles, responsibilities, and escalation strategies, reducing chaos during large-scale emergencies.

In high-stakes situations, professionals must balance critical thinking with strict protocol adherence. Follow our structured mass casualty management protocol

Fostering a culture of preparedness and teamwork, ensuring smooth coordination under pressure.

A well-prepared ED operates efficiently, even in crisis scenarios.

13. What is the Future of Emergency Medicine?

The future of Emergency Medicine is EMCrit (Emergency Critical Care)—which is why ED ICUs are being developed to provide comprehensive care beyond the initial stabilisation of the ED.

The ED ICU approach has two components:

1. ICU Care – Mastering airway, breathing, circulation (ABC approach), hemodynamic stabilization, and advanced resuscitation techniques.

2. Speciality Care – Coordinating with specialists to optimise targeted treatment while ensuring continued critical care support

14. What is the Importance of Documentation?

Documentation is not just a formality— it is a critical tool for patient safety, quality improvement, and medicolegal protection.

"If you cannot measure, you cannot improve."

15. How to Maintain Happiness in ED Life?

Happiness comes in two forms — choosing the right one determines our mental well-being 

1. Short-Term Happiness – A Trap of Temporary Pleasure, Often followed by guilt or emptiness, like indulging in unhealthy food or procrastination. It gives an instant dopamine rush but doesn’t contribute to long-term satisfaction.

2. Long-Term Happiness – The Gooseberry Effect Initially bitter, but ultimately fulfilling, much like a gooseberry. Requires effort, discipline, and patience but leads to lasting contentment.

Ensure strong family support – A stable personal life provides emotional resilience.

Wash out negative emotions through forgiveness – Foster a culture of forgiveness, letting go of resentment to maintain emotional balance.

16. The Strongest Emotion We Should Possess – Gratitude

The most powerful emotion that brings peace to the mind is gratitude.

• Be grateful to your seniors for their guidance.

• Be grateful to your patients, as they give you purpose.

• Be grateful to your colleagues, as teamwork makes ED functional.

Without gratitude, frustration will accumulate, making one unfit to work in the high-stress ED environment. Developing the habit of gratitude ensures mental stability, emotional resilience, and long-term professional fulfillment.

17. The Nature of Training – "No Pressure, No Diamonds"

Training in the ED is intense for a reason: growth comes from challenges.

Just like diamonds are formed under pressure, the best ED professionals emerge only through tough experiences. Instead of resisting the pressure, embrace it with a good attitude—treat every challenge as a chance to learn. The right mindset will make even the toughest shifts a stepping stone to mastery.

Clinical Examinations

Adventitious lung sounds: additional respiratory sounds superimposed on normal breath sounds. Continuous sounds (>250 ms)-Wheeze and ronchi, 

Discontinuous sounds—fine and coarse crackles

1. Wheezes (high pitched 400Hz, Turbulent airflow through narrowed lower airways.)-often audible & louder than breath sounds, Indicates: Bronchospasm (asthma, COPD), airway narrowing or obstruction

Ronchi (low pitched 200Hz, Air moving through secretions in large airways)- have snoring quality (due to retained secretions), may clear with coughing, indicates: Large airway secretions, seen in chronic bronchitis, pneumonia. 

2. Crackles (Rales; sudden opening of small airways/collapsed alveoli, or air move through exudates): 

• Fine crackles: Late inspiration → think interstitial fibrosis, early pulmonary edema, early pneumonia

• Coarse crackles: Early inspiration or expiration. Larger airways are involved → bronchiectasis, pneumonia, CHF, volume overload, COPD exacerbation with fluids

3. Squeak; Squawks are short inspiratory (late) wheezes. Squawks are found in pulmonary fibrosis of various causes, particularly in hypersensitivity pneumonitis.

4. Pleural rub: Biphasic (inspiration & expiration)

Indicates: Pleuritis, usually localised and painful

5. Stridor - High-pitched, harsh sound heard loudest over the neck during inspiration

Indicates: Upper airway obstruction (e.g., laryngeal edema, foreign body, croup, epiglottitis)

Review

• Fine crackles = alveolar/interstitial pathology. Think: fibrosis, early edema.

• Coarse crackles = secretions or fluid pooling. Think: pneumonia, CHF.

• Wheeze = bronchospasm or obstruction. Diffuse vs focal changes your differential completely

• Rhonchi = secretions in large airways. Often clears with cough/suctioning.

• Stridor = upper airway alarm. Inspiratory = extrathoracic; biphasic = fixed obstruction.

• Pleural rub = dry inflammation of pleura. Painful. Usually localized.

Red Flag to Rule Out

• Stridor -> Impending airway collapse

• Wheeze + hypotension -> Anaphylaxis

• Fine crackles in hypertensive patient -> Flash pulmonary edema

• Coarse crackles + fever -> Pneumonia

• Pleural rub + pleuritic chest pain ->Pulmonary embolism