Department of Emergency Medicine & Trauma

Overview

For meticulous care during times of Emergency – Think Gleneagles Global

A health emergency demands the most experienced of doctors, skilled in their fields and thorough in their care – this is exactly what Gleneagles Global Health City’s emergency department provides. Our surgeons have worked in the best hospitals and have a wealth of experience behind them. Our doctors are aided by specially trained nurses who provide the specialized assistance medical emergencies demand. Emergency care spans departments and our trauma and emergency care physicians are the best when it comes to handling such cases.

We are one of India’s leading providers of emergency care and we treat thousands of patients every year. Of course, no emergency care department is complete without state-of-the-art equipment and technology and we spare no pains in making sure we provide nothing but the best for our patients. Our emergency care department is compartmentalized into the following units to provide focused care:

  • Rapid treatment
  • Evaluation and treatment
  • Decontamination

Treatments

  1. Rapid Treatment Unit

  2. As the name implies, the purpose of the rapid treatment unit is swift treatment and care for the critically ill. The term rapid treatment takes on a whole new meaning when it comes to emergency care as it makes the difference between life and death. Critical patients are treated quickly and recover faster. As a result, the overall waiting time drastically reduces while patient satisfaction increases.

  3. Evaluation and Treatment Unit

  4. The purpose of the evaluation and treatment unit is to assess the patients quickly so that they can be rendered appropriate care. As soon as the patient comes in, he/she will be given basic treatment and evaluated. Here triaging happens – patient care is prioritized based on the criticality of the condition. Evaluation involves medical history, physical examination and diagnostic tests. If the patient is ill he/she will be immediately evaluated and resuscitated (treated) accordingly. If not, the doctor will await the results of the tests to determine further treatment.

  5. Decontamination Unit

  6. Decontamination involves the removal of dangerous substances from the patient. It will prevent spread of the contaminant and will also reduce the risk of infection. The contaminating agent could be anything from pesticides and shard of glass to bacteria or other chemicals – removing it is vital.

Emergency Unit – Medical Conditions

Spontaneous Abortion

Spontaneous abortion is another term for miscarriage. It refers to the loss of the fetus before 20 weeks. The abortion happens on its own without any external intervention. When a spontaneous abortion happens, women might experience stomach cramps and vaginal bleeding. For some women the cramps might worsen when the vaginal bleeding contains fetal tissue. To confirm a spontaneous abortion, an ultrasound is needed. If the tissue after abortion is not expelled completely, it could lead to infection. Left untreated, it might lead to septic abortion which is a life-threatening condition. When an incomplete abortion is suspected, doctors might recommend a procedure called D&C (dilatation and curettage) to prevent septic abortion. However, when the abortion is complete there is no need for D&C.

It is common for mothers to experience guilt and disappointment after a miscarriage. Emotional support from family at this time will help immensely. Doctors will also guide them on how to handle the next pregnancy.

Traumatic Brain Injury

When the head/brain experiences a sudden forceful impact, it might suffer a traumatic brain injury. Usually the result of road traffic accidents, bad falls, violent acts, etc. the brain might get bruised and the nerves in the brain injured. Sometimes, the skull itself can be fractured and in such cases a piece of the skull might pierce the brain. Symptoms for a traumatic brain injury vary from headache and vomiting to vision issues and cognitive problems. A brain injury requires immediate medical attention. Doctors will order a CT scan to examine the brain thoroughly. They will also keep a check on any increase in brain pressure.

For mild injuries, rest and observation should be sufficient. In case of pain, doctor will prescribe pain killers. When the injury is bad and requires emergency care, the doctor will make sure the brain is receiving sufficient oxygen and blood pressure is kept under control. Treatment will progress depending on the injury sustained. Emergency surgery might also be performed. Typically, after traumatic brain injuries rehabilitation will be needed.

Heart Attack

Heart attack is a condition wherein plaque builds up on the artery walls and inhibits flow of blood through the arteries. Sometimes, the plaque might break and cause a clot. This clot will also block the blood flow. When the blood does not reach all the parts of the heart, those parts will suffer damage. This condition is called a heart attack and it requires immediate medical attention. The symptoms of a heart attack vary greatly – from no symptoms at all to chest pain, breathlessness, fatigue, etc. Patients should become alert when they experience chest pain which has its onset with physical activity and disappears with rest. This is called an angina and when it is diagnosed early, treatment can also start early. The doctor will order an ECG and blood tests. Treatment will focus on making sure the blood flow to the heart is restored. The doctor might perform an angioplasty to open a blocked artery. Sometimes, a bypass surgery will be done to bypass or avoid the blocked artery.

Trauma

Trauma patients are those who have sustained life-threatening injuries. Trauma treatment deals with rendering immediate care to those people who are fighting for their lives. Doctors who have a lot of expertise in treating trauma cases will make a part of the trauma unit. After being treated at the trauma unit the patient will be shifted to other departments, depending on the nature of the injury. Traumas include the following:

  • Burn injuries
  • Extreme road traffic accidents
  • Severe brain damage
  • Being hit with force
  • A puncture wound caused by stabbing

Respiratory Failure

When there is not enough oxygen or when there is an excess of carbon di oxide, the condition is called respiratory failure. A person suffering from respiratory failure will exhibit trouble breathing, blue skin coloration and dullness. The need for emergency care increases when the person is unable to talk and is gasping for breath. The person might even lose consciousness. Acute respiratory failure needs emergency treatment. Immediate treatment involves making sure the person gets enough oxygen and removing carbon di oxide. After ensuring the patient is stable, treatment for the cause will commence.

Treatment techniques include:

  • Using an oxygen mask
  • A surgical procedure called tracheostomy wherein a hole is made in the neck and a tube placed at the wind pipe to increase the volume of oxygen reaching the lungs
  • Connecting the patient to a ventilator
  • IV fluids to boost the flow of blood

Bone Fractures

A fracture is a crack or a complete break in the bone. They might be caused by road traffic accidents, a bad fall from a height, playing contact sports or by health conditions like osteoporosis. Fractures are classified as simple and compound. In a simple fracture, the skin remains intact and diagnosis is not possible without an x-ray. Compound fracture involves injury to the skin. Sometimes even the bones could be visible in a compound fracture. Not all fractures need emergency treatment, but they must be examined by a doctor without delay. If the fracture has a bone sticking out or if the injured part of the body is visibly deformed, then emergency treatment is necessary. Treatment involves:

  • Positioning the bone properly – the doctor will set the bone in the correct position.
  • Putting splints and casts to restrict movement – this is crucial for the proper setting of the fracture.
  • Medication to deal with the pain.
  • Surgery, if required, to set the bone – for simple fractures the doctor might prefer to wait till inflammation subsides.

Why Choose Us?

Excellent Doctors

Doctors form the backbone of the medical system. At Gleneagles Global our doctors are highly experienced and proficient in emergency care. Their prompt action has made a world of difference to the patients who have come to us in their hour of need. Aiding them is our efficient support staff of nurses who are trained to handle the rigors of emergency care. Together, they provide the essential superior quality medical service emergency care demands.

World Class Infrastructure

Compromise is a term we do not understand. Be it our doctors, our equipment or our infrastructure, we provide only the best. Our Emergency Department has the cutting-edge equipment needed to provide the quality of care that will influence the future course of the patient’s treatment and recovery. The urge to give the best to our patients is what drives us and we are amply rewarded by the smiling faces of our patients when they recover and thank us for our efforts.

Latest Technology

The evolution of technology makes possible enhanced treatment methodologies. We make sure we keep up with the constantly changing trends and adapt to it. Our motto is simple – we harness the best in medical technology to provide the best to our patients.

Procedures

Mechanical Ventilation

Mechanical ventilation helps patients who have difficulty breathing on their own. In such instances, the ventilator is connected to the patient via a hollow tube inserted into the patient’s airway. In this way, ventilation is provided – oxygen is supplied and carbon di oxide is removed – until the patient is well enough to be disconnected from the ventilator. It is a boon for patients as the ventilator gives them the time to recover. It should be noted that being on ventilator is not a treatment for the patient’s condition – rather it gives the patient a helping hand while other treatment protocols are carried out.

Advantages of Mechanical Ventilation

  • The patient’s respiratory system gets some rest
  • Gives the patient time to recover
  • Performs the important task of supplying oxygen and removing carbon di oxide

However, there are risks associated with mechanical ventilation and that is the possibility of infection through the tube when the patient is on ventilator for a long time (around 2 weeks). Another risk is the possibility of injury to the lung. In such cases, the patient will be removed from the ventilator and tracheostomy will be done instead.

The duration for which a person is on ventilator will depend purely on the patient’s condition. Some may need it only for a few hours while others may need it for weeks. The patient will not be able to talk or eat normally while on ventilator. However, friends and family need not worry that it will be a painful process for the patient – it does not cause pain but some discomfort because of the tube is expected. Patients on ventilator are usually monitored in the ICU.


Electrocardiogram (ECG)

An electrocardiogram or ECG is one very simple way of checking on the heart’s functioning. During the test, leads are attached to different parts of a patient’s body (chest, arms and legs) and the other end of the leads is connected to the ECG machine. The electrical impulses produced by the heart are then recorded. From the ECG readings, doctors can get an idea of different things:

  • Fast or slow heart beat
  • Stable or irregular heart beat
  • How strong the electrical impulses are

Based on the above, the condition of the heart will be evaluated. The ECG is a very useful tool in emergency situations with treatments being decided based on the ECG result.

An ECG is required in the following scenarios:

  • When a patient is suffering from chest pain
  • A patient complains of breathlessness or has had fainting spells
  • To find out if the patient is suffering from irregular heartbeat
  • After a heart surgery to check on the heart’s functioning
  • To check on the functioning of an implanted pacemaker
  • To check whether medication given for heart conditions has been effective

The procedure itself is painless and gets over quickly. There are hardly any risks associated with it. In some cases, skin irritation at the point where the electrodes made contact with the skin might be experienced.


Arterial Line

An arterial line refers to the hollow tube (catheter) which is inserted into the patient’s artery for reading the patient’s blood pressure. This is more accurate than the readings we get with a BP apparatus and it also allows for continuous monitoring. Usually done for patients in the intensive care unit or ICU, the line is often attached to the patient’s wrist – it can even be connected to the groin or any other artery. An added advantage of arterial line is that blood can be drawn whenever necessary to check the levels of oxygen and carbon di oxide and also for other laboratory test purposes.

When is an arterial line given?

  • Hypertension: When the patient is showing extremely high blood pressure readings and efforts are being made to bring it within control, continuous monitoring of blood pressure becomes a necessity. In such cases an arterial line will be given to monitor the patient’s BP.
  • Hypotension: When the patient is suffering from low BP, IV fluids and sometimes medication will be given to bring the BP back to normal limits. By continuous monitoring of the BP with the help of an arterial line, the IV fluids and medication can be adjusted accordingly.
  • Lung Conditions: When the patient is having respiratory issues, the levels of oxygen and carbon di oxide will have to be continuously monitored. An arterial line eliminates the need for frequent painful drawing of blood by syringe.

When an arterial line is applied, the medical staff will be on the watch-out for blood clots forming, possible infection and bleeding.


Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation or CPR is a life sustaining technique that keeps up the flow of oxygen to the brain and other organs when the patient has suffered a heart attack or has experienced a near drowning incident and the heart has stopped beating. When the heart stops beating the flow of blood and oxygen through the body stops. Organ failure soon follows. If the brain does not get oxygen for 3-4 minutes, it can suffer irreparable damage. By administering CPR, the oxygen delivery to the parts can be continued without interruption till emergency medical help arrives. During CPR, compressions are applied manually in the chest area between the nipples at the rate of 100-120 compressions per minute to maintain blood flow.

CPR normally combines compressions (applied manually to the chest) with mouth-to-mouth breathing. If a person is not trained in CPR even just applying the compressions to the patient can make a huge difference. Starting CPR for a patient has proved life-saving in many scenarios. It is always good to be aware of how to perform CPR – one never knows when it will prove useful.

CPR is applied in the following cases:

  • When a person collapses suddenly
  • He does not seem to be breathing or breathing is limited
  • No pulse is detected

When the patient stirs and shows signs of life CPR can be stopped.

Diseases and Treatments

Cardiac Arrest

Cardiac Arrest Overview

When the heart stops beating suddenly, the condition is called a cardiac arrest. It is important to note that a cardiac arrest and a heart attack are not the same. A cardiac arrest is caused by a problem in the electrical impulses generated by the heart whereas a heart attack is a blockage in the blood flow to the heart. A heart attack can result in a cardiac arrest.

Signs and Symptoms of Cardiac Arrest

Cardiac arrest can have a sudden onset. The person will collapse without warning and no pulse or breathing will be recorded. He/she will also lose consciousness. Sometimes the following signs and symptoms may precede it:

  • Breathlessness
  • Fatigue
  • Pain in the chest
  • Increased heart rate

Causes and Risk Factors of Cardiac Arrest

When the electrical impulses are not generated properly by the heart, an arrhythmia will result. While most arrhythmias, or abnormal heart beat, will not cause any harm, in some cases a cardiac arrest might result. Usually, an arrhythmia in the left ventricle of the heart causes a cardiac arrest. Rarely, a cardiac arrest will happen in a person with no history of heart disease. In most cases, one of the following conditions will be present:

  • The arterial walls will be blocked by plaque resulting in a condition called coronary artery disease.
  • Thickened heart walls called cardiomyopathy.
  • Damaged heart valves called heart valve disease.
  • Heart defect since birth. Adults who have had corrective surgery for the same are also at risk.
  • Long QT syndrome that causes rapid heartbeat. Might lead to fainting spells.
  • A heart attack which can cause a cardiac arrest.

Risk Factors include:

  • Hypertension
  • Increased cholesterol levels
  • Diabetes
  • Being overweight or obese
  • An unhealthy lifestyle

Complications of Cardiac Arrest

A cardiac arrest can prove fatal if emergency treatment is not administered. This is because when the heart stops beating, blood flow to the different parts of the body, including the brain, stops. The brain when deprived of blood will be damaged. If the heart does not start beating again, the person will die.

Diagnosis of Cardiac Arrest

After emergency treatment (CPR) has been given, the doctor might do the following tests:

  • An ECG to check if there is an arrhythmia
  • A blood test to check the levels of various chemicals
  • A chest x-ray to check for heart failure
  • An echo to check on heart valves and to see if there is any damage to the heart
  • Testing for blocks in the artery using a procedure called coronary catheterization

Surgery/Treatment of Cardiac Arrest

Emergency treatments include CPR and defibrillation. During CPR, compressions are applied to the heart to keep up the continuity of blood supply to the body parts. Defibrillation is the application of an electric shock to the heart to help it return to its normal rhythm.

Once the patient has been stabilized, further investigations will be done. The exact cause of the cardiac arrest will be determined and treatment rendered accordingly. The following surgeries might be done depending on the cause of the cardiac arrest.

  • An angioplasty to remove any blocks in the heart arteries.
  • A bypass surgery to bypass blocked arteries.
  • Blocking the path of an abnormal electrical impulse by radiofrequency catheter ablation.

Prevention of Cardiac Arrest

  • Living a healthy life – eating nutritious food and exercising regularly
  • Quitting smoking
  • Avoiding alcohol
  • Maintaining correct body weight

Stroke

Stroke Overview

When a blood vessel in the brain bursts or when the blood supply to the brain is cut-off due to a cardiac arrest, the blood flow to the brain will stop. A stroke is a condition in which the brain cells do not receive blood (and hence oxygen) and eventually die. Stroke can prove fatal if left untreated.

Signs and symptoms of Stroke

  • Paralysis on one side of the body
  • Slurred speech
  • A feeling of confusion
  • Problems with vision
  • Headache and vomiting
  • Instability while walking

The symptoms depend on which part of the brain has been affected/damaged.

Causes and risk factors of Stroke

An ischemic stroke is caused by the deposition of fat in the brain blood vessels. This leads to narrowing of blood vessels and a reduction in blood supply.

A hemorrhagic stroke happens when there is a rupture in a blood vessel due to causes like high BP, road traffic accident, aneurysms, etc.

A transient ischemic attack (TIA) is a mini-stroke that is caused by short-term reduction in brain blood supply. Those who experience TIA are at greater risk of a stroke.

Risk factors include:

  • Age – the risk increases significantly over the age of 55
  • Men are more at risk than women
  • Hypertension
  • Obesity
  • Increased bad cholesterol level
  • Unhealthy diet
  • Smoking
  • Excessive alcohol consumption
  • Illegal drug consumption
  • Absence of physical activity
  • Cardio vascular conditions
  • Family history of stroke

Complications of Stroke

  • Paralysis on one side of the body
  • When the mouth and throat muscles are affected, there might be difficulty speaking, swallowing, etc.
  • Loss of memory and inability to understand situations
  • Possibility of depression and problems with emotional management
  • Pain in some parts of the body

Diagnosis of Stroke

  • Detailed medical history
  • Physical examination
  • Blood tests
  • CT scan to check the damage done to the brain
  • Electrocardiogram or ECG to see if a heart condition was the cause of stroke
  • Cerebral angiogram to check the brain arteries
  • Carotid ultrasound to check for fat deposits in the carotid arteries
  • Echocardiogram to check for blood clots in the heart which might be a cause of stroke

Surgery/Treatment of Stroke

The treatment protocols depend on the type of stroke.

An ischemic stroke will be treated with:

  • Anti-coagulants and other drugs that will act on the blood clots to break them down.
  • Sometimes a stent may be placed to widen the artery
  • Surgery to remove the clot/plaque

A hemorrhagic stroke will be treated with:

  • Medicines to impede the effect of blood thinners
  • Coiling will be done wherein a coil like device will be placed to control the hemorrhage
  • Clamping aneurysms to stop them from rupturing
  • Surgery to handle ruptured aneurysm
  • Surgery to relieve pressure on the brain (craniotomy)

Prevention of Stroke

  • Good lifestyle practices – eating healthy, exercising
  • Quitting smoking
  • Weight management
  • Making sure BP, sugar levels, etc. are all within control
  • Regular medical check-ups that will help detect dormant conditions

Our Doctors

Dr Sriram Rajamani

M.B.B.S., M.D., MRCEM

Senior Consultant - Emergency Medicine & Trauma

Dr Meena K

M.B.B.S, FEM (RCGP UK), PGDEM (GWU USA), FICM, MEM

Senior Consultant

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