國軍桃園總醫院

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Why should a patient be retained for observation? What do we do for the retained patients?

The emergency division of any hospital is there to provide services including: 24-hour standing-by, treatment of emergent situations, stabilization of vital signs, to offer timely and effective first aid to emergent patients whose life is at stake. More than that, in the emergency division here in Taiwan it is very common a practice to set up observation beds, which is to all purposes and intents an extension of emergency service. But then you may ask, why a patient must be retained for observation? What can the medicare staff do for patients thus retained for observation?
Let us first of all have a look at the course of an emergent case. When the patient arrives at the emergency service, has its trauma/wound classified, following doctor’s preliminary inquiry as to antecedent history and physical checkup, the patient may need some basic inspections done on the spot:
These include: chest X ray check, blood sampling test, or preliminary oral drug input or intravenous injection. Regarding aggravated patients the first step to be done is to stabilize its vital signs, have it standing by for hospitalization for further treatment. If the case is relatively milder, such that taking rest at home will do, the patient will be discharged for clinic followup. The pity, however ,that confounds it all is that quite a number of diseases in the initial phase to do not manifest themselves in typical symptoms, or else diseases which deserve careful observations will need a longer while to observe and on the basis of the observation, to come to an assessment. Where such is the case, the patient will have to be retained for hospitalized observations. There are also certain other diseases, both acute and chronical, which, in addition to warranting emergent treatment, my settle down against short term observation and treatment, they would make cases for hospitalized observation too. In fact there seems to evolve, in that context, a new discipline called “observation medicine”, in this connection, then, it can be readily appreciated that “retained observation” is a key part of the diagnostic as well as treatment course of an emergent case.

The following is a citation of common diseases that call for retained observation in the hospital:

• Chest pain: the causes of a chest pain very greatly, way from those endangering life instantly, such as: angina pectoris, myocardiac infarction, arterial exfoliation, the grave cases, to the much mitigated gullet ailments (gastro-gular introversion), muscular pain or even anxiety. In dealing with these, in addition to careful diagnosis, what is needed in particular is several hours of observation for assessment.
• Headache: certain grave cerebral vessel diseases, sbumeningeal hemorrhage, for instance, may manifest itself only in the form of headache in the initial onset period.
• Vertigo or coma: the causes for which can hardly be assessed all at once, in the onset period close observation is mandatory.
• Palpitation: this symptom complicated with tachycardia must be retained for observation to trace the causes.
• Abdominal pain: a lot of severe diseases may not manifest themselves markedly in abdominal pain in the onset phase.
• Fever
• Loss of consciousness
• Gastro-intestinal or urinary duct hemorrhage
• Overdosed intake of drugs
• Epilepsy, spasmus
• Various trauma: abdominal, encephalic, and chest.
• Certain inspections or post-treatment observations

Some diseases often manifest themselves in acute fits, which in addition to deserving emergent treatment, warrant short term observation for followup treatment, these including:

• asthma or chronical phthisis breaking out in a fit;
• heart failure;
• dehydration of whatever nature;
• diarrhea or acute gastroenteritis;
• hyperglycemia or hypoglycemia;
• hypertension in acute manifestation;
• disposition relating to hematic tumor;
• infections;
• pancreatic;
• pediatric, gerontologic or gynecologic diseases.

Patient of the afore-mentioned diseases, given a short term observation following emergent treatment, and confirmed of its stability, will normally be discharged for clinic followup.
Observation beds is an extension of the emergent service, and forms an important part of the emergent service. In medically advanced countries, in the USA, one third of local hospitals, in Australia half of local hospitals, and in both Britain and Canada nearly 100% of all the local hospitals are equipped with observation beds. Due to its operational nature, apart from doctors staying 24 hours a day to respond to various emergent situations, short term observation, diagnosis and treatment is also a routine function considering patients retained for necessary observation and followup. While retained for observation, patients are attended by nursing staff to observe vital signs and to do whatever is instructed by the doctor in charge concerning the patient. Where a new situation develops, the doctor in charge should respond and handle the case appropriately. Under nurse’s carefully care, unsparing cooperation pledged from the patient and family, retained observation is an important chapter of the services offered at an emergency division.