How would the ER diagnose and treat an unconscious victim from a fist fight who has an incomplete fractured ribcage, multiple contusions, and a few abrasions on arms? I'm doing research for a book. A quick answer would be most helpful. Thank You.
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replied February 16th, 2014
Extremely eHealthy
I think you would need to ask the resident ER consultant at a few hospitals.

Clearly there would be best practice to consider but much would be flexible and depend on many variables such as how busy the department is and the available staff and resources and budget of the hospital as well as the other limiting factors such as the physical size of the department.

I am not a doctor but I have observed such things in real life as well as in reality television and drama.

Under ideal situations the ER would ensure the patient is stable with no life-threatening injuries or obvious internal/external bleeding before admitting to a ward until the patient recovered consciousness.
An appropriately equipped ward would have the staff and the machinery to monitor the patient's vital signs and to perform 15 minute observations.

As the patient is unconscious from a fist fight there is almost certainly going to be a concussion and possible consequences. It would be a minimum requirement to keep the patient under observation for at least 24 hours after regaining consciousness, possibly longer, and depending on resources might conduct a variety of scans, x-rays or other tests.

As this is the case the ER wouldn't be under any particular pressure to do anything except ensure the patient is stable and pass him on and the ward staff can deal with dressing contusions and abrasions as required.

If the hospital hasn't a spare bed on a ward it would be another matter and the room and the time and staff to monitor the patient and carry out observations in the ER must then be found until the situation changes.

The situation is likely to be slightly different on a quiet midweek evening to how things are on Friday or Saturday night. At the weekend there will not be enough staff to cope properly and the triage nurse will be constantly busy re-prioritising the work and shuffling staff around due to the constant influx of more patients, hangers-on and drunken gawpers as well as police officers trying to take statements and watch those who are under arrest.

The budget and space a hospital gives the ER will not be more than it needs to perform its function during average usage and so there will be times when the ER performs brilliantly and there will be times when it is absolute chaos and waiting times are greatly extended. During these times best practice isn't always possible.
An inner city ER sometimes resembles a war zone...

I hope this helps. Clearly you need to choose a time and day when the unconscious patient is brought in as well as the size and resources of the hospital in order to provide a starting point for further research in order to obtain realism.
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