Stabilizing a patient may require the direct intervention in
a life-threatening process or an intervention that anticipates a critical
problem developing. In a patient with chest pain, a cardiac monitor and an
intravenous line are placed in anticipation of a dysrhythmia and the need for
medications or volume repletion. These steps demonstrate the emergency
physician’s awareness of the potential hazards of the pathologic processes
associated with the presenting symptoms, not the diagnosis. They represent
actions performed to monitor the course of the process while preparations are
made to intervene quickly if necessary.
One of the most difficult aspects of emergency medicine is
becoming comfortable with uncertainty regarding an exact diagnosis before
important decisions are made. It also applies throughout the steps of care in
the emergency department, especially during disposition decisions. Knowing when
to stop an assessment or treatment is as important as knowing when to persist.
Many common complaints such as chest or abdominal pain remain undiagnosed at
the time the patient leaves the emergency department.
Other serious problems may require early disposition to
sites outside of the department without a precise diagnosis being made (e.g.
obvious penetrating trauma to the abdomen).
