A Q&A with Dr. Lucas, Emergency Room MD

Dr. Mikael Lucas is an Emergency Department Physician in Los Angeles, CA. He received his M.D. from the Geffen School of Medicine at UCLA and received his undergraduate degree (with honors) in Biology from Johns Hopkins University.  Prior to practicing medicine, Dr. Lucas spent 2 years as a Community Health Volunteer for the Peace Corps in Honduras.  Dr. Lucas is certified in: Advanced Cardiac Life Support; Advanced Trauma Life Support; Pediatric Advanced Life Support; APLS; ACLS Instructor; Basic Life Support and has completed hyperbaric chamber training course.

What happens in an emergency situation?

From the moment the patient enters the emergency room the resuscitation begins.

The first few minutes are spent completing a primary assessment which includes attaching the patient to various monitors, getting IV access, obtaining vital signs and completing a quick head to toe physical exam.

At this time several life-saving interventions may need to be completed such as inserting a tube in the patient's airway, gaining IV access to larger blood vessels, and potentially starting a blood transfusion.

The main focus is to quickly stabilize the patient and identify any potentially life-threatening conditions or injuries.  At this moment having certain medical information can be vital.  For example, if I find out that a patient is taking blood thinner medications, I may decide to give additional blood products prior to having the first set of blood test results if the patient is experiencing life threatening bleeding.

Also, administering a medication the patient is allergic to could greatly compromise the resuscitation.  We don't need to know all of your personal medical information, but a few key pieces of information can make a significant difference.


What are the most vital pieces of information first responders need to know about a patient?

The most vital and helpful pieces of information to know are any allergies to medications, the medications that are currently being taken and an emergency contact we can reach.  Basically, we need to know what medications are in your body and what medications we cannot put in your body.


Can you give this information to someone over the phone?

Due to HIPAA regulations, we cannot ask for detailed medical information over the phone nor can we give detailed conditions over the phone.  Furthermore, in a life-threatening emergency the main focus is to begin resuscitating the patient and little time can be spent reviewing non-vital information.


Why is blood type not important to know?

In general, knowing a patient's blood type is not essential.  Since transfusing the wrong blood type can be a fatal mistake, blood is always typed and matched prior to a transfusion.  Most hospital laboratories are able to have the results within half an hour. If an emergency situation arises and the patient needs blood immediately, the patient will be transfused type O blood, which is compatible with any blood type.  Appropriately typed blood will then be transfused as soon as it is available.


So you're saying there is actually a limit to the amount of medical information we should provide?

Medical information is private and personal information.  In a life-threatening emergency there are only a few pieces of key information that may have an impact during that first half hour of resuscitation.   After the first half hour there is time to call the emergency contact and obtain any additional medical information that may be necessary.


How important is it to have an emergency contact?

An emergency contact is necessary to get him/her to the ER as soon as possible.  As mentioned, there is a lot of regulations around the amount of information we can give over the phone so the sooner we can contact someone to get to the hospital the better off everyone will be.  It is also important to have relevant and up to date contact information.  It does not do a lot of good to have a contact that cannot quickly come to the emergency room.


What type of emergency-related information do you recommend someone carry when traveling abroad?

I would recommend taking a list of medications you are taking with the dosage and generic drug name.   Medication brand names sometimes vary in different countries; therefore it may be difficult to purchase the correct medication if you need to do so.

I would also carry the names and phone numbers of your primary physician and any specialists that you see.  This could be useful if you have a complicated medical history and become hospitalized in a foreign country.  The foreign physician may be able to speak with your doctor or have medical information faxed to the hospital.


What are the different types of emergency situations?

The two main types of emergency situations are trauma and medical.

Trauma includes any physical insult to the body.  Examples are being struck by a car, falling and hitting your head, stab wounds, gun shot wounds, etc.

Medical emergencies include everything else such as heart attacks, strokes, losing consciousness, etc.

Regardless of the situation, the first few minutes of resuscitation are the same.  The challenge lies in identifying and treating any emergency conditions after the initial stabilization.  In trauma situations, most injuries can quickly be discovered on physical exam and imaging studies (X-rays, CT scans).

Medical emergencies tend to be more challenging since the clues are not quite as obvious.  In these situations, having a medication list can provide us with an inferred list of current medical conditions such as diabetes and hypertension. Knowing this list, we can then formulate a differential diagnosis of possible complications and start ordering specific blood tests or imaging studies that may elucidate the emergency medical condition present.


What safety measures should we practice when being active outdoors?

In general, it always important to stay well hydrated and maintain an adequate body temperature.  On a hot day that means protection from the sun and drinking plenty of fluids.  On a cold day that means wearing enough layers and also remembering to hydrate.

In both situations, I would recommend carrying along vital information in case of an emergency.