Best Accident and Emergency Centre of Mumbai

Overview

The Accident & Emergency Medicine department at Nanavati Max Hospital is a specialized medical treatment facility that focuses on emergency medicine. Due to the unpredictable nature of patient emergencies, the centre offers initial treatment for a wide range of illnesses and injuries. Some of these conditions can be life-threatening and demand immediate attention. The Accident & Emergency Department also serves as a crucial entry point for individuals who lack other avenues for accessing medical care.

The primary aims of the department include:

• Saving lives during acute medical, surgical, and traumatic emergencies. It caters to individuals with conditions that necessitate immediate medical attention.
• Offering personalized interdisciplinary care to create a positive interaction between patients, attendants, and the hospital care system.
• Providing a platform for academic training and research advancement in the field of emergency medicine.
• Collaborating with patients and their families to develop timely, appropriate, and cost-effective care plans based on evidence-based standards of practice.

Physical Setup:

Situated on the ground floor of the hospital, the Accident & Emergency department has a dedicated entrance. Recognizing that patients can arrive at any time with varying complaints, a pivotal aspect of the department's operation is the prioritization of cases based on clinical urgency. This is typically achieved through the implementation of the Australasian triage system.

Bed Allocation:

The Accident & Emergency department is equipped with 8 designated beds, each serving a specific purpose:

• Triage Bay: Bed No. 1
• Acute Care Beds:
  • Bed No. 2: Life Threatening
  • Bed No. 03: Imminently Life Threatening, Time Sensitive or Severe Pain
• Observation Beds:
  • Bed No. 4 & 5: Potentially Life Threatening, Situational Urgency or Severe Pain
  • Bed No. 6: Potentially Serious Conditions, Situational Urgency, or Severe Pain
  • Bed No. 7 & 8: Less Urgent
• Procedure Room – 1

This well-structured arrangement ensures that patients receive the appropriate level of care based on their medical needs and conditions.

Emergency Medical Ambulance Service:

The Accident & Emergency department offers a dedicated Emergency Medical Ambulance Service, encompassing both Advanced Cardiac Life Support (ACLS) and Basic Life Support (BLS) ambulance calls. These ambulances are fully equipped to manage a diverse range of medical, surgical, and traumatic emergencies.

Facilities and Equipment:

Within the Accident & Emergency department, you'll find a comprehensive set of resources, including:

• 3 ventilators
• 1 portable ventilator
• Telemetry monitors
• Infusion pumps
• Manual defibrillators
• Airway kits tailored for both adult and paediatric emergencies
• A disaster cupboard
• A well-equipped procedure room designed for complex wound repair and plaster application for fracture management.

Expert Staff:

The Accident & Emergency operates around the clock, staffed by a dedicated team of extensively trained and certified specialists in acute care and emergency medicine. Their mission revolves around delivering timely and precise care, with a strong focus on prompt assessment, early resuscitation, and swift stabilization, guided by a directed and focused approach.

Diagnostic and Therapeutic Procedures:

The Accident & Emergency department offers an array of diagnostic and therapeutic procedures, including:

• Cardiopulmonary resuscitation
• Advanced cardiac life support
• Paediatric advanced life support / Neonatal advanced life support
• Advanced Trauma Life Support (for both adult and paediatric cases)
• Cardioversion (chemical and electrical, synchronized)
• Temporary cardiac pacing
• Ultrasound-guided central venous catheterization
• Arterial catheterization (for invasive arterial pressure monitoring)
• Joint reduction for dislocations
• Closed reduction, slab and cast application for fractures
• Removal of slabs and casts
• Cricothyrotomy
• Pleurocentesis
• Paracentesis
• Naso- / oro-gastric tube placement
• Urinary catheterization
• Tube thoracostomy
• Burns dressing
• Wound repair and suturing
• Removal of sutures / surgical staples
• Comprehensive wound care and dressings
• Rabies vaccination for animal bites

Conditions Treated in Accident & Emergency

The Accident & Emergency department handles a wide spectrum of critical medical conditions, including:

• Cardiac arrest
• Acute coronary syndrome
• Heart failure
• Acute pulmonary embolism
• Shock (cardiogenic, hypovolemic, obstructive, distributive)
• Acute severe bronchial asthma
• Respiratory failure (type 1, type 2)
• Adult respiratory distress syndrome
• Community-acquired pneumonia
• Acute altered mental status
• Acute stroke (ischemic and hemorrhagic)
• Seizure disorders
• Upper and lower gastrointestinal haemorrhage
• Hepatic and renal emergencies
• Febrile illness
• Oncologic emergencies
• Trauma – all injuries; wounds, sprains, fractures, dislocations

Acute Coronary Syndrome and the Role of Accident & Emergency:

Acute coronary syndrome, commonly known as a heart attack, occurs when a critical blockage obstructs blood flow in one or more arteries that supply the heart. Patients often arrive at the Accident & Emergency with symptoms such as chest pain, sweating, shortness of breath, palpitations, dizziness, vomiting, or fainting spells. The Accident & Emergency has a specialized setup to manage these cases, activating a Code Green that triggers a coordinated response from the emergency physician, cardiologist, operations team, anesthesiologist, and Cath Lab technician. Rapid assessment, immediate ECG interpretation (within 10 minutes), and a Door-to-Balloon time averaging under 90 minutes in the Cath Lab contribute to a Gold Standard treatment known as Primary Angioplasty in Myocardial Infarction (PAMI). The Accident & Emergency department's efficient response time through the Code Green plays a pivotal role in successful recovery.

Acute Ischemic Strokes and Accident & Emergency's Expertise:

Acute ischemic strokes occur when blood supply to a region of the brain is cut off due to atherosclerotic narrowing. The Accident & Emergency excels in managing such strokes through a Code White protocol. Upon arrival, the emergency physician conducts a swift neurological examination to assess severity and timeline. Activation of the Code White assembles an interdisciplinary team consisting of the emergency physician, intensivist, neuro-radiologist, and interventional neurologist. This approach optimizes timely care for identifying large vessel occlusions and urgent neuro-intervention, ensuring the best possible outcome for the patient.

Specialized Trauma Care:

Accident & Emergency department is staffed by specialists trained and certified in Acute Trauma Life Support. The department is well-equipped to manage polytraumatized patients in an interdisciplinary manner based on protocols. Upon arrival of a polytrauma victim, the Emergency Team systematically assesses the A, B, C—Airway, Breathing, Circulation. Emphasis is placed on protecting the cervical spine in these cases. For patients with substantial blood loss, immediate emergency blood transfusions are initiated in the Accident & Emergency. Once stabilized, patients are either moved to the ICU or the operating theater. Timely arrival within the Golden Hour significantly enhances outcomes for polytrauma patients.