Emergency medicine diagnoses

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Patients can present to the emergency department with any diagnosis, but as emergency physicians we are focused on a finite subset of conditions that require emergent diagnosis and treatment. There are many complex diagnoses we can’t make with the tests at our disposal (internal medicine diagnoses like celiac, Wegener’s, etc), and there are many benign diagnoses we shouldn’t make (family medicine diagnoses like GERD or anxiety) because there are far more concerning conditions to consider

Here are the bulk of emergency medicine diagnoses by system, and the mnemonics I’ve developed to remember and integrate them. I’ve written separate posts in the “Expanded ABCs” section going into more detail on each system, and in the “Integrated approach” section on how this system-based set of mnemonics can be applied to common presentations:

A: ABCDEFGHIJKLMNOP

  • Anaphylaxis, angioedemoa, abscess (peritonsilar, submandibular, retropharyngeal), angina (Ludwig)
  • Bacterial tracheitis
  • Croup
  • Diphtheria
  • Epiglottitis
  • Foreign body
  • Growth
  • Hematoma
  • Inhalation
  • Johnson (SJS)
  • Kawasaki
  • Laryngitis
  • Mono
  • Node: lymphadenopathy, lympadenitis
  • O anti-streptolysin: strep throat
  • Pharyngitis

B: CHEST

  • Collapse: pneumothorax
  • Hyperinflate: asthma, COPD
  • Edema/effusion
  • Sick pneumonia
  • Tumour

C: CARDIOVASCULAR

  • Cardiac arrhythmia
  • Around heart: pericarditis/myopericarditis, pericardial effusion
  • RV strain: pulmonary hypertension, pulmonary embolism
  • Dysfuctional LV: ACS, cardiomyopathies
  • Incompetent valve: stenosis/regurgitation, endocarditis
  • Outflow dissection
  • Volume depletion
  • Abdominal bleed: GI bleed, intraperitoneal bleed
  • Soft tissue bleed: AAA, retroperitoneal, pelvic/femur bleed
  • Child-bearing: ectopic
  • Urticaria: anaphylaxis
  • Lactate: sepsis
  • Adrenal crisis
  • Rx: toxicological shock

D: NEUROLOGIC

  • Neuron seizure
  • Encephalitis, meningitis, abscess
  • Unregulated pressure: intracranial hypertension, hydrocephalus, intracranial hypotension
  • RBC bleed/clot: SDH, EDH, SAH, ICH, CVA, DSVT
  • Onco: brain tumour/met
  • myeLopathy: spinal cord compression, transverse myelitis, epidural abscesss/hematoma
  • Origin (root) compression
  • GBS
  • Intersection neuromuscular disease: botulism, myasthenia
  • CK myopathy

E: ENDO

  • Electrolyte imbalance: hypo/hyper-glycemia/natremia/calcemia/kalemia/magnesemia
  • Normothermia imbalance: hypothermia, hyperthermia
  • Determine acid-base disturbance: alkalosis, acidosis
  • hOrmonal imbalance: diabetes, thyroid, adrenal

F: fluids, fertility

  • renal failure: CREATININE
    • Cardiac output decrease
    • Renal artery stenosis
    • Extracellular volume decrease
    • Auto-immune nephritis
    • Tubular necrosis
    • Interstitial nephritis
    • Neoplasm/mass compression
    • Impacted stone
    • Neurogenic bladder
    • Enlarged prostate
  • female pelvic conditions: PELVIS
    • Pregnancy: normal pregnancy, miscarriage,
    • Ectopic, molar pregnancy
    • Luteal cyst hemorhage
    • Vascular torsion
    • Infection: endometritis, PID, TOA
    • Structural: benign (eg fibrois, cyst), malignant (cervical, endometrial, ovarian)
  • male testicle conditions: A TESTICLE
    • Appy/AAA referred pain
    • Torsion
    • Epididymitis
    • Structural: hydro/varicocele
    • Torsion of appendix
    • Incarcerated hernia
    • Cancer
    • Lymph node orchitis
    • hEnoch-Schonlein

G: ABDOMINAL

  • Ammonia/ascites: liver disease: infection, cirrhosis, cancer, failure
  • Biliary disease: stone, infection
  • Dyspepsia: gastro-esophageal–ulcer, varices, cancer
  • Organomegaly spleen: splenomegaly, splenic bleed
  • Mesenteric ischemia
  • Islets: pancreatitis, pancreatic cancer
  • No motion: adhesion, hernia, tumour, volvulus, intussuception, ileus
  • Appy, diverticulisis
  • Loose stool: colitis–infectious, inflammatory, ischemic

H: HEME

  • Hemoglobin decrease: ANEMIC
    • Abnormal: COHgb, MetHgb
    • Nutritional (iron, B12, folate), toxic (EtOH, lead)
    • Electrophoresis: sickle, thallassemia
    • Megaspleen sequestration
    • Intravascular bleed
    • Consumptive coagulopathy
  • Early platelet plug deficiency (thombocytopenia, functional or numerical): PLATELIT
    • Pseudo (clumping)
    • Low vWF
    • ASA/plavix effect
    • Toxic: uremic/malignant
    • Enlarged spleen
    • Low marrow
    • Immune: ITP
    • Thrombosis: MAHA, HIT
  • Make coagulation factors: hemophilia, anticoagulants
  • Elevated dimer/reduced fibronogen

I: INTOX

  • Ingestions, eg etoh, marijuana, cocaine, ecstacy, GHB
  • Natural: plants, mushrooms, herbal
  • Treatments: anticholinergics, antidepressants, cardiovascular drugs, antipsychotics, opioids, sedatives
  • OTC: aspirin, tylenol
  • X poison: causitcs, toxic alcohols, heavy metals, pesticides

J: joints, bones, skin, eyes

  • joint: ARTHRITIS
    • mono
      • Aureus/gono: septic arthritis
      • Refringent crystals: gout, pseudogour
      • Trauma
      • Hemarthrosis
    •  poly
      • Rheumatic fever
      • Infection prior: reactive
      • Tic: Lyme
      • Infectious viral
      • SLE
  • bones: ORTHOPEDIC
    • clinical
      • Open fracture
      • Reducible: dislocation
      • Test neurovascular
      • Hand: scissor, ring
      • Other: ligament, tendon
    • radiological
      • Proximal/distal (off screen)
      • Extensive: multiple fracture
      • Diseased bone: pathological fracture
      • Invisible/occult fracture
      • Cast
  • skin: DERMATOLOGYZ
    • Drug-reaction: AGEP, bullous, captopril angioedema, DRESS, SJS
    • Eyes: Kawasaki
    • Rigid: meningitis
    • Murmur: endocarditis
    • Abdomen: mono splenomegaly
    • Toxic shock
    • Out of proportion: nec fasc
    • Low platelet: ITP, TTP, DIC
    • Oedema: HSP
    • Gono/syphlis
    • lYme
    • Zoster
  • eyes: OPHTHALMOLOGY
    • On wall: Visual Acuity
    • Phield: retinal field cut, pituitary bitemporal hemianopsia, cortical homonymous hemianopsia
    • Hand follow (extra-ocular motion): blow-out fracture, tumour, orbital cellulitis
    • Tears (lacrymal): dacryocystitis
    • Head: temple (temporal arteritis), pre-auricular (viral conjunctivitis
    • Around eye: chalazion, hordeolum, conjunctivitis, blepharitis, blow-out fracture, cellulitis
    • Light reflex: cataract, tumour
    • Move PEARLA: Horner’s, RAPD
    • Optic disc: CRAO, CRVO, neuritis, papilledema
    • Laternal conjuctiva: conjunctivitis, subconjuctival hemorrhage, foreign body
    • cOrnea: FB, ulcer, keratitis, perf
    • Glaucoma (anterior chamber): ACAG, hyphemoa, iritis, endophthalmitis
    • tonometrY: glaucoma, hyphema, retrobulbar hematoma, globe rupture, iritis, orbital cellulitis

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