Emergency medicine diagnoses

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…

I: INTOX

Toxicology is it’s own speciality, and we rely on the help of poison control centres and toxicologists to manage more complex intoxications. In the ER we need a method to quickly consider whether or not someone’s presentation may be a toxicological problem, and there are a couple of approaches After you run through ABCDEFGH, consider “I” for…

OPHTHALMOLOGY

For the patient with an eye problem, use a thorough OPHTHALMOLOGY exam to guide you through the differential general 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, external Tear: lacrymal, eg dacryocystitis Head: temple (temporal arteritis), pre-auricular lymph node (viral conjunctivitis)…

J: joint, bones, skin

The final systems are the extremities, Here are a few mnemonics for the approach to ARTHRITIS, ORTHOPEDICS and DERMATOLOGYZ   ACUTE JOINT PAIN monoarthritis Aureus and gonorrhea: septic artritis Rifringent crystals: gout and pseudogout Trauma Hemarthrosis polyarthritis Rheumatic fever Infection: bacterial (gonorrhea) or post-infectious (reactive arthritis after GI/GU) Tic: Lyme Infection viral: hepatitis, HIV, parvovirus…

H: HEME

After you consider Airway, Breathing, Cardiovascular, Disability, Endo, Fluids/fertility and GI, you can consider the Heme system–which includes four components: Hemoglobin, Early platelet plug, Making coagulation factors, and Elevated dimer/reduced fibrinogen HEMOGLOBIN: think ANEMIC to determine the cause and specific treatment besides transfusion Abnormal Hgb (functional anemia): COHb, MetHb –> reverse Nutritional: nutritional (iron/B12/folate), toxic-metabolic (eton,…

G: ABDOMINAL

After your Airway, Breathing Cardiovascular D(neuro) E(endo) and F(fluids, fertility) systems comes G. To help think about the GI system, think ABDOMINAL. You can think about this as you examine the patient from RUQ to LUQ, down through the mid abdomen to the lower quadrants, and around for the rectal exam, and consider what further…

F: fluids, fertility

After ABCDE, move on to F: fluids and fertility. Here are a few helpful mnemonics   Fluids: if a patient has renal failure think of CREATININE to work through the differential. This approach can also help consider some causes of hematuria. pre-renal: increase urine specific gravity, decrease urine sodium (kidneys working) Cardiac failure Renal artery stenosis/renal vein…

E: ENDO

After your ABCDs, you should consider E: endocrine-metabolic, using the mnemonic ENDO–Electrolyes, Normothermia, Determine acid-base, consider hOrmones. This starts at the bedside with vital signs (glucose, temp), moves on to full electrolytes and acid/base considerations, and finally considers hormones (which might require treatment even though lab results might not be available). ELECTROLYTES Glucose -hypoglycemia: if you have…

D: NEUROLOGIC

In the ABCDs, D is for disability or neurological emergencies. Think NEUROLOGIC to consider what could be affecting the brain (NEURO), spinal cord (L) and peripheral nervous system (OGIC): Neuron seizure: EEG type: tonic-clonic, absense, myoclonic, atonic, non-convulsive status primary vs secondary (hypoxia, hypoglycemia, hyponatremia, meningitis, brain mass/bleed, pre-eclampsia, toxic/withdrawal) treat: manage aiway, give O2,…

C: CARDIOVASCULAR

In working through your ABCs, the C is for circulation. In the ER we need a rapid and systematic way of thinking about the different components of the cardiovascular system and the different emergencies related to them. Think of the CARDIOVASCULAR system, a mnemonic that reinforces pathophysiology–including electrical rhythm (C), pump (ARDIO), volume (VASC), and vascular…