approach to cocaine intoxication

Cocaine intoxication provides a hypertensive crisis, sodium channel blockade, a dose of serotonin, inflammation from the debris, and potential acute and chronic injury from the portal of entry. So we need a systematic method to consider complications while stabilizing the patient. A: Apply C-spine and Assess airway C-spine injury from fall aspiration risk B: CHEST…

approach to the alcoholic patient

Alcoholic patients are at high risk for emergencies from acute intoxication, chronic effects of substance use and complications like falling/intoxications. It’s a recipe for error to assume that the patient’s agitation, somnolence or vomiting is from alcohol alone and not a complication or other medical emergency. It can help to have a systems-based approach: A…

approach to the pregnant patient

Pregnant patients undergo many physiological changes that can result in fatigue, edema and shortness of breath. But these can also be signs of emergencies, which we can consider using a systems-based approach A more difficult airway management in third trimester B C: CARDIOVASCULAR RV strain: risk of PE from hypercoagulable Dysfunctional LV: risk of peripartum…

approach to the elderly patient

Elderly patients are at higher risk for many emergencies, and it can be helpful to take a systems-based approach A higher risk of c-spine fracture can be more difficult airways for mask and tube B: CHEST Sick pneumonia higher risk, including aspiration, can present less typically (confusion, GI complaints, can be afebrile) C: CARDIOVASCULAR RV…

approach to the cancer patient

Cancer can be a multi-system disease and cancer patient’s are at risk of multiple complications from the tumour itself, the treatment and their immunocompromised state. Using a systems-based approach you can consider complications: A: ABCDEFGHIJKLMNOP Growth: worsening of throat/esophageal ca Hemorrhage of tumour or post-cric B: CHEST Effusion: malignant, can be massive and requiring urgent…

approach to constipation

Constipation affects the GI tract but can arise from broader causes, as the system-based approach shows A B C: CARDIOVASCULAR Volume depletion: dehydration D: NEUROLOGIC myeLopathy: spinal cord lesion E: ENDO Electrolyte: hypercalcemia, hypokalemia, hypomagnesemia hOrmones: diabetes, hypothyroid F: PELVIS Pregnant G: ABDOMINAL No motion: obstruction, tumour H I: INTOX Ingest: narcotic N Treat: opioid,…

approach to diarrhea

Diarrhea is a non-specific symptom that can arise from the GI tract, surrounding structures systemic causes or exposures–and can cause cardiovascular, electrolyte and renal complications in addition to complications related to the underlying cause. A systems-based approach can help diagnose and treat A Anaphylaxis Stevens-Johson B: CHEST Sick: pneumonia, especially Legionella C: CARDIOVASCULAR Volume depletion…

approach to seizure

Seizures require both prompt resuscitation and an approach to diagnosis that includes a wide differential–considering non-convulsive events (eg syncope), a broad etiology of seizure, and potential complications. Using a systems-based approach can help: A C-spine injury, tongue biting complication complication B hypoxia as cause of seizure or consequence of aspiration/chest injury C: CARDIOVASCULAR Cardiac arrhythmia…

approach to INTUBATION

Intubation can save a life or end it, and we need an approach that includes decision-making, preparation, technique and backup approaches After attending the great AIME course, I developed the INTUBATION mnemonic that summarizes these steps:   First decide why they need to be intubated and what problems you may encounter Indication: the system of…

approach to GI bleed

GI bleeds can range from small hemorrhoids to exsanguinating bleeds, and we need a systems-based approach to help resuscitate, diagnose, risk stratify and treat.   A pseudo-GI bleed from swallowed blood risk aspiration from hematemesis B pseudo-GI bleed from hemoptysis C: CARDIOVASCULAR Dysfunctional LV: CHF puts patient at higher risk of GI bleed Outflow: aorto-enteric…