approach to abdo pain

Abdominal pain is a very common presentation to the ER, with diagnoses that range from benign to life-threatening. It’s easy to reduce abdo pain to the GI system and simply rely on the quadrant approach–missing other emergencies, from heart attacks to testicular torsions. Because the differential is so wide and potentially deadly, we need an…

approach to altered mental status

Altered mental status carries a wide differential and requires a systematic approach. Traditionally we are taught some long mnemonic like AEIOUTIPS or IWATCHDEATH which are difficult to remember and represents a shotgun approach to assessment, investigations and treatment. It’s easier and more rational to use a systems-based approach, using the common ER mnemonics that reinforce pathophysiology…

approach to headache

Before diagnosing a headache primary (migraine, cluster) you should consider whether their headache is secondary–including outside the brain, inside the brain, systemically, or head and neck C: CARDIO Outflow dissection: cervical artery dissection (carotid or vertebral) D: NEURO Neuron: seizure Encephalitis/meningitis Unregulated pressure: intracranial hypertension/hypotension RBC bleed/clot: EDH, SDH, SAH, DSVT Onco: tumour E: ENDO Electrolyte: hypontremia, hypoglycemia…

approach to chest pain

Chest pain is a common presentation to the ER with high medico-legal consequences Here’s an approach that starts with a broad differential for your history, physical, bedside ultrasound and ECG, after which you can generate a pre-test likelihood for tests and treatment A foreign body aspiration B: CHEST Collapse: pneumothorax Hyperinflate: asthma/COPD E Sick pneumonia…

approach to shortness of breath

In the rapid pace of the ER it’s easy to reduce the complaint of shortness of breath to the respiratory system, which cuts off a large swath of the differential diagnosis. While the cardio-respiratory system accounts for most diagnoses, you can should consider the expanded ABCs to keep your differential broad: A: ABCDEFGHIJKLMNOP Anaphylaxis, Angioedemia, Angina Ludwig,…

approach to shock

How do you approach the patient in shock? Traditionally we start with the classifications of shock, and there’s even the mnemonic SHOCK: Septic Hypovolemic Obstructive Cardiogenic, anaphylactiK. But these are both broad and incomplete. More recently the advent of Emergency Department Echo (EDE) has led to the development of more focused protocols like RUSH, which…

approach to trauma

Trauma patients can be very complex. It can be easy to become distracted by an obvious fracture and miss an abdominal injury, or inadvertently allow the patient to become hypothermic and contribute to their coagulopathy. In the approach to the trauma patient it can helpful to go through the 10 systems of ABCDEFGHIJ: A c-collar airway B: CHEST Collapse…

approach to cardiac arrest

The standard approach to the cardiac arrest patient is to try to recall the “Hs and Ts,” a terrible mnemonic to remember in high-stress situations, and a classic example of a shotgun approach to diagnosis and treatment. Recently the article A Simplified and Structured Teaching Tool for the Evaluation and Management of Pulseless Electrical Activity helped to…

approach to ECG: HEARTS

How do you read an ECG? The standard answer is “rate, rhythm, axis, ST changes,” but what does this mean and how is this useful? We need an approach to ECG that is systematic. Think about HEARTS HEART RATE/RHYTHM: if you start by categorizing the rhythm based on rate, regularity, and width, you can then use the…

approach to CT head: BRAIN

First, before ordering a CT brain ask yourself why. Will alter your management, and what you will do if it’s normal? What’s your differential, what’s your pre-test likelihood, and how will the the likelihood ratios of the CT alter this? Plain CT has a poor sensitivity for some conditions, and a zero sensitivity for others. Consider the…