Monthly Archives: August 2020

Decreased Level of Consciousness – ED

Decreased Level of Consciousness Level Of Consciousness – AVPU (Alert, respond to Verbal, respond to Pain, Unresponsive) 1. In a patient presenting with altered level of consciousness (LOC), develop an appropriately broad differential diagnosis (e.g., metabolic, infectious, structural, medications, recreational

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Anaphylaxis – ED

Anaphylaxis 1. In any patient presenting with shock, consider anaphylaxis as a possible diagnosis. 2. In a patient with symptoms and signs suggestive of anaphylaxis, recognize and make the diagnosis even when the presentation is incomplete (e.g., may exhibit only

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Abuse – ED

Abuse (Domestic) 1. In patients who may be at higher risk for undeclared domestic abuse (e.g., the elderly, individuals in same-sex relations, pregnant women, substance abusers, frequent presenters to the ED) look for and recognize discrete indicators of possible abuse

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Asthma – ED

Asthma subtype: Aspirin sensitive asthma prior sensitization to NSAID + chronic rhinosinusitis + nasal polyps + asthma Atopic syndrome: allergic asthma, dermatitis, rhinitis (hay fever) Samter’s triad: asthma, ASA/NSAIDs sensitivity, nasal polyps Type 1: inflammation – female + URI –

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Toxicology – ED

Toxicology 1. In a patient with a suspected toxic exposure, gather available collateral history from the scene (e.g., EMS history, empty pill bottles, recent prescriptions) to better identify the likely toxins. 2. Given a patient with a toxic ingestion: a)

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Cerebrovascular Accident (CVA) Ischemic – thrombotic vs embolic, vasculitis, connective tissue disease, IVDU Hemorrhagic – intracerebral / SAH (majority of trauma) – 90% internal capsule, AVM (h/a and Sz if unruptured & coma/ICB if ruptured), mycotic (septic embolus) Epidural hematoma

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Seizures – ED

Seizures 1. Consider the possibility of a seizure in the differential diagnosis for a patient with an atypical presentation but without witnessed frank seizure movements (e.g., confused or altered level of consciousness, incontinence, fall/injury/accident, tics in children). Classifications Generalized tonic-clonic

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Eye: Red Eye/Loss of Vision – ED

Eye: Red Eye/Loss of Vision 1. In patients with red eye, do not make a diagnosis of conjunctivitis without having first ruled out more serious possibilities (e.g., glaucoma, iritis, keratitis, foreign body). Red Eye ddx: conjunctivitis, iritis, keratitis, acute glaucoma

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Deep Venous Thrombosis (DVT)/Pulmonary Embolus (PE) 1. In a patient whom you suspect may have a DVT/PE, include the specific elements in the history that will permit an accurate assessment of the patient’s baseline risk of the illness. History: dyspnea

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Ischemic Heart Disease – ED

Ischemic Heart Disease 1. Given a patient with potential acute coronary syndrome (ACS), initiate diagnostic testing without delay and plan ongoing testing until diagnostic resolution (e.g., early and serial ECG, early biomarker testing, chest pain protocols). 2. In patients with

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August 2020