REBEL Cast

Take Home Points Ask about the red flags: cancer, fever, IVDA, FND, point tenderness, saddle/perianal anesthesia, trauma, urinary retention, bowel incontinence, weight loss Most don’t need XR’s – set this expectation and advise against bed rest Consider XR’s: h/o cancer, extremes of age, osteoporosis, new back pain in the elderly, trauma Perform POCUS and check ... Read more

Take Home Points Get a upreg on any childbearing age female with vaginal bleeding – this is an ectopic pregnancy until proven otherwise Confirm vaginal vs rectal bleeding – it can be hard for patients to tell, especially the elderly Quantify the amount of blood loss – soaking thru >1 pad/hr is a lot Ask ... Read more

Take Home Points Get a upreg on every female patient of child bearing age with lower abdominal pain – this is an ectopic pregnancy until proven otherwise Always consider ovarian/testicular pathology for lower abdominal pain Always have a chaperone when performing genitourinary physical exams Ovarian cysts >5 cm are at high risk for torsion, consider ... Read more

Take Home Points Diffuse abdominal pain can be anything – keep a broad differential and work from there Old patient and flank pain = aortic catastrophe – aortic dissections and aneurysms can knock off flow to the kidneys Appendicitis and diverticulitis can presents diffusely early in their clinical presentation before they localize Kidney stones are ... Read more

Take Home Points Patients don’t necessarily know what’s important – ask lots of questions, find out if they’ve been taking a ton of NSAID’s or Tylenol for their pain and now they have an ulcer or hepatitis Keep a broad differential – the kidneys, the aorta, and consider chest pain differentials in any patient with ... Read more

Take Home Points Go in thinking sick vs not sick – this can take time to develop and that’s ok, this skill will come as you see more patients If you’re thinking about getting a scan or u/s – just get it! You don’t want to go home thinking you should have gotten a scan ... Read more

Take Home Points Think about causes – is it the head, the belly, or something else leading to the vomiting Get a upreg on all females of childbearing age Peritoneal signs – look for rebound/guarding, consider surgery consult prior to imaging if unstable Ask about last BM and if their passing gas – avoid metoclopramide ... Read more

Take Home Points Take chest pain seriously – ACS and PE patients don’t always appear ill – look for the silent killer cases Remember 4-2-1 approach to chest pain = 4 chambers, 2 lungs, 1 esophagus EKG’s – get an old one to compare to for every patient and make sure to perform serial EKG’s Concerning ... Read more

Take Home Points Wheezing can be absent when severe – be wary of the silent chest = impending respiratory failure Not everything that wheezes is asthma! Beware of mimics – COPD, CHF, anaphylaxis, stridor Consider dexamethasone in those with poor compliance – has equal efficacy to prednisone Refill all meds prior to discharge MDI with ... Read more

Take Home Points Keep a wide differential Think of the airway, lungs, heart, blood, kidneys, acid/base, brain Use Wells & PERC consecutively to stratify those who you think may have a PE Silent chest is asthma patients is a harbinger of impending airway compromise Use ultrasound for every respiratory complaint Treat early and aggressively to ... Read more