Procedural sedation is one of the core procedures in Emergency Medicine. You WILL see this during your clerkship Common Scenarios Cardioversion Orthopedic reductions Painful procedures Three Step Approach to Procedural Sedation Step 1: Risk stratify the patient Mallampati score (aka “How visible is the uvula?”) Level 1: Can visualize THE WHOLE uvula Level 2: Can […]

Step 1: Identify Classic Red Flags for Can’t Miss Diagnoses Aortic Dissection and Abdominal Aortic Aneurysm (AAA) Age >50 Hypertension “Ripping” or “Tearing” pain Absent pulses in lower extremities Spinal Infections Fever Immunocompromized HIV Diabetes mellitus Transplant patients Spinal cord compression (especially cauda equina) Urinary retention Consider obtaining post-void residual Saddle anesthesia Fecal incontinence/decreased rectal […]

Minor complaint. Huge SLOE points! Step 1: Identify Which Tooth is Causing Pain Bonus points if you number teeth correctly! Number 1-32 Tooth #1 is top right Tooth #32 is bottom right Refer to dental chart for reference Step 2: Correct Terminology When Making Diagnosis Pulpitis Pain in the tooth itself Reversible Triggered by hot/cold […]

Does the patient have CENTRAL vertigo (bad) or PERIPHERAL vertigo? Step 1: How Does Patient Describe the Vertigo? Asking the patient to describe their dizziness has since been disproven… (However, the classic teaching is) Central vertigo Mild Vague Peripheral vertigo Severe Sudden Step 2: What Are the Associated Symptoms? Central vertigo frequently associated with “The […]

Hyperkalemia = EKG… EKG changes = Calcium… Step 1: Recheck the Potassium Most common cause of hyperkalemia is PSEUDOhyperkalemia Caused by too aggressive/fast of a blood draw Causes RBCs to break open and falsely increase serum potassium Step 2: Get an EKG Earliest EKG change Peaked T waves Late EKG changes Flattened P wave Prolonged […]

A-B-C-D-E-F-G Two Types of X-Rays Anterior-Posterior (“AP”) Classic “portable” xray The beam shoots from in front of the patient (anterior) TO The plate sitting behind the patient (posterior) Posterior-Anterior (“PA”) Requires trip to radiology Results in a better picture The beam shoots from behind the patient (posterior) TO The plate sitting in front of the […]

Mom is Scared. You are Scared. Don’t Be Scared. General Principles Evaluate for intimate partner violence in all poorly explained traumas during pregnancy Get the scans you would order in a non-pregnant patient, even CTs! Shield the uterus if necessary Basic Approach to Trauma in Pregnancy Step 1: Place mother in left lateral decubitus position […]

Four important injuries. Four different imaging studies to obtain. Step 1: Obtain Pelvic X-Ray Commonly performed at bedside as part of initial trauma evaluation A pelvic injury significantly increases risk of GU injury Step 2: Examine the Perineum Common signs of GU injury Blood at urethral meatus Bruising of the perineum Step 3: Obtain Urinalysis […]

Step 1: Does This Patient Need Surgery NOW? Obvious penetrating injury to abdomen Peritonitis Hypotensive Step 2: FAST Scan Performed with bedside ultrasound machine Blood/intra-peritoneal fluid is hypoechoic (black) in appearance Four views required Right upper quadrant Probe marker points towards patient’s head “Morrisons Pouch” Potential space between liver and right kidney Left upper quadrant […]

Cardiac tamponade. Aortic Dissection. Blunt cardiac injury. Cardiac Tamponade Blood fills pericardial sac Increasing pressure on myocardium -> Decreased preload Decreased preload -> Hypotension -> Death Clinical exam shows Beck’s Triad Hypotension Muffled heart sounds Jugular venous distension (JVD) Diagnosed during FAST exam (subxiphoid view) Treat with pericardiocentesis Bedside thoracotomy if patient loses pulse Aortic […]