Use the appropriate order set for all "Code" patients!
•Consider atypical presentation for ACS in elderly patients
•Risk factors for severity of acute pancreatitis include advanced age, obesity, organ failure, and pleural effusion
•Can use APACHE II score to risk stratify in the ED
•Blunt aortic injury (BAI) is a rare but often deadly entity
•Consider in all cases with significant mechanism
•Can have atypical/no symptoms or have distracting injury
•Management of BAI includes permissive hypotension and rapid transfer to the operating room
Retained Foreign Body
Mushroom induced hepatotoxity
· Toddler with a RLE limp
· Infant with inflamed right hemiscrotum
· Pregnant female with right flank pain, pyuria
· Right sided truncal cellulitis
· RUQ discomfort with normal RUQ ultrasound
· Urinary retention
- Ovarian Torsion requires us to be vigilant. It is often misdiagnosed initially by both EM and GYN physicians.
- Reconsider your DDx. "Appendicitis" and "Renal Colic" are common mimics of Ovarian Torsion.
- Fight diagnostic momentum.
- Don’t be fooled by “normal blood flow.” The ovary has two arterial supplies. Diminished venous flow should be alarming even if there is "normal" arterial flow.
- See Ovarian Torsion.
Perforated Gastric Ulcer
- Review your own films! Radiologists are human too. You know what your concern is and may be able to actively see the important abnormality more easily!
- Concerning abdominal exam? You don't need to wait for images to call a surgeon.
- Think twice before sending to CT, especially with a concerning abdominal exam.
- Resuscitate aggressively! Prepare for the patient to become dramatically more ill!
- Don’t forget the broad spectrum antibiotics!
- Resuscitate! (ABCs, Large Bore Access), but be comfortable with permissive hypotension.
- Target SBP ~80-90 mmHg
- Do not be in a hurry to intubate the patient if they are breathing on their own. Many arrest after intubation.
- IF you must intubate, VENTILATE SLOWLY. Increased intra-thoracic pressure will crush their already tenuous pre-load and cause an arrest.
- Cross-matched PRBCs (consider massive transfusion protocol)
- Contact your Vascular Surgeon emergently
- At CMC, activate “Code Rupture”
–Can occur in Toddlers
–Very challenging diagnosis: consider in FUO with GI symptoms
–Factors to consider:
•Younger patient population
•Diffuse tenderness to palpation
•Longer duration of illness
–CLOSE FOLLOW-UP IS CRITICAL
Sneaky Ectopic - Dr. Nichols
GIB and Aortic Graft - Dr. Beverly
Pulmonary embolism + pleural effusion - Dr. West
Traumatic Ptx, Be Kind - Dr. Robertson
Intoxicated with Chest Pain
Infected Kidney Stone