Thank you to Reuben Strayer for allowing me to reproduce his awesome content here. Check out his website at emupdates – return if worse for more emergency medicine content. Email me with comments or questions at Aaron@PracticalEMS.com
Quick tips:
Resuscitation
Does the patient need resuscitation?
– Vitals
– AMS
– Neuro deficits
– Sick appearing
– Threat to self or others
Prioritize patient appropriately and/or call for appropriate resources
Identifying dangerous conditions
– This is most of our ED patients
– Review RN/triage notes before seeing patient
– Prior visits/discharge summaries/ems runsheet
– Ask “What medical problems are you known for?”
– Ask for changes in medications
– Med non-compliance
– Social questions
– Ask last “Why have you come to the ED on this fine evening?”
– Have you ever had these symptoms before?
– Plan: what else need to be ruled out with imaging/lab work?
– Plan on what will happen with negative results, before they come back
– Positive results will usually dictate the plan
Run your board frequently
– What are we waiting on?
– Patient improving or getting worse
– Should I offer update, food, pain meds
– Update charting
– Always place orders before charting
Find a method for managing interruptions that works for you
If HPI and physical exam are difficult or limited – expand your work up
Don’t make waste basket diagnosis such as costochondritis, gastroenteritis, GERD, anxiety
Follow key cases
