Emergency Tips

Any elderly patient with flank, back, abdominal pain, hypotension, syncope, or pulseless electrical activity (PEA) should have an emergency ultrasound examination to evaluate for an AAA

With few exceptions, procedures performed in the ED can be done with fewer complications and greater success using ultrasound guidance

Be aware of the long-term cancer risk of patients exposed to diagnostic radiation, particularly those who are young or have had multiple studies.

When allowing a patient to leave against medical advice, consideration of the patient’s ability to pay is not part of the equation. Only the risks, benefits, and patient’s ability to understand the risks and benefits are important.

The most deceptive of serious hand injuries is the high pressure injection injury from a hydraulic paint or oil gun because despite a seemingly innocuous appearance on initial presentation, these injuries require aggressive, surgical management.

A pregnant woman with hypertension and seizures should be treated with IV magnesium sulfate and consideration of emergent delivery of the fetus.

A BP greater than 140/90 in a pregnant woman is suspicious for preeclampsia

In the presence of carbon monoxide (CO), pulse oximetry will yield a falsely elevated reading.

No diagnostic studies are indicated in an asymptomatic patient exposed to smoke in a nonenclosed space

b-blockers are contraindicated in the treatment of stimulant toxicity because they may potentiate alpha effects and cause coronary artery vasoconstriction and hypertension

Amphetamine and cocaine toxicity should be treated with IV benzodiazepine in incremental doses titrated to adequate control of heart rate, blood pressure (BP), and temperature.

If using antibiotics to treat abscesses, assume Methicillin-resistant Staphylococcus aureus (MRSA) as the causative agent

Necrotizing fasciitis should be considered in any patient with a soft-tissue infection who has pain and tenderness out of proportion to the visible degree of cellulitis

Culture and antibiotics are not indicated in non-immunocompromised patients with a cutaneous abscess

Early goal-directed therapy in patients with severe sepsis reduces short-term mortality by 10% to 20% compared with an unstructured treatment regimen

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