How to Think Like an Emergency Physician Part 3

Practical EMS

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 [e-mail]
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
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