-
Overdose (Iron)
22y/o female via EMS for NVD p intentional overdose
- Large bore IV access and fluid bolus
- EKG
- Whole bowel irrigation
- Deferoxamine 5mg/kg/hr IV-->15mg/kg/hr NTE 6gm/day
- FSG: ferrous fumurate 33%, sulfate 20%, gluconate 12%
- Toxic: 300-500mcg/dl or as low as 10-20mg/kg elemental
-
Vomiting Infant (Pyloric Stenosis)
- iv access and adequate hydration
- abdominal examination: peristaltic waves, "olive" sign
- ng tube, NPO
- abdominal US
-
AMS(nontraumatic intrancranial hemorrhage)
- Checking ETT placement upon arrival
- large-bore IV access and fluids
- lab eval (coag factors)
- head CT for new onset coma
- reversal for anticoagulation
- neurosurg consult, ICU consult
- finger stick glucose
-
COMA
- bilateral hemispheric pathology or damage to reticular activating system
- causes: trauma,infarction or hemorrhage; central venous thrombosis, meningitis, hydrocephalus, malignancy, cerebral abscess, toxic overdose hepatic or renal failure, sepsis and metabolic abnl's, CO poisoning
- Cushing's Reflex: bradycardia and hypertension (inc ICP)
-
Chest Trauma (Tension Pneumo)
- Needle thoracostomy-->tube thoracostomy
- upright CXR
- pain management-->surgical consult
-
Abdominal Pain and Vomiting (Cholecystitis)
- large bore IV access
- RUQ US
- pain management, surgery consult, abx (eg. amp/sulbactam)
-
Weak Infant (Sepsis)
- iv or io access and multiple fluid boluses
- early abx
- ICU consult
-
Chest Pain (Borhaave's Syndrome)
- Note crepitus on physical exam
- Consider esophageal tear in chest pain ddx
- CXR to evaluate lungs and mediastinum
- STAT GI and ENT consults to determine etiology of pneumomediastinum.
- CT Surgery consult for potential operation.
- Resuscitative fluids and abx for mediastinitis.
-
Back Pain (Epidural Abscess)
- Consider dx in person w/back pain and fever.
- Obtain rectal temperature.
- Obtain stat imaging.
- Neurosurgery consult.
- Determine cause: UTI (hx urinary retention).
-
Leg Swelling (Necrotizing Fasciitis)
- Early recognition d/t appearance,rapidity of sx development, pain and possible sepsis.
- Aggressive resuscitation w/ IV fluids.
- IV abx.
- Immediate Surgical consult.
- Do not allow delay of operative intervention.
- Avoid vasopressors if possible. Lower extrems most common site follwed by upper extremities.
-
Weakness (Hyperkalemia)
- Obtain EKG
- Note hyperkalemia (ekg or labs)
- Immediate stabilization w/calcium
- Meds to shift potassium and decrease total body potassium
- Admission
-
Eye Pain (Acute angle-closure glaucoma)
- Thorough eye exam including including visual acuity, intraoccular pressure and slit lamp.
- Early administration of glaucoma meds: Brimonidine (or other alpha agonist), Timolol, Acetazolamide (contraindicated in sickle cell dz), Mannitol, Prednisolone, Pilocarpine.
- Emergent Ophthalmology consult.
-
Abdominal Pain ( Incarcerated hernia with obstruction)
- Recognition of hernia
- large bore IV access and fluid bolus
- AAS
- NGT placement
- Pain Management
- Surgery Consult
-
Ringing in Ears (Salicylate toxicity) 17y/o female
- Large bore IV access
- Pregnancy Test
- Hx salicylate use
- Alkalinization on urine with sodium bicarb.
- Close monitoring of pt and salicylate levels.
- ICU admission
-
Vomiting child (Henock-Schonlein Purpura)
6y/o boy
- Fluid resuscitation
- AAS
- Pain management
- Labs for liver and renal injury
- Surgery Consult (hematemesis/blood diarrhea)
-
Snake Bite (python) 7y/o (acting nl p 1 hr)
- Assess ABCs
- Assess wound
- Identify snake for risk of venom exposure
- Thorough hx and physical--total exposure
- Poison Control Center
-
Visual Impairment (Retinal Vascular Occlusion)
- Ocular Exam: Optic disc edema and diffuse retinal hemorrhages in all quadrants. Marcus Gunn Pupil if complete occlusion.
- Ophthalmology Consult
-
Syncope (11y/o female with 2 episodes p exercise) Torsades
- EKG: prolonged QT
- Recognition of Torsades after pt decompensates
- Resuscitation per PALS guidelines (magnesium and defib).
- Cardiology consult
-
Retropharyngeal Abscess ( 3y/o male w/ fever,drooling,sorethroat)
- Airway cart, prep for intubation
- Soft tissue Neck xray
- ENT Consult
- Abx
- ICU admission
-
SCFE (15 y/o obese male w/ left knee pain and limp)
- Physical Exam of both hips
- Bilateral hip xrays w/lateral views
- Ortho Consult for SCFE
- Pain meds and non-weight-bearing
-
Testicular Torsion (3y/o w/abd pain and new "diaper rash")
- Testicular exam
- Immediate Urology consult/pediatric surgery consult
- Testicular US
- Pain Management, NPO
- Manual detorsion attempt
- OR for surgical exploration and detorsion
-
Gastric Perforation (79y/o fem w/abd pain)
- Large bore iv access and fluid bolus
- Upright chest xray (AAS)
- Pain management
- Surgery consult
-
Pertussis (1y/o male w/ cough paroxysms)
- Oxygen
- Saline for tachycardia
- CXR
- Abx for patient AND close contacts
- Admit to respiratory isolation
-
AAA (77 y/o male w/flank pain)
- Large bore iv and fluid bolus
- Bedside US
- Surgery Consult
- Blood transfusion (10-16 units pRBCs and FFP available)
- Grey-Turner's = retroperitoneal hemorrhage
-
Carbon Monoxide Poisoning (68y/o female w/lethargy and depression (cat died night before))
- 100% NRB mask
- FS glucose
- Obtain hx c/w CO poisoning
- Obtain COHb level
- Transfer to hyperbaric treatment facility
-
Maxillofacial Trauma (Assault to Face, LeFort II Fracture)
hx baseball bat to face w/epistaxis
- Early airway control using advanced airway technique w/ cricothyrotomy set up simultaneously
- Hemorrhage control (pressure to nose/packing)
- C-spine immobilization
- CT: head, c-spine, face
- Trauma consult/Oral Maxillofacial Surgery (OMFS)
-
Burn (24y/o male fell in the fire, EtOH) face/mouth burned
- Large bore IV and fluid resuscit (Parkland formula)
- Analgesia
- Intubation
- Escharotomy for 3d degree circumferential burn to extremity
- Tetanus administrationj
- Transfer to Burn Unit
-
Vomiting Blood (37y/o female alcoholic) Variceal Bleeding
- Large bore IV access
- Hemodynamic monitoring
- Blood, platelets, FFP transfusion
- GI consult (EGD)
- ICU admit
- vasopressin, octreotide, esomeprazole
-
Light-headedness (87y/o female) Sinus Bradycardia
- EKG, O2 sat
- Atropine
- Pacing (transcut or transvenous)
- Cardiology consult
- ICU admit
- glucagon for metoprolol overmedication
-
Status Asthmaticus (37 y/o obese male with resp distress)
Shortness of Breath
- Pulse-Ox, Cardiac monitoring
- Supplemental O2
- Albuterol, Solumedrol, Atrovent
- Frequent reassessment (peak flows, p-ox,resp effort)
- Adjunctive tx prn (magnesium, epi, BiPap)
- ICU admit
-
Rash and Fever
27y/o w/Rash and Fever
Stevens-Johnson Syndrome (Erythema Multiforme Major)
- Obtain history of recent abx use
- Skin Exam (target lesions), mucocutaneous lesions (oral and vaginal)
- Establish dx of Erythema multiforme major
- Derm consult
- ICU admission (Burn unit)
-
Weakness (Guillain-Barre syndrome)
67 y/o male w/ascending weakness
- Finger stick glucose
- Thorough neuro exam--> dx of GBS
- Neurology consult
- Recognize worsening respiratory status-->intubate electively
- Admit to ICU
- Begin plasma exchange or IV immunoglobulin
- Avoid succinylcholine as paralytic-->hyperK
-
Abdominal Pain w/Vomiting: Small Bowel Obstruction
51 y/o female (hx prior abd surgeries)
- IV access and fluids
- AAS
- Pain management
- Surgery consult
- NG tube
-
Chest Pain: Cocaine induced chest pain
37y/o male
- EKG and monitor, O2 administration
- Benzodiazepines
- Pain management prn (nitrates and morphine)
- Cardiac enzymes
- CXR
- Admit to Obs to eval for cardiac ischemia
-
Seizure: Simple febrile seizure
34m/o male w/generalized seizing
- Detailed H&P to assess for meningitis or other obvious bacterial infection
- APAP Q4H or ibuprofen Q6H to reduce fever
- Counsel parents re simple febrile seizures and f/u
- note: pt discharged home in book answer, no LP, no CT
- LP recommended for children under 12 months or focal, toxic, not playful after p ictal period, or concern w/ f/u or pt already on abx.
-
Chest Pain: PE
45 y/o female s/p left ankle surgery x 2 weeks
- EKG, CXR, VQ scan or chest CT angio
- Heparin: unfractionated IV, or low molecular weight IM
- admit for anticoagulation
- Consider thrombolysis (alteplase) w/cardiorespiratory collapse d/t PE
-
Throat Swelling: Anaphylaxis
5 y/o w/peanut allergy
- Airway assessment
- O2, epi, and benadryl or hydroxyzine
- NS (20cc/kg) bolus IV
- Obs for at least 6 hours
- If discharged, rx for epi autoinjector, benadryl and avoid allergic trigger
-
Abdominal Pain (Appendicitis)
24 y/o female
- Urine pregnancy test, UA
- Pelvic exam in woman of child-bearing age
- Pain management
- Abx pre-operatively, Serial abdominal exams
- CT abdomen/pelvis with enteric (rectal) contrast
- Surgery Consult
- US possible if pregnant
-
Altered Mental Status (Subdural Hematoma w/midline shift)
85 y/o male w/disorientation
- Early finger stick blood glucose
- Obtain hx recent fall
- Noncontrast head CT, lab evaluation
- Pain mgt, no NSAIDs which could worsen bleed
- Neurosurgery consult
- ICU admit
-
Rectal Pain, Uncomplicated Perianal Abscess
28 y/o male with pain in anal region
- Pain meds
- Thorough exam to r/o sx fistula or systemic involvement
- I&D
- Discuss p I&D mgt: sitz baths, stool softeners, drsg changes
- Arrange f/u
-
Vag Bleed (Ectopic Pregnancy)
25 y/o female w/abdominal pain and vaginal bleeding
- Large bore IV access and fluid bolus
- Blood type & cross
- HCG
- Rho (D) immune globulin IM
- Pelvic exam, pelvic US
- Pain management
- OB-Gyn consult
-
Agitation (Alcohol intoxication)
49y/o male with agitation
- Finger stick glucose
- Noncontrast Head CT
- Anion gap, osmolar gap
- Lac repair
-
Abdominal Pain (DKA, UTI)
45 y/o female w/abdominal pain and fever
- Early blood glucose assessment
- Fluid replacement NS
- Insulin drip
- Replete potassium (nl but will drop with insulin)
- EKG
- ICU admission, abx for UTI
-
Abdominal Pain (Inferior wall MI w/ right ventricular involvement)
61 y/o male w/epigastric pain and nausea
- EKG, right-sided EKG
- IV access and fluid bolus
- ASA administration, avoid NTG administration
- Cardiology consult
- Activating cardiac cath lab
-
Abdominal Pain (Ovarian Torsion)
25 y/o female with abdominal pain
- Pregnancy test
- Pelvic exam
- Pelvic US
- OB-Gyn consult for laparoscopy and detorsion
- Analgesia
-
Altered Mental Status (Opiod OD)
33 y/o male found unconscious
- Finger stick glucose (DONT protocol)
- Naloxone administration
- EKG, CXR
- Reassessment after interventions
Naloxone 2mg, may repeat Q3min until 10mg given
-
Diarrhea (Traveler's Diarrhea)
34 y/o male w/abdominal pain and diarrhea
- Elicit social hx: travel, risk factors for immune compromise, recent abx
- Stool sample for O&P, fecal leuk's,Giardia antigen/C.diff
- Rehydrate and replete electrolyte deficiencies
- Prescribe abx (metronidazole, cipro or albendazole) x 5d
- Arrange for f/u
-
Seizure (Thrombotic thrombocytopenic purpura)
45 y/o male w/seizure
- Note petechiae on physical exam
- Obtain CBC
- Steroids
- Plasmaphoresis
- Heme consult (noting possible TTP)
- Admission
-
Toothache (Ludwig's Angina)
36 y/o male with infected tooth
- Airway mgt, prep for difficult airway
- Abx
- ENT Consult
- Admission
-
Penetrating Chest Trauma, Acute Pericardial Tamponade
24 y/o male stabbed in chest
- Intubating patient for airway protection
- Large volume fluid immediately
- Dx'ing tamponade (Beck's triad: JVD, muffled heart sounds and hypotension), or performing US/thoracotomy
- Starting blood transfusion
- Surgical Consult for emergent OR repair
-
Animal Bite
35 y/o male w/cat bite 4 hr pta
- Appropriate abx
- Tetanus immunization
- f/u for wound check
-
Abdominal Pain, TOA (2/2 STD)
24 y/o female w/lower abd pain x 4 days
- Urine pregnancy test
- GU exam
- Pelvic US
- Abx
- Gyn consult
- Pain meds
-
Headache, Cavernous sinus thrombosis
55 y/o male brought in by wife w/ worsening headache, fever, and eye pain x 2 days
- Early abx and steroids
- LP
- MRI for dx
- ICU
-
Fever, Kawasaki's
20 m/o male w/fever x 5 days, rash x 1 day
- ASA (100mg/kg/day divided Q6H and IVIG (2gm/kg IV over 8-12 hours)
- consult infectious disease or pediatric rheum
- d/w family/PCP re dx and management
- thrombocytosis (plt > 650k) a/w coronary artery thrombosis
-
Back Pain, Cauda Equina Syndrome (from disc herniation)
42 y/o male w/back pain and RLE pain s/p fall x 1 month
- Pain control
- Complete neurological examination
- MRI
- Neurosurg consult for decompression surgery
- Dexamethasone (controversial) for edema
-
Cardiac Arrest, SIDS
7 m/o male brought in mom and EMS, found unresponsive
- Initiate appropriate PALS life support
- Assess for signs of abuse
- Resuscitate and ensure temp in WNL before pronouncement of death.
- Provide psychosocial support to family
-
Knee pain, Septic Arthritis
54 y/o female w/r.knee pain and swelling x 2 days
- Knee arthrocentesis (informed consent, timeout, etc)
- Ortho consult: possible joint irrigation in OR
- Admit for iv abx
- Abx: nafcillin or vancomycin if MRSA suspect
-
Rash, Rocky Mountain Spotted Fever
14 y/o male w/rash,fever, abdominal pain w/vomiting and diarrhea x 2 days, 1 day hx of rash
- Obtaining travel hx--camping
- Examination of rash
- CBC, BMP, LFT
- Complete physical exam including chest, lungs, abdomen, and neurological exam
- Abx (doxycycline or chloramphenicol)
- Consider co-infection w/other tickborne dz's: Lyme, Ehrlichiosis, babesiosis
-
Sickle Cell Disease: Acute Chest Syndrome
18 y/o male w/left shoulder and left-sided chest pain x 3 days
- Oxygen
- CXR and identification of pulmonary infiltrate
- Pain control w/ IV opiate
- Abx
- Exchange transfusion or heme consult
- Admission to medical ICU
-
Headache, Bacterial Meningitis
22 y/o male w/fever and headache
- Appropriate abx tx BEFORE imaging or lumbar puncture
- LP
- Admission to isolation bed and ICU
- Assessment of public health concerns (roommates, close contacts, etc).
-
Chest Pain, Pericarditis
34 y/o male w/chest pain (recent URI)
- EKG
- Cardiac examination
- Echocardiogram
- NSAID
- Admission
-
AMS, Hypoglycemia 2/2 sulfonylurea
73 y/o female w/confusion and facial droop, garbled speech
- IV access
- finger stick glucose
- iv dextrose
- Further antihypoglycemic intervention (feeding, octreotide, dextrose fluids)
- Admission
-
Headache, High Altitude Cerebral Edema
42 y/o skier w/ headache, nausea and "flu like sx" x 1 day
- Head CT
- Tx w/dexamethasone
- hyperbaric chamber temporizes
- Rapid descent (transfer to lower facility)
- Oxygen
-
AMS, Digoxin toxicity
79 y/o w/AMS, nausea, weakness "things have yellowish hue"
- EKG
- Digibind
- Treatment for hyperkalemia (NO CALCIUM!!!)
- CCU
- Atropine or pacer pads for bradycardia
-
SOB, CHF Exacerbation
82 y/o female w/ sudden onset sob x 30 min
- High-dose ntg drip initiated
- Furosemide
- Oxygen
- Aspirin
- CCU consult
- Admit CCU
-
SOB, Critical aortic coarctation
10 d/o male w/sob,"tiring out while feeding, sleeps a lot"
- Recognize respiratory distress
- Oxygen administration, intubation
- IV access, EKG, CXR
- Recognize cardiomegaly and cardiac etio of resp distress
- Cardiology consult
- Prostaglandin administration
-
Flank Pain, Kidney stone
30 y/o male with flank pain for 2 days, taking Vit A and Vit C
- Large bore IV access and hydration w/more than 1L NS
- Early pain control
- Confirmation of dx of renal colic with CT (1st episode)
- UA
- Temperature
-
Seizure, Status Epilepticus (2/2 alcohol withdrawal)
45 y/o male via EMS seizing despite IM Lorazepam
- Finger stick glucose
- IV access
- IV benzodiazepine (until at least Lorazepam 8mg iv given)
- Head CT
- Labs and serum/urine tox
- Neuro consult for new onset seizure/status epilepticus
-
Fever, Fournier's Gangrene
70 y/o demented male from NH w/ fever
- Full exam for source of fever
- Adequate fluid resuscitation
- Emergency surgical consult
- Broad spectrum abx
-
Vomiting, Intussusception
7 m/o male w/abd pain and vomiting
- NS bolus 20ml/kg
- Complete physical exam
- Barium enema
- Peds surgical consult
-
Fever, HIV Pneumonia (likely PCP)
45 y/o male w/fever and cough
- Oxygen supplementation
- IV fluids
- CXR, UA
- Abx
- Respiratory isolation
-
Palpitations, SVT
39 y/o female w/hx HTN brought in by EMS w/palpitations
- Large bore iv access
- EKG
- Discussion re side effects of adenosine
- Adenosine w/rhythm strip (repeated)
- Repeat EKG and vitals after breaking rhythm
-
Cough, Community Acquired Pneumonia
45 y/o female w/ sob, cough and fever
- iv access
- NS fluid bolus > 2L
- CXR
- Abx
- Admission
-
Drowning, C-spine fx and Neurogenic Shock
27 y/o male via EMS after diving into shallow end, + LOC
- Large bore iv access
- C-spine precautions
- CT c-spine
- Neurosurg consult
- Intubation (C-4 burst fx)
- Pressors for neurogenic shock
-
Abdominal Pain, Pancreatitis
54 y/o male alcoholic w/severe epigastric pain
- 2L NS bolus iv
- type and hold
- pain medications: opiates
- discussion w/pt re alcohol cessation
-
Abdominal Pain, Ischemic Bowel (embolus to Sup Mes a.)
84 y/o female w/intermittent crampy abd pain and diarrhea
- NS 2L bolus
- CT abd/pelvis w/contrast
- Abx
- Surgery consult or interventional radiology consult
- Pain medication
-
SOB, COPD Exacerbation
59 y/o w/hx COPD via EMS for severe respiratory distress
- O2 Supplementation
- B-agonist and anticholinergicd tx via nebulizer
- Steroids
- CXR
- BiPap or CPAP or intubation
-
AMS, Alcohol Withdrawal Seizures
48 y/o male via EMS found on sidewalk unresponsive
- Benzo's until seizure stops
- FS glucose
- Head CT
- Management of agitated pt (haldol, ativan, physical restraints)
-
Weakness, Left MCA Stroke (ischemic)
66 y/o male w/sudden onset r.sided paralysis and slurred speech
- finger stick glucose
- head CT
- Neurology/stroke team notification/consultation
- Neurological exam
- BP control with IV agents
-
Pedestrian Struck, Pelvic Fx w/ hemorrhage, Open r.ankle fx
57y/o female via EMS
- large bore iv access x 2
- blood transfusion
- immediate activation of surgery/trauma service
- FAST exam, chest and pelvic xrays
- reduction and fixation of pelvis
- interventional radiology for emergent embolization
-
Back Pain, Pyelonephritis
29y/o female w/back pain (fever x 3d)
- Pain Control
- Urine pregnancy test
- iv fluids
- abx
- ensuring proper outpatient tx, instructions and f/u
-
AMS, Thyrotoxicosis, Pneumonia
39y/o female via EMS memory loss, confusion,frank psychosis
- NS fluid bolus, 1L
- Finger stick glucose, CXR
- Abx for possible meningitis
- CT & LP for r/o CNS pathology
- Serum tox
- Propranolol, PTU, and Iodine
- ICU consult/admit
-
Abdominal Pain, Nonaccidental Trauma, Splenic Laceration
3y/o male via mom: abd pain after falling off stool
- Recognition of potentially serious abdominal injury
- CT abdomen
- Recognition of inconsistent story, possible abuse
- Surgery Consult
- Social work/child services consult
-
Abdominal Pain, Hemolytic Uremic Syndrome
5y/o boy w/mild abdominal pain, cola-colored urine & diarrhea
- cbc: plt count 35, helmet and burr cells
- large bore iv access and fluid bolus
- discussion with family
- admission
- Peds hematology consult (possible plasmaphoresis if worse)
- Nephrology consult
-
Respiratory Distress, FOB Aspiration
2 y/o with respiratory D
- Airway management prep
- Oxygen supplementation
- CXR (inspiration and expiration)
- ENT consult
-
Overdose, Acetaminophen overdose
45y/o female w/foot pain and depression (50 oxycodone tabs)
- Determine timing of ingestion
- check APAP level AND likely coingested substances
- start NAC immediately based on calculated dose (>140mg/kg)
- check EKG
- Place patient on suicide watch
-
chest pain, anterolateral MI
59 y/o male w/chest pain
- cardiac monitoring
- ekg w/in 10 minutes of arrival
- cardiology cath consult
- aspirin
- pain control w/morphine and/or nitroglycerine
-
Fever,SIRS d/t pneumonia
89y/o female via EMS from NH for fever and AMS
- large bore iv access and fluid bolus
- lactate
- CBC, blood cx, urine cx, CXR
- eval for sources of fever including cellulitis, decub ulcers, UTI
- early abx or initiate EGDT if pt decompensates
-
AMS, Heatstroke
81y/o female via EMS from home: lying by bed in very warm apartment
- check blood glucose
- large bore iv access and fluid bolus
- immediate cooling
- core temp monitor
- CT head
- ICU admission
-
SOB,Pericardial tamponade
56y/o male from renal clinic w/lowBP, sob and dizziness
- large bore iv access and fluid bolus
- CXR,EKG
- bedside cardiac echo
- cardiothoracis surgery consult
-
Stab to chest, Tension Pneumothorax
53y/o female w/stab to chest and dyspnea
- Emergent decompression (tube or needle followed by tube)
- FAST exam
- pain management
- CXR to confirm tube placement
-
Abdominal Pain, Diverticulitis with fever
50y/o female with lower abd pain
- Pelvic exam
- Urine pregnancy test
- Pain management
- CT abd/pelvis w/iv and po contrast
- Early surgery consult
- Abx
-
Seizure, Eclampsia
42y/o female 7 days postpartum
- large bore iv access
- magnesium iv infusion
- CT head
- emergency obstetric consultation
- UA
-
Palpitations, Ventricular tachycardia
59y/o male woke from sleep at 5am w/palpitations and SOB
- 12 lead EKG
- Amiodarone 150mg bolusees then drip when stable
- Synchronized cardioversion (100J monophasic or equivalent biphasic equivalent) for instability(ams, low bp, or chest pain)
- Cardiology consult, CCU admission
-
Seizure, TCA overdose
28y/o female
- large bore iv access and fluid bolus (vasopressors prn)
- EKG, repeat EKG after treatment
- Sodium bicarb
- Administration of activated charcoal
- Medical ICU
-
Fever, Post liver transplant fever
66y/o male w/fever and abd pain, s/p liver transplant
- large bore iv access and fluid bolus
- cultures before abx
- Paracentesis w/fluid analysis and cx
- Broad spectrum abx
- Pain meds
- Contact appropriate consultant (transplant team)
- Reverse isolation hospital bed/ICU
-
Abdominal trauma,Blunt abd trauma--splenic rupture
46y/o male s/p MVA (bent steering wheel)
- large bore iv access and fluid bolus
- blood type and cross-match
- pain control
- trauma surgery or general surgery
- FAST exam
- early pRBC transfusion w/destabilization of vital signs
- advocate for laparotomy when patient decomps
-
Hematochezia, Necrotizing enterocolitis
20 d/o male w/poor feeding and blood in diaper
- iv access and fluid bolus
- abd xray AP and lateral decub (pneumointestinalis) +/- US
- cultures/abx to r/o sepsis
- peds surgery consult
-
Abdominal pain, Spontaneous bacterial peritonitis
68y/o male w/ worsening abd pain x 2 d, hx cirrhosis
- iv access and fluid bolus
- early paracentesis
- early abx
- pain management
-
Cough, Pulmonary inhalation anthrax
42y/o male (alpaca farmer)
- CXR
- Early abx (pcn, doxycycline, erythromycin, cipro)
- Intubation, Isolation
- MICU admission
- Call CDC
- Prophylax healthcare workers and family (cipro)
-
Headache, Hypertensive Emergency
56y/o male w/headache (sudden onset), hx htn and ran out of meds 235/128
- iv antihypertensive medicine
- pain control
- head CT, LP
- Admission
-
Drowning, Hypothermnia 2/2 cold-water immersion
15y/o female, fell into partially frozen lake
- Airway management
- Undressing patient and assessing for sx trauma
- Temperature monitoring w/rectal probe
- Aggressive warming (fluids,bair hugger, lavage, foley)
- PICU consult
-
Cyanosis, Aortic coarctation
12 d/o male with episode of turning blue in the face
- Supplemental oxygen
- Listen to anterior chest AND BACK for murmurs
- CXR
- Prostaglandin E1
- Discuss condition w/family
- Cardiology consult
-
Diarrhea, Enteroinvasive diarrhea
33 y/o male w/bloody diarrhea x 2 d
- Rehydration
- Repletion of electrolytes
- Abx: cipro
-
Cough, Pneumocystis Pneumonia (PCP)
59y/o male from prison w/productive cough and SOB
- CXR
- Airway management--oxygen
- Abx for CAP and PCP (Rocephin, Azithro, Septra)
- Airborne isolation
- MICU consult
-
AMS, INH Overdose
63y/o homeless male found on shelter floor
- Airway management
- Glucose
- Pyridoxine administration
- Serum Tox screen for asa and apap
- CT head
-
Weakness, Elder Abuse (neglect)
92 y/o male found in by neighbor covered in urine and feces
- Reporting case as mandated by law for elder abuse
- Social work involvement
- IV hydration
- Check CPK for rhabdomyolysis
- EKG
- Work-up for infection/sepsis including UA and CXR
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Foot pain, Gout
43 y/o male w/right foot pain and swelling x 4 hours
- Joint (1st MTP) aspiration to r/o septic arthritis
- Pain management (Indocin or colchicine)
- Counseling on alcohol
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Neck Pain, Carotid Artery Dissection
37y/o female w/headache, neck pain and visual changes
- Pain control
- CT head w/o contrast
- CT neck angiography or MRA
- Neurology consult
- Heparin
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Abdominal Pain, Sigmoid Volvulus
78y/o male from NH w/chronic constipation and abd pain
- Pain control
- iv line placement
- obstructive series (AAS)
- nasogastric tube
- consult gastroenterology for sigmoidoscopy if no sx necrosis
- consult general surgery for OR if sx necrosis
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