Avoiding Common Errors in the Emergency Department
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Avoiding Common Errors in the Emergency Department

by Amal Mattu

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ISBN-10: 1605472271

ISBN-13: 9781605472270

Pub. Date: 05/31/2010

Publisher: Lippincott Williams & Wilkins

Avoiding Common Errors in the Emergency Department succinctly describes 400 errors commonly made by attendings, residents, medical students, nurse practitioners, and physician assistants in the emergency department, and gives practical, easy-to-remember tips for avoiding these pitfalls. This pocket book can easily be read immediately before the start of a


Avoiding Common Errors in the Emergency Department succinctly describes 400 errors commonly made by attendings, residents, medical students, nurse practitioners, and physician assistants in the emergency department, and gives practical, easy-to-remember tips for avoiding these pitfalls. This pocket book can easily be read immediately before the start of a rotation or used for quick reference on call.

Each error is described in a short clinical scenario, followed by a discussion of how and why the error occurs and tips on how to avoid or ameliorate problems. Areas covered include psychiatry, pediatrics, poisonings, cardiology, obstetrics and gynecology, trauma, general surgery, orthopedics, infectious diseases, gastroenterology, renal, anesthesia and airway management, urology, ENT, and oral and maxillofacial surgery. Sections that focus on non-clinical aspects of emergency medicine practice—such as proper documentation, communication with consultants, and interactions with lawyers—are also included.

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Lippincott Williams & Wilkins
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Table of Contents

Section I Abdominal/Gastrointestinal
1 Obtain the appropriate imaging test when evaluating abdominal pain
2 Don’t miss a Sigmoid Volvulus
3 Be aggressive with intravenous fluid resuscitation in acute management of small bowel obstruction
4 Don’t miss the deadly causes of painless jaundice in the emergency settings
5 Administer medications to patients with liver failure with great care
6 Don’t ignore the possibility of spontaneous bacterial peritonitis in patients with liver disease that “look good”
7 Use CT scans to help guide the care of patients with acute pancreatitis
8 What you probably learned about the diagnosis and treatment of cholangitis is wrong
9 Do not over-rely on ultrasound findings in patients with RUQ pain
10 Know what to look for when patients with post-ERCP complications present to the ED
11 Know the differential for post-cholecystectomy pain
12 Don’t be fooled by atypical presentations of acute appendicitis
13 Do not fear radiography in pregnant patients with suspected appendicitis
14 Abdominal pain in the patient with inflammatory bowel disease should never be considered routine
15 Give appropriate dosages of analgesics to patients with abdominal pain
16 Never assume that any intra-abdominal condition in an elderly patient will present “typically”
17 Know how to risk stratify patients with upper GI bleeding
18 Manage acute variceal bleeding aggressively 
19 Don’t miss the deadly causes of rectal bleeding and pain
20 Don’t overestimate the value of the FAST exam
21 Don’t expect the “typical” when transplant patients present with abdominal pain
22 Act quickly when suspecting mesenteric ischemia
23 Manage dislodged gastric feeding tubes quickly
24 Diagnose and treat hernias in the ED quickly  
25 Acute diverticulitis is common…so know the disease well!
26 Know how to properly diagnose a ruptured AAA using ultrasound
Section II Airway / Sedation
27 Double-check medication dosages in rapid sequence intubation
28 Don’t rely on the clinical examination alone to confirm correct endotracheal tube placement
29 Know the proper use of a bougie
Section III Allergy
30 Be wary of the atypical presentations of anaphylaxis
31 Beware of the biphasic reaction of anaphylaxis
32 Understand the proper use of epinephrine in patients with allergic reactions
33 Consider beta-blocker potentiation in patients with anaphylaxis that are not responding to epinephrine
34 Always provide proper instructions, prescriptions, and follow-up when discharging patients after allergic reactions
35 Be on the lookout for drug allergies
Section IV Billing
36 A ‘complicated’ patient is not always a level 5
37 Critical care billing is not location specific
38 Don’t rely on your student’s documentation
39 Know what to document in the review of systems?
40 Stop resisting change … electronic health records are here to stay!
41 Understand the purposes of the ED chart … and where to focus your attention
Section V Cardiovascular
42 Always consider aortic dissection in patients presenting chest pain and ischemic changes on electrocardiogram
43 Remember to aggressively manage blood pressures in patients with acute thoracic aortic dissection
44 Don’t confuse atrial fibrillation with multifocal atrial tachycardia
45 Know how to manage patients with atrial fibrillation
46 Don’t confuse Mobitz Type I and Type II AV block
47 Don’t confuse electrocardiographic artifact for dysrhythmias
48 Beware of Wolff-Parkinson-White Syndrome
49 Never rely on the ECG or clinical information to distinguish between ventricular tachycardia and supraventricular tachycardia with aberrant conduction
50 Know the mimics of ventricular tachycardia and treat accordingly
51 Don’t assume all patients with acute coronary syndromes have chest pain
52 Don’t exclude cardiac causes of chest pain just because a patient is young
53 Don’t forget to consider “nontraditional” risk factors for coronary artery disease in patients with chest pain
54 Don’t forget about the non-coronary causes of acute chest pain
55 Beware attributing chest pain as “anxiety” in patients with recent emotional events
56 Never rely on a single negative or indeterminate troponin to rule out acute coronary syndromes
57 Don’t ignore positive troponins in a renal failure patient
58 Never assume that a “negative” recent angiogram definitively rules out acute coronary syndrome
59 Never assume that a recent negative stress test definitively rules out acute coronary syndrome
60 Remember to obtain a right-sided electrocardiogram in a patient with an inferior myocardial infarction
61 Don’t forget to appropriately manage right ventricular ischemia in inferior myocardial infarction
62 Don’t rely on “reciprocal” changes on the electrocardiogram to diagnose acute ST segment elevation myocardial infarction
63 Don’t rely on a single ECG to evaluate chest pain in the emergency department
64 Be wary of ECG lead misplacement
65 Don’t forget to consider non-ACS causes of ST segment elevation
66 Know the ECG findings of acute MI in patients with pacemakers
67 Be aggressive with intravenous nitroglycerin dosing in acute congestive heart failure
68 Avoid beta-blockers in cocaine-associated myocardial infarctions
Section VI Clinical Practice
69 Always clarify your patients’ understanding of their own care
70 Be an effective teamplayer: A nursing perspective
71 Be congnizant of bias
72 Beware “the curbside consult” 
73 Giving bad news, it’s better to be direct
74 Know how to prepare your ED for pandemic influenza
75 Learn how to interact with consultants appropriately
76 Make “customer service” a priority when working in the ED…or you’ll be looking for a new job soon!
77 Understand decision-making fatigue and how it influences your of clinical judgement
78 Understand the cost of ED gridlock
79 Understand the documentation requirements of mid-level practitioners
Section VII Emergency Medical Systems
80 “Scoop and run” vs. “stay and play”: Which method is optimal for trauma patients?
81 Transportation to the closest facility is not always best for the patient
Section VIII Ears, Nose, Throat
82 Respect the mouth, Part I: Beware the pitfalls in managing bony oral trauma
83 Respect the mouth, Part II: Beware the pitfalls in managing soft tissue oral trauma
84 Non-Traumatic Dental Pain is Common…Know How to Treat it Properly
85 Know how to diagnose and treat the various types of dental trauma
86 Understand the limitations of common diagnostic studies in patients with new-onset headaches
87 Recognize the Danger Signs of Life-Threatening Headaches
88 Remember these simple pearls to help in treating children with nasal foreign bodies
89 Know the Physical Exam Findings of Orbital Fractures and Know When to Order the CT
90 Never assume that a facial fracture is just a “simple” facial fracture
91 Optimal management of mandible fractures requires knowledge of anatomy, epidemiology of fractures patterns, and sound assessment of associated injuries
92 Don't rely on the presence of respiratory compromise to make the diagnosis of retropharyngeal abscess
93 Beware epiglottitis…it’s not yet an extinct disease!
94 Recognize the presentation of foreign body aspiration and order the correct diagnostic test
95 Use an organized approach to managing epistaxis to make your job easier
96 Do not rely on a head CT to exclude serious causes of vertigo
97 Don’t forget about the potentially serious complications of otitis media
98 Manage traumatic ear injuries carefully to avoid cosmetic and functional impairments
99 Pediatric sinusitis: It’s snot necessary to give antibiotics to every kid with a runny nose
100 The non-traumatic red eye—it’s not always conjunctivitis
101 Manage eyelid lacerations with extreme caution
102 Don’t discharge the HA (headache) without thinking TA (temporal arteritis)
Section IX Environmental
103 Understand the differences in resuscitation of the severely hypothermic patient
104 Know the basics of rewarming and resuscitation of hypothermic patients
105 Do not cause further tissue injury during the management of frostbite
106 Beware snakebite injuries…including the ones that initially have benign presentations
107 Know the symptoms of acute mountain sickness and remember that descent is the only definitive treatment
108 Do not over-resuscitate the patient with heatstroke
109 Smoke inhalation: there’s more to treatment than just securing the airway
Section X Geriatrics
110 Remember… “atypical” presentations of acute coronary syndrome are typical in elderly patients
111 Abdominal pain in the elderly patient…be afraid…be very afraid!
112 Consider thyroid disorders in the elderly
113 Don’t miss the occult hip fracture in elderly patients
114 Recognize that elderly patients at high risk for falls
115 Don’t mistake delirium for dementia in the elderly
116 Don’t forget that neglect is a type of elder abuse
117 Don’t be afraid to treat pain in elderly patients aggressively
118 Be very careful with medication dosing in the elderly patient
119 Be aware of the dangers of polypharmacy in the elderly
Section XI Hematology/Oncology
120 Treat actively bleeding ITP patients with platelets, IVIG and steroids
121 Recognize TTP and don’t give the “knee-jerk” platelet transfusion
122 Beware acute chest syndrome in the pediatric patient
123 Treat Tumor Lysis Syndrome aggressively
124 Search diligently for the source of fever in patients with neutropenia
125 Administer antibiotics early to neutropenic patients with a fever
126 Don’t underdose factor replacement in patients with hemophilia emergencies
127 Don’t over-test or under treat patients with vaso-occlusive pain crises secondary to Sickle Cell Anemia
128 Rule out malignant spinal cord compression in all cancer patients presenting with back pain
Section XII Infectious Disease
129 Consider CA-MRSA when treating skin and soft tissue infections 
130 Diagnose and treat necrotizing soft tissue infections quickly
131 Understand post-exposure prophylaxis for HIV in the emergency department
132 Always prescribe a multi-drug regimen for HIV post-exposure prophylaxis
133 Early recognition and intervention for SIRS and sepsis are vital
134 Administer fluids aggressively in patients with septic shock
135 Use vasopressors in the septic patient appropriately
136 Treat influenza with the proper antivirals
137 Don’t wait for a rash petechiae, or signs of meningitis to consider invasive meningococcal disease
138 Manage meningitis quickly and aggressively; Part I
139 Manage menintitis quickly and aggressively; Part II
140 Don’t be misled by the traditional myths of diarrhea
141 Toxic shock syndrome: Do not hesitate—resuscitate
142 Don’t give prophylactic antibiotics for low risk procedures…the risk of anaphylaxis may be greater than the risk of endocarditis!
143 Consider endocarditis early and treat appropriately
144 Don’t miss the diagnosis of catheter related bloodstream infection
Section XIII Legal Issues
145 Determine decision-making capacity before allowing a patient to refuse care
146 Don’t ignore the nursing notes
147 Informed consent should be honored in the ED whenever possible
148 Know the laws for consent of minors and adolescents in the emergency department
149 Know what’s in your contract
150 Know your responsibility for “left without being seen” patients
151 Maintain a proper balance between patient care and cooperation with law enforcement officers
152 Never talk to your patient’s lawyer unless your own lawyer is present
153 Thoroughly understand the Emergency Medical Treatment and Labor Act (EMTALA)
154 Understand the basics of medical malpractice in order to avoid it
155 Understand the Health Insurance Portability and Accountability Act (HIPAA) - The privacy rule
Section XIV Metabolic/Endocrine
156 Acid – Base: A normal anion gap does not exclude acidosis
157 Administration of normal saline is the treatment for hyponatremia
158 Don’t find out your patient is hypoglycemic on the CT scanner
159 Don’t forget about octreotide for some patients with hypoglycemia
160 Don’t just focus on the glucose in patients with diabetic ketoacidosis
161 Don’t rely on orthostatic vital sign testing for diagnosing dehydration
162 Hyperglycemic hyperosmolar nonketotic syndrome: Be afraid…be very afraid!
163 Know the 3-pronged treatment of hyperkalemia: Stabilize, redistribute, and reduce
164 Know which thyroid function tests to order (and what they mean!)
165 Understand the limitations of testing for urinary ketones and serum acetone
166 Understand the role of magnesium in the treatment of hypokalemia
167 Use venous rather than arterial blood gas measurements 
Section XV Miscellaneous
168 Don’t discount the complaints of “frequent fliers”
169 Be vigilant for physical abuse and neglect
170 Be certain to protect patients or third parties from harm
171 Understand the dangers associated with TASER injuries
Section XVI Musculoskeletal
172 Maintain a low threshold to perform arthrocentesis in patients with swollen joints
173 Don’t assume that synovial fluid analysis is 100% accurate for the diagnosis of septic arthritis
174 If only joint disease was crystal clear…crystal arthropathies do not preclude a septic joint
175 Know the causes of back pain that kill patients
176 Always consider cauda equina syndrome in patients with low back pain
177 Never miss compartment syndrome! Pearls and pitfalls of evaluation
178 Consider occult hip fracture in patients with hip pain and inability to walk even if plain films are negative
Section XVII Neurological
179 Admit all high-risk patients with TIA
180 Admit patients with acute Guillain-Barré Syndrome to monitored beds
181 Beware the co-morbidities and complications of acute stroke
182 Not miss a cerebral venous thrombosis
183 Don’t be fooled by the mimics of stroke
184 Don’t confuse central and peripheral 7th cranial nerve palsies
185 Don’t confuse elevated blood pressure plus headache for true hypertensive encephalopathy
186 Don’t forget to consider subclinical status epilepticus
187 Don’t mistake seizures for syncope
188 Don’t overlook the central causes of vertigo
189 Don’t rely on plain x-rays or computed tomography (CT) to rule out spinal cord compression
190 Don’t rely simply on computed tomography (CT) to rule out subarachnoid hemorrhage
191 Give appropriate antibiotics to patients with meningitis and meningoencephalitis
192 Use fibrinolytics for stroke with care
Section XVIII Obstetrical/Gynecological
193 Do not withhold radiologic imaging in pregnancy when it is necessary for the diagnosis
194 Avoid placing pressure on the uterine fundus when attempting to reduce a shoulder dystocia during emergency delivery
195 Remember to consider peripartum cardiomyopathy in pregnant patients with shortness of breath
196 Know the indications…and contraindications…for methotrexate therapy in ectopic pregnancy
197 Know the complications of infertility treatment  
198 Beware of post-partum headaches
199 Don’t forget to consider nonobstetric causes of abdominal symptoms in a pregnant patient
200 Ovarian torsion: Tips to make this tough diagnosis
201 Remember that eclampsia can occur postpartum, and in women with no prior diagnosis of preeclampsia
202 Don’t forego a pelvic ultrasound in patients with a clinical suspicion for ectopic pregnancy but a low b-hCG
203 Perimortem Cesarean Section – the clock is ticking
204 Pelvic inflammatory disease is a difficult diagnosis to make: Know the CDC recommendations
205 Consider pulmonary embolism in pregnancy and the postpartum period
206 Don’t misinterpret vital signs in the pregnant patient
207 Always monitor third trimester pregnant patients after they have sustained trauma of any severity
208 Be prepared to manage postpartum hemorrhage at EVERY delivery
Section XIX Pediatric
209 Simple “rules” of pediatric resuscitation 
210 Don’t forget that drying, warming and positioning are as important to neonatal resuscitation as the ABC’s
211 Remember…not all kids with wheezing have asthma
212 Pediatric airways are not just “little adult” airways
213 Don’t assume that all stridor is caused by croup
214 Recognize the differences in pediatric vs. adult burn management
215 Don’t forget about the simple, easy-to-fix causes of irritability in infants
216 Pediatric procedural sedation: Do it right (or don’t do it!)
217 Intussusception is a “can’t miss” diagnosis…know how to diagnose and manage these patients
218 Don’t miss abdominal injuries after blunt trauma in the pediatric patient
219 The ‘shocky’ newborn: There’s more to consider than just sepsis
220 Be wary of medication dosing errors in pediatric resuscitation
221 Don’t rely solely on patient appearance or laboratory results when determining the disposition of a febrile neonate from the ED
222 Do not rely on a urinalysis to exclude UTI in patients younger than two years old
223 Not all ear pain is acute otitis media…and not all require antibiotics!
224 Know the diagnostic approach to pediatric acute appendicitis
225 Know the differential diagnosis and proper workup for the limping child
226 Know the causes of and work up for apparent life threatening events
227 Know how to work up a febrile seizures appropriately
228 Pediatric head trauma: Know which patients need a workup…and which patients don’t!
229 Focus on the ABCs in patients with cyanotic congenital heart disease
230 Don’t fail to recognize or report child abuse or neglect
231 Understand the proper management of pediatric submersion injuries
232 Never miss a case of Kawasaki disease
233 Beware the complications in managing DKA, especially cerebral edema
234 Don’t miss (or mismanage) the pediatric diarrheal illness that is more than just diarrhea
235 Don’t let athletes with concussions return to play too early
236 Don’t miss a pediatric thoracic injury in blunt trauma
237 Never miss a case of spinal cord injury without radiographic abnormality (SCIWORA)
Section XX Procedures
238 Anesthesia for fracture reduction: Know your options
239 Be familiar with intraosseous access in the emergency department
240 Consider the intra-articular saline load for open knee injuries
241 Consider trephination instead of nail plate removal for most subungual hematomas
242 Corneal foreign body removal in the ED: Know “when,” and know “how”
243 Cricothyrotomy: Stabilize that larynx
244 Don’t assume that needle decompression of a tension pneumothorax is 100% reliable and effective
245 Don’t be lazy…use maximal barrier protection when performing invasive procedures in the ED
246 Know how to interpret lumbar puncture results properly
247 Know how to perform a lateral canthotomy and cantholysis
248 Know how to perform a lumbar puncture properly
249 Know how to perform an escharotomy
250 Know the potential complications of closed tube thoracostomy 251 Know when a head CT is needed before the LP…and when it is not
252 Know when a large volume paracentesis is indicated in the ED 253 Know when to consider awake endotracheal intubation 254 Learn how to diagnose lower extremity DVT with bedside ED ultrasound
255 Learn how to perform ultrasound-guided peripheral intravenous access 256 Minimize the risk of infection when placing central lines 257 Not all shoulder dislocations require procedural sedation for reduction
258 Paracentesis in the emergency department: Know the indications and technique
259 Pigtail catheters: Know the indications and pitfalls
260 Procedural sedation: Know your options
261 The intravenous catheter—Is bigger better?
262 Treatment of pneumothorax: Consider performing needle aspiration
263 Us the optimal position when performing an LP
264 Use bedside ultrasound for the detection of pneumothorax
265 Use caution when stopping a code due to cardiac standstill on bedside echo
266 Use the right dose of vecuronium for RSI
267 Use the supraclavicular approach to central lines
268 Use the vertical incision in ED cricothyrotomies
Section XXI Psychiatric
269 Never assume that acute delirium is caused by pre-existing psychiatric disease
270 Think twice before diagnosing “anxiety” in the ED
271 Use of chemical or physical restraints judiciously
272 Beware of sedation of patients with delirium or dementia
273 Never diagnose malingering or factitious disorder until you’ve ruled out organic disease
274 Check the QT interval prior to administration of antipsychotics whenever possible 2
75 Beware suicidal ideation or behavior
Section XXII Pulomnary
276 Don't forget to administer steroids in patients with acute asthma exacerbations
277 Consider cryptogenic organizing pneumonia as a cause of persistent pulmonary infiltrates
278 Consider venous thromboembolism more highly in patients with HIV
279 Croup is common…so know it well!
280 Do not withhold oxygen to a hypoxic patient with COPD
281 Don’t assume that a normal oxygen saturation always means that the patient is oxygenating or ventilating adequately
282 Don’t assume that succinylcholine is the paralytic of choice for all adults undergoing RSI
283 Don’t be afraid to use terbutaline and epinephrine in acute management of asthma
284 Don’t exclude pneumonia simply based on a “negative” chest x-ray
285 Don’t exclude pulmonary embolus simply based on a negative chest CT
286 Don’t exclude TB simply based on a “negative” chest x-ray
287 Don’t rely on arterial blood gas measurements to manage patients with asthma
288 Fight the urge to prescribe antibiotics in acute, uncomplicated bronchitis
289 Know how to properly use a d-dimer in the evaluation of PE 290 Know the basics of managing pulmonary hypertension in the ED
291 Know the causes and management of hemoptysis well
292 Know when you need to taper steroids…and when you don’t need to
293 Pneumothorax: To tube or not to tube
294 Remember—all that wheezes is not necessarily asthma (or COPD)
295 Understand proper ventilatory management in patients with asthma
296 Use antibiotics wisely in patients with COPD
297 VQ verses CT for PE in pregnancy
Section XXIII Resuscitation
298 Remember to initiate therapeutic hypothermia for post-cardiac arrest patients
299 Allow families the opportunity to be present during the resuscitation of a loved one
300 Be willing to discuss end of life wishes and Do Not Attempt Resuscitation (DNAR) orders in the emergency department
301 Know your resuscitation equipment
302 Abandon the use of high-dose epinephrine
303 Be extra careful with medication dosages during pediatric resuscitation
304 Beware that amiodarone produces QT-prolongation
305 Remember to synchronize cardioversion in patients with pulses
306 Consider the potential causes of PEA and treat accordingly
307 Minimize interruptions in chest compressions while managing patients in cardiac arrest
Section XXIV Toxicology
308 Do not rely on abnormal vital signs and tremor to diagnose alcohol withdrawal
309 Don’t rely on the presence of tachycardia to confirm anticholinergic syndrome
310 Consider beta-blocker or calcium channel blocker toxicity in the patient with unexplained bradycardia or hypertension
311 Be wary of drug-drug interactions when treating cocaine intoxicated patients
312 In suspected tricyclic antidepressant overdose, start sodium bicarbonate as soon as the QRS duration is over 100 ms
313 Digibind is your friend…don’t let it become your enemy
314 Beware of cardiac complications with IV administration of phenytoin and fosphenytoin
315 Do not rely upon the presence of an anion gap acidosis or an elevated osmol gap to diagnose toxic alcohol ingestion
316 Remember to maintain moderate alkalemia in patients suffering from ASA toxicity
317 Acute lithium intoxication is more dangerous in individuals already taking lithium than in those who are lithium naïve
318 Treating an opioid overdose: know when it is time to start the naloxone drip
319 Do not discontinue N-acetylcysteine if anaphylactoid symptoms develop
Section XXV Trauma
320 Know the basics of electricity to understand the injury patterns
321 Conductive energy weapons (TASER): An increasing cause of injury you better know how to treat!
322 Know when intubation can make a trauma patient acutely worse 
323 Know the zones of the neck and the appropriate workup for penetrating injuries in each zone
324 Know when and how to do a resuscitative thoracotomy
325 Understand the basics of gunshot wound (GSW) treatment
326 Check for thumb laxity to avoid missing the diagnose of “Game Keeper’s Thumb”
327 Use abdominal CT scanning liberally based on mechanism or in unevaluable patients to rule out blunt abdominal trauma
328 Intubate early for patients with traumatic brain injury (TBI)
329 Know the appropriate indications for emergent angiography in patients with penetrating extremity injuries
330 Know the basics of CT interpretation for patients with traumatic brain injury (TBI)
331 Always perform a complete neurologic assessment of the trauma patient
332 Know when a chest tube is truly needed 333 Strongly consider arteriography in patients with knee dislocations
334 IV access in trauma: Carefully decide where to place it and which catheter to use 
335 Admit patients with displaced supracondylar fractures for frequent neurovascular checks
336 Know the radiographic signs of a scapholunate dislocation 
337 Know the difference between a Jones fracture and a Pseudo-Jones fracture
338 Consider other causes of shock (neurogenic, cardiogenic, obstructive, anaphylactic) in the non-bleeding trauma patient
339 Know which trauma patients need screening for blunt cerebral vascular injury (BCVI) 
340 Always search for other injuries in patients with scapular fracture
341 Use adjuncts instead of packed red blood cells (PRBCs) alone for trauma patients with massive hemorrhage
342 Know when and how to do an Ankle-Brachial Index (ABI)
343 In patients with a radial head fracture, know the signs of an associated Essex-Lopresti lesion
344 Recognize and correct rotational deformity of Boxer’s/metacarpal fractures
345 Be meticulous in giving medications to patients with acute traumatic brain injury (TBI)
346 Use a bedsheet to stabilize open-book pelvic fractures when more definitive measures are not immediately available
347 Avoid converting a meta-stable airway to an unstable airway in trauma patients … but also know how to do a surgical cricothyroidotomy
348 When patients have rib fractures, always assume associated solid organ injuries, and treat pain aggressively
349 Don’t “pop the clot” - the role of hypotensive resuscitation in trauma care
350 Always palpate the proximal fibula in ankle injuries
351 Always consider domestic violence in women, elderly, and pediatric victims of trauma
352 Reduce hip dislocations in a timely manner 353 Patients with snuff box tenderness and normal scaphoid x- rays should have a splint and orthopedic follow up
354 Use CT scanning liberally for identification of spine fractures
355 Remember to x-ray the spine in cases of calcaneal fractures after a fall from height
356 Don’t assume a normal heart rate and/or blood pressure rules out hypovolemic shock
357 Never judge a book by its cover: beware benign-appearing high-pressure injection injuries
358 Know how to manage burns properly 359 Remember that decompression sickness can sometimes present in a delayed manner after SCUBA diving
Section XXVI Ultrasound
360 Cholecystitis: Don’t rely on your physical exam, but rely on your ultrasound
361 Is it a pericardial effusion – or isn’t it? Pitfalls in the use of limited bedside echocardiography
362 Garbage in, garbage out. Beware common technical errors in the FAST exam  363 Want to find the fluid? Know the factors that affect the FAST exam 364 Use ultrasound guidance for central venous access 365 Clot or no clot? Pitfalls in the use of bedside ultrasound to evaluate for deep venous thrombosis
366 Where is that fetal heartbeat? Pearls and pitfalls for bedside ultrasound in early pregnancy
367 Ensure that you have visualized the entire abdominal aorta in two planes to accurately exclude AAA 368 Use bedside ultrasound instead of needle aspiration in the assessment of soft tissue infections
369 UnStable patient = UltraSound. Use ultrasound to evaluate hemodynamically unstable patients
370 It’s not the machine’s fault! Use basic system controls to improve your ultrasound images
Section XXVII Urogenital
371 Treat patients with epididymitis and their partners for STDs
372 Don’t fail to consider torsion in patients with intermittent scrotal pain
373 Consult a urologist immediately for suspected testicular torsion
374 Don’t exclude the diagnosis of renal colic purely based on the urinalysis
375 Provide adequate treatment and appropriate disposition for patients with renal colic
376 Don’t delay suprapubic catheterization when needed 377 Don’t confuse simple with complicated UTIs
378 Treat pyelonephritis in the pregnant patient aggressively
379 Dose renally-excreted medications based on renal function 380 Know the indications for emergent hemodialysis
Section XXVIII Wound Care
381 Deep sutures: When, why, and why not?
382 Be certain to perform a neurological examination of the hand prior to anesthetizing a laceration
383 Keep it clean: Pitfalls in traumatic wound irrigation
384 Don’t believe the old adage that epinephrine cannot be used in digital blocks
385 Prophylactic antibiotic use for simple, non-bite wounds is not necessary
386 Explore and image: Don’t miss a foreign body in a wound
387 Explore wounds properly prior to repair
388 Don’t neglect proper wound care for patients with mammalian bites
389 Be aware of the high risk associated with “fight bites”
390 Consider the diagnosis of spider envenomation and maintain a broad differential diagnosis in patients with unexplained local or systemic illness
391 Local anesthetics for abscess I&D are usually inadequate
392 Eyelid lacerations: Use a three-step approach to repair
393 Know the alternatives to the simple interrupted suture method
394 The complicated laceration: Know your options for repair
395 Use field blocks rather than local anesthesia before facial laceration repair
396 Know which wounds to close…and which ones can be left open
397 The keys to good stapling
398 When irrigating a wound, don’t consider all methods to be equal

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