Avoiding Common Errors in the Emergency Department [Minkštas viršelis]

Section IAbdominal/Gastrointestinal
1 Obtain the appropriate imaging test when evaluating abdominal pain
2 Dont miss a Sigmoid Volvulus
3 Be aggressive with intravenous fluid resuscitation in acute management of
small bowel obstruction
4 Dont miss the deadly causes of painless jaundice in the emergency
settings
5 Administer medications to patients with liver failure with great care
6 Dont 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 Dont 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 Dont miss the deadly causes of rectal bleeding and pain
20 Dont overestimate the value of the FAST exam
21 Dont 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 commonso know the disease well!
26 Know how to properly diagnose a ruptured AAA using ultrasound
Section IIAirway / Sedation
27 Double-check medication dosages in rapid sequence intubation
28 Dont rely on the clinical examination alone to confirm correct
endotracheal tube placement
29 Know the proper use of a bougie
Section IIIAllergy
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 IVBilling
36 A complicated patient is not always a level 5
37 Critical care billing is not location specific
38 Dont rely on your students 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 VCardiovascular
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 Dont confuse atrial fibrillation with multifocal atrial tachycardia
45 Know how to manage patients with atrial fibrillation
46 Dont confuse Mobitz Type I and Type II AV block
47 Dont 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 Dont assume all patients with acute coronary syndromes have chest pain
52 Dont exclude cardiac causes of chest pain just because a patient is
young
53 Dont forget to consider nontraditional risk factors for coronary artery
disease in patients with chest pain
54 Dont 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 Dont 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 Dont forget to appropriately manage right ventricular ischemia in
inferior myocardial infarction
62 Dont rely on reciprocal changes on the electrocardiogram to diagnose
acute ST segment elevation myocardial infarction
63 Dont rely on a single ECG to evaluate chest pain in the emergency
department
64 Be wary of ECG lead misplacement
65 Dont 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 VIClinical 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, its 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 EDor youll 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 VIIEmergency 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 VIIIEars, 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 CommonKnow 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 epiglottitisits 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 Dont forget about the potentially serious complications of otitis media
98 Manage traumatic ear injuries carefully to avoid cosmetic and functional
impairments
99 Pediatric sinusitis: Its snot necessary to give antibiotics to every kid
with a runny nose
100 The non-traumatic red eyeits not always conjunctivitis
101 Manage eyelid lacerations with extreme caution
102 Dont discharge the HA (headache) without thinking TA (temporal
arteritis)
Section IXEnvironmental
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 injuriesincluding 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: theres more to treatment than just securing the
airway
Section XGeriatrics
110 Remember atypical presentations of acute coronary syndrome are typical
in elderly patients
111 Abdominal pain in the elderly patientbe afraidbe very afraid!
112 Consider thyroid disorders in the elderly
113 Dont miss the occult hip fracture in elderly patients
114 Recognize that elderly patients at high risk for falls
115 Dont mistake delirium for dementia in the elderly
116 Dont forget that neglect is a type of elder abuse
117 Dont 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 XIHematology/Oncology
120 Treat actively bleeding ITP patients with platelets, IVIG and steroids
121 Recognize TTP and dont 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 Dont underdose factor replacement in patients with hemophilia
emergencies
127 Dont 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 XIIInfectious 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 Dont 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 Dont be misled by the traditional myths of diarrhea
141 Toxic shock syndrome: Do not hesitateresuscitate
142 Dont give prophylactic antibiotics for low risk proceduresthe risk of
anaphylaxis may be greater than the risk of endocarditis!
143 Consider endocarditis early and treat appropriately
144 Dont miss the diagnosis of catheter related bloodstream infection
Section XIIILegal Issues
145 Determine decision-making capacity before allowing a patient to refuse
care
146 Dont 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 whats 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 patients 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 XIVMetabolic/Endocrine
156 Acid Base: A normal anion gap does not exclude acidosis
157 Administration of normal saline is the treatment for hyponatremia
158 Dont find out your patient is hypoglycemic on the CT scanner
159 Dont forget about octreotide for some patients with hypoglycemia
160 Dont just focus on the glucose in patients with diabetic ketoacidosis
161 Dont rely on orthostatic vital sign testing for diagnosing dehydration
162 Hyperglycemic hyperosmolar nonketotic syndrome: Be afraidbe 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 XVMiscellaneous
168 Dont 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 XVIMusculoskeletal
172 Maintain a low threshold to perform arthrocentesis in patients with
swollen joints
173 Dont assume that synovial fluid analysis is 100% accurate for the
diagnosis of septic arthritis
174 If only joint disease was crystal clearcrystal 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 XVIINeurological
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 Dont be fooled by the mimics of stroke
184 Dont confuse central and peripheral 7th cranial nerve palsies
185 Dont confuse elevated blood pressure plus headache for true hypertensive
encephalopathy
186 Dont forget to consider subclinical status epilepticus
187 Dont mistake seizures for syncope
188 Dont overlook the central causes of vertigo
189 Dont rely on plain x-rays or computed tomography (CT) to rule out spinal
cord compression
190 Dont 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 XVIIIObstetrical/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 indicationsand contraindicationsfor methotrexate therapy in
ectopic pregnancy
197 Know the complications of infertility treatment
198 Beware of post-partum headaches
199 Dont 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 Dont 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 Dont 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 XIXPediatric
209 Simple rules of pediatric resuscitation
210 Dont forget that drying, warming and positioning are as important to
neonatal resuscitation as the ABCs
211 Remembernot all kids with wheezing have asthma
212 Pediatric airways are not just little adult airways
213 Dont assume that all stridor is caused by croup
214 Recognize the differences in pediatric vs. adult burn management
215 Dont forget about the simple, easy-to-fix causes of irritability in
infants
216 Pediatric procedural sedation: Do it right (or dont do it!)
217 Intussusception is a cant miss diagnosisknow how to diagnose and
manage these patients
218 Dont miss abdominal injuries after blunt trauma in the pediatric
patient
219 The shocky newborn: Theres more to consider than just sepsis
220 Be wary of medication dosing errors in pediatric resuscitation
221 Dont 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 mediaand 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 workupand which
patients dont!
229 Focus on the ABCs in patients with cyanotic congenital heart disease
230 Dont 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 Dont miss (or mismanage) the pediatric diarrheal illness that is more
than just diarrhea
235 Dont let athletes with concussions return to play too early
236 Dont miss a pediatric thoracic injury in blunt trauma
237 Never miss a case of spinal cord injury without radiographic abnormality
(SCIWORA)
Section XXProcedures
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 Dont assume that needle decompression of a tension pneumothorax is 100%
reliable and effective
245 Dont be lazyuse 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 LPand 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 catheterIs 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 XXIPsychiatric
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 youve ruled out
organic disease
274 Check the QT interval prior to administration of antipsychotics whenever
possible 2
75 Beware suicidal ideation or behavior
Section XXIIPulomnary
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 commonso know it well!
280 Do not withhold oxygen to a hypoxic patient with COPD
281 Dont assume that a normal oxygen saturation always means that the
patient is oxygenating or ventilating adequately
282 Dont assume that succinylcholine is the paralytic of choice for all
adults undergoing RSI
283 Dont be afraid to use terbutaline and epinephrine in acute management of
asthma
284 Dont exclude pneumonia simply based on a negative chest x-ray
285 Dont exclude pulmonary embolus simply based on a negative chest CT
286 Dont exclude TB simply based on a negative chest x-ray
287 Dont 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 steroidsand when you dont need to
293 Pneumothorax: To tube or not to tube
294 Rememberall 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 XXIIIResuscitation
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 XXIVToxicology
308 Do not rely on abnormal vital signs and tremor to diagnose alcohol
withdrawal
309 Dont 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 frienddont 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 naļve
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 XXVTrauma
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 Keepers
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 Boxers/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 Dont 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 Dont 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 XXVIUltrasound
360 Cholecystitis: Dont rely on your physical exam, but rely on your
ultrasound
361 Is it a pericardial effusion or isnt 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 Its not the machines fault! Use basic system controls to improve your
ultrasound images
Section XXVIIUrogenital
371 Treat patients with epididymitis and their partners for STDs
372 Dont fail to consider torsion in patients with intermittent scrotal
pain
373 Consult a urologist immediately for suspected testicular torsion
374 Dont exclude the diagnosis of renal colic purely based on the
urinalysis
375 Provide adequate treatment and appropriate disposition for patients with
renal colic
376 Dont delay suprapubic catheterization when needed 377 Dont 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 XXVIIIWound 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 Dont 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: Dont miss a foreign body in a wound
387 Explore wounds properly prior to repair
388 Dont 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 closeand which ones can be left open
397 The keys to good stapling
398 When irrigating a wound, dont consider all methods to be equal