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Avoiding Common Errors in the Emergency Department

Avoiding Common Errors in the Emergency Department

9781605472270
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Description
Avoiding Common Errors in the Emergency Departmentsuccinctly 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.
Product Details
LWW
47359
9781605472270
9781605472270

Data sheet

Publication date
2010
Issue number
1
Cover
paperback
Pages count
1152
Dimensions (mm)
3226 x 5161
Weight (g)
839
  • Section IAbdominal/Gastrointestinal1 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 IIAirway / Sedation27 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 IIIAllergy30 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 IVBilling36 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 VCardiovascular42 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 infarctionsSection VIClinical Practice69 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 practitionersSection VIIEmergency Medical Systems80 “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 patientSection VIIIEars, Nose, Throat82 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 Dont 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 IXEnvironmental103 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 airwaySection XGeriatrics110 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 elderlySection XIHematology/Oncology120 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 painSection XIIInfectious Disease129 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 infectionSection XIIILegal Issues145 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 ruleSection XIVMetabolic/Endocrine156 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 XVMiscellaneous168 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 injuriesSection XVIMusculoskeletal172 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 negativeSection XVIINeurological179 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 careSection XVIIIObstetrical/Gynecological193 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 deliverySection XIXPediatric209 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 XXProcedures238 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 cricothyrotomiesSection XXIPsychiatric269 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 behaviorSection XXIIPulomnary276 Dont 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 pregnancySection XXIIIResuscitation298 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 arrestSection XXIVToxicology308 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 developSection XXVTrauma320 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 divingSection XXVIUltrasound
    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 imagesSection XXVIIUrogenital371 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 hemodialysisSection XXVIIIWound Care381 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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