Emergency Tips

Lightning strike is the one exception to the usual multicasualty incident (MCI) triage rules: The first priority should go to those who are not breathing and not moving because only those who present in cardiac arrest are at high risk of dying

As little as 2 weeks of chronic steroid use (prednisone > 20 mg/day) will cause adrenal suppression, making a patient more prone to adrenal crisis

Consider domestic violence in women with depression, suicidal ideations, chronic pain, psychosomatic complaints, or multiple ED visits

Always exclude associated fractures of the spine and lower extremities in patients with calcaneal fractures

Never restrain a patient in the prone position; restrain on their side to minimize risks of aspiration and sudden death

In the case of vascular and/or skin compromise of a deformed limb, urgent realignment and splinting of the involved extremity should precede radiography

Children manifest shock later than adults with the same percentage of blood loss, yet decompensate more quickly once this critical volume is lost

A single negative abdominal ultrasound alone does not reliably exclude significant intraperitoneal injury

Obtain a CT scan of the head on any patient on warfarin (Coumadin) with even a minor head trauma

In a lucid patient with blunt abdominal trauma, the clinical examination is the best guide for selection of diagnostic tests

Suspect ectopic pregnancy when there is no evidence of intrauterine pregnancy (IUP) by transvaginal ultrasound and the quantitative human chorionic gonadotropin (HCG) concentration is greater than 2000 IU/L

Myocarditis should be considered in a patient with a sustained, unexplained tachycardia

The concomitant ingestion of ethanol (ETOH) with methanol or ethylene glycol protects against toxic metabolites

Consider a retropharyngeal space infection in a young child presenting with a history of fever, refusal to drink, sore throat, and reluctance to move their neck

In patients with hyponatremia, to avoid central pontine myelinolysis, serum sodium should never be raised by more than 0.5 mEq/hr or 12 mEq in 24 hours.

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