Thanks to Dr Paul Page for his summary
Edited by Dr David Lewis
Top tips from this month’s rounds:
1. Presenting Complaint: Abdominal Pain – Might not be due to Abdominal pathology
Keep in mind other life threatening causes of abd pain not in the abd. ( ie Aortic Dissection, PE, ACS, Pneumonia).
ECG on all pts who present with pain between chin and umbilicus.
2. Presenting Complaint: Back Pain – Careful with diagnosis of MSK Back Pain
Careful review of vital signs (current and recorded – including EMS). Persistent hypotension or even an episode of recorded hypotension should warrant further evaluation to rule out other more serious diagnoses (AAA, Pancreatitis, bowel perf, hemorrhage etc). (see article pdf below). PoCUS for AAA is highly sensitive and specific and should be considered in all patients >60 who present with back pain, syncope, transient hypotension etc. Although this study found that Routine Screening for Asymptomatic Abdominal Aortic Aneurysm in High-risk Patients Is Not Recommended in Emergency Departments That Are Frequently Crowded
Midline Abdomen, Transverse PoCUS view of the Abdominal Aorta – Spot the abnormality?
3. Can you reliably differentiate Cardiac Chest pain from Non Cardiac Chest pain by history alone?
Whilst the history is very important in the assessment of a patient with chest pain, it cannot reliably exclude Cardiac Chest Pain. Neither can examination (chest wall tenderness etc). All patients who present to ED with chest pain should have an ECG.
Link to a good article on Non Cardiac Chest Pain here.
