EM Reflections – March 2015

Dr Natasha DeSousa 

M&M top tips


1.     Be aware of cognitive biases in decision-making. Premature closure can preclude consideration of other important diagnoses. 

2.     Clear, legible, discharge instructions are not only important for patients, but help physicians subsequently involved in care understand the plan.

3.     If a patient is vomiting because pain is severe, CTAS II is the appropriate triage category.

4.     High pressure air injection injuries are at risk of developing necrotizing fasciitis

5.     A negative set of troponins does NOT rule out unstable angina.  Unstable angina is in the spectrum of ACS – Cardiology should be consulted for these patients.

6.     If you are looking for a AAA on POCUS, remember to look for a pericardial effusion as well (especially if the IVC appears distended and the patient is hypotensive)

The clip below from a hypotensive patient with sudden onset back pain demonstrates a non compressible IVC and a dissection flap within the abdominal aorta.

In hypotensive patients the initial PoCUS appearance of the IVC will be:

A. Small (difficult to visualize) / Collapsing – Think Hypovolemia


B. Large (easily visible) / Non- Collapsing – Think Cardiac Tamponade, PE, Cardiogenic Shock


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