Overview

Avoiding Common Errors in the Emergency Department succinctly 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.

Full Product Details

Author:   Amal Mattu ,  Arjun S. Chanmugam ,  Stuart P. Swadron ,  Carrie Tibbles, MD
Publisher:   Lippincott Williams and Wilkins
Imprint:   Lippincott Williams and Wilkins
Dimensions:   Width: 12.70cm , Height: 3.30cm , Length: 20.30cm
Weight:   0.862kg
ISBN:  

9781605472270

ISBN 10:   1605472271
Pages:   1152
Publication Date:   01 June 2010
Audience:   Professional and scholarly ,  Professional & Vocational
Replaced By:   9781496320742
Format:   Paperback
Publisher's Status:   Out of Print
Availability:   In Print  
Limited stock is available. It will be ordered for you and shipped pending supplier's limited stock.

Table of Contents

Section I Abdominal/Gastrointestinal 1 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 II Airway / Sedation 27 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 III Allergy 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 reactions35 Be on the lookout for drug allergies Section IV Billing 36 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 V Cardiovascular 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 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 dysrhythmias48 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 infarctions Section VI Clinical 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, 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 practitioners Section VII Emergency 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 VIII Ears, 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 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 Don't 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 IX Environmental 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 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 airway Section X Geriatrics 110 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 patient119 Be aware of the dangers of polypharmacy in the elderly Section XI Hematology/Oncology 120 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 pain Section XII Infectious 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 Don't wait for a rash petechiae, or signs of meningitis to consider invasive meningococcal disease138 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 infection Section XIII Legal Issues 145 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 rule Section XIV Metabolic/Endocrine 156 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 XV Miscellaneous 168 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 XVI Musculoskeletal 172 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 evaluation178 Consider occult hip fracture in patients with hip pain and inability to walk even if plain films are negative Section XVII Neurological 179 Admit all high-risk patients with TIA 180 Admit patients with acute Guillain-Barre 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 XVIII Obstetrical/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 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 delivery Section XIX Pediatric 209 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 patients218 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 edema234 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 XX Procedures 238 Anesthesia for fracture reduction: Know your options 239 Be familiar with intraosseous access in the emergency department240 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 technique259 Pigtail catheters: Know the indications and pitfalls 260 Procedural sedation: Know your options261 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 cricothyrotomies Section XXI Psychiatric 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 you've ruled out organic disease 274 Check the QT interval prior to administration of antipsychotics whenever possible 275 Beware suicidal ideation or behavior Section XXII Pulomnary 276 Don't forget to administer steroids in patients with acute asthma exacerbations 277 Consider cryptogenic organizing pneumonia as a cause of persistent pulmonary infiltrates278 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 well292 Know when you need to taper steroids...and when you don't need to293 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 XXIII Resuscitation 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 XXIV Toxicology 308 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 naive 318 Treating an opioid overdose: know when it is time to start the naloxone drip319 Do not discontinue N-acetylcysteine if anaphylactoid symptoms develop Section XXV Trauma 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 zone324 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 injuries351 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 height356 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 diving Section XXVI Ultrasound360 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 images Section XXVII Urogenital 371 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 UTIs378 Treat pyelonephritis in the pregnant patient aggressively 379 Dose renally-excreted medications based on renal function 380 Know the indications for emergent hemodialysis Section XXVIII Wound 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 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 repair388 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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