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Acute Mesenteric Ischemia
  • History of atrial fibrillation
  • “Pain out of proportion to exam”
Bowel Obstruction
  • History
    • Abdominal pain
    • Bloating/Distention
    • Vomiting
    • Decrease stool/flatus
  • Exam
    • Abdominal tenderness and distention
    • If guarding/rigidity/rebound tenderness (aka peritonitis)
      • Consider perforated bowel
  • Testing
    • Obtain CT abdomen with IV contrast
  • Treatment
    • Fluids
    • NPO
    • NG Tube
Acute Diverticulitis
  • NOTE: DiverticulOSIS is what causes GI bleeding
  • History/Exam
    • Fever
    • Left lower quadrant pain/tenderness
  • Testing/Treatment
    • CT abdomen with IV contrast
    • Liquid diet
    • Antibiotics
  • Complications
    • Abscess
    • Stricture
    • Fistula
    • Perforation
    • Obstructions

Abdominal Aortic Aneurysm

  • If suspected, perform bedside ultrasound of the abdomen
    • Aortic diameter >3 cm
Spontaneous Bacterial Peritonitis
  • Diagnose by performing a paracentesis
    • Look for >250 white blood cells
  • Treat with ceftriaxone

Kidney Stones

  • CT without contrast
  • If the stone is <5mm
    • Treat with analgesics and tamsulosin
  • If the stone is >5mm
    • Consult urology
Common Indications for Emergency Dialysis
  • Mnemonic: AEIOU
    • Acidosis (pH <7.1)
    • Electrolytes (K > 6.5)
    • Intoxication
      • Lithium
      • Ethylene Glycol
      • Methanol
      • Aspirin
    • Overload of volume resistant to diuresis
    • Uremia that is symptomatic
      • Altered mental status
      • Pericarditis
Ectopic Pregnancy
  • Testing
    • BhCG QUANTITATIVE
    • Type and screen for Rh Status
    • Pelvic ultrasound
      • IUP = Gestational sac PLUS a Yolk sac
      • Beware “heterotopic” pregnancy in fertility treatment patients (IVF)
    • Treatment
      • If no IUP visualized, ectopic pregnancy is a possibility, and management depends on hCG
        • If <1500
          • Consider sending stable patients home and repeat hCG in 48 hours
        • If >1500
          • Ectopic until proven otherwise, consult OBGYN
      • Rh- needs RhoGAM
        • Prevents complications in future pregnancies
Additional Reading