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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
- If <1500
- Rh- needs RhoGAM
- Prevents complications in future pregnancies
- If no IUP visualized, ectopic pregnancy is a possibility, and management depends on hCG
Additional Reading
- Ectopic Pregnancy (EM Clerkship)
- Abdominal Aortic Aneurysm (EM Clerkship)