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You are working a shift at ABEM General when three patients check in simultaneously at the start of your shift at 6AM.
Initial Vitals#1 (Ms. Taylor, 65F with Back Pain)
- Temp 98.8
- HR 120
- RR 22
- BP 210/110
- O2 97%
Critical Actions#1 (Ms. Taylor, 65F withBack Pain)
- Obtain Medication/Social Hx (Ciprofloxacin use, Cocaine use)
- Diagnose Aortic Dissection (Type B)
- Treat HR Appropriately (Esmolol drip)
- Treat BP Appropriately (Cardene drip)
- Treat Pain
Initial Vitals#2 (Ms. Thomas, 50F with Dysuria)
- Temp 101.0F
- HR 120
- RR 22
- BP 106/65
- O2 98%
Critical Actions #2 (Ms. Thomas, 50F with Dysuria)
- Obtain pregnancy test
- Perform chaperoned pelvic exam
- Diagnose PID /w Fitz Hugh Curtis & Treat /w abx
- Treat pain
- Council patient appropriately on +STD (treatment of partner, no intercourse until treated)
Initial Vitals#3 (Ms. Wells, 40F with Knee Pain)
- Temp 99.9F
- HR 90
- RR 18
- BP 120/80
- O2 98%
Critical Actions#3 (Ms. Wells, 40F with Knee Pain)
- Obtain appropriate workup (ESR, CRP, XRay, Cultures)
- Treat pain
- Perform Arthrocentesis
- Gonococcal Arthritis
- Treat with appropriate Antibiotics
Further Reading