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Tip #16

Recheck the patient’s heart rate and respiratory rate (and put in your presentation that you did so)

  • Heart rate frequently falsely elevated when being triaged
  • Respiratory rate frequently falsely normal when being triaged
Tip #17

Fully examine the specific complaint. Some common misses include…

  • Neurologic complaints (headache, paresthesias, dizziness, asymptomatic hypertension, seizures, visual complaints)
    • Finger-Nose
    • Heel-Shin
    • Gait (if possible)
    • Visual FIELDS
  • Spinal complaints (neck pain, back pain)
    • Straight leg raise
    • Crossed straight leg raise
    • Achilles and patellar reflexes
    • Midline tenderness
Tip #18

Independently OBTAIN stool sample (if clearly appropriate) or articulate in your presentation that you are WILLING to get it

  • Elderly syncope
  • Abdominal pain with dark stool/melena
  • Severe anemia or large drops in hemoglobin/hematocrit

Note: You should NOT be doing full pelvic exams, rectal exams, GU exams INSTEAD of your attending (stool samples probably fine in my opinion), and you should NOT be doing these exams without a CHAPERONE.

Tip #19

Get the patient into a gown (at a minimum you should expose the area of concern)

Tip #20

Bring the ultrasound, gel, and towels to bedside. Appropriate chief complaints for this would include…

  • Patients over 50 with back/flank pain (AAA exam)
  • Patients with severe hypotension/shock (RUSH exam)