Non-Traumatic Lower Back Pain

Most of us will have lower back pain in our lives (80–90% lifetime prevalence) and it accounts for 2–3% of ED visits (so quite a bit). As with everything in EM, there are benign and serious causes and we need to differentiate between the two. The serious causes include diagnoses in the back and those … Continue reading Non-Traumatic Lower Back Pain →

Discharge Instructions

The October edition of EM-RAP had a great section on how to write good discharge instructions. This is not the pre-printed stuff that comes with the EMR but instructions written specifically for each patient. I modified my DCI (discharge instruction macro) to make those points more obvious. You have been diagnosed with ***, this is … Continue reading Discharge Instructions →

Brief Resolved Unexplained Events (BRUE)

ALTE has been deprecated and replaced with BRUE. Apparent Life-Threatening Events scared parents and led physicians to unnecessary testing. The American Academy of Pediatrics has issued the following guideline. BRUE ==== STEP 1: Meets DEFINITION of BRUE - BRIEF: less than 1 minute episode - RESOLVED: back to baseline/normal - UNEXPLAINED: no other etiology (no URI, … Continue reading Brief Resolved Unexplained Events (BRUE) →

HEART Score

Used to risk stratify patients for further cardiac workup in the ER according to risk of major adverse cardiac events (MACE). History 2: highly suspicious 1: moderately suspicious 0: slightly or non-suspicious ECG 2: significant ST-depression 1: non-specific repolarization 0: normal Age 2: > 65 years old 1: 45-65 years old 0: < 45 years … Continue reading HEART Score →

Mental Status Exam

For the inevitable moment when the medical record eats all my macros, I'm backing them up here. Also, if anyone finds them useful, feel free to steal them. I stole them from elsewhere. MENTAL STATUS EXAM: - Appearance: ***well-groomed, alert, co-operative - Mood: ***pt states they feel depressed - Affect: ***pt appears depressed, ***congruent with … Continue reading Mental Status Exam →

Syncope MDM

This patient had the classic characteristics of syncope (1) transient LOC, (2) loss of postural tone and (3) full & immediate spontaneous recovery. There is nothing in the history or physical to suggest common syncope mimics: ***seizure, ***posterior circulation stroke, ***hypoglycemia, ***hypoxemia, ***heat stroke or ***head trauma. My suspicion for ***AAA, ***PE, ***MI, ***GIB, ***ectopic … Continue reading Syncope MDM →