Clinical Tips

That's years of wrong meds, lost driver's licenses, and missed cardiac problems. Your weapon: FAST-R. Five questions.

Don't just ask "Did they bite their tongue?" Ask WHERE. • Lateral side → Seizure 96% specific • Tip → May be syncope

Reality: Myoclonic jerks occur in up to 90% of prolonged syncope The key question: "Did the shaking start BEFORE or A

Husband: "She turned white, then twitched for 5 seconds" Now fully alert. No confusion. Tip bite only. FAST-R: Pale, j

F — Fatal: Hemodynamic instability, peritoneal signs, pulsatile mass, pain out of proportion A — Assess: Vitals trend,

10% mortality rate. 30-40% will need surgery. The problem: We expect classic presentations in a population where 80% p

Vitals: 118/74, HR 88, afebrile. Soft abdomen. Labs pending. ER doc: "Probably viral." 3 hours later: OR for ruptured

Before discharge or downgrade, check ALL four: S — Shock signs? hypotension, tachycardia, poor perfusion T — Tendernes

Reality: Labs are falsely reassuring in elderly patients • >50% elderly cholecystitis: NO fever, vomiting, OR leukocy

Patient writhing in agony but abdomen is soft and non-tender? Think mesenteric ischemia — 70-90% mortality if missed.

Often called renal colic, back pain, or diverticulitis. Classic triad: • Abdominal or back pain • Hypotension • Pulsat

Neonates 0-28d: Bilious vomiting → Volvulus Infants 2mo-2yr: Intermittent pain + leg drawing → Intussusception Children