Clinical Tips

Reality: In elderly patients, atypical IS typical • 80% of elderly appendicitis looks "atypical" • Perforation rate:

Four diagnoses that mimic abdominal pathology: • Testicular/ovarian torsion → lower abdominal pain • Incarcerated hern

Old → Evidence-Based: Wait for labs to worsen → Escalate on clinical presentation Diagnose gastroenteritis → Diagn

F — Fatal: Diaphoresis, BP diff >20mmHg, altered LOC, SpO2 <90% A — Assess: Onset time, bilateral BP, complete vitals,

Those patients have 2x the mortality of those who were admitted. 7-8 million ED visits for chest pain each year. Only

Before ANY other diagnosis, exclude all 6: A — ACS pressure, radiation, diaphoresis P — PE pleuritic pain, dyspnea, DV

Reality: 5-7% of patients with reproducible chest wall tenderness have ACS That's 1 in 15 to 1 in 20 patients. Actio

Both cardiac ischemia AND esophageal spasm respond to nitroglycerin. Why? Nitro relaxes smooth muscle everywhere. GI c

No chest pain. Nauseous all morning. Tired for a week. Rubbing her left shoulder. Slightly sweaty. Physician says: "Pr

"They're too young for a heart attack" — wrong. Young adults CAN have ACS: • Cocaine/stimulants → coronary vasospasm,

• Single ECG sensitivity: only ~50% for ACS • Single troponin can miss an evolving MI Half of ACS patients have a norm

Reality: 29% of cardiac patients have significant anxiety Almost 1 in 3. Anxiety and heart disease often coexist. Ca