First do no harm Beware the silent chest in asthma Common things are common The best monitoring device is you You are never too busy to treat someone's pain An unstable patient should never leave the department unescorted Beware of abdominal pain in the young and elderly Don't be afraid to say you don't know A basic neurological exam always include a test for co-ordination Experience is the ability to make the same mistakes over and over again with increasing confidence Fever may mean sepsis or meningitis in the infant The priorities of treatment ABC and Analgesia Not all vertigo is due to vestibular problem Never be afraid to get help Low oxygen saturation and blood pressure needs immediate treatment Beware a normal pCO2 in asthma Most cardiac arrests are preventable Shock is the silent killer Any person with abnormal mental state, seizures or coma needs a BSL If you don't ask the patient you will never know 'Sudden' anything is usually a bad sign The absence of an answer is not the same as the absence of a problem Renal calculi + obstruction + infection = sepsis There is no such thing as an unobtainable history Sudden abdominal pain in pregancy = ectopic Only a competent patient can leave against advice Everyone makes mistakes - Fools make them twice Airway obstruction and respiratory depression are easily missed in drowsy patients Frusemide is rarely the treatment for oliguria Tests are an expensive form of procrastination You won't diagnose it if you didn't think of it A collapse is cardiac in origin until proven otherwise Treating a patient includes treating their anxieties The last place you want to treat an emergency is in a lift Spinal patients are vulnerable to many illnesses Any ONE of the following may mean PE - chest pain OR hypoxia OR tachycardia OR syncope Never be afraid to ask for help All neonates with fever require admission Absence of a symptom is often due to the absence of the question More is missed by not doing then not knowing Low BSL is easily treated but often forgotten Abnormal vital signs always need to be explained Beware of the 'worst-ever' headache in migraine sufferers People sue due to poor communication rather than poor treatment Early pregnancy bleeding is ectopic until proven otherwise With most things, it is all in the history Hidden blood loss catches someone everyday If the patient doesn't trust you then you might as well go home Cardiac enzymes rarely tell you something that you already didn't know from the history Don't order a test that you aren't intending to follow up Beware of discharging a patient with abnormal vital signs One normal ECG does not rule out MI Beware the diagnosis of 'anxiety' Beware of a 'sudden-onset' headache If you can remember only one thing - remember ABC You may not be able to fix someone but at least show that you have tried Infection is not the only cause of exacerbation of COAD Respiratory alkalosis is not always related to anxiety Monitors - the most misused equipment in the ED A lot of abnormal patient behaviour stems from fear and anxiety PPPPPP - Prior preparation prevents piss-poor performance For most people 3 litres in and litre out per day New onset constipation is cancer until proven otherwise Don't forget Anti-D in early pregnancy bleeding Beware of the child that doesn't cry 'Vaso-vagal'syncope is a diagnosis of exclusion Anaphylactic shock does not need a rash A normal CT does not rule out SAH Beware of abdominal pain in spinal patients Fever + chemotherapy = febrile neutropenia Any women of child-bearing age with abdominal pain is pregnant until proven otherwise If a person say they have pain, believe them Constipation is a symptom not a diagnosis Test - an excuse for lazy thinking? Fever + Jaundice = ascending cholangitis Knife-wounds can be more serious than they look Broad complex tachycardia is VT until proven otherwise Pain is a potent respiratory stimulant It is not tonsillitis if they annot open their mouth Fluid resuscitation is more important than frequent BP checks Cleaning a wound is infinitely more important than closing it Don't let pregnant women lie flat Serum potassium is the most important electrolyte in a cardiac arrest Don't believe everything you see on a monitor A calf sprain may in fact be a tendon rupture Persistent tachycardia should never be attributed to anxiety
Always have a back-up plan Uncommon presentations of common diseases happen more often than common presentations of uncommon diseases Beware of fever in the immuno-compromised Do not discharge a swollen, infected hand A sore throat can sometimes be fatal Be careful of repeat presentations The commonest cause of metabolic acidosis is undiagnosed shock Beware of trauma in the warfarinised patient A proper ENT exam includes ears, nose, throat AND neck Always look for compartment syndrome in long-bone fractures Beware of abdominal pain in a person on steroids Not all childhood injuries are accidental Be careful when diagnosing 'drug-seeking behaviour' Most differential diagnoses include infection Don't wait for the blood pressure to fall before treating shock Abnormal behaviour has an organic cause until proven otherwise Never close a bite wound Learn to read blood gases It is amazing how many ruptured aneurysms die from 'renal colic' Air (oxygen) and water (fluid) save lives Unappreciated sepsis kill someone every day ECGs made easy? - first learn to diagnose VT and an acute MI Carer and relatives are often more important sources of history than the patient Watchful waiting still means you have to be watchful Macrocytic/Microcytic blood pictures should always be noted Beware of hypertension in late pregnancy Proper patient instruction and follow-up prevents many disasters Proper wound cleaning prevents infection more than antibiotics Never give steroids to the red eye Superior judgement is better than superior skill A UTI in a child is never normal A change in vital signs is as important as abnormal signs Beware of a 'normal' blood pressure in a paraplegic Always compare tests with old ones - labs, ECG , X-rays Beware of back pain in the elderly Babies get cold very quickly Beware of any headache in AIDS Pregnancy + seizure = eclampsia Don't just assess, re-assess Aortic dissection is more common than you think Normal cardiac enzymes do not rule out MI Sudden-onset anything is a bad sign Don't x-ray bones that you don't know the names of An indeterminate V/Q means nothing Beware of haematemesis in a person with a AAA Beware of head injuries in a drunk Psychiatric patients also get sick In chest pain, history is (almost) everything Don't forget organic causes in psychiatric illness There is no such thing as a 'wrist sprain' If you think a person is sick, you are probably right Shingles is the great mimicker Fever and hypotension = septic shock Beware of people holding their heads after a neck injury If someone looks like their heart has stopped then it probably has If you don't know what you are looking for then ordering a test won't help Chronic steroids can mask infection Drug users get sick too One set of vital signs is rarely enough TIAs do not make people 'collapse' A thorough history and exam beats a test any day Don't forget temporal arteritis and acute glaucoma in headache X-rays are rarely helpful in abdominal pain Hypothermia may equal infection Learn to read a lateral wrist xray An ignored monitor is worse than no monitor Oxygen - under-prescribed in the sick and over-prescribed in the well Never discharge unrelieved or undiagnosed chest pain Give antibiotics early in meningitis Lack of O2 kills faster than too much CO2 A low serum bicarbonate is never normal The most important person in the department is the patient GI bleeding is often under-estimated A discharge involves a discharge plan Undiagnosed sepsis is the commonest cause of preventable death Another person's pain is easy to bear An emergency is the last place to learn how to put in a 16 gauge cannula