ACS is most common in patients < 35 years of age. These patients have increased risk of high-energy injuries, stronger fascia, and greater muscle bulk. Males are 10x more likely to experience ACS compared to females - Brit Long, MD. emDOCs
Aortic dissection may occur in any location along the aorta and therefore the range of presentations is broad. Many AD patients do not fit the textbook presentation - Alexandra Ortega, MD, Core EM
In spite of all our technological advances in medicine, mesenteric ischemia remains a very difficult disease process to identify early. The signs and symptoms of mesenteric ischemia are vague with "pain out of proportion to exam" being the classic presentation - Sundip Patel, MD, CDEM
The time of diagnosis of OCS is not the time to be first learning the procedure, the necessary equipment, its indications and contraindications, and complications. A survey study suggested that over 90% of EPs felt inadequately trained in lateral canthotomy and inferior cantholysis (LCIC) - Shyam Murali, RebelMD
In patients presenting with ischaemic symptoms, horizontal ST depression in the anteroseptal leads (V1-3) should raise the suspicion of posterior MI _ Ed Burns - LITFL
This is the first of a two-part series on surgical emergencies. This series discusses “cannot miss” diagnoses that require immediate, or at least emergent, surgical intervention.
This is the second in a two-part series discussing can’t-miss diagnoses that may require emergent surgical intervention. Part 1 (http://www.emdocs.net/cant-miss-surgical-emergencies-part-1/) included ruptured ectopic pregnancy, ruptured AAA, and aortic dissection. In this article, we will explore three more disease processes that can be easy to miss, though delay in diagnosis and treatment can lead to long-term sequelae and even death. So, without further ado, let’s jump right in to discuss three more surgical emergencies.
You can do this for other differentials, such as hyponatremia, but I find this more useful because we tend to think in chief complaints. Some patterns emerge when you break these into groups:
Common: We see these every day, and they are straightforward. Maybe a little workup or treatment, but it's clear what to do.
Rare: We might see these once a month, once a year, or once a decade. Or we might never see it (or might miss it), and they often require some workup because you need to prove they are not something more common.
Minor: These patients are going to be fine, and will suffer little morbidity or mortality. They have “DC home” written all over them.
Dangerous: These people are getting a large number of studies because they might have something really bad.