Managing Emergencies in the Outpatient Setting: Pearls for Primary Care

Description

Many primary care clinicians are busy to the point of being overwhelmed and there is not time to do thorough evaluations on every patient. The outpatient clinician must be able to quickly identify and manage the overtly ill but also those with potential or even hidden issues that require a referral to the emergency department. This book provides a concise yet comprehensive summary of the various conditions the primary care practitioner could encounter in his/her office that require emergency department referral. Organized system by system, this manual provides short, readable yet detailed descriptions of situations where the clinician must make the quick decision to escalate the level of care. The book is comprised of thirteen main sections, each detailing a medical specialty and is further broken down into specific conditions within these specialties. The specialties that are featured are cardiology, dermatology, endocrinology, gastroenterology, HEENT, hematology and oncology, infectious disease, nephrology, neurology, gynecology, ophthalmology, psychiatry, pulmonology and urology. The chapters are broken down into five key aspects. First, a brief synopsis of the problem is identified covering the incidence, the risk factors and general information to give the clinician the insight to manage the situation. Next, there is a review of key elements of the history that can elucidate whether the patient has or does not have the emergent condition. Physical exam findings that the clinician can look for during the evaluation are then discussed followed by diagnostics that the clinician can get quickly the same day to help evaluate the situation. Lastly, treatments that can be provided while waiting for the urgent or emergent condition to be evaluated are identified. Written by experts in the field, Managing Emergencies in the Outpatient Setting is a valuable resource for primary care physicians, physician assistants and nurse practitioners alike. Preface Acknowledgments Legal Disclaimer Contents Contributors Cardiovascular Disease 1 Introduction 2 Coronary Artery Disease 2.1 General Considerations 2.2 History 2.3 The Exam 2.4 Diagnostics 3 Pericarditis 3.1 General Considerations 3.2 History 3.3 Exam 3.4 Diagnostics 4 Congestive Heart Failure 4.1 General Considerations 4.2 History 4.3 Exam 4.4 Diagnostics 5 Arrhythmias 5.1 General Considerations 6 Tachyarrhythmias 6.1 History 7 Sinus Tachycardia 7.1 General Considerations 7.2 Diagnostics 8 Atrial Fibrillation 8.1 General Considerations 8.2 Diagnostics 9 Atrial Flutter 9.1 General Consideration 9.2 Diagnostics 10 Multifocal Atrial Tachycardia 10.1 General Considerations 10.2 Diagnostics 11 Atrioventricular Nodal Reentrant Tachycardia 11.1 General Considerations 11.2 Diagnostics 12 Other Supraventricular Tachycardias 13 Ventricular Arrhythmias 13.1 General Considerations 14 Bradyarrhythmias 14.1 General Considerations 14.2 Diagnostics 15 Pulmonary Embolism 15.1 General Considerations 15.2 History 15.3 Exam 15.4 Diagnostics 16 Deep Vein Thrombosis 16.1 General Considerations 16.2 History 16.3 Exam 16.4 Diagnostics 17 Syncope 17.1 General Considerations 17.2 History 17.3 Exam 17.4 Diagnostics 18 Diseases of the Aorta 18.1 Abdominal Aortic Aneurysm (AAA) 18.1.1 General Considerations 18.1.2 History 18.1.3 Physical Exam 18.1.4 Diagnostics 18.2 Thoracic Aortic Aneurysm 18.2.1 General Considerations 18.2.2 History 18.2.3 Exam 18.2.4 Diagnostics 18.3 Aortic Dissection 18.3.1 General Considerations 18.3.2 History 18.3.3 Exam 18.3.4 Diagnostics 19 Acute Limb Ischemia 19.1 General Considerations 19.2 History 19.3 Exam 20 Hypertensive Urgencies and Emergencies 20.1 General Considerations 20.2 History 20.3 Exam 20.4 Diagnostics 21 Rheumatic Fever 21.1 General Considerations 21.2 History 21.3 Exam 21.4 Diagnostics Further Reading Infectious Disease 1 Introduction 2 Sepsis and Toxic Shock 2.1 General Considerations 2.2 History 2.3 Exam 2.4 Diagnostics 3 Skin and Soft Tissue Infections 3.1 General Considerations 3.2 History 3.3 Exam 3.4 Diagnostics 4 Septic Arthritis 4.1 General Considerations 4.2 History 4.3 Exam 4.4 Diagnostics 5 Osteomyelitis 6 Contiguous Osteomyelitis 6.1 General Considerations 6.2 History 6.3 Exam 6.4 Diagnostics 7 Vertebral Osteomyelitis 7.1 General Considerations 7.2 History 7.3 Exam 7.4 Diagnostics 8 Pyelonephritis 8.1 General Considerations 8.2 History 8.3 Exam 8.4 Diagnostics 9 Infective Endocarditis 9.1 General Considerations 9.2 History 9.3 Exam 9.4 Diagnostics 10 Pneumonia 10.1 General Considerations 10.2 History 10.3 Exam 10.4 Diagnostics 11 Tuberculosis 11.1 General Considerations 11.2 History 11.3 Exam 11.4 Diagnostics 12 Cases of Immunosuppression 12.1 Human Immunodeficiency Virus (HIV) 12.1.1 General Considerations 12.1.2 History 12.1.3 Exam 12.2 Transplant Patients 12.2.1 General Considerations 12.2.2 History 12.2.3 Exam 12.2.4 Diagnostics 13 Neutropenic Fever 13.1 General Considerations 13.2 History 13.3 Exam 14 The Febrile Traveler 14.1 General Considerations 15 Fever Without a Rash 15.1 Malaria 15.1.1 General Considerations 15.1.2 History 15.1.3 Exam 15.1.4 Diagnostics 15.2 Yellow Fever 15.2.1 General Considerations 15.2.2 History 15.2.3 Exam 15.2.4 Diagnostics 15.3 Leptospirosis 15.3.1 General Considerations 15.3.2 History 15.3.3 Exam 15.3.4 Diagnostics 16 Fever with a Rash 16.1 Enteric Fever 16.1.1 General Considerations 16.1.2 History 16.1.3 Exam 16.1.4 Diagnostics 16.2 Dengue Virus 16.2.1 General Considerations 16.2.2 History 16.2.3 Exam 16.2.4 Diagnostics 16.3 Chikungunya Virus 16.3.1 General Considerations 16.3.2 History 16.3.3 Exam 16.3.4 Diagnostics 16.4 Zika Virus 16.4.1 General Considerations 16.4.2 History 16.4.3 Exam 16.4.4 Diagnostics 16.5 Rocky Mountain Spotted Fever 16.5.1 General Considerations 16.5.2 History 16.5.3 Exam 16.5.4 Diagnostics 17 Miscellaneous Potentially Fatal Diseases 17.1 Rickettsial Diseases 17.2 Respiratory Infections 17.3 Viral Hemorrhagic Fevers 17.4 Measles 17.4.1 General Considerations 17.4.2 History 17.4.3 Exam 17.4.4 Diagnostics 17.5 Diphtheria 17.5.1 General Considerations 17.5.2 History 17.5.3 Exam 17.5.4 Diagnostics 17.6 Surgical Site Infection 17.6.1 General Considerations 17.6.2 History 17.6.3 Exam 17.6.4 Diagnostics Further Reading Gastroenterology 1 Introduction 2 Initial Evaluation 2.1 General Considerations 2.2 History 2.3 Physical Exam 3 Gastrointestinal Surgical Emergencies 3.1 Appendicitis 3.1.1 General Considerations 3.1.2 History 3.1.3 Exam 3.1.4 Diagnostics 3.2 Cholecystitis 3.2.1 General Considerations 3.2.2 History 3.2.3 Physical Exam 3.2.4 Diagnostic 3.3 Diverticulitis 3.3.1 General Considerations 3.3.2 History 3.3.3 Exam 3.3.4 Diagnostics 4 Small and Large Bowel Obstruction 4.1 General Considerations 4.2 History 4.3 Exam 4.4 Diagnostics 5 Miscellaneous 5.1 Mesenteric Ischemia 5.1.1 General Considerations 5.2 Hernias 5.3 Gastric Volvulus 5.3.1 General Considerations 5.4 Intestinal Volvulus and Malrotation 5.4.1 General Considerations 6 Gastrointestinal Medical Emergencies 6.1 Ascending Cholangitis 6.1.1 General Considerations 6.1.2 History 6.1.3 Exam 6.1.4 Diagnostics 6.2 Acute Liver Failure 6.2.1 General Considerations 6.2.2 History 6.2.3 Exam 6.2.4 Diagnostics 6.3 Acute on Chronic Liver Disease 6.3.1 General Considerations 6.3.2 History 6.3.3 Exam 6.3.4 Diagnostics 6.4 Pancreatitis 6.4.1 General Considerations 6.4.2 History 6.4.3 Exam 6.4.4 Diagnostics 6.5 Gastrointestinal Bleeding (GI Bleed) 6.5.1 General Considerations 6.5.2 History 6.5.3 Exam 6.5.4 Diagnostics 7 Miscellaneous 7.1 Esophageal Emergencies 7.1.1 Food Impaction 7.1.2 Esophageal Perforation 7.1.3 Inflammatory Bowel Disease General Considerations 8 Miscellaneous Complications of Gastrointestinal Procedures 8.1 Bariatric Surgery 8.1.1 General Considerations 8.1.2 Endoscopic Procedures 8.1.3 Medicines Used in Gastroenterology Further Reading Neurology 1 Introduction 2 Transient Ischemic Attack 2.1 General Considerations 2.2 History 2.3 Exam 2.4 Diagnostics 2.5 Therapeutics 3 Cerebrovascular Accident (Embolic and Hemorrhagic) 3.1 General Considerations 3.2 History 3.3 Exam 3.3.1 Hemorrhagic Cerebrovascular Accident 3.4 General Considerations 3.5 History 3.6 Exam 3.7 Diagnostics 4 Traumatic Brain Injury 4.1 General Considerations 4.2 History 4.3 Exam 5 Bell’s Palsy 5.1 General Considerations 5.2 History 5.3 Exam 6 Meningitis and Encephalitis 6.1 General Considerations 6.2 History 6.3 Exam 7 Spinal Cord Compression 7.1 General Considerations 7.2 History 7.3 Exam 7.4 Diagnostics 8 Multiple Sclerosis 8.1 General Considerations 8.2 History 8.3 Exam 8.4 Diagnostics 9 Myasthenia Gravis 9.1 General Considerations 9.2 History 9.3 Exam 10 Seizures 10.1 General Considerations 10.2 History 10.3 Exam 10.4 Diagnostics 11 Miscellaneous 11.1 Guillain–Barre Syndrome 11.2 General Considerations 11.3 History 11.4 Exam 12 Transverse Myelitis 12.1 General Considerations 12.2 History 12.3 Exam 13 Wernicke’s Encephalopathy 13.1 General Considerations 13.2 History 13.3 Exam 14 Botulism 14.1 General Considerations 14.2 History 14.3 Exam Further Reading Nephrology 1 Introduction 2 Acute Kidney Injury 2.1 General Considerations 2.2 History 2.3 Exam 2.4 Diagnostics 3 Pre-renal Acute Kidney Injury 3.1 General Considerations 3.2 History 3.3 Exam 3.4 Diagnostics 4 Intrinsic Renal Disease 4.1 General Considerations 4.2 History 4.3 Exam 4.4 Diagnostics 5 Post-renal Acute Kidney Injury 5.1 General Considerations 5.2 History 5.3 Exam 5.4 Diagnostics 6 Renal Vein Thrombosis 6.1 General Considerations 6.2 History 6.3 Exam 6.4 Diagnostics 7 Electrolytes 7.1 Hyponatremia 8 Hypernatremia 9 Hypokalemia 10 Hyperkalemia 11 Hypocalcemia 11.1 General Considerations 12 Hypercalcemia 12.1 General Considerations 13 Hypomagnesemia 13.1 General Considerations 14 Hypermagnesemia 14.1 General Considerations 15 Hypophosphatemia Further Reading Urology 1 Introduction 2 Nephrolithiasis 2.1 General Considerations 2.2 History 2.3 Exam 2.4 Diagnostics 3 Urinary Retention 3.1 General Considerations 3.2 Causes of Urinary Retention 3.3 History 3.4 Exam 3.5 Diagnostics 4 Prostatitis 4.1 General Considerations 4.2 History 4.3 Exam 4.4 Diagnostics 5 Fournier’s Gangrene 5.1 General Considerations 5.2 History 5.3 Exam 5.4 Diagnostics 6 Testicular Torsion 6.1 General Considerations 6.2 History 6.3 Exam 6.4 Diagnostics 7 Other Scrotal Pathology 7.1 General Considerations 7.2 History 7.3 Exam 7.4 Diagnostics 8 Priapism 8.1 General Considerations 8.2 History 8.3 Exam 8.4 Diagnostics 9 Miscellaneous 9.1 Penile Fracture 10 Surgical Complications 10.1 History 10.2 Exam 10.3 Diagnostics 11 Cauda Equina Syndrome 12 Complication of Lithotripsy 13 Complications of Ureteral Stents Further Reading Obstetrics and Gynecology 1 Introduction 2 Ectopic Pregnancy 2.1 General Considerations 2.2 History 2.3 Exam 2.4 Diagnostics 3 Ovarian Torsion 3.1 General Considerations 3.2 History 3.3 Exam 3.4 Diagnostics 4 Pelvic Inflammatory Disease 4.1 General Considerations 4.2 History 4.3 Exam 4.4 Diagnostics 5 Vaginal Bleeding 5.1 Vaginal Bleeding in the Non-pregnant Patient 5.1.1 General Considerations 5.1.2 History 5.1.3 Exam 5.1.4 Diagnostics 5.2 Vaginal Bleeding in the Pregnant Patient 5.2.1 General Considerations 5.2.2 Exam 5.3 Vaginal Bleeding After Elective Abortion 5.3.1 General Considerations 5.3.2 History 6 Pre-eclampsia 6.1 General Considerations 6.2 History 6.3 Exam 6.4 Diagnostics 7 Hyperemesis Gravidarum 7.1 General Considerations 7.2 History 7.3 Exam 7.4 Diagnostics 8 Sexual Assault 8.1 General Considerations Further Reading Otolaryngology (Ear Nose and Throat) 1 Introduction 2 Epistaxis 2.1 General Considerations 2.2 History 2.3 Exam 2.4 Diagnostics 2.5 Treatment 3 Peritonsillar Abscess 3.1 General Considerations 3.2 History 3.3 Exam 3.4 Diagnostics 3.5 Treatment 4 Retropharyngeal Abscess 4.1 General Considerations 4.2 History 4.3 Exam 4.4 Diagnostic Testing 4.5 Treatment 5 Lemierre’s Syndrome 5.1 General Considerations 5.2 History 5.3 Exam 5.4 Diagnostics 5.5 Treatment 6 Epiglottitis 6.1 General Considerations 6.2 History 6.3 Exam 6.4 Diagnostics 7 Mastoiditis 7.1 General Considerations 7.2 History 7.3 Exam 7.4 Diagnostics 7.5 Treatment 8 Malignant Otitis Externa 8.1 General Considerations 8.2 History 8.3 Exam 8.4 Diagnostics 8.5 Treatment 9 Vertigo 9.1 General Considerations 9.1.1 Peripheral Vertigo 9.1.2 Central Vertigo 9.2 History 9.3 Exam 9.4 Diagnostics 9.5 Treatment 10 Sudden Sensorineural Hearing Loss 10.1 General Considerations 10.2 History 10.3 Exam 10.4 Diagnostics 10.5 Treatment 11 Acute Rhinosinusitis 11.1 General Considerations 11.2 History 11.3 Exam 11.4 Diagnostics 11.5 Treatment 12 Miscellaneous 12.1 Foreign Bodies 12.1.1 General Considerations 12.1.2 Ear 12.1.3 Nose 12.1.4 Throat Further Reading Pulmonology 1 Introduction 2 Asthma and COPD 2.1 General Considerations 2.2 History 2.3 Exam 2.4 Diagnostics 2.5 Treatment 3 Interstitial Lung Disease 3.1 General Considerations 3.2 History 3.3 Exam 3.4 Diagnostics 4 Hemoptysis 4.1 General Considerations 4.2 History 4.3 Exam 4.4 Diagnostics 5 Pleural Effusion 5.1 General Considerations 5.2 History 5.3 Exam 5.4 Diagnostics 6 Pneumothorax 6.1 General Considerations 6.2 History 6.3 Exam 6.4 Diagnostics Further Reading Endocrinology 1 Introduction 2 Diabetic Ketoacidosis 2.1 General Considerations 2.2 History 2.3 Exam 2.4 Diagnostics 3 Hyperglycemic Hyperosmolar State 3.1 General Considerations 3.2 History 3.3 Exam 3.4 Diagnostics 4 Hypoglycemia 4.1 General Considerations 4.2 Treatment 4.3 Diagnostics 5 Thyroid Storm 5.1 General Considerations 5.2 History 5.3 Exam 5.4 Diagnostics 6 Myxedema 6.1 General Considerations 6.2 History 6.3 Exam 6.4 Diagnostics 7 Adrenal Crisis 7.1 General Considerations 7.2 History 7.3 Exam 7.4 Diagnostics 8 Pituitary Apoplexy 8.1 General Considerations 8.2 History 8.3 Exam 8.4 Diagnostics 9 Hypercalcemia 9.1 General Considerations 9.2 History 9.3 Exam 9.4 Diagnostics 10 Hypocalcemia 10.1 General Considerations 10.2 History 10.3 Physical Exam 10.4 Diagnostics 11 Acute Suppurative Thyroiditis 11.1 General Considerations 11.2 History 11.3 Exam 11.4 Diagnostics Further Reading Hematology and Oncology 1 Introduction 2 Spinal Cord Compression 2.1 General Considerations 2.2 History 2.3 Exam 2.4 Diagnostics 3 Acute Leukemia 3.1 General Considerations 3.2 History 3.3 Exam 3.4 Diagnostic Tests 4 Hyperviscosity Syndrome 4.1 General Considerations 4.2 History 4.3 Exam 4.4 Diagnostics 5 Anemia 5.1 General Considerations 5.2 History 5.3 Exam 5.4 Diagnostics 6 Thrombocytopenia 6.1 General Considerations 6.2 History 6.3 Exam 6.4 Diagnostics 7 Hemarthrosis and Hemophilia 7.1 General Considerations 7.2 History 7.3 Exam 7.4 Diagnostics 8 Sickle Cell Disease 8.1 General Considerations 8.2 History 8.3 Exam 8.4 Diagnostics Further Reading Ophthalmology 1 Introduction 1.1 General Considerations 2 Painful Vision Loss 2.1 Chemical Exposure 2.1.1 General Considerations 3 Major Trauma 3.1 General Considerations 3.2 Exam 4 Minor Trauma 4.1 General Considerations 4.2 History 4.3 Exam 4.4 Treatment 5 Keratitis 5.1 General Considerations 5.2 History 5.3 Exam 5.4 Treatment 6 Scleritis and Uveitis 6.1 General Considerations 6.2 History 6.3 Exam 6.4 Treatment 7 Endophthalmitis 7.1 History 7.2 Exam 7.3 Treatment 8 Optic Neuritis 8.1 History 8.2 Exam 8.3 Treatment 9 Acute Angle Closure Glaucoma 9.1 History 9.2 Exam 10 Orbital Cellulitis 10.1 General Considerations 10.2 History 10.3 Exam 10.4 Diagnostics 11 Temporal Arteritis 11.1 General Considerations 11.2 History 11.3 Exam 11.4 Diagnostics 11.5 Treatment 12 Painless Vision Loss 12.1 Amaurosis Fugax and Central Retinal Artery Occlusion 12.1.1 General Considerations 12.1.2 History 12.2 Exam 12.3 Diagnostics 12.4 Treatment 13 Retinal Detachment 13.1 General Considerations 13.2 History 13.3 Exam 13.4 Treatment 14 Pinguecula and Pterygium Further Reading Dermatology 1 Introduction 2 Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) 2.1 General Considerations 2.2 History 2.3 Exam 2.4 Diagnostics 3 Drug Eruption with Eosinophilia and Systemic Symptoms 3.1 General Considerations 3.2 History 3.3 Exam 3.4 Diagnostics 4 Pemphigus Vulgaris 4.1 General Considerations 4.2 History 4.3 Exam 4.4 Diagnostics 5 Purpura and Vasculitis 5.1 General Considerations 5.2 History 5.3 Exam 5.4 Diagnostics 6 Angioedema 6.1 General Considerations 6.2 History 6.3 Exam 6.4 Diagnostics 7 Viral Infections in the Immunosuppressed 7.1 General Considerations 7.2 History 7.3 Exam 7.4 Diagnosis Further Reading Psychiatry 1 Introduction 2 Depression and Anxiety 3 Suicide 3.1 General Considerations 3.2 History 3.3 Exam 3.4 Diagnostics 4 Psychosis 4.1 General Considerations 4.2 History 4.3 Exam 4.4 Diagnostics 5 Altered Mental Status and Delirium 5.1 General Considerations 5.2 History 5.3 Exam 5.4 Diagnostics 6 Withdrawal Syndromes 6.1 General Considerations 6.2 History 6.3 Exam 6.4 Diagnostics 7 Neuroleptic Malignant Syndrome (NMS) 7.1 General Considerations 7.2 History 7.3 Exam 7.4 Diagnostics 8 Serotonin Syndrome (SS) 8.1 General Considerations 8.2 History 8.3 Exam 8.4 Diagnostics Further Reading Index