Emergency and Urgent Care
Core concepts
Emergency medicine rewards rapid triage and pattern recognition. Master ABCs, shock recognition, and time-critical diagnoses: STEMI, stroke, sepsis, anaphylaxis, and pulmonary embolism. Know when to activate pathways (e.g., tPA window for ischemic stroke, door-to-balloon for STEMI) and the initial stabilization steps. Understand sepsis bundles (cultures, antibiotics, fluids), anaphylaxis management (IM epinephrine first), and opioid overdose (naloxone). Recognize red flags in headache, chest pain, and abdominal pain that mandate urgent workup.
Traps
- Giving antihistamines or steroids before IM epinephrine in anaphylaxis-epinephrine is first-line.
- Delaying antibiotics in sepsis while awaiting results.
- Missing atypical presentations of ACS in women, older adults, and diabetics.
- Confusing the stroke thrombolysis window (up to 4.5 hours in eligible patients) with thrombectomy eligibility.
Worked example / rule of thumb
A patient with hives, wheezing, and hypotension after a bee sting: give IM epinephrine to the lateral thigh immediately, then airway support, fluids, and adjuncts. Rule of thumb: in anaphylaxis, epinephrine is the first and most important drug.
Triage
Use validated tools (e.g., HEART score for chest pain, NIHSS for stroke) to risk-stratify and decide disposition. Document reassessment.