KNOW THE HIGH RISK BIG KILLERS FOR EACH SYMPTOM
Chest Pain: Big 5:AMI, Aortic Dissec./Aneur/Tear, PE, Pneumothorax, Pericarditis
Belly Pain: Big 14: Appendicitis, Aortic Aneurysm/Dissection, Perforated Ulcer, AMI, Bowel Obstruction, Ischemic Bowel, Ectopic Pregnancy, Perforated Divertiulum/Abscess., Cholangitis/cholecystitis, Ruptured Spleen, Occult Trauma, Pancreatitis, Pneumonia, Incarcerated Hernia
Dyspnea: Big 7: PE, Ventilatory failure/hypoxemia, CHF, Pneumonia, Pneumothorax, Metabolic Acidosis, Asthma/COPD
Stridor: Big 5: Epiglottitis, FB, Retropharyngeal Abscess, Tracheitis, Anaphylaxis
Headache: Big 8: SAH, Meningitis/encephalitis, Tumor, AVM, Temporal Arteritis, HTN Crisis(Malignant=papilledema), CO, RMSF
Neuro deficit: Big 5: TIA, CVA in Evolution, Hemorrhagic CVA, Tumor, Intracerebral Hematoma: Intracortical=Dilantin
Overdose: Big 11: ASA, Tylenol, TCA, Cocaine, Theophylline, Narcotics, CO, Methanol,Ethylene Glycol, B-blocker, CCB, Cyanide(fire= MetHb)
Peds fever: Big 4: Meningitis, Pneumonia, Pyelonephritis, Occult Bacteremia
Peds diarrhea: Big 3: Dehydration(urine W/i 6-hrs), Reyes, Bacterial Diarrhea
Peds Trauma: Big 4: Child Abuse, Spleen/liver Bleed, ICH, Pulmonary Contusion
Ob: 3rd Trimes: Big 6: Premature Labor, Fetal Distress, Abruptio, Placenta Previa, Appendicitis, Ruptured Uterus
Ob: HTN/edema: Preeclampsia: Get HELLP(hemolysis, elevated LFTs, low platelets)
Ob: Rash/fever: Rubella (German Measles-baby killer)
Ob: Bleeding/childbirth: Rh Incomp., Retained Products, septic endometritis, DIC
Gyn: abnormal bleeding: Big 4: Ectopic, Cervical Cancer, Ruptured TOA & Hem. Cor. Lut. Cyst
Red/pain Eye: Big 7: Glaucoma, Iritis, FB, Herpes Keratitis, Chemical Conjuctivitis, Periorbital/Orbital Cellulitis, Corneal Ulcer
Dec. Vision: Big 5: Central Retinal Artery/Vein, Detached Retina, Temp. Arteritis, Amaurosis Fugax, Papillitis(multiple sclerosis)
Eye Trauma: Big 7: Blow-out Fx, Hyphema, Retinal Detachment, Corneal Lac, Globe Lac, Complex Lid Lac(margin,sept. Fat Exposed), Retained FB
Facial Trauma: Big 5: Septal Hemat., Blowout Fx, Sinus Fx, Pinna Hemat., Tripod Fx.
Hand Injury: Big 5:Gamekeepers Thumb, Mallet, FPL Injury, Keep MCPs at 90 Degrees W/splinting, Tendon, Artery & Nerve injury, FB
Wrist Pain: Big 5: CTS, Scaphoid Fx, Lunate/perilunate Dislocation, VISI-DISI, DeQuervains/Intersection Syndrome
Bone/jt. Pain: Big 4: Tenosynovitis, Osteomyelitis, Septic Arthritis, Aseptic Necrosis
Ottawa Ankle Rules: must Have All Three: 1. Take 4 FWB Steps in ED, 2. No Post (med&lat) Malleolar Tenderness to Palpation, 3. NL Mental Status
Head Trauma: Big 4: Epidural, Subdural, Cerebral Bleed: Intracortical=Dilantin, Cerebellar Bleed: (>3cm=surgery)
Neck Injury: Big 4: C-spine Fx/disloc.,SCI, Penetrating Neck (Platysma Violated), Upper Airway Injury: expanding hematoma
Chest Trauma: Dirty Dozen: 6- Quick Killers:airway Obstruction, Cardiac Tamponade, Open Pneumo, Tension Pneumo, Hemothorax, Flail Chest; 6-slow Killers: Cardiac Contusion, Lung Contusion, Aortic Tear(may Have HTN in ED), Tracheal/bronchial Tear, Diaphram Tear, Esophgeal Tear
Belly Trauma: Big 5: Rupt. Spleen/liver, Perf. Viscus, GU Injury(clear Urine=Nothing Surgical), Pelvic Fx, Retroperitoneal Hematoma; Always Do Rectal
Back Injury: Big 4: Vertebral Fracture, SCI, GU Injury, Retroperitoneal Injury(falls)
Wounds: Big 7: FB, Open Fx, Tendon Lac, Nerve Lac, Human / Animal Bite, High Pressure Injury
Painful Swollen Extremities: Big3: Cellulitis, DVT, Compartment Syndrome
Testicle Pain: Big 4: Appendicitis, Torsion, Epididymitis, Kidney stone at UVJ
Dysuria: Big 3: Pyelonephritis, Prostatitis, STD
Psych: depression: Big 2: Suicide, Occult Drug Ingestion
Psychosis: Big 5: Psychiatric, Metabolic, Meningitis, CVA, OD, AEIOUTIPPS
Intox Pt.: Big 6: Etoh, OD, Ethylene Glycol, Methanol, ICH, Delerium Tremens
