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ER goldbook
"To study the phenomenon of disease without books is to sail an uncharted sea, while to study
books without patients is not to go to sea at all." Sir William Osler 1894-1919

17

..2556
Acutepainmanagement

(Acutepain)

Visualanalog
scale)

Recentpost
EDbasicknowledge/prehospitalcare
Specialsituation
Resuscitation
Cardiovascularemergency

***visualanalogscale

13mm

>30mm

Pulmonaryemergency
Gastrointestinalemergency
Renal&GUemergency
OB/GYNemergency
Pediatricemergency
Infectiousemergency
Neurologicalemergency
Toxicology
Environmentalemergency
Endocrineemergency

hospiceworld.org:Visualanalogscale

Hematologic/rheumatological/dermatol
gyemergency
Eye,ENT,oralemergency

Mildpain(VAS<40mmNRS<4)

Trauma&orthopedicemergency

Moderatepain(VAS4070mmNRS47)

Psychosocialissue

Severepain(VAS>70mmNRS>7)

AdministrationinED
CommondiseaseMx(Nonemergency)

lowpotency

highpotency

mild

moderatepain
NSAIDs
moderateseverepain

opioid

NSAIDs
NSAIDs

renalcolic,biliarycolic

Search

Nonopioid
Paracetamol650mgPOq46h
NSAIDs
aspirin325650mgPOq4h,ibuprofen400800mgPOq46h,
celecoxib100200mgPObid(IV

POroute

)
Opioid

Morphine0.1mg/kgIV
10mgIM/SC(onset12min(IV),1015min
(IM/SC)peakeffect35min(IV),1530min(IM))
Fentanyl1.0mg/kgIV(onset<1min(IV)peakeffect25min(IV)duration

FOAMEM
LITFL
ResearchandReviewsinthe
Fastlane080
12

FOAMEMRSSFOAMEMRSS
VisualDiagnosis#10
18

3060minutes(IV))
100gnasalspray
Tramadol50100mgPO(onset1015minduration46h)
***

(hypersensitivity)

piperidine
(fentanyl,alfentanil,sufentanil,
meperidine)
***

sideeffect
antiemeticdrug

lowrisk
OpioidAgonistantagonist
buprenorphinebutorphanol,dezocine,nalbuphine,
pentazocine

opioidadditive
withdrawalsymptoms

Ketamine0.20.3mg/kgIVover10mindrip

trauma,acuteflareneuropathicpain
SCdrippalliative

care

Nitrousoxide

prehospitalcare

mixtureO2(50/50,70/30)

alteredmentalstatus,headinjury,
pneumothorax,perforatedabdominalviscus
Topicalmedication
topicalNSAIDssofttissueinjury,topical
lidocainepostherpeticneuralgiadiabeticneuropathy,topical
capsaicin

Anticonvalsant,cyclicantidepressant
neuropathicpain

Amitriptyline10mgPOodintheevening,gabapentin300mg/d,carbamazepine
100mgPObid,pregabalin50mgPOtid

(inflammation)(musclespasm)

immobilization

cognitivebehavioraltechnique
TEN
Specificpopulation

doseopioid

renaldysfunction
fentanyl

GFR<50

Fentanyl

75%dose
GFR<10

50%dose

Trauma
fentanyl

regionalanalgesia

intranasaldrugdelivery,drugseekerinER

Ref:Tintinalli'semergencymedicine8ed,medscape,painmanagementinpatientswith
CKD2009NDTplus

(EPnote)
20:16

Alcoholicwithdrawalsyndrome
2

Electrolyteimbalance
Fluid&ElectrolyteHyperkalemia/
HypokalemiaHypernatremia/
HyponatremiaHypercalcemia/
Hypocalcemia
Hypermagnesemia/hypomag...
EKGinterpretation

EKG

StandardizationRhythmRate
PwavePRinterv...
StrokeFastTrack
***

AmericanCollage
ofEmergencyPhysicians
AmericanAcademyofNeurology

LevelAtPA

...

(MassCasualty
Incident:MCI)

(Mass...
Localizationofneurologicallesion
Approachtoneurologicalcases

Localization:...

(Acute
pancreatitis)
Pancreatitis

2/3

Serum
amylase
lipaselevels>3xUNL
Imagefinding(US...
UpperGIhemorrhage(UGIH)
Resuscitation(protectairway,oxygen,
ECGmonitoring,ivaccess)History

(hematemesis)

...
BasicUSinER

probe

Curved
arrayprobe
USabdomen,
vascularmorbidlyobesity,...

(Asthma)&

(Acuteasthmaticattack)
AsthmaDx:Triad:

(wheezing)

(...

Emergency

SeverityIndex(ESI)

...

4 2 1 4 7 9

...

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