المحتوى التفصيلي والمواضيع الرئيسية لكورس طوارئ الباطنة الشامل
Course Curriculum
1. How To Identify Acute Unwell Patient
NEWS 2 Score
2. ABCDE Assessment
• Assessment, warning signs and actions of:
A – Airway
B – Breathing
C – Circulation
D – Disability
E – Exposure
DEF – Glucose and Heroin
3. Resuscitation For Unresponsive Pulseless Apnic Patient
• Check response
• BLS – Basic Life Support
• ACLS – Advanced Cardiac Life Support
4. Approach to Chest Pain in ER
To assess a case of chest pain, follow these steps:
Step 1: What are the causes of chest pain?
Step 2: Memorize the clues for each cause
Step 3: Take focused history and focused examination depending upon clues elicited from the history
Step 4: What to do? Investigations
5. Management of Acute Coronary Syndrome
A: STEMI (ST segment elevation MI)
B: NSTE-ACS (Non-ST segment elevation ACS)
• NSTEMI (Non-ST elevation MI)
• UA (Unstable Angina)
6. Management of Other Causes of Chest Pain
• Aortic dissection
• Cardiac tamponade
• Pulmonary embolism
• Tension pneumothorax
• Pleurisy
• Esophageal perforation
• Diffuse esophageal spasm
• Musculoskeletal
• Herpes zoster
• Panic attack
7. Approach to Acute Dyspnea in ER
To assess a case of Acute Dyspnea, follow these steps:
Step 1: What are causes of Acute Dyspnea
Step 2: Clues for each cause
Step 3: Focused history, focused examination and general investigation
Step 4: Management of each cause
8. Management of Pulmonary Edema
• Cardiogenic Pulmonary Edema
• Non-cardiogenic Pulmonary Edema (ARDS)
9. Management of:
• Pleural effusion
• Acute COPD exacerbation
• Acute asthma exacerbation
10. Management of:
• Acute Upper Airway Obstruction ( Stridor )
• Psychogenic dyspnea
• Hyperventilation
11. Approach Palpitation in ER
To assess a case of palpitation, follow these steps:
Step 1: Causes and clues for each cause
Step 2: Focused history, focused exam
Step 3: What to Do? Investigations
Step 4: Management of each cause
12. Management of:
♦ Regular Arrhythmia:
• Sinus Tachycardia
• Supraventricular Tachycardia (SVT)
• Ventricular Tachycardia (VT)
• Heart Block ?!
♦ Irregular Arrhythmia:
• Regular irregular → Extrasystoles
• Irregular irregular → Atrial Fibrillation (AF), Multifocal Atrial Tachycardia (MAT)
13. Hypertensive Crisis in ER
• Hypertensive Emergency
• Hypertensive Urgency
14. Hypotension in ER
• Stable Patient !!
• Shocked Patient !!
15. Shock in ER
To Assess a Case of Shock, Follow these steps:
Step 1: How to recognize shock?
Step 2: Identify the type:
• Hypovolemic
• Cardiogenic
• Distributive
• Obstructive
Step 3: Easy Types to Know!!
Step 4: What to do in ER:
• ABC assessment
• IV fluids
• RUSH protocol
16. Hypovolemic Shock
Step 1: How to recognize?
Step 2: Which type of hypovolemic shock:
• Fluid loss
• Blood loss
Step 3: Investigations
Step 4: Management of each type
17. Distributive Shock
Step 1: How to recognize?
Step 2: Which type of distributive shock:
• Septic shock
• Anaphylactic shock
• Adrenal Crisis
• Neurogenic shock
Step 3: What to DO? investigations
Step 4: Management of each type
18. Obstructive & Cardiogenic Shock
Step 1: How to recognize?
Step 2: Which type
Step 3: Investigations
Step 4: Management of each type
19. Upper Respiratory Tract Infection
• Coryzal (Nasal)
• Sore throat
20. Lower Respiratory Tract Infection
• Bronchitis
• Pneumonia
21. Approach to Hemoptysis in ER
Step 1: Identify the cause
Step 2: Stabilization if massive & Focused history and examination
Step 4: What to Do? Investigations
Step 5: How to Manage?
22. Approach to Fever in ER
♦ Ask about duration:
• ≤ 2 weeks → Acute febrile illness
• 2–3 weeks → Persistent fever (FUO)
♦ Follow these steps:
Step 1: Causes and clues
Step 2: History, examination, screen for sepsis?
Step 3: What to do? (Investigations)
Step 4: Admission and management of the cause
23. Fever of Unknown Origen ( FUO )
Fever lasting more than 2–3 weeks
24. Transient Loss of Consciousness (TLOC)
To assess a case of TLOC, follow these steps:
Step 1: Causes and clues
• Syncope
• Seizure
• Conversion
• TIA
• Hypoglycemia
• Others
Step 2: Focused history / examination
Step 3: What to do? (Investigations)
Step 4: Management of each cause
25. Approach to Dizziness in ER
• Vertigo
• Pre-syncope (impending fainting)
• Non-specific
26. Disturbed Conscious Level (DCL)
DCL classified into:
♦ Coma
• Unarousable unconsciousness (GCS < 9)
♦ Coma mimics:
• Locked-in syndrome
• Brain death
• Vegetative state
• Psychogenic unresponsiveness
♦ Delirium
• Acute confusional state (GCS > 9)
27. Delirium (Acute Confusional State)
♦ To assess a case of delirium, follow these steps:
Step 1: Causes and clues for each cause
Step 2: History
Step 3: What to do? (Investigations)
Step 4: How to Manage? (ABC approach + manage the cause if possible)
♦ Management of meningitis and encephalitis
28. Approach to Seizures in ER
♦ Classification of seizures (4 types):
1. Focal seizures
2. Generalized tonic-clonic
3. Non-convulsive fits
4. Functional non-epileptic seizures
♦ To assess any case of seizure follow these steps:
Step 1: Identify type then causes
Step 2: History and examination
Step 3: What to do? (Investigations)
Step 4: How to Manage? (stabilization in ER + treat each cause)
♦ Status Epilepticus
29. Approach to Headache in ER
♦ Headache in ER classified into:
• Sudden severe headache (Thunderclap headache)
• Acute headache (Primary)
• Secondary headache
30. Approach to Hemiplegia in ER
Hemiplegia may be:
♦ Stroke: Ischemic, Hemorrhagic, TIA
♦ Stroke mimics:
• Multiple sclerosis (MS)
• Encephalitis
• Brain tumor (SOL)
• Hypoglycemia
• Hysterical hemiplegia
• Hemiplegic migraine
31. Paraplegia and Quadriplegia in ER
Sensory level:
♦ Myelopathy
• Compressive
• Non-compressive
♦ Pure motor or glove/stocking pattern:
• Acute peripheral neuropathy → Guillain-Barré Syndrome (GBS)
• Myasthenic crisis
• Myopathy
32. Stroke
• Ischemic infarction
• Transient Ischemic Attack (TIA)
• Intra-Cerebral Hemorrhage (ICH)
• Cerebral venous infarction
• Subdural hemorrhage
33. Approach to Acute Abdominal Pain in ER (1)
To Assess acute abdominal pain in ER , follow these Steps:
Step 1: Causes and simplified approach
• Epigastric Pain
• Right Hypochondrial Pain
• Left Hypochondrial Pain
• Periumbilical Pain
• Right Lumbar Pain
• Left Lumbar Pain
• Supra-Pubic Pain
• Right Iliac Pain
• Left Iliac Pain
• Diffuse Abdominal Pain
34. Approach to Acute Abdominal Pain in ER (2)
Step 2: Focused history and examination
Step 3: What to do? (Investigations)
Step 4: How to Manage each cause?
35. Approach to Vomiting in ER
Follow these steps:
Step 1: Is it acute or persistent? Causes and clues
Step 2: History and examination
Step 3: What to do? (Investigations)
Step 4: How to Manage?
36. Approach to Diarrhea in ER
Follow these steps:
Step 1: Is it acute or chronic? Causes and clues
Step 2: History and examination
Step 3: What to do? (Investigations)
Step 4: How to Manage?
37. Approach to Upper GI Bleeding in ER
To assess a case of upper GI bleeding:
Step 1: Identify type, then resuscitate (IV fluids + ABC approach)
Step 2: History and examination
Step 3: What to do? (According to cause)
Step 4: How to Manage?
38. Approach to Lower GI Bleeding
To assess a case of lower GI bleeding:
Step 1: Identify type of bleeding — Causes / Clues
Step 2: History and examination
Step 3: What to do? (Investigations)
Step 4: How to Manage each cause?
39. Introduction to Chronic Liver Disease
Signs of Decompensation:
• Vascular
• Parenchymal
40. Ascites in CLD
Types of ascites:
• Moderate
• Tense ascites
♦ Indication of paracentesis
41. Spontaneous Bacterial Peritonitis (SBP)
Step 1 : How to recognize and suspect it?
Step 2 : What to do? (Investigations)
Step 3 : How to Manage?
42. Approach to Ascites
Ascites may be:
• Transudative → ↓ Protein (< 3 gm)
• Exudative → ↑ Protein (> 3 gm)
43. Hepato-Renal Syndrome
Step 1 : How to recognize and suspect it?
Step 2 : What to do? (Investigations)
Step 3 : How to Manage?
44. Hepatic Encephalopathy
Step 1 : How to recognize and suspect it?
Step 2 : What to do? (Investigations)
Step 3 : How to Manage?
45. Approach to Jaundice
Follow these steps:
Step 1: How to identify type?
Step 2: What to do? (investigations)
Step 3: How to Manage each type
46. Acute Kidney Injury (AKI)
Follow these steps:
Step 1: Identify type of AKI
Step 2: What to do? (Investigations)
Step 3: How to Manage each type?
47. Management of AKI
• Fluid management
• Management of hyperkalemia
• Management of metabolic acidosis
• Indications for urgent dialysis
48. Hyperkalemia & Hypokalemia
To assess a case of Hyper or Hypokalemia, follow these steps:
Step 1: Causes / Clues
Step 2: History / Examination
Step 3: What to do? (Investigations)
Step 4: How to manage each cause?
49. Approach to Hyponatremia
Follow these steps:
Step 1: Causes / Clues for each cause
Step 2: Focused History / Examination
Step 3: What to do? (Investigations)
Step 4: How to manage each cause
50. Approach to Hypernatremia
Follow these steps:
Step 1: Causes / Clues for each cause
Step 2: Focused History / Examination
Step 3: What to do? (Investigations)
Step 4: How to manage each cause
51. Approach to Hypo & Hypercalcemia
Follow these steps:
Step 1: Causes / Clues for each cause
Step 2: Focused History / Examination
Step 3: What to do? (Investigations)
Step 4: How to manage each cause
52. Diabetic Ketoacidosis (DKA) in ER
To assess a case of DKA, follow these steps:
Step 1: How to identify? (Criteria)
Step 2: Focused History / Examination
Step 3: What to do? (Investigations)
Step 4: Management in ER / ICU
53. Hyperosmolar Hyperglycemic State (HHS)
To assess a case of HHS, follow these steps:
Step 1: How to identify? (Criteria)
Step 2: Focused History / Examination
Step 3: What to do? (Investigations)
Step 4: Management in ER / ICU
♦ Stress hyperglycemia
54. Hypoglycemia in ER
Step 1: How to recognize?
Step 2: History / Examination
Step 3: What to do? (Investigations)
55. Endocrinal Emergencies
• Adrenal Crisis
• Thyroid Storm
• Myxedema Coma
56. Rheumatological Emergencies
• Joint Articular Presentations
• Multi-System Affection
• Vasculitic Rash
57. Hematological Emergencies
• Anemia
• Thrombocytopenia
• Neutropenia
• Pan / Bi-cytopenia
58. Toxicology in ER
To deal with patient having toxicity, follow these steps:
Step 1: Rapid History, ABC, First Aid
Step 2: Explore clues for some toxicity
Step 3: Management for each
59. Generalized Edema (Anasarca) in ER
To deal with patient having anasarca, follow these steps:
Step 1: Causes / Clues
Step 2: History / Examination
Step 3: What to do? (Investigations)
Step 4: How to manage each cause
60. Pre-eclampsia / Eclampsia in ER
Follow these steps:
Step 1: How to identify? (Criteria)
Step 2: Focused History / Examination
Step 3: What to do? (Investigations)
Step 4: How to Manage?
61. ECG in ER / Casualty
♦ Simple Introduction to ECG
• Systematic Comment on ECG
• Rapid Comment on ECG
♦ When to order ECG in ER?
62. ECG in Chest Pain
♦ ECG in Acute Coronary Syndrome (ACS):
• STEMI
• NSTEMI
• UA
♦ ECG in Pulmonary Embolism
63. ECG in a Patient with Palpitation
♦ Regular Arrhythmia
♦ Irregular Arrhythmia
64. ECG in a Patient with Syncope
♦ Bradyarrhythmias
65. ABG in ER
♦ Simple Introduction to ABG
♦ When to order ABG in ER?
66. ABG Interpretation
Examples of ABG Interpretations
67. Metabolic Acidosis in ER
♦ How to deal with a patient having metabolic acidosis in ER?
68. Respiratory Acidosis in ER
♦ How to deal with a patient having Respiratory acidosis in ER?
69. Respiratory Alkalosis & Metabolic Alkalosis
♦ How to deal with a patient having:
• Respiratory Alkalosis in ER
• Metabolic alkalosis in ER
70. CBC in ER
• Simple Introduction
• Abnormalities of CBC, How to Deal?
• When to order CBC in ER?
71. Liver Function Tests (LFT)
• Simple Introduction
• When to order LFT in ER?
• Abnormalities, How to Deal?
72. Renal Function Tests (RFT)
• Simple Introduction
• When to order RFT in ER?
• Abnormalities, How to Deal?
73. Coagulation Profile & ESR & CRP
• Simple Introduction
• When to order in ER?
• Abnormalities, How to Deal?
74. Chest X-Ray in ER
• Simple Introduction
• When to order CXR in ER?
• Pathological Changes, How to Deal?
75. CT Chest in ER
• Simple Introduction
• When to order CT in ER?
• Pathological Changes, How to Deal?
76. Abdominal X-Ray in ER
• When to order Abdominal X-Ray in ER?
• Pathological Changes, How to Deal?
77. CT Brain in ER
• Introduction to Normal CT Brain
• When to order CT Brain in ER?
78. Pathological Changes in CT Brain
• Ischemic Stroke
• Hemorrhagic Stroke
• Subarachnoid Hemorrhage
• Subdural Hemorrhage
• Extradural Hemorrhage
79. Fluids & Fluid Therapy in ER
• Normal Water Distribution in the Body
• Types of Fluids & Distribution
• When to Use Fluids
• How to Assess Fluid Status
• How to Calculate Fluid & Choose for Your Patient