Emergent Conditions

Shock

• Undifferentiated

• Hypovolemic

  • Blood loss: Hemorrhage

  • Water/electrolyte loss: Vomiting, diarrhea, diuresis

  • Plasma loss: Burns

• Cardiogenic/obstructive

  • Heart defect: Acute coronary syndrome, cardiomyopathy, valvular insufficiency

  • Arrhythmia

  • Obstruction

• Distributive: ↑ vasodilation/capillary permeability = ↓ distribution

  • Anaphylaxis

  • Sepsis

  • Myxedema/adrenal crisis

  • Neurogenic (↓ vascular tone)

Cardiovascular

• Acute coronary syndrome

• Tachycardia: Atrial fibrillation with rapid ventricular response

• Bradycardia

Neurologic

• Stroke

  • Ischemic

  • Hemorrhagic

• Status epilepticus

Obstetric

• Shoulder dystocia

• Vaginal breech delivery

• Postpartum hemorrhage

• Preeclampsia with severe features

Pediatric

Emergency Department Presentations (Most to Least Common)

• Respiratory distress

  • Upper respiratory (most common): Deviated nasal septum, allergic rhinitis, acute laryngitis, acute/chronic tonsillitis, streptococcal sore throat

  • Lower respiratory

    • Chief complaint: Cough, wheezing

    • Diagnosis: Influenza, asthma, acute bronchitis, bronchiectasis, pneumonia, aspiration pneumonitis, pneumothorax

• Injury and poisoning

  • Injury per CHOP: Physical abuse, traumatic brain injury, burn, dental trauma, open long bone fracture, pelvic fracture, head trauma, laceration, spinal cord injury

  • Additional injury: Concussion, skull/maxillofacial fracture, ankle sprain, wrist sprain

• Neurologic

  • Headache

  • Convulsion/seizure

  • Gait disturbance

• Gastroenterological

  • Common

    • Colic

    • Nausea/vomiting/diarrhea: Gastroenteritis

    • Constipation: HoldingOrders, CHOP

  • Life threatening: Adhesions, appendicitis, hemolytic uremic syndrome, intussusception, primary bacterial peritonitis

    • Neonate: Malrotation and midgut volvulus, necrotizing enterocolitis

    • < 5 years old: Foreign body ingestion, incarcerated hernia, Hirschsprung disease

    • > 5 years old: Trauma, myo/pericarditis, diabetic ketoacidosis, perforated ulcer

  • Surgical emergencies: Hypertrophic pyloric stenosis, appendicitis, Meckel's diverticulum, intussusception, malrotation, and midgut volvulus

• Fever of unknown origin

• Mental and substance abuse disorders

  • Behavioral health issues including suicidal ideation, aggressive behavior, mental health concerns, developmental/autism spectrum disorders

  • Cannabis use, alcohol use, opioid use

• Genitourinary disorders

  • Urinary tract trauma, urinary tract infection, hydronephrosis, nephrolithiasis, glomerulonephritis, hemolytic uremic syndrome

  • Males: Inguinal hernia, priapism, hydrocele, scrotal/testicular pain (HoldingOrders, CHOP)

  • Females

    • Uterine bleeding (HoldingOrders, CHOP, CHOP DDX)

    • Pelvic pain: Pelvic inflammatory disease, ruptured ectopic pregnancy

• Musculoskeletal disorders

• Skin and subcutaneous tissue disorders

• Endocrine disorders: Diabetes mellitus

• Dehydration

References

• CHOP Clinical Pathways Library - Emergency

• Weight-based resuscitation

• Pharmacology