THE GOLDEN RULES

 

First do no harm           Beware the silent chest in asthma           Common things are common           The best monitoring device is you           You are never too busy to treat someone's pain           An unstable patient should never leave the department unescorted           Beware of abdominal pain in the young and elderly           Don't be afraid to say you don't know           A basic neurological exam always include a test for co-ordination           Experience is the ability to make the same mistakes over and over again with increasing confidence           Fever may mean sepsis or meningitis in the infant           The priorities of treatment ABC and Analgesia           Not all vertigo is due to vestibular problem           Never be afraid to get help           Low oxygen saturation and blood pressure needs immediate treatment           Beware a normal pCO2 in asthma           Most cardiac arrests are preventable           Shock is the silent killer           Any person with abnormal mental state, seizures or coma needs a BSL           If you don't ask the patient you will never know           'Sudden' anything is usually a bad sign           The absence of an answer is not the same as the absence of a problem            Renal calculi + obstruction + infection = sepsis           There is no such thing as an unobtainable history           Sudden abdominal pain in pregancy = ectopic           Only a competent patient can leave against advice           Everyone makes mistakes - Fools make them twice           Airway obstruction and respiratory depression are easily missed in drowsy patients           Frusemide is rarely the treatment for oliguria           Tests are an expensive form of procrastination            You won't diagnose it if you didn't think of it           A collapse is cardiac in origin until proven otherwise           Treating a patient includes treating their anxieties            The last place you want to treat an emergency is in a lift           Spinal patients are vulnerable to many illnesses           Any ONE of the following may mean PE - chest pain OR hypoxia OR tachycardia OR syncope           Never be afraid to ask for help           All neonates with fever require admission           Absence of a symptom is often due to the absence of the question           More is missed by not doing then not knowing           Low BSL is easily treated but often forgotten           Abnormal vital signs always need to be explained           Beware of the 'worst-ever' headache in migraine sufferers           People sue due to poor communication rather than poor treatment     Early pregnancy bleeding is ectopic until proven otherwise           With most things, it is all in the history           Hidden blood loss catches someone everyday           If the patient doesn't trust you then you might as well go home           Cardiac enzymes rarely tell you something that you already didn't know from the history           Don't order a test that you aren't intending to follow up           Beware of discharging a patient with abnormal vital signs           One normal ECG does not rule out MI           Beware the diagnosis of 'anxiety'           Beware of a 'sudden-onset' headache           If you can remember only one thing - remember ABC           You may not be able to fix someone but at least show that you have tried           Infection is not the only cause of exacerbation of COAD           Respiratory alkalosis is not always related to anxiety           Monitors - the most misused equipment in the ED           A lot of abnormal patient behaviour stems from fear and anxiety           PPPPPP - Prior preparation prevents piss-poor performance           For most people 3 litres in and   litre out per day           New onset constipation is cancer until proven otherwise           Don't forget Anti-D in early pregnancy bleeding           Beware of the child that doesn't cry           'Vaso-vagal'syncope is a diagnosis of exclusion           Anaphylactic shock does not need a rash           A normal CT does not rule out SAH           Beware of abdominal pain in spinal patients           Fever + chemotherapy = febrile neutropenia           Any women of child-bearing age with abdominal pain is pregnant until proven otherwise           If a person say they have pain, believe them           Constipation is a symptom not a diagnosis           Test - an excuse for lazy thinking?           Fever + Jaundice = ascending cholangitis           Knife-wounds can be more serious than they look            Broad complex tachycardia is VT until proven otherwise           Pain is a potent respiratory stimulant           It is not tonsillitis if they annot open their mouth           Fluid resuscitation is more important than frequent BP checks           Cleaning a wound is infinitely more important than closing it           Don't let pregnant women lie flat           Serum potassium is the most important electrolyte in a cardiac arrest           Don't believe everything you see on a monitor           A calf sprain may in fact be a tendon rupture           Persistent tachycardia should never be attributed to anxiety

 

 

 

Always have a back-up plan           Uncommon presentations of common diseases happen more often than common presentations of uncommon diseases           Beware of fever in the immuno-compromised           Do not discharge a swollen, infected hand           A sore throat can sometimes be fatal           Be careful of repeat presentations            The commonest cause of metabolic acidosis is undiagnosed shock           Beware of trauma in the warfarinised patient           A proper ENT exam includes ears, nose, throat AND neck           Always look for compartment syndrome in long-bone fractures           Beware of abdominal pain in a person on steroids           Not all childhood injuries are accidental           Be careful when diagnosing 'drug-seeking behaviour'           Most differential diagnoses include infection           Don't wait for the blood pressure to fall before treating shock           Abnormal behaviour has an organic cause until proven otherwise           Never close a bite wound           Learn to read blood gases           It is amazing how many ruptured aneurysms die from 'renal colic'           Air (oxygen) and  water (fluid) save lives           Unappreciated sepsis kill someone every day           ECGs made easy? - first learn to diagnose VT and an acute MI           Carer and relatives are often more important sources of history than the patient           Watchful waiting still means you have to be watchful           Macrocytic/Microcytic blood pictures should always be noted           Beware of hypertension in late pregnancy           Proper patient instruction and follow-up prevents many disasters           Proper wound cleaning prevents infection more than antibiotics           Never give steroids to the red eye           Superior judgement is better than superior skill           A UTI in a child is never normal           A change in vital signs is as important as abnormal signs           Beware of a 'normal' blood pressure in a paraplegic           Always compare tests with old ones - labs, ECG , X-rays           Beware of back pain in the elderly           Babies get cold very quickly           Beware of any headache in AIDS           Pregnancy + seizure = eclampsia           Don't just assess, re-assess           Aortic dissection is more common than you think           Normal cardiac enzymes do not rule out MI           Sudden-onset anything is a bad sign           Don't x-ray bones that you don't know the names of           An indeterminate V/Q means nothing           Beware of haematemesis in a person with a AAA           Beware of head injuries in a drunk           Psychiatric patients also get sick           In chest pain, history is (almost) everything           Don't forget organic causes in psychiatric illness           There is no such thing as a 'wrist sprain'           If you think a person is sick, you are probably right           Shingles is the great mimicker           Fever and hypotension = septic shock           Beware of people holding their heads after a neck injury           If someone looks like their heart has stopped then it probably has           If you don't know what you are looking for then ordering a test won't help           Chronic steroids can mask infection           Drug users get sick too           One set of vital signs is rarely enough           TIAs do not make people 'collapse'           A thorough history and exam beats a test any day           Don't forget temporal arteritis and acute glaucoma in headache           X-rays are rarely helpful in abdominal pain           Hypothermia may equal infection           Learn to read a lateral wrist xray           An ignored monitor is worse than no monitor           Oxygen - under-prescribed in the sick and over-prescribed in the well          Never discharge unrelieved or undiagnosed chest pain           Give antibiotics early in meningitis           Lack of O2 kills faster than too much CO2            A low serum bicarbonate is never normal           The most important person in the department is the patient          GI bleeding is often under-estimated           A discharge involves a discharge plan           Undiagnosed sepsis is the commonest  cause of preventable death           Another person's pain is easy to bear       An emergency is the last place to learn how to put in a 16 gauge cannula