Emergency Medicine

Perform ED triage assessment for [patient]:

Chief complaint: [patient's stated problem]
Vital signs: [initial vitals]
Appearance: [overall presentation]
History: [brief relevant history]
Arrivals: [ambulance vs walk-in]
ED volume: [busy status]

Triage assessment:
- ESI level (1-5 determination):
  - Level 1: Resuscitation (immediate, life-threatening)
  - Level 2: Emergent (high risk, severe pain, altered mental status)
  - Level 3: Urgent (stable with 2+ resources needed)
  - Level 4: Less urgent (1 resource needed)
  - Level 5: Non-urgent (no resources needed)
- Rationale for ESI level
- Immediate interventions needed
- Red flags identified
- Isolation precautions needed
- Resources anticipated
- Pain score
- Fall risk
- Estimated wait time communication
- Reassessment time if not immediately roomed
- Special populations (pediatric, geriatric, behavioral)
- Documentation of decision-making
- Communication to team

Conduct rapid medical assessment for [emergency]:

Presentation: [chief complaint]
Vitals: [abnormal values]
Time sensitivity: [stroke, MI, trauma]
Patient responsiveness: [alert vs altered]
Mechanism: [if trauma]

Rapid assessment (ABCDE approach):
- Airway: Patent, threatened, obstructed?
  - Intervention needs (positioning, airway adjunct, intubation)
- Breathing: Rate, effort, oxygen saturation
  - Breath sounds, work of breathing
  - Oxygen/ventilation needs
- Circulation: Pulse, BP, perfusion, bleeding
  - IV access needs
  - Fluid resuscitation
  - Hemorrhage control
- Disability: Neurological status
  - GCS score
  - Pupils
  - Focal deficits
- Exposure: Full body exam, environmental control
- Life-threatening conditions identified
- Time-sensitive interventions (door-to-needle, door-to-balloon)
- Specialist consultation triggers
- Diagnostic testing prioritized
- Documentation of time of events

Perform trauma primary survey:

Mechanism: [how injured]
Vitals: [initial]
GCS: [score]
Injuries apparent: [visible]
Prehospital: [EMS report]
Trauma activation: [level]

Primary survey:
- Airway (with C-spine protection)
  - Patent vs compromised
  - C-collar in place
  - Intubation needs
- Breathing
  - Respiratory rate and effort
  - Bilateral breath sounds
  - Chest wall integrity
  - Tension pneumothorax assessment
  - Needle decompression if needed
- Circulation
  - Hemorrhage control (direct pressure, tourniquet)
  - Pulse presence and quality
  - Blood pressure
  - FAST exam
  - IV access (2 large bore)
  - Massive transfusion protocol trigger
- Disability
  - GCS calculation
  - Pupil assessment
  - Gross motor/sensory
- Exposure
  - Fully undress patient
  - Log roll for back exam
  - Hypothermia prevention
- Adjuncts (labs, imaging as stabilization allows)
- Reassessment continuous

Evaluate chest pain in emergency setting:

Patient: [age, gender, risk factors]
Chest pain: [location, quality, radiation]
Onset: [sudden vs gradual, at rest vs exertion]
Associated symptoms: [SOB, diaphoresis, N/V]
Cardiac history: [CAD, prior MI, stents]
Current vitals: [values]

Chest pain evaluation:
- OPQRST assessment
- Cardiac risk stratification (HEART score)
- ECG (12-lead within 10 minutes)
  - STEMI present?
  - STEMI equivalent?
  - Old changes vs new
- Cardiac biomarkers (troponin timing: 0 and 3 hours)
- Differential diagnosis prioritized:
  - ACS (STEMI, NSTEMI, unstable angina)
  - Aortic dissection
  - Pulmonary embolism
  - Pneumothorax
  - Pericarditis
  - Esophageal
  - Musculoskeletal
- Immediate interventions:
  - Oxygen if hypoxic
  - Aspirin (if no contraindication)
  - Nitroglycerin (if appropriate BP)
  - Morphine for pain
  - Cath lab activation if STEMI
- Further diagnostic testing (CTA if dissection suspected)
- Disposition planning (admit, observe, discharge)

Manage acute stroke alert:

Symptom onset time: [last known normal]
Deficits: [facial, arm, speech, other]
Vitals: [BP critical]
Glucose: [level]
Anticoagulation: [on blood thinners?]

Stroke protocol:
- Time documentation (every step)
- Last known normal time established
- Stroke team activation
- NIH Stroke Scale assessment
- Immediate exclusions for tPA:
  - Time >4.5 hours
  - Hemorrhagic stroke
  - Recent surgery
  - Anticoagulation/bleeding
  - BP >185/110 despite treatment
- CT brain STAT (non-contrast)
- Labs (CBC, coags, BMP, glucose, type & screen)
- Blood pressure management (permissive hypertension unless tPA candidate)
- IV access
- NPO status
- tPA eligibility determination
- Informed consent if tPA candidate
- tPA administration protocol
- Post-tPA monitoring (q15min x 2hr, then q30min x 6hr, then q1hr)
- Neurosurgery consult if indicated
- ICU admission
- Documentation of door-to-needle time

Identify and manage sepsis:

Infection source: [suspected]
Vitals: [temp, HR, RR, BP]
Mental status: [baseline vs current]
Labs: [if available]
Symptom onset: [timing]
Immune status: [immunocompromised?]

Sepsis management:
- SIRS criteria met? (2+ of: temp, HR, RR, WBC)
- qSOFA score (mental status, RR>22, SBP<100)
- Sepsis alert if criteria met
- Hour 1 bundle:
  - Measure lactate (recheck if >2)
  - Obtain blood cultures BEFORE antibiotics
  - Administer broad-spectrum antibiotics
  - Fluid resuscitation (30mL/kg crystalloid if hypotensive or lactate ≥4)
  - Vasopressors if hypotensive during/after fluids
- Source control identification (imaging if needed)
- Additional labs (CBC, BMP, LFTs, coags, troponin, UA)
- Antibiotic selection (based on suspected source and local antibiogram)
- Reassessment of perfusion (lactate clearance, capillary refill, mental status)
- ICU consultation
- Sepsis protocol documentation
- Quality metrics (time to antibiotics, fluid volume)

Assess pediatric emergency patient:

Age: [child's age]
Weight: [kg - critical for dosing]
Chief complaint: [problem]
Vitals: [age-appropriate norms]
Appearance: [well vs ill-appearing]
Parent concern: [level of worry]

Pediatric assessment:
- Pediatric assessment triangle (PAT):
  - Appearance (tone, interactiveness, consolability)
  - Work of breathing (sounds, positioning, retractions)
  - Circulation to skin (pallor, mottling, cyanosis)
- Age-appropriate vital signs interpretation
- Weight-based medication dosing
- Pediatric-specific red flags:
  - Ill appearance
  - Inconsolability
  - Altered mental status
  - Respiratory distress
  - Fever in infant <2 months
  - Dehydration signs
- PEWS score if available
- Family-centered care approach
- Child-friendly communication
- Developmental considerations
- Non-pharmacologic comfort measures
- Child life consultation if available
- Caregiver education
- Disposition (discharge instructions vs admission)
- Follow-up plan with pediatrician

Evaluate behavioral health emergency:

Presentation: [agitation, suicidal, psychosis, intoxication]
Safety: [patient and staff safety]
Medical clearance: [completed?]
Substance use: [intoxicated?]
Baseline: [known psych history]
Voluntary vs involuntary: [legal status]

Psych emergency evaluation:
- Safety assessment immediate:
  - Violent risk (staff safety)
  - Weapons or means
  - Security presence
  - Seclusion/restraint needs
- Medical clearance:
  - Vital signs stable
  - Glucose checked
  - Labs if indicated (drug screen, metabolic panel)
  - Head CT if trauma or new onset psychosis
  - Rule out medical cause (delirium, infection, metabolic)
- Psychiatric assessment:
  - Mental status exam
  - Risk assessment (suicide, homicide)
  - Substance intoxication/withdrawal
  - Psychosis present
  - Capacity assessment
- Legal considerations:
  - Voluntary vs involuntary hold
  - Criteria for involuntary commitment
  - Legal paperwork
- De-escalation techniques
- Medication for acute agitation if needed
- Psychiatric consultation
- Disposition (admit psych, discharge with outpatient, transfer)
- Ensure follow-up arranged if discharge

Create discharge instructions for [condition]:

Diagnosis: [ED diagnosis]
Treatment provided: [what was done]
Medications: [prescriptions]
Work/school: [restrictions]
Follow-up: [when and with whom]
Red flags: [return precautions]

Discharge instructions:
- Diagnosis explanation (patient-friendly language)
- Treatment summary (what we did today)
- Home care instructions:
  - Activity level (rest, restrictions, gradual return)
  - Ice/heat/elevation
  - Wound care if applicable
- Medications:
  - New prescriptions (name, dose, frequency, duration)
  - Over-the-counter recommendations
  - What to take and when
  - Side effects to expect
- Follow-up plan:
  - Primary care follow-up (timeframe)
  - Specialist referral if needed
  - Wound check if applicable
  - Test results pending (how patient will get)
- Return precautions (specific red flags):
  - Worsening symptoms
  - New symptoms
  - Signs of complications
- Work/school note if needed
- Patient questions addressed
- Understanding verified (teach-back)
- Written copy provided