Pearls

Airway Pearls        Criteria for Migraine Dx        Wells' Score for PE            Ottowa Rules      PERC Rule        SF Syncope Rules

Airway


Quick Pediatric Numbers
Age in Years Weight in Kg ETT Size
0 Variable 3
1 10 4
5 20 5
10 30 6




Headache

Modified Diagnostic Criteria For Migraine

1. Episodic attacks of headache lasting 4 to 72 hrs

2. With two of the following symptoms:

o Unilateral pain

o Throbbing

o Aggravation on movement

o Pain of moderate or severe intensity

3. And one of the following symptoms:

o Nausea or vomiting

o Photophobia or phonophobia

*Criteria are those specified for migraine without aura by the International Headache

Society. Adapted from Headache Classification Committee of the International

Headache Society: Classification and diagnostic criteria for headache disorders, cranial

neuralgias and facial pain. Cephalalgia 1998;8:Suppl 7:1-96.

 

 

 

Ottowa Rules

 

Ottowa Ankle Rules

X-rays are required if any of the following are true:

  1. Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus
  2. Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus
  3. Bone tenderness at the base of the fifth metatarsal (for foot injuries).
  4. Bone tenderness at the navicular bone (for foot injuries).
  5. An inability to bear weight both immediately and in the emergency department for four steps.

Notes:  Not studied on ≤ 18 years old or AMS; approximately 100% sensitive; reduces x-rays by ~ 35%.

 

Adapted from Bachmann, L. M et al. BMJ 2003;326:417

Ottowa Ankle Rules Pic\\

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ottowa Knee Rules

X-rays are required if any of the following are true:

  1. ≥ 55 years of age

  2. Isolated tenderness of the patella

  3. Tenderness at the head of the fibula

  4. Inability to flex the knee to 90 degrees

  5. Inability to weight bear both immediately post injury and in ED (4 steps)

 

 

 

 

Pulmonary Embolism

 

 

Well's Score for Determining the Clinical Probability of Pulmonay Embolism*

 

Clinical Feature

Score

Clinical signs & Symptoms of DVT (objectively measured leg swelling and pain with palpation in deep-vein system)

3.0

Heart Rate > 100 bpm

1.5

Immobilization for ≥ 3 consecutive days or surgery in previous 4 weeks

1.5

Previous objectively diagnosed PE or DVT

1.5

Hemoptysis

1.0

Cancer (with treatment within past 6 months or palliative treatment)

1.0

Pulmonary Embolism likely or more likely than alternative diagnosis (on basis of Hx, PE, CXR, EKG, laboratory)

3.0


Probability

Score

Low Probabilty

< 2.0

Moderate Probability

 2.0 - 6.0

High Probability  

 ≥ 6.0

     *Taken from Wells, et al.  Ann Intern Med.  2001; 135:  98-107.

Notes:

  1. It's been shown that clinical judgment is just as good as using this scoring system to place patients into probability groups. 

  2. You must place a patient into 'their probability group' prior to imaging.

 

PERC RULE for Low Risk PE Patients

This rule is used to decide whether a d-dimer should be sent in LOW RISK patients only. 

If all of the following are true in a LOW RISK patient, the patient is PERC rule negative and does not need a d-dimer.

1)      Age < 50

2)      Pulse < 100

3)      Pulsox > 94%

4)      No unilateral leg swelling

5)      No hemoptysis

6)      No recent surgery

7)      No prior PE or DVT

8)      No oral hormone use

 

Syncope

San Francisco Syncope Rules (CHESS)

CHF history

Hematocrit < 30%

EKG abnormality - not sinus rhythm or new changes compared to previous EKG

Shortness of breath complaint

Systolic bp < 90 mm Hg (in triage)

96% sensitivity (CI95 92-100%) and 62% specificity (CI95 58-66%) for identifying patients at short term risk for serious outcomes.  Can reduce admissions by about 10%.


**Note that this study did not look at those over 65 years old and may not apply to this group of patients. 


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