GASTROINTESTINAL EMERGENCIES. EVIDENCE-BASED ANSWERS TO KEY CLINICAL QUESTIONS

1. What Are the “Rules of the Road” When Approaching Patients with Acute Abdominal Pain? What Are Common Diagnostic Errors and Who Are High-Risk Patients?
2. What Is the Accuracy of the Physical Exam in Intra-abdominal Emergencies? Does Administration of Pain Medication Alter the Accuracy of the Physical Examination?
3. The Utility of Laboratory Data: What to Consider and How to Interpret in Common Abdominal Diseases
4. What Imaging Strategies Are Effective for Rapid and Accurate Diagnosis of Abdominal Pain Etiologies?
5. Evaluation of Acute Abdominal Pain with Computed Tomography
6. What Is My Patient’s Risk of Cancer from Radiation Exposure with Computed Tomography of the Abdomen and Pelvis? What Do I Tell My Patient?
7. Who Should Be Admitted? Who Can Be Discharged? What Should Be Included in the Discharge Planning?
8. Consultant Corner: General Approach to Abdominal Pain
9. How Can I Tell If My Patient Has a Gastrointestinal Bleed? Is It an Upper Gastrointestinal Bleed (UGIB) or Lower Gastrointestinal Bleed (LGIB)?
10. What Is the Best Risk Stratification Tool for a Patient with a Suspected Upper GI Bleed?
11. Diagnostic Testing for Patients with Gastrointestinal Hemorrhage
12. Is NG Aspiration Sensitive and Specific to Detect Upper GI Bleeding?
13. What Is the Optimal Timing of Endoscopy?
14. What Medications Are Helpful in Treating a GIB?
15. What Is the Optimal Resuscitation of the Patient with a Gastrointestinal Bleed?
16. Reversing Coagulopathy in Patients with Suspected GI Bleed
17. When to Suspect an Aortoenteric Fistulae
18. End-Stage Liver Disease and Variceal Bleeding
19. Consultant Corner: Gastrointestinal Bleeding
20. What Clinical Factors Should Arouse Suspicion for Abdominal Aortic Aneurysm?
21. What Is the Ideal Imaging Strategy for Diagnosing AAA, Abdominal Aortic Dissection, and Aortic Rupture?
22. Which Patients Can Be Treated Medically, and Who Needs Surgical Intervention?
23. What Is the Role of Hypotensive Resuscitation/Damage Control Resuscitation in Ruptured AAAs?
24. My Patient’s Aorta Was Repaired. What Complications Arise from AAA Repair? When Should I Be Concerned About Recurrence?
25. The Asymptomatic AAA: When to Be Concerned and What to Tell Your Patient?
26. Consultant Corner: Abdominal Aortic Aneurysm and Aortic Dissection
27. What Clinical Features Lead to the Diagnosis of Acute Mesenteric Ischemia?
28. What Is the Most Sensitive and Specific Laboratory Test(s) for the Detection of Acute Mesenteric Ischemia? What Is the Utility of Lactate? Are There Other Laboratory Tests Which Are Helpful in Making the Diagnosis?
29. What Is the Most Sensitive and Specific Imaging Study for the Detection of Acute Mesenteric Ischemia? Is MDCT the Gold Standard?
30. What Is the Utility of Clinical Scoring Systems for the Diagnosis/Prognosis of Mesenteric Ischemia?
31. Chronic Mesenteric Ischemia: What Clinical Features Lead to the Diagnosis of CMI? Can This Diagnosis Be Made in the Emergency Department? What Is the Appropriate Disposition?
32. What Are the Goals of Resuscitation in the ED? What Intravenous Fluids Should Be Used? Are Vasopressors Beneficial or Harmful? Should Antibiotics Be Administered?
33. Morbidity and Mortality of Acute Mesenteric Ischemia: How Can Emergency Medicine Clinicians Impact Outcomes?
34. Consultant Corner: Acute Mesenteric Ischemia
35. When Should a Non-gastrointestinal Cause of Nausea and Vomiting Be Considered?
36. Customizing Your Antiemetic: What Should You Consider?
37. What Is the Best Management of Cyclic Vomiting Syndrome and Cannabinoid Hyperemesis Syndrome?
38. When Should QT Prolongation Be Considered in Antiemetic Use?
39. Opioids in Gastroparesis: Is There a Better Way?
40. Consultant Corner: Abdominal Pain and Vomiting
41. Diagnosis: What Historical Features and Laboratory Test(s) Are the Most Helpful to Make the Diagnosis? Is There Really a Normal Lipase with Active Pancreatitis? What “Red Flags” Suggest a Complicated Course?
42. Risk Stratification and Disposition: What Is the Usual Course of Acute Pancreatitis? Which Patients Require a Higher Level of Care and Which Patients May Be Appropriate to Discharge?
43. How Should I Manage My in the Pancreatitis Patients Emergency Department? Who Needs Imaging? Antibiotics? Surgery? Interventional Radiology? ERCP?

This book answers key questions asked by emergency clinicians faced with complex gastrointestinal and abdominal pain presentations. Instead of a traditional format that includes epidemiology, pathophysiology, diagnosis, and treatment options, this book takes an approach that mirrors the way clinicians interact with patients – by asking and answering specific clinical care questions. The book is organized into sections by presentation – gastrointestinal bleeding, for example – each of which contains chapters on specific questions, such as “What is the best clinical risk score for low risk GIB patients?” Each clinical question comes with a detailed, evidence-based response and a summary that gives best practices, recommendations, and references. Additionally, at the end of each section is a chapter titled “Expert Corner,” which asks the same clinical questions to a surgical or gastrointestinal specialist and includes key pearls these experts have for emergency medicine practitioners. Gastrointestinal Emergencies: Evidence-Based Answers to Key Clinical Questions is an essential guide for emergency medicine physicians, residents, and medical students who want to review and improve their care of acute gastrointestinal emergencies.

Features
• Provides a question-driven, evidence-based review of gastrointestinal emergencies with best practice answers
• Addresses a complex, high-volume, high-risk complaint
• Includes a consultation section where specialists provide their perspective on individual topics

Authors
• Autumn Graham, MD. Associate Professor of Emergency Medicine. Department of Emergency Medicine. MedStar Georgetown University Hospital & Washington Hospital Center. Washington, D.C
• David Carlberg, MD. Associate Program Director. Assistant Professor of Emergency Medicine. Department of Emergency Medicine. MedStar Georgetown University Hospital & Washington Hospital Center. Washington, D.C