Articles in Emergency Medicine & Critical Care (5)

Revised Atlanta classification requires ≥2 of 3 criteria: (1) acute epigastric pain radiating to the back, (2) serum lipase or amylase ≥3× upper limit of normal, (3) characteristic imaging findings on CECT/MRI/US. Leading causes: gallstones (40-50%) and alcohol (30%).

UK JBDS diagnostic triad: (1) Capillary blood ketones ≥3.0 mmol/L (or ketonuria ≥2+), (2) Blood glucose >11.0 mmol/L (or known diabetes), (3) Venous bicarbonate <15.0 mmol/L and/or venous pH <7.3. Cornerstones of management: IV 0.9% NaCl resuscitation, potassium replacement, and fixed-rate IV insulin infusion (0.1 units/kg/hr).

Stratify pre-test probability using the Wells score or Geneva score. Low/intermediate risk: age-adjusted D-dimer. High probability: immediate CT pulmonary angiography (CTPA). Haemodynamically unstable (massive PE with SBP <90 mmHg): bedside echocardiography and systemic thrombolysis.

Acute total coronary occlusion presenting with crushing central chest pain and persistent ST-segment elevation in ≥2 contiguous ECG leads (or new LBBB with Sgarbossa concordance). Immediate management: dual antiplatelet therapy + primary PCI within 120 minutes (or fibrinolysis within 10 minutes if PCI unavailable).

Diagnostic requires ≥2 of 4 ESC criteria: (1) pericarditic chest pain relieved by sitting forward, (2) pericardial friction rub, (3) widespread concave ST elevation / PR depression on ECG, (4) new or worsening pericardial effusion. First-line therapy: high-dose NSAID + colchicine.