History

Presentation synopsis

Exposure history core

OPQRST

Onset

Provocation and palliation

Quality

Region and radiation

Severity

Timing

Associated symptoms

Symptom clusters

Context and baseline

Baseline and prior episodes

Alarm Features

Immediate escalation triggers

High risk triggers

Vital sign danger thresholds

High risk vital patterns

Medications

Current and recent medications

Medication reconciliation focus

Adherence and changes

Recent changes

Diet

Intake and hydration

Recent intake patterns

Stimulant co exposures

Dietary stimulant exposure

Review of Systems

Cardiopulmonary

Cardiopulmonary symptoms

Neurologic and psychiatric

Neuropsychiatric symptoms

GI and GU

GI and GU symptoms

Infectious and inflammatory

Infection mimics

Collateral History and Family History

Collateral and reliability

Collateral sources

Family history

Inherited and early disease

Risk Factors

Patient level risks

Cardiovascular risk

Neurologic risk

Psychiatric and substance use risk

Situational risks

Exposure risks

Differential Diagnosis

Life threatening

Must not miss

Common

Common alternatives

Less common

Less common and mimics

Past Medical History

Relevant conditions and baseline

Baseline medical status

Physical Exam

General and vital pattern

Toxidrome and severity

Cardiovascular and respiratory

Cardiorespiratory exam

Neurologic and tox findings

Neurotox exam

Skin and musculoskeletal

Skin and muscle injury

Lab Studies

Core ED labs

Initial laboratory evaluation

Cardiac and tox focused

High yield additional labs

Imaging

Scoring Systems

Risk stratification tools

MRI

MRI indications

MRI constraints

CT

CT indications

CT cautions

Ultrasound

POCUS applications

POCUS limitations

Special Tests

Bedside monitoring and procedures

Critical bedside tests

Targeted diagnostic procedures

Procedures when indicated

ECG

Indications and high risk patterns

ECG evaluation

High risk ECG findings

Serial strategy

Repeat ECG triggers

Assessment

Working diagnosis and severity

Stimulant toxicity syndrome

Key alternative diagnoses

Competing diagnoses prioritized by risk

Plan

First 5 minutes

Immediate stabilization

Agitation and psychosis control

Sedation strategy

Hyperthermia management

Cooling and organ protection

Hypertension and tachycardia

Hemodynamic control principles

Chest pain and ACS pathway

Ischemia management

Seizure management

Seizure control

Rhabdomyolysis and renal protection

Rhabdomyolysis bundle

Serotonin syndrome branch

Serotonergic toxicity management

Reassessment loop

Iterative reassessment

Disposition

Level of care criteria

ICU criteria

Admission and observation

Inpatient admission criteria

Observation pathway criteria

Discharge criteria

ED discharge criteria

Discharge Instructions

Copy discharge instructions

Summary

Medications and substances

Hydration and rest

Follow up

Return to ED now for

References

Guidelines and key sources

Core references

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