What are the common emergency medicine chief complaints, their workup, and management?

Top 30 Emergency Medicine Chief Complaints and Their Workup/Management

The most common emergency medicine chief complaints require systematic evaluation and management protocols that prioritize life-threatening conditions first, with chest pain, altered mental status, and dyspnea representing critical presentations that demand immediate attention. 1, 2

1. Chest Pain

Presentation

• Central/substernal compression, pressure, tightness, heaviness, burning
• Radiation to neck, jaw, shoulders, back, or arms
• Associated symptoms: dyspnea, nausea/vomiting, diaphoresis 1

Workup

1. Immediate vital signs and ECG (within 10 minutes)
2. Focused history (onset, quality, radiation, aggravating/alleviating factors)
3. Physical exam (heart, lungs, abdomen)
4. Laboratory: cardiac enzymes, CBC, electrolytes, BNP
5. Imaging: chest X-ray, consider CT angiography if PE or aortic dissection suspected

Management

• Aspirin 325mg chewed immediately (unless contraindicated)
• Nitroglycerin (if SBP >90 mmHg)
• Oxygen if hypoxic (SpO2 <90%)
• Pain control with morphine if needed
• Treat underlying cause based on diagnosis 2, 3

2. Altered Mental Status

Presentation

• Confusion, disorientation, lethargy, agitation
• Altered behavior, inattention, hallucinations
• Associated with 8.1% overall mortality 1

Workup

1. ABCs and vital signs (including temperature, glucose)
2. Neurological examination
3. Laboratory: CBC, electrolytes, BUN/Cr, LFTs, toxicology screen, blood cultures
4. Imaging: CT head without contrast
5. Consider lumbar puncture if meningitis/encephalitis suspected

Management

• Secure airway if GCS <8
• Treat hypoglycemia if present
• Naloxone for opioid overdose
• Thiamine before glucose in suspected alcoholism
• Antibiotics for suspected meningitis/sepsis (ceftriaxone 2g IV) 4, 2

3. Dyspnea

Presentation

• Shortness of breath, respiratory distress
• May be cardiac or pulmonary in origin
• Associated with high mortality (9.4%) 5

Workup

1. Vital signs including oxygen saturation
2. Focused cardiopulmonary exam
3. ECG, chest X-ray
4. Laboratory: CBC, BNP, troponin, D-dimer if PE suspected
5. ABG if severe respiratory distress

Management

• Oxygen to maintain SpO2 >94%
• Bronchodilators for bronchospasm
• NIV for respiratory failure with intact mental status
• Diuretics for CHF
• Antibiotics for pneumonia 2

4. Abdominal Pain

Presentation

• Location, quality, radiation, timing
• Associated symptoms: nausea, vomiting, diarrhea, constipation

Workup

1. Vital signs
2. Abdominal examination
3. Laboratory: CBC, electrolytes, LFTs, lipase, urinalysis, pregnancy test
4. Imaging: Ultrasound or CT abdomen/pelvis

Management

• IV fluids for dehydration
• Pain control
• Antibiotics for suspected infection
• Surgical consultation for acute abdomen
• NPO if surgical intervention likely

5. Headache

Presentation

• Onset (thunderclap vs. gradual)
• Associated symptoms: neck stiffness, photophobia, fever

Workup

1. Neurological examination
2. CT head without contrast for sudden severe headache
3. Consider lumbar puncture if SAH suspected with negative CT
4. MRI for suspected posterior fossa pathology

Management

• Analgesia (avoid opioids if possible)
• Specific treatment based on etiology
• Neurosurgical consultation for SAH or intracranial hemorrhage 2

6. Trauma

Workup

1. Primary survey (ABCDE)
2. Secondary survey
3. Trauma series X-rays
4. FAST exam
5. CT scan based on mechanism and findings

Management

• Hemorrhage control
• Fluid resuscitation
• Blood product transfusion if needed
• Surgical intervention as indicated

7. Fever

Workup

1. Vital signs
2. Focused exam based on symptoms
3. Laboratory: CBC, urinalysis, blood cultures
4. Chest X-ray if respiratory symptoms

Management

• Antipyretics
• IV fluids
• Antibiotics for suspected bacterial infection
• Source control if identified

8. Seizure

Workup

1. ABCs, protect from injury
2. Glucose check
3. Laboratory: electrolytes, toxicology, anticonvulsant levels
4. CT head if new-onset seizure

Management

• Benzodiazepines for active seizure
• Correct electrolyte abnormalities
• Load anticonvulsants if indicated
• Treat underlying cause

9. Back Pain

Workup

1. Neurological examination
2. Red flag assessment
3. Consider imaging if neurological deficits present

Management

• Analgesia
• Muscle relaxants if spasm
• Neurosurgical consultation for cauda equina syndrome

10. Syncope

Workup

1. Orthostatic vital signs
2. ECG
3. Focused cardiac and neurological exam
4. Consider telemetry monitoring

Management

• IV fluids for dehydration
• Cardiac monitoring
• Treat underlying cause

11. Psychiatric Complaints

Workup

1. Medical clearance to rule out organic causes
2. Suicide/homicide risk assessment
3. Consider toxicology screen 2

Management

• Safety measures
• Psychiatric consultation
• Chemical restraint if agitated and dangerous

12. Extremity Pain/Injury

Workup

1. Neurovascular examination
2. X-ray of affected area
3. Consider advanced imaging for complex injuries

Management

• Immobilization
• Analgesia
• Reduction of dislocations/fractures
• Orthopedic consultation as needed

13. Bleeding (GI/GU/Vaginal)

Workup

1. Vital signs, orthostatic measurements
2. CBC, coagulation studies
3. Type and cross
4. Endoscopy/colonoscopy for GI bleeding

Management

• IV access, fluid resuscitation
• Blood product transfusion
• Reversal of anticoagulation if indicated
• Intervention based on source

14. Weakness

Workup

1. Neurological examination
2. CT head if stroke suspected
3. Laboratory: electrolytes, glucose

Management

• Stroke protocol if indicated
• Correct electrolyte abnormalities
• Neurology consultation

15. Dizziness/Vertigo

Workup

1. HINTS exam
2. Neurological examination
3. Consider CT/MRI if central cause suspected

Management

• Antiemetics
• Vestibular suppressants for peripheral vertigo
• Neurology consultation for central causes

16. Palpitations

Workup

1. ECG
2. Cardiac monitoring
3. Laboratory: electrolytes, TSH, cardiac enzymes

Management

• Rate control medications
• Cardioversion if unstable
• Treat underlying cause

17. Allergic Reaction/Anaphylaxis

Workup

1. Assess airway, breathing, circulation
2. Identify trigger if possible

Management

• Epinephrine for anaphylaxis
• Antihistamines, steroids
• Airway management if needed

18. Intoxication/Overdose

Workup

1. ABCs
2. Toxicology screen
3. Specific antidote levels if indicated

Management

• Supportive care
• Specific antidotes if available
• Enhanced elimination if indicated

19. Hypertensive Emergency

Workup

1. Vital signs
2. End-organ damage assessment
3. ECG, basic labs, urinalysis

Management

• IV antihypertensives
• Treat underlying cause
• Neuroimaging if neurological symptoms

20. Rash

Workup

1. Detailed skin examination
2. Consider systemic symptoms

Management

• Topical treatments
• Systemic steroids if severe
• Antibiotics for bacterial infections

21. Eye Complaints

Workup

1. Visual acuity
2. Slit lamp examination
3. Tonometry for suspected glaucoma

Management

• Specific to diagnosis
• Ophthalmology consultation for vision-threatening conditions

22. ENT Complaints

Workup

1. Focused examination
2. Consider imaging for deep space infections

Management

• Antibiotics for bacterial infections
• Drainage of abscesses
• ENT consultation as needed

23. Urinary Complaints

Workup

1. Urinalysis
2. Consider imaging for suspected obstruction

Management

• Antibiotics for UTI
• Urologic consultation for retention/obstruction

24. Vaginal Bleeding

Workup

1. Pregnancy test
2. Pelvic examination
3. Ultrasound if pregnant

Management

• Fluid resuscitation if heavy bleeding
• OB/GYN consultation
• Specific treatment based on cause

25. Dental Pain

Workup

1. Oral examination
2. Consider facial X-rays for trauma

Management

• Analgesia
• Antibiotics for abscess
• Dental consultation

26. Foreign Body

Workup

1. Localization with examination/imaging
2. Assess for complications

Management

• Removal techniques specific to location
• Specialist consultation as needed

27. Burns

Workup

1. Assess depth and percentage of BSA
2. Evaluate for inhalation injury

Management

• Fluid resuscitation per Parkland formula
• Wound care
• Pain control
• Burn center transfer if indicated

28. Hypothermia/Hyperthermia

Workup

1. Core temperature
2. Assess for underlying cause

Management

• Active rewarming/cooling
• Treat underlying cause
• Supportive care

29. Stroke Symptoms

Workup

1. NIHSS assessment
2. CT head without contrast
3. CT angiography if large vessel occlusion suspected
4. Laboratory: glucose, coagulation studies

Management

• Thrombolysis if eligible
• Thrombectomy for large vessel occlusion
• Neurology consultation
• Blood pressure management 6

30. Respiratory Distress

Workup

1. Vital signs including oxygen saturation
2. Arterial blood gas
3. Chest X-ray
4. ECG

Management

• Oxygen therapy
• NIV or intubation based on severity
• Treat underlying cause (bronchodilators, antibiotics, etc.) 2

Critical Considerations

• Time-sensitive conditions require immediate recognition and intervention (stroke, STEMI, aortic dissection)
• Atypical presentations are common in elderly, diabetic patients, and women
• Diagnostic errors are most common with chest pain, with misdiagnosis rates of up to 12% 2
• Resource utilization should be appropriate to acuity level
• Disposition decisions must balance patient safety with resource constraints

Remember that the initial assessment of any emergency patient should follow the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) before proceeding to complaint-specific workup and management.