EM LOGIC

EPs know blood thinners increase the risk of intracranial bleeding, and there are many classes of blood thinners, each with a different risk profile. Dr. Pregerson delves into antiplatelet agents, warfarin, and DOACs . R ead more in the Show Notes .

Dr. Pregerson digs deep into how missed vital sign red flags account for malpractice cases. He reviews unexplained tachycardia, soft blood pressure, minor temperature elevation, and mild hypoxia. R ead more in the Show Notes .

Dr. Pregerson tells you all you need to know about using CT contrast in the ED. R ead more in the Show Notes .

Dr. Pregerson says EPs have to think like detectives for cases that don't fit the typical pattern of viral illness and must think more logically about these infections . R ead more in the Show Notes .

Urinalysis can be a ship for fools , Dr. Pregerson says in this month's podcast where he explains why you need logic not to miss true UTIs. R ead more in the Show Notes .

Pain medications make patients feel better and want to go home, but Dr. Pregerson says don't send them home with more medication unless a definitive diagnosis was made because they may not come back if the medication masks that their condition has gotten worse. R ead more in the Show Notes .

Dr. Pregerson logically dissects an aortic dissection, answering when to consider a chest CT, where to take the blood pressure, and w hen to do a pericardiocentesis, this month with bonus video! ( https://bit.ly/EMNVideoGallery .) R ead more in the Show Notes .

Dr. Pregerson asks—and answers—the important questions about intubation: Why is it important to synchronize a bag-valve-mask ventilation with the patient's breathing? Why is upright intubation better? Why you should use the SALAD technique, and what are the benefits of ketamine? R ead more in the Show Notes .

Dr. Pregerson delves into minor and serious cases of hemoptysis, how to treat these patients, and why positioning is so critical. Read more in the Show Notes .

Dr. Pregerson explains why it's important to find out why patients want to leave AMA because that might help you change their mind. Either way, chart what patient says and your response and listen to his other tips for handling these discharges. Read more in the Show Notes .

Dr. Pregerson explains why troponin will sometimes be falsely negative early in an occlusion MI when the benefit of intervention is highest, how a urinalysis can lead you astray, and why some EMRs don't flag abnormally high bands. Listen in to hear all about these intriguing topics and read more in the Show Notes.

Lab values aren't just lab values, and there's a logic to understanding how to interpret them. Listen in to hear all about this fascinating topic and read more in the Show Notes .

It's true that EPs should be looking for horses when they hear hoofbeats, but sometimes they have to go on a zebra hunt, says Dr. Pregerson. Tune in to hear why gastroenteritis, anxiety, and dehydration should set off your Spidey senses. Listen in to hear the answers and read more in the Show Notes .

Why are most bleeding gastric ulcers painless? Why do people have a vasovagal reflex in the first place? Dr. Pregerson says there are logical answers that he can't prove are right but most likely are. Listen in to hear the answers and read more in the Show Notes .

Show Notes : First ask, "Are you having pain now?" If your patient answers no, consider this unstable angina until proven otherwise even if the pain went away with an antacid. Antacids relieve pain in about 15 percent of ACS. Why? Coincidence. The real lesson here is that the percentage of acute coronary syndrome that presents as unstable angina is probably 15 percent at a minimum. It's actually p...

Show Notes : Head-Jolt sign: This is about 99% sensitive and 50% specific for meningitis. Have patients rapidly turn their head side to side. If it doesn't hurt or they have to do it twice, make sure they don't have meningitis. I will often grab their head and do it for them, but first definitely explain what I am doing to family members. Eyes-Red eyes: Consensual photophobia or limbal flush sugge...

Show Notes : Head-Jolt sign: This is about 99% sensitive and 50% specific for meningitis. Have patients rapidly turn their head side to side. If it doesn't hurt or they have to do it twice, make sure they don't have meningitis. I will often grab their head and do it for them, but first definitely explain what I am doing to family members. Eyes-Red eyes: Consensual photophobia or limbal flush sugge...

Show Notes: PID is often missed because the exam can be unimpressive. Remember more than 50 percent of men and more than 80 percent of women have no symptoms with chlamydia, so if you use your logical brain, it follows many cases are mild. In terms of risk, remember that PID is not always an STI; it is caused by vaginal flora in about 15 percent of cases. Fitz-Hugh-Curtis (FHC) is also often misse...

Show Notes : Return Precautions: These are your safety net, and there's a huge variance in what physicians write. The nucleus should always be to return if not improving or worse or if anything new happens. Logic: Most people don't want to return for the same thing that you just sent them home for, so you must emphasize this, focusing on things like syncope, abdominal pain, fever, and vomiting. In...

Show Notes: Classic PE: Pleuritic chest pain, shortness of breath, tachycardia, and S1Q3T3 after starting an oral contraceptive on a long flight to get chemo. Large PE Misses: About 20 percent of PEs are painless and probably about 50 percent of the large ones are painless, but this is rarely taught. The logic is that there is collateral circulation. Large PEs almost always cause SOB, however. The...

SHOW NOTES: Therapeutic Trials: Maalox relieves pain in 15 percent of cases of ACS. Why? The logical answer is coincidence, so before you order Maalox, ask if the pain is already improving. Do the same for NTG, and you will be less likely to get fooled by coincidences. Second Troponin: Before doing a second troponin, do a second history to nail down the timing and duration as best as possible. Oth...