EM Thinker: Pearls From The Frontlines

Authors: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)

Welcome back to The EM Thinker series. This series will provide important considerations for the practice of emergency medicine. Today’s post provides pearls on a variety of topics including airway optimization and high risk complaints and patients.


1) Acute, severe abdominal pain is likely not a good thing; consider worst first.

2) Sinusitis is a wastebasket diagnosis for the headache patient in front of you. Closely look for other more dangerous conditions with your history and exam.

3) Airway management: be systematic each and every time. Don’t skip over to mastering new tools without knowing the basics cold; they’ll save you in the true emergency.

4) New airway tools have moved us away from the anatomically challenging airway to focusing on the physiologically challenging airway. Keep in mind the HOP killers.

5) Alcohol intoxication is a diagnosis of exclusion in a patient with alcohol abuse/dependence. Think critically about what made the patient come to the ED. They’re not there to hang out with you!

6) Hypertension: leave it alone unless an emergency exists. Use history and exam to evaluate for end-organ injury.

7) When reviewing new EKGs, always review old ones. Use a systematic approach.

8) Elderly patients tend to minimize symptoms. Physical exam findings in trauma can be subtle. These patients have higher morbidity and mortality. Always dig for an underlying etiology, and consider elder abuse.

9) In the male with abdominal pain, consider GU etiologies (testicular torsion). In the female with abdominal pain, consider gynecologic etiologies (ovarian torsion).

10) Know high-risk medications: 1) those that make you bleed; 2) those that impact glucose; 3) those that can have major interactions (ie, trimethoprim-sulfamethoxazole with an ACE inhibitor); 4) those with major problems in the elderly (benzos and fall risk).

References / Further Reading:

emDocs – Sinusitis Mimics

First10EM – Airway Optimization

EM Educator – High Risk Intubation

EMCrit – HOP Killers

emDocs –Alcohol Intoxication Mimics

An Emergency Medicine Mindset

emDocs – Geriatric Trauma

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