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 collection will provide important considerations for the practice of emergency medicine.

1) Know high-risk patient populations, and consider doing more for the evaluation of these patients: EtOH/drug dependence, immunocompromised, psychiatric history, elderly, low socioeconomic status, etc.

2) Glass foreign body of the hand will humble you. It is often missed and produces unpredictable injury patterns.

3) Assume a female of reproductive age is pregnant until the pregnancy test returns negative.

4) Just because your symptomatic treatment was successful doesn’t mean you’ve arrived at a reassuring diagnosis. Remember, the patient with chest pain who improves with GI cocktail does not exclude ACS, and the same goes for the patient with acute, severe, maximal onset headache who improves with your headache cocktail.

5) Learn to read people’s faces and body language in the room; it’s vital to uncovering internal emotions that will help you to manage the case.

6) Let your patients teach you about life (and medicine outside of the academic box). Travel the world alongside them.

7) Walk patients back to the beginning of the illness; most define their illness starting when they felt their worst. Remember, we only see a glimpse in the timeline of the patient’s condition.

8) Normotensive may be hypotensive for your patient (especially in elderly patients); check/ask about baseline values.

9) For each and every neurologic exam, watch them walk, hear them talk, and look into their eyes.

10) Rename medical clearance of psychiatric patient to there’s currently no acute medical emergency.

References / Further Reading:


An Emergency Medicine Mindset

emDOCs – Traveling the World

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