Emergency Medicine Rules of the Road (first few; click here for all)

- Read the triage note
  - Patients/medics may have told triage nurse something important but forgot to or couldn’t tell you
  - If there is an inconsistency between triage and your history make sure to clarify that
- History is king
  - It is not the patient’s job to provide a good history; it is your job to elicit one
  - Listen to your bedside nurse if they raise concerns and document your response
  - Know when to dig deeper, like with timing and duration for chest pain
  - If there is pain always have them show you exactly where by pointing.
- Always think worst case scenario first
  - This is also in the original 10 commandments: LINK or see summary below
  - Reasonably rule out the more rare but more dangerous explanation before landing on the benign one.
  - Remember: you are a detective not a gambler and ER patients are guilty until proven innocent
- Fine tune your physical exam and know when to add bedside ultrasound
  - Know key techniques to have a more sensitive focused exam. Spend less time on parts that aren’t relevant and more time on parts that are.
  - Listen to EM logic episode 6 for a better lung exam, jolt sign for meningitis, a better neuro exam, the importance of the pedal pulse and other key considerations
- Bounce-backs get bigger workups and/or get admitted
  - Second visit do more: testing, consult, etc.
  - Third visit admit: SMV/PUD story, CSVT stories
- Beware of false negative tests
  - CT in ischemic stroke: “CT rules out a bleed not a stroke”
  - Troponin in unstable angina or first 5 hours of MI
  - WBC is normal in up to 30% of cases of sepsis or sever infection
  - STEMI criteria in OMI (misses ~1/3 of occlusion MIs)

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TESTIMONIALS & QUOTATIONS

“Dr. Pregerson. You have no idea how many times you rescued me over the years with your exceptional handbooks. I put you in the ranks of the great ones (Like Tintinalli, Rosen, Greg Henry, etc. I love your handbooks and recommend them often to young doctors whom I mentor.” – Gordy Leingang, DO, FACEP, FACOEP. Bismarck, ND.

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