Sneaky Emergencies

Some patients may, indeed, have “classic” presentations of these disease processes. On the other hand, other patients may have more subtle signs and symptoms - Sarah Brubaker MD and Brit Long MD

Sneaky Emergencies

image by: Mikhail Nilov

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Put Your Diagnosis in a Box

You make a body system list when you're in medical school learning about chief complaints and differential diagnoses. “Chest pain. What's in the chest? The heart, lungs, esophagus, ribs and muscles, mediastinum, skin....” Then you make sub-lists for each body system: “Esophagus: GERD, reflux, nutcracker esophagus,” and then take that long list of 20 or 30 things, and start narrowing it down.

Once you're done with your training, however, those lists become readily available at a moment's notice because you have played the chest pain game many times before. I have realized I no longer categorize these differential diseases in list format but in a nice, handy 2x2 table.

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 Put Your Diagnosis in a Box

You can do this for other differentials, such as hyponatremia, but I find this more useful because we tend to think in chief complaints. Some patterns emerge when you break these into groups: Common: We see these every day, and they are straightforward. Maybe a little workup or treatment, but it's clear what to do. Rare: We might see these once a month, once a year, or once a decade. Or we might never see it (or might miss it), and they often require some workup because you need to prove they are not something more common. Minor: These patients are going to be fine, and will suffer little morbidity or mortality. They have “DC home” written all over them. Dangerous: These people are getting a large number of studies because they might have something really bad.

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