EM Logic Episode #39: ACS ECG Logic

This episode explores whether D-dimer has a role in evaluating unstable angina, reviewing studies that found elevated levels in many patients with unstable angina despite negative troponins, while also highlighting conflicting evidence about its diagnostic value. Dr. Pregerson discusses the many causes of positive and false-positive D-dimer results and explains why overreliance on the test can lead to unnecessary imaging and diagnostic uncertainty.

Late sepsis is early to diagnose but catching the early signs is more critical. Don't miss these clinical pearls on inflammatory markers and much more.

Most ureteral stones pass on their own, but a few demand urgent intervention. Learn the "PENIS" framework for spotting high-risk patients and avoiding the catastrophic mistake of missing an infected obstructing stone. Read More in the Show Notes

This episode focuses on practical strategies to obtain a high‑yield history that drives accurate ED diagnosis. This includes structured approaches (like OLD CARTS), critical pitfalls to avoid, and specific red flags for conditions such as ACS and dissection. It emphasizes reading the triage note, seeking collateral information from unreliable historians, and resisting anchoring by deliberately considering rare, dangerous diagnoses first.

ATLS 2025 emphasizes early hemorrhage control (X-ABC's), rapid blood product use with TXA, and updated airway, breathing, and spine protocols, including "spinal protection" and anterior axillary needle decompression. These changes build on 2018's shift toward video laryngoscopy, limited crystalloids, and streamlined transfer practices.

In Episode #43 of EM Logic, Dr. Pregerson reviews common radiology errors in the ED, from missed fractures to subtle tumors, and breaks down why communication and clinical context matter. He also shares real cases and practical tips for improving teamwork with radiologists. Read more in the Show Notes.

In Episode #42 of EM Logic, Dr. Pregerson highlights new research on occult ventricular fibrillation seen only on bedside echo and reviews the DOSE VF trial showing improved survival with dual sequential defibrillation. He also connects pearls from prior episodes on heads-up CPR and hypokalemic arrest. Read more in the Show Notes.

Don't be blamed for providing inadequate aftercare instructions. Minimize the chances that your discharged patient doesn't return. In Episode #41, Dr. Pregerson covers the pearls and pitfalls of aftercare instructions. Read more details in the Show Notes.

In Episode #40 of EM Logic, Dr. Pregerson reviews the diagnosis and management of testicular torsion, emphasizing its peak presentation in 13- to 14-year-olds. Epididymitis is the diagnosis on the chart of 61% of settled malpractice cases. He stresses the importance of not waiting for ultrasound before manual detorsion. Read more in the Show Notes.

In Episode #39 of EM Logic, Dr. Pregerson discusses occlusion MIs (OMI) that are missed by STEMI criteria. One-fourth to one-third of NSTEMIs are actually missed acute coronary occlusions, which would be best treated with emergent reperfusion. Read more details here in the Show Notes.