EM LOGIC - podcast cover

EM LOGIC

Brady Pregerson, MDsites.ovid.libsynpro.com
The EM Logic Podcast was born of 20 years of observation that errors in medicine often occur not because of limited knowledge or being unaware of the latest literature but because the provider was on autopilot or failed to use basic logic in decision-making. EM Logic is meant to compliment but never replace what health care providers learn in medical school, residency, and the evidence-based literature. It is meant to get you thinking rather than just following management algorithms you have learned during your career. Dr. Pregerson will focus on the pitfalls of confusing cause with coincidence, being falsely reassured by normal tests, and getting burned by illogical assumptions. He hopes it will improve the care you provide and your patients’ outcomes, and keep you from being an honored guest at your department’s next peer review meeting. Dr. Pregerson has been practicing emergency medicine since 2000, lecturing and writing about medical topics since 2004, and has reviewed more than 180 malpractice cases since 2008. He is the author of three EM pocket references, the creator of EMresource.org and EM1minuteconsult.com, and the author of the EMN column BradyCardia (http://bit.ly/BradyCardiaEMN. If you would like to be considered as a guest on a future episode, contact Dr. Pregerson at Safetydoc@gmail.com.
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Episodes

January 2023: Lab Values, Part

Dr. Pregerson explains why troponin will sometimes be falsely negative early in an occlusion MI when the benefit of intervention is highest, how a urinalysis can lead you astray, and why some EMRs don’t flag abnormally high bands. Listen in to hear all about these intriguing topics and read more in the Show Notes.

Dec 30, 202211 min

December 2022: Lab Values, Part 1

Lab values aren’t just lab values, and there’s a logic to understanding how to interpret them. Listen in to hear all about this fascinating topic and read more in the Show Notes .

Nov 30, 202213 min

November 2022: Diagnosis of Exclusion Logic

It’s true that EPs should be looking for horses when they hear hoofbeats, but sometimes they have to go on a zebra hunt, says Dr. Pregerson. Tune in to hear why gastroenteritis, anxiety, and dehydration should set off your Spidey senses. Listen in to hear the answers and read more in the Show Notes .

Oct 31, 202210 min

October 2022: Bleeding Logic

Why are most bleeding gastric ulcers painless? Why do people have a vasovagal reflex in the first place? Dr. Pregerson says there are logical answers that he can’t prove are right but most likely are. Listen in to hear the answers and read more in the Show Notes .

Sep 29, 20228 min

September 2022: Acute Coronary Syndrome Logic

Show Notes : First ask, “Are you having pain now?” If your patient answers no, consider this unstable angina until proven otherwise even if the pain went away with an antacid. Antacids relieve pain in about 15 percent of ACS. Why? Coincidence. The real lesson here is that the percentage of acute coronary syndrome that presents as unstable angina is probably 15 percent at a minimum. It’s actually probably at least twice that because not everyone tries an antacid. If you are looking for unstable a...

Aug 31, 202214 min

August 2022: Physical Exam Logic

Show Notes : Head-Jolt sign: This is about 99% sensitive and 50% specific for meningitis. Have patients rapidly turn their head side to side. If it doesn’t hurt or they have to do it twice, make sure they don’t have meningitis. I will often grab their head and do it for them, but first definitely explain what I am doing to family members. Eyes-Red eyes: Consensual photophobia or limbal flush suggests iritis or keratitis rather than conjunctivitis. Pulmonary exam: Demonstrating how you want them ...

Jul 29, 202212 min

July 2022: Physical Exam Logic

Show Notes : Head-Jolt sign: This is about 99% sensitive and 50% specific for meningitis. Have patients rapidly turn their head side to side. If it doesn’t hurt or they have to do it twice, make sure they don’t have meningitis. I will often grab their head and do it for them, but first definitely explain what I am doing to family members. Eyes-Red eyes: Consensual photophobia or limbal flush suggests iritis or keratitis rather than conjunctivitis. Pulmonary exam: Demonstrating how you want them ...

Jun 30, 202210 min

June 2022: STD Logic

Show Notes: PID is often missed because the exam can be unimpressive. Remember more than 50 percent of men and more than 80 percent of women have no symptoms with chlamydia, so if you use your logical brain, it follows many cases are mild. In terms of risk, remember that PID is not always an STI; it is caused by vaginal flora in about 15 percent of cases. Fitz-Hugh-Curtis (FHC) is also often missed, and you are probably missing it if you are not diagnosing about one case a year. The classic case...

May 31, 20227 min

May 2022: After Care Logic

Show Notes : Return Precautions: These are your safety net, and there’s a huge variance in what physicians write. The nucleus should always be to return if not improving or worse or if anything new happens. Logic: Most people don’t want to return for the same thing that you just sent them home for, so you must emphasize this, focusing on things like syncope, abdominal pain, fever, and vomiting. Incidental Findings: Diagnose lung and adrenal nodules, ovarian cysts, etc., and give them copies, tel...

Apr 29, 202210 min

April 2022: PE Logic

Show Notes: Classic PE: Pleuritic chest pain, shortness of breath, tachycardia, and S1Q3T3 after starting an oral contraceptive on a long flight to get chemo. Large PE Misses: About 20 percent of PEs are painless and probably about 50 percent of the large ones are painless, but this is rarely taught. The logic is that there is collateral circulation. Large PEs almost always cause SOB, however. These PEs often mimic ACS or sepsis due to tachycardia (rare in ACS) or low blood pressure, ischemic EC...

Mar 31, 202212 min

March 2022: Unstable Angina Logic

SHOW NOTES: Therapeutic Trials: Maalox relieves pain in 15 percent of cases of ACS. Why? The logical answer is coincidence, so before you order Maalox, ask if the pain is already improving. Do the same for NTG, and you will be less likely to get fooled by coincidences. Second Troponin: Before doing a second troponin, do a second history to nail down the timing and duration as best as possible. Otherwise, you may end up wasting time, or worse, giving yourself false reassurance. Pain Duration: Ass...

Mar 01, 202211 min
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