General Approach to the ED Patient

At the risk of stating the completely obvious, this essay assumes that patient doesn’t need any immediate intervention to stabilize them.

What you should be trying to do for any ED patient is to identify what are the “emergency medical conditions*” (EMCS) that need to be ruled out. This should be a practical list of the immediate threats to life, limb, or vital function. It is not a differential diagnosis in the exhaustive sense of the phrase as it is often used, but has some similarities. Another way to express this concept is that you are trying to make sure that the patient doesn’t leave the ED with an undiagnosed condition likely to lead to immediate complications.

The process of ruling out an EMC is just that: a process. It continues and is altered by each new piece of information you receive about the patient. The vast majority of EMCS are effectively ruled out by the H&P. For example, consider the following.

Not all emergency physicians practice this way. Some of them think and act like any and all diagnoses need to be pursued in the ED. I think this is impractical and unnecessary. You will eventually need to choose your own comfort level.

*The term emergency medical condition is borrowed from the EMTALA law; please see my essay on that subject to learn more