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

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HWN Suggests
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.
Resources
Acute Compartment Syndrome
ACS is most common in patients < 35 years of age. These patients have increased risk of high-energy injuries, stronger fascia, and greater muscle bulk. Males are 10x more likely to experience ACS compared to females - Brit Long, MD. emDOCs
Aortic Dissection
Aortic dissection may occur in any location along the aorta and therefore the range of presentations is broad. Many AD patients do not fit the textbook presentation - Alexandra Ortega, MD, Core EM
Mesenteric Ischemia
In spite of all our technological advances in medicine, mesenteric ischemia remains a very difficult disease process to identify early. The signs and symptoms of mesenteric ischemia are vague with "pain out of proportion to exam" being the classic presentation - Sundip Patel, MD, CDEM
Orbital Compartment Syndrome
The time of diagnosis of OCS is not the time to be first learning the procedure, the necessary equipment, its indications and contraindications, and complications. A survey study suggested that over 90% of EPs felt inadequately trained in lateral canthotomy and inferior cantholysis (LCIC) - Shyam Murali, RebelMD
Posterior Myocardial Infarction
In patients presenting with ischaemic symptoms, horizontal ST depression in the anteroseptal leads (V1-3) should raise the suspicion of posterior MI _ Ed Burns - LITFL
Can’t Miss Surgical Emergencies – Part 1
This is the first of a two-part series on surgical emergencies. This series discusses “cannot miss” diagnoses that require immediate, or at least emergent, surgical intervention.
Can’t Miss Surgical Emergencies – Part 2
This is the second in a two-part series discussing can’t-miss diagnoses that may require emergent surgical intervention. Part 1 (http://www.emdocs.net/cant-miss-surgical-emergencies-part-1/) included ruptured ectopic pregnancy, ruptured AAA, and aortic dissection. In this article, we will explore three more disease processes that can be easy to miss, though delay in diagnosis and treatment can lead to long-term sequelae and even death. So, without further ado, let’s jump right in to discuss three more surgical emergencies.
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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