EM LOGIC
The EM Logic Podcast focuses on reducing medical errors by encouraging deliberate logical reasoning in clinical decision-making rather than relying on autopilot or rigid algorithms. Host Dr. Brady Pregerson draws on decades of emergency medicine experience, malpractice case review, and teaching to explore common pitfalls like mistaking coincidence for causation, over-trusting normal tests, and making illogical assumptions. The show complements, but does not replace, formal medical education and evidence-based literature. It aims to sharpen clinicians’ thinking and improve patient outcomes.
Episodes
D-Dimer in Unstable Angina 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 lea
Episode 49 – Early Sepsis Logic
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.
Episode 48: Ureteral Stone Logic
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
Episode #45: History Logic
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 con
Episode #44: ATLS UPDATE
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.
Episode #43: Radiologist Errors
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.
Episode #42: Resuscitation
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.
Episode #41: Aftercare Revisited
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.
EM Logic Episode #40: Testicular Torsion Logic
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.
EM Logic Episode #39: ACS ECG Logic
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.
EM Logic Episode #38: Resuscitation Before Intubation Logic
In Episode #38 of EM Logic, Dr. Pregerson reviews what you can do before intubation in order to prevent triggering a subsequent cardiac arrest. Read more details here in the Show Notes.
EM Logic Episode #37: Hyperacute T-Wave Logic
In Episode #37 of EM Logic, Dr. Pregerson discusses a paper by Dr. Stephen W. Smith on hyperacute T-waves. STEMI misses 30% to 40% of acute coronary occlusions that would benefit from emergent revascularization. Read more details here in the Show Notes.
March 2025 Episode #36: SVT Logic
In Episode #36 of EM Logic, Dr. Pregerson reviews the literature and finds on the role of troponin testing in patients with supraventricular tachycardia. SVT conversion and the reasons why diltiazem is better than adenosine is also discussed. Read more details in the Show Notes.
January 2025: Vital Signs Logic
Dr. Pregerson says vital signs are not just normal or abnormal but a continuum. The closer to abnormal they are, the more concerning they should be, of course, but there's still more to learn in this month's podcast. Read more in the Show Notes.
December 2024: Diagnostic Momentum Logic
As the literature says, you can't diagnose cyclic vomiting syndrome until you rule out Dietl's crisis. Dr. Pregerson discusses recurrent abdominal pain, which is often diagnosed as CVS, IBS, or abdominal migraine, but notes that Dietl's crisis may present similarly. Read more in the Show Notes.
November 2024: Literature Logic
Knowing how to interpret the literature is an important part of how emergency physicians stay up to date. Dr. Pregerson discusses all kinds of biases, from comparison bias and the Hawthorne effect to outcome bias and publication bias, only in this month's podcast. Read more in the Show Notes. Note from Dr. Pregerson: Thanks to Jerome Hoffman, MD, a giant in emergency medicine and a professor
October 2024: Triage ECG Logic
Dr. Pregerson talks all about the guidelines for reading ECGs, how to minimize interruptions while you're reading them, and ways to build your skills, only in this month's podcast. Read more in the Show Notes.
September 2024: Aortic Dissection Logic
Dr. Pregerson with how to use ultrasound to diagnose aortic dissection and not miss pericardial effusion, ascending aorta, and dissection flap, only in this month's podcast. Read more in the Show Notes.
August 2024: Abdominal Pain Logic
Dr. Pregerson tells you the red flags to look for in patients with abdominal pain, green flags that say you're on the right track, and return precautions to give the patient, only in this month's podcast. Read more in the Show Notes
July 2024: Delta Troponin Logic
Dr. Pregerson reviews the ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain by focusing on high-sensitivity troponin, delta troponin, unstable angina, renal failure, and baseline troponin, only in this month's podcast. Read more in the Show Notes.
June 2024: Temperature Logic
Dr. Pregerson says assessing temperature in the emergency department is more complicated than you think. He discusses the reliability of thermometers, what constitutes a fever, and how to diagnose hypothermia in this month's podcast. Read more in the Show Notes.
Dr. Pregerson takes a different approach to finding the cause of metabolic acidosis or alkalosis, delving into the anion gap and discussing mnemonics that can help you make the diagnosis, only in this month's podcast. Read more in the Show Notes.
Dr. Pregerson takes a different approach to finding the cause of metabolic acidosis or alkalosis, delving into the anion gap and discussing mnemonics that can help you make the diagnosis, only in this month's podcast. Read more in the Show Notes.
April 2024: Rabies Logic
Dr. Pregerson said he thinks EPs over-prophylax rabies cases, which carries risks and costs. He discusses the incidence of rabies, which symptoms to look for, and how to treat it in this month's podcast. Read more in the Show Notes.
April 2024: Rabies Logic
Dr. Pregerson said he thinks EPs over-prophylax rabies cases, which carries risks and costs. He discusses the incidence of rabies, which symptoms to look for, and how to treat it in this month's podcast. Read more in the Show Notes.
March 2024: Stroke Logic
Dr. Pregerson has all you need to know about strokes, including that posterior strokes are missed twice as often as anterior ones, ruling out mimics like vertigo, headache, and vomiting, and which tests you should be doing in this month's EM Logic podcast. Read more in the Show Notes.
February 2024: ACLS Logic
Dr. Pregerson dives deep into ACLS, noting that anything that compromises good CPR and early defibrillation can make things worse, and he offers tips for treating ED patients who need CPR, defibrillation, intubation, and medications in this month's EM Logic podcast. Read more in the Show Notes.
January 2024: Steroid Logic
Dr. Pregerson parses the literature on steroids for severe infection and why EPs need to know the nuances of how and when to use them in this month's EM Logic podcast. Read more in the Show Notes.
December 2023: Hypokalemic Arrest Logic
Hypokalemia gets a lot of attention in the literature, but Dr. Pregerson said he has never had a patient with hyperkalemic cardiac arrest. Listen in as he discusses the ECG changes seen with hypokalemia and how to treat hypokalemic arrest if you see it. Read more in the Show Notes.
November 2023: Blood Thinner Logic
EPs know blood thinners increase the risk of intracranial bleeding, and there are many classes of blood thinners, each with a different risk profile. Dr. Pregerson delves into antiplatelet agents, warfarin, and DOACs. Read more in the Show Notes.
October 2023: Vital Signs Logic
Dr. Pregerson digs deep into how missed vital sign red flags account for malpractice cases. He reviews unexplained tachycardia, soft blood pressure, minor temperature elevation, and mild hypoxia. Read more in the Show Notes.
September 2023: CT Contrast Logic
Dr. Pregerson tells you all you need to know about using CT contrast in the ED. Read more in the Show Notes.
August 2023: Viral Infection Logic
Dr. Pregerson says EPs have to think like detectives for cases that don't fit the typical pattern of viral illness and must think more logically about these infections. Read more in the Show Notes.
July 2023: Urinalysis Logic
Urinalysis can be a ship for fools, Dr. Pregerson says in this month's podcast where he explains why you need logic not to miss true UTIs. Read more in the Show Notes.
June 2023: Pain Medicine Logic
Pain medications make patients feel better and want to go home, but Dr. Pregerson says don't send them home with more medication unless a definitive diagnosis was made because they may not come back if the medication masks that their condition has gotten worse. Read more in the Show Notes.
MAY 2023: Aortic Dissection Logic
Dr. Pregerson logically dissects an aortic dissection, answering when to consider a chest CT, where to take the blood pressure, and when to do a pericardiocentesis, this month with bonus video! (https://bit.ly/EMNVideoGallery.) Read more in the Show Notes.
April 2023: Intubation Logic
Dr. Pregerson asks—and answers—the important questions about intubation: Why is it important to synchronize a bag-valve-mask ventilation with the patient's breathing? Why is upright intubation better? Why you should use the SALAD technique, and what are the benefits of ketamine? Read more in the Show Notes.
March 2023: Hemoptysis Logic
Dr. Pregerson delves into minor and serious cases of hemoptysis, how to treat these patients, and why positioning is so critical. Read more in the Show Notes.
February 2023: Leaving Against Medical Advice
Dr. Pregerson explains why it's important to find out why patients want to leave AMA because that might help you change their mind. Either way, chart what patient says and your response and listen to his other tips for handling these discharges. Read more in the Show Notes.
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.
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.
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.
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.
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 pr
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 sugges
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 sugges
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 misse
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. Inc
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. The
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. Oth
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