Talk to any emergency doctor worth their salt, and they'll tell you that it isn't the wildly sick patients who keep them up all night.

It's the ones they send home.

Part of what makes emergency medicine so difficult is the need to quickly sort out patients into three main categories.

Low risk, medium risk, and high risk.

Or another way of thinking about it, safe to go home, say fish for home,

and you're sleeping here tonight. Every disease has high and low risk patients, and every patient

has diseases they're individually more or less likely to have. It's a battle of odds,

and the stakes couldn't be higher. So fittingly, today, we're talking about a high-risk topic but in low-risk patients, chest pain.

Now, if this isn't bread and butter emerge, I don't know what is.

By the end of this episode, we hope you'll be able to wield tools like the heart score

and repeat your opponents with ease and with a singular goal in mind.

Today, we answer the question,

who with chest pain can I send home?

Welcome to the Emergency Medicine Cases Podcast. I'm your host, Dr. Anton Hellman,

bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.

It seems that the current ED standard of practice for managing patients with low-risk chest pain and possible ACS in the U.S. involves admission or observation in an observation unit

and non-invasive cardiac testing either

immediately or in a day or two. But this approach isn't so efficient, cost a boatload,

and has never really been shown to improve patient outcomes. We probably underestimate the risks

of admitting patients to the hospital and probably underestimate the risks of overdiagnosis and all the false positives associated with non-invasive cardiac tests.

And we don't want to miss ACS ever, really, so erring on the side of testing and admission

for low-risk chest pain is really very common.

...