Emergency Differential Diagnosis Systematizer
Systematize emergency differentials with red-flag rule-outs and evidence-based protocols
What You Can Do
You can rapidly develop evidence-based differential diagnoses for complex emergency presentations, systematically rule out critical conditions using red-flag protocols, and create structured assessment plans with specific diagnostic thresholds. This skill helps you document your clinical reasoning in a defensible format while avoiding cognitive biases like anchoring and premature closure that lead to diagnostic delays.
Features
automatically generates life-threatening diagnoses that must be excluded first based on chief complaint
ranks diagnoses by likelihood and acuity using evidence-based epidemiology for your patient population
creates specific test sequences with decision thresholds and branch points to efficiently rule diagnoses in or out
builds explicit decision trees to counteract anchoring bias, availability bias, and premature closure in real time
formats your reasoning in a clear, reviewable narrative that demonstrates appropriate systematic thinking
visualizes your diagnostic approach with specific go/no-go criteria at each step
prioritizes investigations by urgency and discriminatory value rather than reflex ordering
Example Output
Chief Complaint: Acute chest pain with dyspnea
Red-Flag Rule-Outs (Assess First):
- Acute coronary syndrome (EKG, troponin, risk stratification)
- Aortic dissection (BP differential, imaging)
- Pulmonary embolism (D-dimer, imaging if high probability)
- Tension pneumothorax (physical exam, CXR)
Structured Differential with Assessment Plan:
- Acute MI (30% pre-test probability) — EKG within 10 min, serial troponin; decision threshold: troponin >99th percentile
- Unstable angina (25%) — Similar workup, negative troponin but ischemic EKG changes
- Aortic dissection (8%) — BP >180 systolic; if yes, stat CT angiography
- PE (12%) — Unilateral leg swelling or risk factors; Wells score >4 triggers CT PE protocol
- Acute bronchitis (15%) — Normal vitals, clear lungs, negative troponin, normal EKG
Medicolegal Summary: Patient presented with acute chest pain. I systematically ruled out life-threatening etiologies using EKG, troponin, and vitals. Given presentation and negative workup, diagnosis is consistent with acute bronchitis.
What's Included
- SKILL.md instruction file with frameworks for differential generation and red-flag prioritization:
- Chief complaint template: structured intake checklist for rapid history and physical key features
- Red-flag decision matrix: quick reference table mapping presentations to critical rule-outs
- Assessment protocol workflow: step-by-step diagnostic sequencing with decision thresholds
- Medicolegal documentation template: narrative format for clear reasoning documentation
Who It's For
- Physician Assistants in emergency medicine working high-acuity shifts
- Emergency department attending physicians supervising trainees and managing complex cases
- Resident physicians learning systematic diagnostic reasoning in acute care
- Urgent care providers managing undifferentiated acute presentations
- Quality assurance teams reviewing diagnostic delays or near-miss cases
Best For
- Broad-differential presentations (chest pain, abdominal pain, dyspnea, syncope, altered mental status)
- Rule-out protocols for life-threatening conditions before ancillary workup results return
- Teaching scenarios where you need to model diagnostic reasoning for trainees
- Medicolegal documentation of your clinical thinking after a case
- Cognitive debiasing when you recognize you've anchored to one diagnosis too early
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