ER Rapid Differential Diagnosis Generator
Generate ranked differential diagnoses for acute presentations using structured clinical reasoning
What You Can Do
You can rapidly generate comprehensive, ranked differential diagnoses for complex acute care presentations by leveraging structured clinical reasoning that mitigates anchoring bias and cognitive overload. The skill organizes differentials by acuity and likelihood, ensuring life-threatening conditions are considered systematically rather than relying on pattern recognition alone. Your outputs remain defensible for chart review, peer assessment, and medicolegal scrutiny.
Features
Uses Anchoring mitigation, Categorization, and Evidence weighting to combat diagnostic bias
Systematically surfaces dangerous conditions before common mimics
Specifically designed to overcome anchoring, availability, and confirmation bias
Organizes differentials by urgency, probability, and clinical actionability
Generates clinical reasoning that withstands peer review and medicolegal scrutiny
Practical for time-pressured emergency environments without sacrificing rigor
Handles vague, atypical, or overlapping presentations effectively
Example Output
Chief Complaint: Chest pain, 58M with dyspnea and diaphoresis
Life Threats (Immediate Consider):
- Acute coronary syndrome — Diaphoresis + dyspnea + age/risk profile; ECG required
- Pulmonary embolism — Dyspnea + tachycardia; D-dimer/imaging threshold
- Aortic dissection — Sudden onset + hypertension; CTA chest if high suspicion
- Tension pneumothorax — Unilateral dyspnea; rapid imaging if hypoxic
Likely Category (Moderate Acuity): 5. Unstable angina — Chest wall tenderness; troponin/serial EKG 6. Acute decompensated heart failure — Orthopnea + crackles; BNP/CXR
Lower Acuity (Reassess if Stable): 7. Musculoskeletal strain — Reproducible pain; normal vitals 8. Anxiety/panic — Normal workup; reassurance after rule-out
Chief Complaint: Altered mental status, 72F, no fever
Immediately Life-Threatening:
- Hypoglycemia — Confusion + autonomic signs; finger-stick first
- Intracranial hemorrhage — Acute onset; STAT CT head
- Sepsis (non-obvious source) — Altered mentation; labs/cultures despite normal temp
High-Priority Differentials: 4. Acute stroke — Focal deficits; CT/MRI consideration 5. Medication effect/toxin — Recent medication changes; urine screen 6. Hypoxemia — SpO2 check; ABG if low normal 7. Hyponatremia/electrolyte derangement — Labs urgently needed
What's Included
- SKILL.md instruction file with ACE framework, bias-mitigation protocols, and clinical decision rules:
- Chief Complaint Decision Matrix mapping 20+ acute presentations to starter differentials:
- Life-Threat Checklist ensuring dangerous diagnoses are never anchored away:
- Cognitive Bias Prompts to use when you suspect pattern recognition error:
- Documentation Template for defensible differential reasoning in medical records:
Who It's For
- Emergency medicine physicians — Generate rigorous differentials under time pressure
- Hospitalists with ER coverage — Systematize acute diagnostic reasoning
- Residents and fellows — Learn structured approach to differential generation
- Physician assistants and nurse practitioners in acute care — Strengthen clinical reasoning documentation
- Medical educators — Teach bias-aware diagnostic frameworks to trainees
Best For
- Undifferentiated presentations (chest pain, dyspnea, altered mental status, syncope)
- Atypical or multisystem cases where anchoring bias is high risk
- High-cognitive-load scenarios with multiple competing diagnoses
- Building defensible charts for peer review or medicolegal purposes
- Teaching diagnostic reasoning to trainees or colleagues
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