Check a glucose first in anyone with altered mental status or a focal deficit.
Hypoglycemia can look like a stroke or a seizure, and it is fast to check and fast to fix. Make the fingerstick part of the first minute, before the work-up grows.
Pearls
Short takeaways from PAs in practice. Each one is reviewed before it goes live.
Pearls are starting points, not orders. Check current guidelines and your own protocols before you change care.
A single early troponin doesn't close the case.
Timing matters. A normal value soon after symptom onset can't rule out a heart attack on its own. Follow your department's serial testing pathway, and weigh the story as heavily as the number.
Start with what could hurt the patient in the next hour.
Before you settle on the likely diagnosis, list the dangerous ones the presentation could still be. Then say out loud which ones you've excluded, and how.
Pulse oximetry can look normal in carbon monoxide poisoning.
Standard pulse oximeters can't tell carboxyhemoglobin from oxyhemoglobin, so the number can be reassuring while the patient is sick. Think of it with headache and nausea, or when several people in one place feel unwell.
Reconcile the medication list before you write the first order.
Admission orders built on an unverified list carry the errors forward. Ask the patient, the pharmacy, and the bottles, and note which source you trusted.
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