What are you thankful for?

High-sensitivity troponin has changed chest pain risk stratification, video laryngoscopy has largely overtaken direct laryngoscopy for emergency intubation, and GRACE-4 gives emergency clinicians a practical framework for alcohol use disorder. These are three meaningful shifts in emergency medicine care with direct bedside impact.

Chest Pain Risk Stratification

• HEART score foundation: The HEART score remains a practical starting point for ED chest pain evaluation, giving a structured risk estimate that helps separate low-risk patients from those needing closer ischemic workup.
• High-sensitivity troponin value: High-sensitivity troponins sharpen early MI assessment and help avoid low-acuity admissions when paired with sound clinical risk stratification rather than used in isolation.
• OMI versus NOMI framing: Occlusive MI versus non-occlusive MI is a more useful clinical lens than STEMI alone, because dangerous coronary occlusion can be present without classic ST-elevation.
• Disposition implications: Combining clinical scoring with modern troponin testing improves routing to the right level of care within a reasonable timeline, and we get into that practical framing in the episode.

Direct Versus Video Laryngoscopy

• Video laryngoscopy advantage: Current airway data increasingly support video laryngoscopy as the more effective default intubation tool, especially when first-pass success is the outcome that matters most.
• Blade and device nuance: The modern question is often less video versus direct and more which video setup to choose, since blade geometry and device familiarity both affect performance.
• Direct laryngoscopy role: Direct laryngoscopy still has a place in selected emergency airway scenarios, but its strongest indications are narrower than they once were.
• Evidence-informed airway choices: The intubation conversation is now guided by a much larger evidence base than before, with practical exceptions and operator considerations we walk through on the show.

Alcohol Use Disorder Care

• GRACE-4 guidance: GRACE-4 gives emergency clinicians a clearer framework for patients with alcohol use disorder, moving care beyond the old binary of ICU admission versus discharge to keep drinking.
• Withdrawal care gap: Many EDs still lack the resources to treat addiction longitudinally, but better guidance can still improve immediate safety, symptom control, and next-step planning.
• At-risk population focus: Alcohol use disorder care is a core emergency medicine equity issue, because these patients often present repeatedly during moments of high medical and social vulnerability.
• Actionable bedside tools: The value of GRACE-4 is its practical bedside utility for a difficult population, and we cover where it changes day-to-day ED decisions in the chapter.