Don’t rely on a negative initial troponin to re-assure you – rely on you’re physical exam – if they look sick and sweaty – still consider ACS and get repeat EKG’s
Improvement with NSAID or GI cocktail should not be re-assuring – this may still be ACS
Don’t forget about atypical presentations – epigastric pain, DKA, shortness of breath, these by be cases of ACS
Patients often confuse palpitations with pain – consider ischemic arrhythmias
Don’t forget the skin exam! You may find zoster hiding
Give aspirin to every patient unless they have an allergy
Don’t discharge patients that are still having chest pain!