Erin Raiolo, M.Ed, BSN, RN, CEN, TCRN
Emergency nurses know the most dangerous patients don’t always look sick. In today’s fast‑paced emergency department, subtle presentations can hide life‑threatening pathology. That challenge is at the center of “Silent Killers in the ED: Subtle Presentations You Can’t Miss,” an interactive, case‑based education session that takes place today from 1:45-2:30 p.m.
“This particular session actually highlights five different patient situations that I’ve had as a nurse over the last 12 years,” explained session presenter Erin Raiolo, M.Ed, BSN, RN, CEN, TCRN, a nursing instructor with 12 years of ED experience.
Each case begins with only a snippet of information, mirroring real ED triage. From there, attendees will identify differentials, challenge assumptions, and adjust their thinking as new details unfold.
Overlooked Conditions
The session highlights on high‑risk, low‑frequency conditions that present deceptively. Common complaints, such as abdominal pain, headache, weakness, shortness of breath or “not feeling right,” can mask serious disease. One case highlights how a headache initially treated as a migraine later revealed a more serious underlying condition when symptoms worsened.
“That’s when they caught the brain bleed on the CT,” she recalled.
Another case involves a patient with right‑lower‑quadrant pain. Clinicians focused on a recent ovarian issue before discovering a massive blood clot from her hip to her ankle. Together, the cases show how narrowing too early can lead to missed diagnoses.
“We get into a rhythm and a routine,” Raiolo said. “We don’t necessarily understand that atypical presentations are actually a lot more common than they are rare.”
She notes that cognitive traps, including anchoring, premature closure and bias toward benign explanations, are especially dangerous in a busy ED, where nurses may make decisions from limited data.
Raiolo acknowledges the tension nurses face. Ideally, every patient would receive a broad differential and careful evaluation. In reality, EDs are stretched thin. “We’re just tired,” she said. For that reason, she sees the session as a practical reset and asks, “Nope, take a step back. What are we missing?”
Attendees can expect to leave with a sharper sense of how to pause before closing a differential, recognize when a familiar complaint may signal something serious, and use consistent assessment habits when the department is busy.
To help nurses navigate this pressure, Raiolo emphasizes practical habits they can use immediately, including a consistent assessment approach to avoid missing subtle abnormalities.
“If you’re just kind of willy‑nilly throwing your care together, that’s when things are going to get missed,” she said.
Listening closely to patients, reassessing frequently, and trusting gut instinct while grounding decisions in clinical data are key strategies she hopes attendees will adopt.
Raiolo stressed this session is for everyone, from new nurses learning to think broadly to seasoned clinicians who may have grown comfortable in their routines.
“Don’t be complacent. … Keep your mind open. The last thing we want to do is miss something and have our patients be harmed,” she said.
With eye‑opening cases, audience participation and real‑world lessons, the session offers Emergency Nursing 2026 attendees a powerful reminder that subtle doesn’t mean safe.