II. History
- Avoid labeling patients
- Drug seeking patients can also have life-threatening illnesses
- Considered differential diagnosis should be complete regardless of a patient's frequency of emergency department visits
- Document findings that contribute to medical decision making
- Do not use a stereotype or label (e.g. drug seeker or frequent flyer) in the documentation
- Do not rely on or document postulated patient intentions of Secondary Gain by family, friends or staff
III. Signs
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Abnormal Vital Signs
- Follow serial values when Vital Signs are abnormal
- Thoroughly investigate potential causes of Abnormal Vital Signs before discharging a patient
- Vital Signs are often abnormal in patients with an unanticipated death after emergency department discharge
- Sklar (2007) Ann Emerg Med 49(6): 735-45 [PubMed]
-
Gait has significant diagnostic and prognostic value
- Abnormal Gait may be the only finding in a patient with an underlying neurologic disorder
- A patient who walks into the emergency department should be able to walk out (not discharged by Wheelchair)
IV. Disposition
- Pain relief is not a cure and is not an endpoint for emergency department discharge
- A determinant for discharge is a reasonable differential diagnosis and exclusion of life threatening causes
V. References
- Weinstock in Majoewsky (2012) EM:RAP 12(3): 1-3