II. History

  1. Avoid labeling patients
    1. Drug seeking patients can also have life-threatening illnesses
    2. Considered differential diagnosis should be complete regardless of a patient's frequency of emergency department visits
    3. Document findings that contribute to medical decision making
      1. Do not use a stereotype or label (e.g. drug seeker or frequent flyer) in the documentation
      2. Do not rely on or document postulated patient intentions of Secondary Gain by family, friends or staff

III. Signs

  1. Abnormal Vital Signs
    1. Follow serial values when Vital Signs are abnormal
    2. Thoroughly investigate potential causes of abnormal Vital Signs before discharging a patient
    3. Vital Signs are often abnormal in patients with an unanticipated death after emergency department discharge
    4. Sklar (2007) Ann Emerg Med 49(6): 735-45 [PubMed]
  2. Gait has significant diagnostic and prognostic value
    1. Abnormal Gait may be the only finding in a patient with an underlying neurologic disorder
    2. A patient who walks into the emergency department should be able to walk out (not discharged by wheelchair)

IV. Disposition

  1. Pain relief is not a cure and is not an endpoint for emergency department discharge
    1. A determinant for discharge is a reasonable differential diagnosis and exclusion of life threatening causes

V. References

  1. Weinstock in Majoewsky (2012) EM:RAP 12(3): 1-3

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