High Risk Patients

Identify high-risk patients

• High risk CC without diagnosis on d/c (abd pain, CP, h/a, fever)
• Abnormal VS
• Comorbid conditions - mental/psychiatric/drug abuse
• Chronic disease with decompensation
• Difficulty obtaining accurate data - language barrier, dementia, intoxications
• Advanced age
• Angry patients
• Unmet expectations
• Bouncebacks
• "Gut" feeling

Review your evaluation prior to d/c

• Address all documented complaints in the medical record
• Confirm H&P
• Consider other DDx of potentially life or limb threatening conditions
• Fully explore abnormal labs, VS, or imaging
• Write a progress note documenting medical decision making process
• Assure f/u and return to ER instructions
• Confirm that pt understands plan

Potential High-Risk Chief Complaints

• Back/Chest pain
• Weakness
• Headache
• Altered MS
  
• Abdominal pain
  

Back Pain/Chest Pain

• AAA
• A-Dsxn
  

Low Back Pain

• Fever
• Neuro deficits
• Saddle anesthesia
  

Headache

• Complete neuro exam (sensory, motor, cerebellar)
• Auscultate carotid arteries
• SAH, dissection, thrombosis, IIH

Ingestion/Altered MS

• Accucheck
• Alcohol
• UDS
• Osmolality
• Salicylate
• Acetaminophen

Eye Pain

• Visual Acuity - Snellen (use glasses if patient wears glasses)
• IOP
• Papilledema

Testicle Pain

• Cremaster reflex
• Equal flow to testicles on ultrasound