Emergency Medicine Pitfalls


Emergency Medicine Pitfalls, Emergency Medicine Pearls, Emergency Department BounceBacks, BounceBacks

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