Thanks to Dr Natasha DeSousa for her M&Ms presentation today.
Top tips from October 2015 M&Ms
1. Consider a ‘road test’ before sending a patient home, especially if s/he has received multiple doses of narcotics. Ensure that the success or failure of the ‘road test’ is documented in the chart.
2. If home is the disposition, ensure patients have someone to accompany them if s/he has received multiple doses of narcotics.
3. Renal stones are painful; remember, we have a Renal Colic protocol that facilitates pain relief before a patient is even seen by a physician.
4. Beware fundamental attribution bias – intoxicated patients can still have painful fractures that require expedient analgesia.
5. Documentation facilitates communication between ourselves and other colleagues, and serves as an important medicolegal record of a patient encounter.
6. Newly confused patients or patients with new objective limb weakness should receive an emergent head CT before admission to the hospitalist service.
7. Avoid administering ASA to newly confused or weak patients before a head CT confirms absence of a SDH/SAH.
8. Consider documenting conversations with Radiology when discussions about CTs occur.
Resources
- Safe Discharge from the Emergency Setting – Emergency Nurses Association position statement
- Evaluation of the 20m Walk Test
- Improving the Emergency Department Discharge Process – Agency for Healthcare Research and Quality
- Managing intoxicated patients in the emergency department – CMPA
- Alcohol Related Emergencies – Emergency Medicine Practice
