I think I made a booboo. Took a pt home that prolly wasn't ready

[Bieber]

Heh... man, I feel your pain. If you weren't here at the time, or if you didn't see it, I had a similar experience a little more than a year ago. Feel free to look over my own experience, though it was a little different from yours.. http://www.emtcity.com/topic/19392-was-i-wrong/

As for your particular situation, and for any future situations, I can't tell you what to do, only that taking patients from the ER to their home can be one of the most difficult situations and one of the biggest grey areas in this job. You have to temper the patient's rights with their condition and medical needs, and even if you're expected and paid to just shut up and take them where the doc says, you have to remember the humanistic side of this profession, and remember that we're patient advocates first and foremost. If your patient had a CT to rule out CVA, though, I think she was probably appropriate to discharge despite her wacky vitals.

Good luck to you man, take this experience and remember it in the future, and don't lose that passion to do what's right for your patients, even if it means rustling a few feathers.

Addendum: Also, for what it's worth, you handled your incident a lot better than I did mine. So kudos!

[1EMT-P]

Just because a patient is being transported home doesn't mean that we should treat that patient differently. Patients are patients regardless if they are Critical Care, EMS (911) or Transports & they should be given the same standard of care. We should be getting an H&P including baseline vitals, list of allergies & list of medications on all of our patients & we should be documenting who we got report from, what the patient's condition & problem was, any treatment, where we are transporting the patient & how we transported & left the patient. The patient in this case had Atrial Fib, Hypertension, Stroke & was complaining of a Headache. Given her chief complaint & her history clearly a detailed evaluation is warranted, sometimes things do not always show up on CT. I've taken care of lots of high risk patients in the ICU over the years who were evaluated in the ED for similar symptoms & later sent home, only to return hours later with a positive CT Scan & Stroke.

[Kiwiology]

Given her chief complaint & her history clearly a detailed evaluation is warranted, sometimes things do not always show up on CT

I'm not sure a CT and review by a Consultant Physician can get more detailed; except if she was seen by me, a Consultant Kiwiologist, why? because Kiwiology makes all branches of medicine look like crap, except Chuck Norrisology, I can't compete with that beard and cowboy hat.

Unfortunately medicine is an inexact science, people with no risk factors for cardiac disease drop dead from cardiac arrest, people with no abnormal immune biochemistries and normal physical exams drop dead from viral meningitis which the underfed, dangerously overworked and extremely fatigued House Surgeon forgot about because most people forget there is viral and bacterial meningitis and so on ...

[craig]

kiwiologist? thats a new one............

surely you mean chEck nUrris?.......and yes i did call you surely.................

BTW I agree with your second paragraph....................

[Kiwiology]

Bitch please if you Aussieologists actually did some work and not lounged around all day at the beach or watching the cricket you might be as awesome as us

Within the realm of medicine we only know so much; the principle (especially in emergency medicine) is to exclude serious pathology through selected imaging, biochemistry and other studies (for example ECG) as well as physical examination/observation and if we can't tick enough boxes to say that what the investigations show meets the criteria for something then we revert to managing symptoms and out the door with you because we need to meet that six hour target set by the Ministry of Health oh by the way see your GP if you don't improve, hey can somebody get me a trolley over here the House Surgeon just collapsed from being malnourished; now did we ever get a locum to cover for the Registrar who died three weeks ago from fatigue? And oh man don't look now but it's one of those educated nurses to hassle me about something, they've probably interpreted the biochemistry and imaging studies I ordered themselves ....

I think this bloke's desire to want more for his patient is admirable but if the hospital has performed sufficiently sufficient examination and investigations and found nothing major wrong then at that point there's not a whole lot more the emergency department can do.

Where's the Emergentology bloke when you need him? I think I see him over there on the phone trying to organise a locum Registrar to cover the other Registrar who died three weeks ago from fatigue ....