Discharge //

The patient is a good candidate for outpatient care. The patient is well appearing and vital signs are stable. The patient was given instructions to follow up with their primary care doctor in 1-2 days. I explained the findings and plan to the patient, who expressed verbal understanding and agreed with plan for discharge and follow up. The patient was given after care instructions and welcomed to return to the ED for any new or worsening symptoms. [***]On re-assessment, the patient feels better. The patient was re-evaluated after ED treatment and stabilizing measures, and symptoms have improved. The patient is a good candidate for outpatient care and will be discharged with instructions to follow up with their PMD in 1-2 days. I had an extensive conversation with the patient about the findings. The patient states that they understand the finding and discharge and follow up. The patient was given after care instructions and strict precautions with which the patient showed to return to the ED, especial for any new or worsening symptoms. The patient is stable at the time of discharge. Prescription: [none] [***]Patient's blood pressure was elevated (>120/80) but appears stable without evidence of hypertensive emergency or urgency. The patient was counseled about the risks of hypertension and urged to pursue outpatient monitoring and therapy within a week with their primary care physician. ADD TO CHEST PAIN DISCHARGES: [***] Evaluation for acute coronary syndrome was performed. The HEART score (www.mdcalc.com) was utilized for risk stratification and found to be less than or equal to 3. Based on this evaluation the patients risk of major adverse cardiac events is <1%. Shared decision making occurred with patient and the decision has been made to discharge the patient for outpatient evaluation and functional study within 72 hours. The patient presented with symptoms concerning for ACS. I considered pulmonary embolism, aortic dissection, pneumothorax among other diagnoses. Evaluation for acute coronary syndrome was performed. The HEART score (www.mdcalc.com) was utilized for risk stratification and found to be < 3. Repeat EKG was unchanged and repeat troponin remained negative @ 3 hours. Based on this evaluation the patient’s risk of major adverse cardiac events is <1%. Shared decision making occurred with patient and the decision has been made to discharge the patient with follow up with PMD or cardiologist within 72 hours for further discussion about outpatient management. Return precautions discussed with patient.



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