Podcast #235: ER Discharge and Mortality

Podcast #235: ER Discharge and Mortality

Author: Pete Bakes, M.D.

Educational Pearls

  • One of the roles of the ER provider is to discharge patients only after life-threatening conditions have been ruled out. However, some patients that are discharged from the ED die within days of their discharge. One recent study sought to investigate the factors and diagnoses associated with death within 7 days of discharge.
  • This study was a retrospective study in 10 million medicare recipients that presented to the ER over 10 years. They excluded palliative, hospice and SNF patients.
  • 0.12% of these patients died within 7 days of ER discharge. Signs and symptoms such as altered mental status, general malaise and fatigue, and nonspecific dyspnea had relative risks of 3-5 for death following discharge.
  • Think carefully before discharge in patients with the signs/symptoms above.

References: Obermeyer Ziad, Cohn Brent, Wilson Michael, JenaAnupam B, Cutler David M. Early death after discharge from emergency departments: analysis of national US insurance claims data BMJ 2017;356 :j239

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Podcast #311: Recurrence of Seizures in Pediatrics

Podcast #311: Recurrence of Seizures in Pediatrics

Author: Aaron Lessen, M.D. Educational Pearls: Recurrence rate for first time unprovoked seizures - 5% after 48 hours, 14% at 2 weeks , 30% after 4 months. Higher risk for recurrence: age under 3; pa...

28 Maalis 20182min

Podcast #310: Bicarb in DKA

Podcast #310: Bicarb in DKA

Author: Gretchen Hinson, M.D. Educational Pearls: Controversial topic. Pathophysiology - acidosis leads to an extracellular potassium shift. Patients in DKA will be intracellularly potassium deplete,...

26 Maalis 20185min

Podcast #309: Return Visits to the ED for UTI

Podcast #309: Return Visits to the ED for UTI

Author: Alicia Oberle, MD Educational Pearls: Recent study has shown risk factors for return included patients at high risk for resistance (nursing home, obstructive uropathy), patient where diagno...

23 Maalis 20182min

Podcast #308: Ultrasound in Cardiac Arrest

Podcast #308: Ultrasound in Cardiac Arrest

Author: Aaron Lessen, M.D. Educational Pearls: There is currently debate within the medical community about what constitutes cardiac activity on ultrasound in the setting of cardiac arrest. A recent ...

21 Maalis 20182min

Podcast #307: Guillain-Barre Syndrome

Podcast #307: Guillain-Barre Syndrome

Author: Peter Bakes, M.D. Educational Pearls: Rare disease with 1-2 patients out of 100,000. About 60% of patients report a preceding diarrheal illness and classically presents with an ascending mo...

19 Maalis 20184min

Podcast #306: Tramadol Drama

Podcast #306: Tramadol Drama

Author: Nick Hatch, M.D. Educational Pearls Tramadol acts at multiple receptors and is a partial agonist at the mu opioid receptor, but also blocks reuptake of serotonin and norepinephrine throughou...

16 Maalis 20183min

Podcast #305: Stuffers vs. Packers : Drug-Packet Ingestion

Podcast #305: Stuffers vs. Packers : Drug-Packet Ingestion

Author: Aaron Lessen, M.D. Educational Pearls A "stuffer" is a term for someone who hastily and conceals a bag of drugs orally/rectally/vaginally in an unplanned situation. A "packer" is someone who...

14 Maalis 20183min

Podcast #304: Nostalgia

Podcast #304: Nostalgia

Author: Dylan Luyten, MD Educational Pearls Johannes Hoffer coined term Nostalgia in 1688 in his medical dissertation. Nostalgia was a formal medical diagnosis, and one that dates back to 17th...

12 Maalis 20185min

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