Be very careful with this attitude.
You are a medical student. You do not have the slightest clue as to what it's like to carry multiple patients of varying acuity in a busy ED. You do not have experience with the nuances of presentation, and how both benign and deadly illness can overlap significantly.
If you expect to become a practicing emergency physician and go a career (or even a year) without sending someone home who has a bad outcome, you have a very inflated and possibly dangerous opinion of your abilities.
Maybe I'm reading too far into your comment, but you need to take a moment of reflection. Humble yourself. This kind of confidence is inappropriate at your level of training. If you maintain this attitude into internship, I'd personally be weary of having the responsibility of supervising you.
Keep in mind that every time you go to the gym (or even up a few flights of stairs) that you develop a few of the SIRS criteria . . .
You sound a little out of your league. Unless of course you're being sarcastic.
Why would you be humiliated for wanting to discharge someone once their vital stabilize (assuming that they are otherwise ready for discharge)? Are you saying that any abnormality in vital signs at any point warrant an admit? What about a tachycardia in the setting of a fever that resolves after tylenol and you decided the fever does not need a work up (say a kid has an URI x 1 day and nothing else concerning on history of physical)?
Wow. I go away for a couple days and find out I really made some people upset.
First off, let me apologize for coming across a bit as a know it all (in retrospect, reading my original post I sound a little like a brat).
I've actually gone and done some research following my mistake, reread the article (a poor source to judge from but the only one we have unfortunately), and consulted with a couple other doctors. Also, while I'm still a med student, I am a bit older, and have worked in emergency medicine departments/related fields for a long time now (>10 years without giving anything away. Finally I am the farthest thing from an expert, but have seen a lot of patients).
I am hoping there is something to be learned from this tragedy, and I am wondering what in the patient's history makes a lot of posters on here feel so comfortable releasing him (again, it's a fairly biased article, so probably at the time there was more information indicating he could be discharged--but we don't know)
Looking at the story again though, I can't imagine this child being released so quickly from any medical center I have ever worked in. Is there something huge that I am missing?
First off, he was 12 years old, 5'9" tall, and weighed nearly 170 pounds (almost my size). It's true kids aren't just little adults, but in light of this, at the places I've worked, adult criteria are given at least some acknowledgment.
He came in from a community pediatrician (I've always been told when someone sends you a sick patient, your index of suspicion should rise considerably) with a pulse of 140, a temp of 102, and a respiration rate of 36. It sounds like he had considerable leg pain, was vomiting a lot, and his skin was mottled (a kid who is apparently non-stop vomiting and his chief concern is leg pain just seems odd). That sounds like a pretty sick kid to me, at least sick enough to spend a little more time on.
When he was discharged his pulse was still in the 130s and a temp of 102. While at the EDs I have worked in have sent home kids with abnormal vitals, I haven't seen someone with vitals like that following a presentation such as this one sent away without some kind of better explanation and pending lab results. It's also surprising to me that he was apparently in and out of there in 2 hours.
[sarcasm] On an unrelated note, an educational model that involves 'public humiliation' for the most junior members of a team sounds just spectacular. [/sarcasm]
And yeah, some times it can be tough being a med student where I am. It feels like they expect a lot of us, and I have been chewed out a lot of times (by public humiliation I mean getting sternly lectured in front of the team, not in the town square) but it's clear that the attendings are trying to make sure something sticks rather than belittle us. I suppose I would rather be publicly humiliated than not learn something they consider to be an important lesson.