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In general, consultants do not wish to hospitalize patients who, in their opinion, do not need admission. Since EPs do not wish to send patients home who, in their opinion, should not be discharged, conflict may be inherent to this interaction. As always, keep the patient’s best interests in mind. Consider alternate options such as holding patients in the ED until the next consultant comes on duty, finding a different service to admit the patient, enlisting the assistance of social services, admitting the patient to an observation unit (either in the ED or the hospital), or recognizing that it may be safe to send that particular patient home despite your initial impression.
5 mg/kg rapid IV push in adults. In children Ͻ10 years of age, the recommended dose is 2 mg/kg rapid IV push. In newborns, use 3 mg/kg rapid IV push. There is little harm to giving too much SCh; however, giving too little SCh can result in an inadequately paralyzed patient and affect one’s ability to successfully intubate. The main drawback to SCh are its side effects, including muscle fasciculations, bradycardia, hyperkalemia, prolonged neuromuscular blockade, trismus (masseter spasm) and malignant hyperthermia.
If a patient walked in to the ED, or “should be able to walk,” then this patient should be able to walk at discharge. Patients should be discharged to a safe environment, preferably in the company of a responsible adult who also understands the discharge instructions. If they have been in the ED for an extended period, providing a meal is appropriate, as they may be too ill or tired to prepare one for themselves upon returning home. Wheelchairs may be used to assist patients to their cars. Patients should not drive if they might be distracted, were given medication that may interfere with driving, or presented with a lapse of consciousness that may recur without warning.