46 - Heat Stroke Tx, A New Virus, Oral Cephalosporins Vs Pyelo, Safe Discharges | The 2 View

About this Episode

Episode 46 of “The 2 View” – Heat Stroke Tx, A New Virus, Oral Cephalosporins Vs Pyelo, Safe Discharges

Segment 1A – Music Therapy In the ED

Edited by Chaphalkar A. Music therapy eases pain and anxiety in the ED. Medscape. May 2, 2025.
https://www.medscape.com/viewarticle/music-therapy-eases-pain-and-anxiety-emergency-department-2025a1000apm

Episode 1. The 2 View. 2view.fireside.fm. Published January 11, 202.
https://2view.fireside.fm/1

Segment 1B – Heat Stroke Guidelines

Barletta JF, Palimeri TL, Toomy SA, et al. Society of Critical Care Medicine Guidelines for the Treatment of Heat Stroke. Crit Care Med. 2025; 53(2):p e490-e500.
https://journals.lww.com/ccmjournal/fulltext/2025/02000/society_of_critical_care_medicine_guidelines_for.22.aspx

Eifling KP, Gaudio FG, Dumke C, et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update. Wildness Environ Med. 2024;35(1_suppl):112S-127S.
https://journals.sagepub.com/doi/10.1177/10806032241227924

Hawkins SC, David F. An Evidence-Based Guide to Heat Stress. Image. Raw Medicine.
https://rawmedicine.org/episodes/f/episode-6-heat-emergencies-with-tod-schimelpfenig-and-tim-durkin Published July 1, 2018.

Segment 2A – Cephalosporins for Outpatient Treatment of Pyelonephritis

Gupta K, Hooton TM, Naber, KG, et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Inf Dis. 2011;52(5):e103-120.
https://academic.oup.com/cid/article/52/5/e103/388285

Koehl J, Spolsdoff D, Negaard B, et al. Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study. Ann Emerg Med. 2025;85(3):240-248. https://www.annemergmed.com/article/S0196-0644(24)01140-5/abstract

Segment 2B - Ouropouche Virus

Clinical Overview of Oropouche Virus Disease. Centers for Disease Control and Prevention. May 8, 2025.
https://www.cdc.gov/oropouche/hcp/clinical-overview/index.html

Glatter RD, Sader Neves Ferreira J. Why Is Oropouche Spreading so Fast? Medscape. May 19, 2025.
https://www.medscape.com/viewarticle/why-oropouche-spreading-so-fast-2025a1000cgb

Segment 3 - Discharging Patients

Safe Discharge From The Emergency Department. Ann Emerg Med. 2019;74(5):e95.
https://www.annemergmed.com/article/S0196-0644(19)30622-5/abstract

Ward, M. When And How Should Clinicians View Discharge Planning as Part of a Patient’s Care Continuum? AMA J Ethics. 2023;25(12):e866-872.
https://journalofethics.ama-assn.org/article/when-and-how-should-clinicians-view-discharge-planning-part-patients-care-continuum/2023-12

Some Points to Consider Before Discharging a Patient, from Mike and Martha:

History / Physical
• Abnormal vital signs – treated/explained
• Timely repeat vital signs relative to discharge
• Addressed all concerns raised in your history-taking and nursing notes
• Pertinent history & exam positives/negatives

Diagnostics / Decision-Making
• Reviewed all diagnostics ordered
• Documented abnormalities, explained their significance, & directed follow-up
• Adequately considered differential diagnosis

• Even in a non-acute setting, adequately ruled out life/limb/organ threats
• Appropriately documented communication with staff, consultants, pt’s family
• Documented patient declining any diagnostics/treatment and their reasons

• Documented any reasonable attempts at an alternative plan
• Documented assessment of pt’s capacity to make informed medical decisions

General Documentation
• Reviewed “smart phrases” word-for-word to ensure they apply to this pt
• Documented use of language services in accordance with institution policies
• Documented all appropriate diagnoses (including abnormal vital signs and abnormal diagnostics as appropriate)

Discharge Plan
• A discharge plan that make sense for this patient, including taking social determinants of health into consideration
• Patient can reasonably attend follow-up visits
• Follow-up timeframe is appropriate for patient
• Patient can afford or obtain essential medications and treatments
• Discharge instructions and return precautions, especially for high-risk issues (chest/abdo pain, wounds, infections, fx, splints/casts, controlleds)?

Recurring Sources

Center for Medical Education. http://ccme.org
The Proceduralist. http://www.theproceduralist.org
The Procedural Pause. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx
The Skeptics Guide to Emergency Medicine. http://www.thesgem.com

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