Test Your Knowledge

What is the appropriate patient status?

76-year-old male with a past medical history significant for hypertension, hyperlipidemia , diabetes, chronic atrial fibrillation, and CKD stage 3 presented to the ED with chest pain.

Day of presentation:

2332: EKG demonstrates atrial fibrillation with a heart rate 111 and non-specific ST-T wave changes. Troponin 0.03

2347: Diltiazem drip initiated

Day 1:

0250: Observation order placed

0412: H&P assessment: chest pain, multiple risk factors. Plan trend troponins, hold diltiazem, aspirin, cardiology consult

1050: Progress note update: NPO for potential cardiac catheterization

1348: Cardiac catheterization: PCI x4 stents placed

1832: Post procedure: patient developed rectal bleeding. Patient on apixaban, dual antiplatelet treatment. Plan for pantoprazole and GI consult.

1850: Inpatient order placed

Day 2:

1530: Discharge to home

Would you Status:

Inpatient
Outpatient
out patient
The provided case involves a patient with atrial fibrillation, who underwent cardiac catheterization with placement of four stents and subsequently developed rectal bleeding while on apixaban and dual antiplatelet therapy. The decision to admit the patient as an inpatient is supported by several factors outlined in the clinical indications for inpatient care: * High Short-term Risk Factors: The patient’s condition involves atrial fibrillation with multiple risk factors. These risk factors may include congestive heart failure, hypertension, age over 65, diabetes mellitus, vascular disease, and a history of thromboembolism, which necessitate inpatient care. * Contraindications to Outpatient Anticoagulation: Given the patient's rectal bleeding and anticoagulant use, there might be contraindications to managing anticoagulation on an outpatient basis. Specifically, the patient's bleeding and recent invasive procedure increase the risk associated with outpatient anticoagulation management. * Inpatient Treatment and Monitoring: The patient's condition requires close monitoring and treatment that is best provided in an inpatient setting. This includes management of anticoagulation therapy, monitoring of prothrombin time/INR, partial thromboplastin time, CBC with platelet count, renal and hepatic function, and potential drug-drug interactions. Additionally, the patient might need a hematological consultation given the complexity of their condition. * Extended Stay for Stabilization: The patient’s extended stay seems justified until there is no bleeding, the INR is therapeutic or not indicated, an anticoagulation regimen for the next level of care is established, and there's no requirement for hospital-level care for the primary condition or comorbidities. These conditions ensure patient safety and appropriate management before discharge. Therefore, based on these criteria, the patient’s case meets the criteria for inpatient care,
Add your answer

Results

Submit the form below to see the appropriate response as ruled by the DOJ on this case.

Test Your Knowledge: February 2023

FEBRUARY 202371- year-old male with history of TAVR, cardiomyopathy, pacemaker, cirrhosis, DM, HTN and chronic vertigo presented with syncope accompanied by vertigo. The patient reported a fall several days earlier, striking head.Day of presentation: 1838: CT head...

Test Your Knowledge: December 2022

73-year-old male with a past medical history of ventral hernia with 3 prior surgeries presented to ED complaining of worsening abdominal pain with nausea.Day of presentation: 2053: CT demonstrated SBO with thick-walled small bowel loop in ventral hernia. 2218:...

Test Your Knowledge – November 2022

70-year-old male with a past medical history significant for nephrolithiasis, MI, CABG, CVA and DM presented to ED with 1 day history of worsening right flank pain, nausea, vomiting and chills. Seen one day earlier with CT demonstrating a stone in the right mid-ureter...

Test Your Knowledge

What is the appropriate patient status?

Day of presentation:

Day 1:

Day 2:

Submit the form below to see the appropriate response as ruled by the DOJ on this case.

Test Your Knowledge: February 2023

Test Your Knowledge: December 2022

Test Your Knowledge – November 2022

Login:

How We Work

Solutions

Resources

Company