In Chest Pain & Medical Malpractice, medical malpractice expert witness Barry Gustin, M.D. writes:
Any patient who has unstable vital signs or who requires resuscitation should be promptly admitted to the critical care unit and the appropriate consultants should be accessed in a timely manner. Patients with “classic” presentations of life-threatening diseases such as acute myocardial infarction or dissecting thoracic aneurysms also require admission and immediate stabilization. Well-trained emergency physicians should not have any difficulty recognizing acute situations.
But how should the physician approach the patient with an atypical or confusing clinical picture and what should the criteria be for admission versus discharge? In general, patients who have clinical presentations clearly indicative of benign or non-life threatening diseases may be sent home. This would include, for example, a young patient with a mild, sharp chest pain which increases with deep breathing and movement who has no risk factors for pulmonary embolism or cardiac disease and has a normal electrocardiogram, chest x-ray and blood gas. This patient can be sent home even though a clear diagnosis may not be indentified in the ER. Of course, the patient must be instructed to follow up with his private MD sooner if worse, within 24-48 hours.