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Updates: September, 2020
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• Head / ENT
Headache (Migraine)
You were seen today for a headache.  You were treated with medications and fluids to help resolve your pain. Your evaluation was not concerning for an emergency at this time, however changes in your headache or other symptoms may be concerning and signal a medical emergency for which you need to return for further evaluation. You should return to any ER or call 911 if you experience confusion, worsening headache, weakness or numbness, any changes in vision such as blurring or loss of vision, fevers, pain with neck movement, or other concerning symptoms. To help your symptoms resolve, be sure to get plenty of sleep and hydrate well. Decrease use of screens including televisions, computers, and phones. Try to rest in dark conditions with minimal stimulation. You should follow up with your primary care doctor within the next week. Call for an appointment today, 
Thank you for choosing the George Washington Emergency Department
Seizure (known disorder)
You were seen today after a seizure. Your labs, imaging, and evaluation was reassuring. If you are currently on an anti-epileptic medication, it is important to continue taking them. You should follow up with your neurologist within 3 days for re-evaluation and to discuss any changes or additions to your current medications. You should return to an Emergency Room or call 911 if you have additional seizures, trouble walking, speaking, numbness, weakness, fevers,chills, or any other concerns. 
Thank you for choosing the George Washington Emergency Department
Syncope/Near Syncope
You were seen today for an episode of  XXXXXX. Your labs, imaging, and evaluation were reassuring. This episode may be due to many factors, including poor food or fluid intake, exertion, heart problems not present at the time of exam, or other causes.  Because of this, you need to follow up with your primary care physician for further evaluation. At any time, you should return to the ER or call 911 if you experience chest pain, palpitations, shortness of breath, additional similar episodes, or any other concerning symptoms. You should follow up with your primary care doctor to further evaluate your need for additional diagnostic studies or treatment. Call for an appointment today.
Thank you for choosing the George Washington Emergency Department.
Concussion
You were seen today for _________.  A concussion is a clinical diagnosis based on a provider’s evaluation, and is not able to be seen on CT scans or other imaging. You should not participate in any activities that increase the chance for a repeat concussion. To help you return to work/play, and decrease your post-concussive symptoms, follow these instructions; Be sure to get plenty of sleep. Take daytime rests or naps when fatigued. You should alter your work schedule to allow for frequent breaks. You may experience symptoms such as headaches, dizziness, confusion, and delayed thought processes. These symptoms will be made worse with increasing exertion. Decrease use of screens including televisions, computers, and phones. Try to rest in dark conditions with minimal stimulation. You should return to the ER if you experience worsening confusion, worsening headache, weakness or numbness, or other concerning symptoms. You should follow up with your primary care doctor within the next 3-4 days. Call for an appointment today. 
For more information regarding concussions and returning to daily activities; http://www.cdc.gov/headsup/
Thank you for choosing the George Washington Emergency Department
CDC_return to work.pdf
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Corneal Abrasion
You were seen today for eye pain and diagnosed with a corneal abrasion. Your physical exam was otherwise reassuring. If you wear contacts, do not wear them until cleared by an ophthalmologist. You should use the prescribed drops as prescribed, and follow up with our eye clinic, below, within the next 4 days. Please return to the ER if you have worsening pain, trouble seeing or loss of vision, headaches, or other concerns. 
Thank you for choosing the George Washington Emergency Department. 
Conjunctivitis
You were seen today for eye discharge and diagnosed with conjunctivitis, an infection of the surface of your eye, also known as 'pink eye'. . You should use the prescribed ointment as prescribed, and follow up with our eye clinic, below, within the next 4 days. Please wash your hands diligently, as this can spread to others very easily.. Please return to the ER if you have pain, trouble seeing or loss of vision, facial swelling or pain, headaches, or other concerns. 
Thank you for choosing the George Washington Emergency Department. 
Throat Pain, Viral 
You were seen today for throat pain, and treated with ______ . Your symptoms appear to be due to a viral illness, which is treated with supportive care, such as over-the-counter pain medications and fever reducers. Please follow up with your primary doctor in 1 week. Call for an appointment today. Your current symptoms are reassuring that you do not have a bacterial infection or require antibiotics, however if your pain increases, have problems talking or breathing, experience swelling of your throat, or have any other concerns, please return to the ER or call 911 for further evaluation. 
Thank you for choosing the George Washington Emergency Department 
Dental Pain-- Go to the dentist
You were seen today for dental pain, and treated with ______ .  Please follow up with a dentist in the next few days. If you do not have a dentist, please use "ZocDoc.com" or your insurance company to help find a dentist. If your pain increases, have problems talking or breathing, experience swelling of your throat, or have any other concerns, please return to the ER or call 911 for further evaluation
Thank you for choosing the George Washington Emergency Department
CDC_return to school.pdf
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Vertigo (peripheral) Rx Meclizine, neuro followup
You were seen today for dizziness and diagnosed with vertigo, a condition that leads to severe dizziness. You were prescribed a medication to help with your symptoms, which you should take as prescribed. Please follow up with our neurology clinic, below, at the next available appointment, call for an appointment today. Please return to the ER if you have worsening dizziness, numbness or weakness of your arms or legs, vision changes, headaches, or other concerns.  
Thank you for choosing the George Washington Emergency Department.
Bell's Palsy, Steroids & Antivirals
You were seen today for an episode of facial weakness. You were diagnosed with Bell's Palsy and placed on steroids and antivirals, which you should continue as prescribed. Your evaluation was reassuring, however, changes in your symptoms may represent an emergency. Be sure to use an eyepatch or scotch tape to keep your eye closed on the effected side when sleeping, to prevent drying out, ulceration, and pain of the eye. During the day, use saline drops or artificial tears to keep your eye moist.  You should return to the ER if you experience eye pain, changes in vision such as blurred or decreased vision, facial pain, swelling, fevers, or any other concerning symptoms. You should follow up with your primary care doctor to further evaluate your need for additional diagnostic studies or treatment.. Call for an appointment today.
Thank you for choosing the George Washington Emergency Department. 
• chest
Unknown Cause of Chest Pain
Today, you were seen in the ER for chest pain. Your EKG, chest x-ray, and bloodwork were reassuring, but did not reveal any explanation for your symptoms. The exact cause for your pain is unclear. However, things can change, and you should return to the ER or call 911 if you have: worsening of your chest pain, difficulty breathing, or any other new or concerning symptoms, as these may be a sign of a new problem or worsening of your condition.
Please follow-up with your primary doctor within 1-2 days for re-evaluation.
Thank you for choosing the George Washington Emergency Department.
MSK/Costochondritis
You were seen today for chest pain. You were XXXXXXX . Your labs, imaging, and evaluation were reassuring and not indicative of an emergency at this time. Chest pain that is not associated with abnormal labs, imaging, or evaluation may be due to muscle strain or inflammation of the chest wall, even if you are unable to recall a specific cause.  However, things can change, and you should return to the ER or call 911 if you have: worsening of your chest pain, difficulty breathing, or any other new or concerning symptoms, as these may be a sign of a new problem or worsening of your condition. Please follow-up with your primary doctor within 1-2 days for re-evaluation. Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
CHF Volume Overload (increase lasix)
You were seen today for shortness of breath and leg swelling. Your EKG and bloodwork were reassuring, and your shortness of breath and leg swelling is believed to be due to your congestive heart failure. Please increase your water pill, or diuretic, as discussed with your provider. You should followup with your primary care doctor within the next 2 days for re-evaluation. Please return to the ER if you have worsening shortness of breath, chest pain, fever of 100.4 or higher, you feel as if you may pass out, or other concerns. 
Thank you for choosing the George Washington Emergency Department
Palpitations
Today, you were seen in the ER for palpitations. Your EKG, blood work, and imaging were reassuring, however we were unable to find a specific cause of your symptoms. There are many causes of palpitations, including arrhythmias which may not be detected when you asymptomatic. A change in your symptoms may indicate an emergency; you should return to the ER or call 911 if you experience chest pain, shortness of breath, worsening or continuation of your palpitations, or any other concerns.
Please follow up with your primary care physician in the next 2-4 days for additional evaluation. If you have frequent palpitations, talk to your doctor about using a Holter Monitor or other devices to help monitor your heart rate and rhythm. 
Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
Cold/Viral Illness
You were seen today for _____ . Your symptoms appear to be due to a viral illness, and your evaluation was not concerning for an emergency at this time. Viral illnesses are treated with supportive care, including increasing your fluid intake, over the counter fever and pain reducers, and rest. To limit the spread of your symptoms to others you should wash your hands frequently and keep surfaces in your home clean.  You condition should improve over the next 5 days with the care discussed. If you experience worsening or prolonged symptoms, this may be due to an additional illness or worsening illness, and you should return to the ER or call 911. You should return if you experience increased fevers, increased or change in color of sputum, changes in vision such as blurry vision, neck stiffness, confusion, or other concerns. You should follow up with your primary care physician in the next week for further evaluation. Call for an appointment today.
Thank you for choosing the George Washington Emergency Departmen
Pneumonia
You were seen today for _____ . Your symptoms appear to be due to a bacterial infection in your lung, called pneumonia.  Your evaluation was reassuring, and you were placed on an antibiotic to treat your infection.  You condition should improve over the next 7 days with the care discussed. If you experience worsening or prolonged symptoms, this may be due to an additional illness or worsening illness, and you should return to the ER or call 911. You should return if you experience increased fevers, increased or change in color of sputum, changes in vision such as blurry vision, neck stiffness, confusion, or other concerns. You should follow up with your primary care physician in the next week for further evaluation in the next 3-5 days. Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
Asthma
You were seen today for an asthma exacerbation. After treatment with oxygen and medications, your breathing improved. You should continue to use your albuterol inhaler as instructed, and prescribed medications as directed.  It is important to use your Albuterol inhaler appropriately. If you experience a worsening of your breathing, shortness of breath, swelling of your throat, trouble breathing, chest pain, or other concerning symptoms, you should return to the ER or call 911. During Heat Advisories or when air quality is poor, it is important to be more aware of your asthma symptoms and use your asthma medications as needed. You should also keep track of possible triggers for your asthma to help prevent future attacks. Please follow up with your primary care doctor in the next 3-5 days to evaluate your current asthma medications and any need for changes. Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
COPD
You were seen today for a COPD exacerbation. After treatment with oxygen and medications, your breathing improved. You should continue to use your albuterol inhaler as instructed, and prescribed medications as directed.  It is important to use your Albuterol inhaler appropriately. If you experience a worsening of your breathing, shortness of breath, swelling of your throat, trouble breathing, chest pain, or other concerning symptoms, you should return to the ER or call 911. During Heat Advisories or when air quality is poor, it is important to be more aware of your COPD symptoms and use your medications as needed. You should also keep track of possible triggers for your COPD to help prevent future attacks. Please follow up with your primary care doctor in the next 3-5 days to evaluate your current medications and any need for changes. Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
• abdomen
ABDOMINAL PAIN—FILL IN CAUSE
You were seen today for abdominal pain.  Your labs, imaging and evaluation XXXXX. You should return to the ER or call 911 if you experience fever greater than 102 degrees, worsening abdominal pain, blood in your stools, worsening nausea or vomiting, or any other concerning symptoms. You should follow up with your primary care doctor in the next 3-5 days for re-evaluation. Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
ABDOMINAL PAIN—Unknown Cause
Today, you were seen in the ER for abdominal pain. Your bloodwork and imaging was reassuring, but did not show any explanation for your symptoms. The exact cause for your pain is unclear, but your pain does not appear to be due to a serious cause at this time.  However, things can change, and you should call 911 or return to the ER if you experience:
-vomiting that prevents you from keeping down fluids or medications
-worsening of your pain
-fever of 100.4 or higher
-any other new or concerning symptoms
Otherwise, please see your primary doctor in 1-2 days for reevaluation. 
Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
Nausea / Diarrhea --Rehydrated 
You were seen today for XXXXXXX. You were treated and rehydrated. You should continue to take in oral fluids, such as water and electrolyte replacement sports drinks, You should follow up with your primary care doctor within the next week for further evaluation if your symptoms do not fully resolve. Call for an appointment today. You should return to the ER or call 911 if your diarrhea worsens, you are unable to keep down fluids or medications, experience fever greater than 102 degrees, or other worrying symptoms.
Thank you for choosing the George Washington Emergency Department
Kidney Stone
You were seen today for abdominal pain, and diagnosed with a kidney stone. Your labs, imaging and evaluation were reassuring, and did not show concerns for infection, however any time you have a kidney stone you should be aware of any signs of infection, which can be dangerous with a kidney stone. You should immediately return to the ER if you experience fever greater than 102 degrees, worsening abdominal pain, nausea or vomiting, or any other concerning symptoms. You should follow up with your primary care doctor in the next week, and urology if your symptoms persist. Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
Nausea / Diarrhea --Rehydrated 
You were seen today for XXXXXXX. You were treated and rehydrated. You should continue to take in oral fluids, such as water and electrolyte replacement sports drinks, You should follow up with your primary care doctor within the next week for further evaluation if your symptoms do not fully resolve. Call for an appointment today. You should return to the ER or call 911 if your diarrhea worsens, you are unable to keep down fluids or medications, experience fever greater than 102 degrees, or other worrying symptoms.
Thank you for choosing the George Washington Emergency Department
Kidney Stone -- Infected
​You were seen today for abdominal pain, and diagnosed with a kidney stone. Your labs, imaging and evaluation also showed signs of an infection of your urinary system. You were prescribed antibiotics for this infection, as well as pain medication. Infections occurring during kidney stones should be followed closely, and any worsening of your symptoms should be evaluated by a practitioner.  You should immediately return to the ER or call 911  if you experience fever greater than 102 degrees, worsening abdominal pain, nausea or vomiting, confusion, trouble urinating or decreased urination, or any other concerning symptoms. You should follow up with your primary care doctor in the next week, and urology if your symptoms persist.
Thank you for choosing the George Washington Emergency Department.
PEG Tube Replacement
Today, you were seen in the ER for a malfunctioning PEG tube, or feeding tube. The tube was replaced and confirmed to be in good position. Your feeding tube is ready for use. Please followup with your primary care doctor as needed. Please return to the ER if you have any of the following;
-bleeding or drainage at the PEG tube site
-malfunction of your PEG tube
-abdominal pain
-fever of 100.4 or higher
-any other new or concerning symptoms
Otherwise, please see your primary doctor in 1-2 days for reevaluation. 
Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
• pelvis
STD -- Treated
You were seen in the ER for XXXXXXXX. You were presumptively treated for gonorrhea and chlamydia, because it takes 3-5 days for cultures to return. You should not have any sexual contact until 1 week after resolution of symptoms. Your sexual partners must also be treated for 1 week prior to sexual contact. You should use a barrier method of protection during intercourse to reduce the chance of infection. Chronic or multiple STD infections may result in infertility. You should return to the ER if your symptoms worsen, you have a fever, worsening abdominal pain, or other concerning symptoms. You should follow up with your primary care doctor, or use the information below to find a primary care doctor. STDs are frequently spread together, and it is important to have an HIV test either with your primary care doctor or a free clinic. Contact the Department of Health, or go online for a listing of clinics.
Thank you for choosing the George Washington Emergency Department
UTI
You were seen in the ER for XXXXXX. You were diagnosed with a urinary tract infection, and started on antibiotics, which you should continue as prescribed. Your physical exam and laboratory findings were reassuring. Please follow up with your primary care doctor in the next 2-4 days Call for an appointment today. Please return to the ER or call 911 if you experience increasing abdominal pain, fever, shortness of breath, decreased urination or trouble urinating, or any new, concerning or worsening symptoms.
Thank you for choosing the George Washington Emergency Department
1st Trimester Bleed
You were seen in the ER for vaginal bleeding during pregnancy. Your evaluation and imaging XXXXXX. First trimester bleeding is common, however, as discussed it may represent an increased risk for the pregnancy. Up to 20-30% of pregnancies experience first trimester bleeding. You should return to the ER or call 911 if you have worsening bleeding, abdominal pain, fever, or other concerning symptoms. You should follow up with your OBGYN physician in the next 3-5 days for further evaluation.
Thank you for choosing the George Washington Emergency Department
1st Trimester Bleed (No yolk sac)
You were seen today for vaginal bleeding during a pregnancy. The ultrasound did not show definitive signs of a normal pregnancy, though it is usually too early at this point to see one. Given your symptoms, it is important you follow up in 48 hours to have your blood drawn again to measure your pregnancy hormone level. This will help us determine whether your pregnancy is progressing normally or if there are problems. Please follow the directions given to you be the Obstetrics and Gynecology team for your return visit.
If anything changes, or you have the following symptoms, please return to the ER right away:
-worsening abdominal pain
-severe nausea and/or vomiting
-excessive vaginal bleeding
Thank you for choosing the George Washington Emergency Department​
• Wound care / Trauma
Narcotic Pain Rx (add on) 
You were given a prescription for nausea medication, please take as directed. You may have some continued vomiting. It is important that you stay hydrated. Please drink plenty of fluids, like water, gatorade, or ginger ale. Please drink in small sips, wait a few minutes, and then have another sip, as too much fluid at once can make your nausea worse. Please follow up with your primary care doctor. Return to the ED for new or worsening symptoms, like an inability to keep any fluids down, dizziness, worsening abdominal pain, or any other concerns. 

Thank you for choosing the George Washington Emergency Department
I&D — Return in 2 days
You were seen today for a painful mass and diagnosed with an abscess. Your abscess was drained, and the wound was packed to help aid with healing. You need to return in 2 days for re-evaluation and for removal of the dressing.  Keep the wound clean, dry, and covered. Try to keep the current dressing in place. You should return to the ER sooner if you experience any of the following:
          Fever greater than 100.4°F (38°C)
          Wound reopens or bleeds
          Increasing pain in the wound
          Signs of infection, such as warmth, redness, swelling, or foul-smelling drainage from the wound
          Persistent numbness or weakness in the affected area

  Thank you for choosing the George Washington Emergency Department. 
I&D No Return!
You were seen today for a painful mass and diagnosed with an abscess. Your abscess was drained, and the wound was covered. You may continue to have drainage from the wound over the next few days.  Keep the wound clean, dry, and covered. You should return to the ER or call 911 if you experience any of the following:
          Fever greater than 100.4°F (38°C)
          Wound reopens or bleeds
          Increasing pain in the wound
          Increased redness, swelling, or foul-smelling drainage from the wound
          Persistent numbness or weakness in the affected area
  Thank you for choosing the George Washington Emergency Department. 
SUTURE CARE
Your wound was cleaned thoroughly, any foreign debris was removed, and the wound was closed with   ______________. Keep the wound clean, dry, and covered. Use water and mild soap to clean every day. You should have the sutures removed in _______ days by your primary care doctor, or return to the ER for suture removal. You should return to the ER or call 911 sooner if you experience any of the following:
          Fever greater than 100.4°F (38°C)
          Wound reopens or bleeds
          Increasing pain in the wound
          Signs of infection, such as warmth, redness, swelling, or foul-smelling drainage from the wound
          Persistent numbness or weakness in the affected area
  Thank you for choosing the George Washington Emergency Department. 

Suture Removal
You were seen in the ER for suture removal. Your physical exam was reassuring and we removed the sutures from your wound, which is healing well. Please follow up with your primary care doctor as needed. .You should return to the ER sooner if you experience any of the following:
          Fever greater than 100.4°F (38°C)
          Wound reopens or bleeds
          Increasing pain in the wound
          Signs of infection, such as warmth, redness, swelling, or foul-smelling drainage from the wound
          Persistent numbness or weakness in the affected area

  Thank you for choosing the George Washington Emergency Department. 
Wound Not sutured -- Tetanus Given
Your wound was cleaned thoroughly and dressed in a protective gauze dressing. Please keep this dressing in place for the next day, and afterwards keep the wound clean and dry. You were also given a tetanus shot today to update your vaccination. You should return to the ER or call 911 if you experience any of the following:
          Fever greater than 100.4°F (38°C)
          Wound reopens or bleeds
          Increasing pain in the wound
          Signs of infection, such as warmth, redness, swelling, or foul-smelling drainage from the wound
          Persistent numbness or weakness in the affected area
​Thank you for choosing the George Washington Emergency Department
Cellulitis
You were diagnosed with cellulitis, which is an infection of your skin. You were started on an antibiotic, which you should continue until completed. You should return to the ER or call 911 if you experience any of the following:
          Fever greater than 100.4°F (38°C)
          Increase in size or pain of the affected area
          Nausea and vomiting preventing you from taking your antibiotic
          Other concerns or worsening symptoms
Otherwise, follow up with your primary care doctor in the next 5 days. 
Call for an appointment today.
​Thank you for choosing the George Washington Emergency Department
Ankle Sprain
You were seen in the ER for ankle pain and diagnosed with an ankle sprain. Your physical exam and radiology findings were reassuring. Please follow up with your primary care doctor in the next week. You may need orthopedic or physical therapy follow up as well, which you should discuss with your primary care physician. Call for an appointment today. Please return to ER if you develop weakness in the affected leg, pain or swelling increases, or other concerning or worsening symptoms.
Thank you for choosing the George Washington Emergency Department.
Shoulder Dislocation
You were seen today for shoulder pain and diagnosed with a shoulder dislocation. Your shoulder dislocation was reduced, and your imaging did not show any signs of other injury.  If you have worsening pain, swelling, numbness, weakness, or other concerns. please return to an emergency department for re-evaluation. You should call the orthopedic clinic, below, to schedule a followup appointment within the next 1-2 weeks. Until then, you should continue to wear your sling when active to reduce the chance of another dislocation or injury. Call for an appointment today. Please return to ER if you develop weakness in the affected leg, pain or swelling increases, or other concerning or worsening symptoms.
Thank you for choosing the George Washington Emergency Department.
MVC No Injuries
You were seen today after a motor vehicle collision. Your evaluation, including imaging, was not concerning for an emergency or fracture at this time, however changes in your symptoms may be concerning, and signal a medical emergency for which you need to return for further evaluation. You may experience some worsening soreness over the next two days, which is normal after a collision.  Continue to take pain medication as directed, ice, and rest. You should return to the ER if you experience confusion, worsening headache, weakness or numbness, any changes in vision such as blurring or loss of vision,, pain with neck movement, or other concerning symptoms.You should follow up with your primary care doctor within the next week. 
Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
Assault No Injuries
You were seen today after being involved in an assault.  Your evaluation, including imaging, was not concerning for an emergency or fracture at this time, however changes in your symptoms may be concerning, and signal a medical emergency for which you need to return for further evaluation. You may experience some worsening soreness over the next two days, which is normal after these types of injuries.  Continue to take pain medication as directed, ice affected areas, and rest. You should return to the ER if you experience confusion, worsening headache, weakness or numbness, any changes in vision such as blurring or loss of vision, pain with neck movement, or other concerning symptoms.You should follow up with your primary care doctor within the next week. 
Call for an appointment today. 
You can report a crime to DC Police online or by calling 311. You can also request to speak to a police officer here before leaving.

If you are a victim of domestic violence, more resources are available at no cost, please call the Domestic Violence Coordinator with DC Police at (202) 727-7137. There are also resources and shelters available for victims of domestic violence. Please ask to speak to a social worker here, or call the above number for more information. 

Thank you for choosing the George Washington Emergency Department
 Back pain
You were seen in the ER for back pain. Your physical exam and evaluation was reassuring, and although an exact cause of your back pain was not found today, it does not appear to be an emergency. Please follow up with your primary care doctor in the next 2-4 days. Call for an appointment today.  Please return to ER if you have worsening pain in your back, numbness, weakness or pain in your legs,  you lose control of your bladder, or other concerns
Thank you for choosing the George Washington Emergency Department
• General / Misc.
Syncope/Near Syncope
You were seen today for an episode  XXXXXX. Your labs, imaging, and evaluation were not indicative of an emergency at this time. This episode may be due to many factors, including poor food or fluid intake, exertion,  heart problems not present at the time of exam, or other causes.  Because of this, you need to follow up with your primary care physician for further evaluation. At any time, you should return to the ER if you experience chest pain, palpitations, shortness of breath, additional similar episodes, or any other concerning symptoms. You should follow up with your primary care doctor to further evaluate your need for additional diagnostic studies or treatment. Call for an appointment today, or consider using our ConnectER program to schedule a Telemedicine followup right in your home. Call 202-677-6421, or ask your ER provider for more information
Thank you for choosing the George Washington Emergency Department. 
Heat Exposure
You were seen today for _ after being exposed to a hot environment. Your evaluation was reassuring and not indicative of an emergency at this time. Your symptoms improved with treatment, and your condition improved.  Please rest in a cool place, and continue to take in fluids and stay well hydrated. At any time, you should return to the ER if you experience confusion, lightheadedness, nausea and vomiting, vision changes, fever, or other concerns. You should follow up with your primary care doctor within the week to further evaluate your need for additional diagnostic studies or treatment. Call for an appointment today, or consider using our ConnectER program to schedule a Telemedicine followup right in your home. Call 202-677-6421, or ask your ER provider for more information
Thank you for choosing the George Washington Emergency Department. 
Allergic Reaction w/ steroids & epi-pen
You were seen today after an allergic reaction. You were treated with medications to help decrease the response to your allergen, and you were monitored. Your evaluation was reassuring, and you were discharged with a prescription for steroids for the next few days, as well as an epi-pen, which you should keep with you for any future allergic reactions which threaten your ability to breath. Please return to the ER for worsening swelling, trouble breathing, changes in voice, trouble swallowing, or any other concerns. Follow up with your primary care doctor, and consider an allergy specialist if you are unsure of your allergic triggers. Call for an appointment today, or consider using our ConnectER program to schedule a Telemedicine followup right in your home. Call 202-677-6421, or ask your ER provider for more information
Thank you for choosing the George Washington University
Opioid Pain Rx (add on) 
You were given a prescription for an opioid pain medication, please take as directed, and do not operate machinery or drive while using this medication. Using too much or mixing with alcohol or other sedatives can cause you to stop breathing and potentially death. 

Ankle Sprain
You were seen in the ER for ankle pain and diagnosed with an ankle sprain. Your physical exam and radiology findings were reassuring. Please follow up with your primary care doctor in the next week. You may need orthopaedic or physical therapy follow up as well, which you should discuss with your primary care physician.  Call for an appointment today. Please return to ER if you develop weakness in the affected leg, pain or swelling increases, or other concerning or worsening symptoms.
Thank you for choosing the George Washington Emergency Department.
 Back pain
You were seen in the ER for back pain. Your physical exam and evaluation was reassuring, and although an exact cause of your back pain was not found today, it does not appear to be an emergency. Please follow up with your primary care doctor in the next 2-4 days. Call for an appointment today.  Please return to ER if you have worsening pain in your back, numbness, weakness or pain in your legs,  you lose control of your bladder, or other concerns
Thank you for choosing the George Washington Emergency Department
oxford_low_back_pain_information.pdf
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all_-_dc_primary_care_follow_up_options.pdf
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Hypertension 
Today, you were seen in the ER for your high blood pressure. Your exam showed no signs of consequences of your blood pressure being elevated. You should continue to take your blood pressure medications as prescribed. Please return to the ER if you have: new weakness, difficulty speaking, chest pain, difficulty breathing, loss of vision, any other new or concerning symptoms.  Otherwise, please follow-up with your primary doctor within the next week. 
Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
MVC No Injuries
You were seen today after a motor vehicle collision. Your evaluation, including imaging, was not concerning for an emergency or fracture at this time, however changes in your symptoms may be concerning, and signal a medical emergency for which you need to return for further evaluation. You may experience some worsening soreness over the next two days, which is normal after a collision.  Continue to take pain medication as directed, ice, and rest. You should return to the ER if you experience confusion, worsening headache, weakness or numbness, any changes in vision such as blurring or loss of vision,, pain with neck movement, or other concerning symptoms.You should follow up with your primary care doctor within the next week.
Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
Sickle Cell
Today, you were seen in the ER for your body pains due to a sickle cell pain crisis. Your exam and bloodwork showed no signs of infection or other major problems at this time.
Please follow-up with your primary doctor or hematologist within the next 2-3 days for a recheck and further recommendations on management of your sickle cell disease. In the meantime, you may use the prescribed pain medication. Please be cautious with the use of these medications, as they may result in drowsiness; please don't use these medications before driving, swimming, or any other potentially dangerous activities.
Please return to the ER if you have:
-pain that is not controlled with medications 
-weakness of any part of your body
-fever of 100.4 or higher
-difficulty breathing or chest pain
-any other new or concerning symptoms
Thank you for choosing the George Washington Emergency Department
• Viral Illness
Cold/Viral Illness
You were seen today for _____ . Your symptoms appear to be due to a viral illness, and your evaluation was not concerning for an emergency at this time. Viral illnesses are treated with supportive care, including increasing your fluid intake, over the counter fever and pain reducers, and rest. To limit the spread of your symptoms to others you should wash your hands frequently and keep surfaces in your home clean.  You condition should improve over the next 5 days with the care discussed. If you experience worsening or prolonged symptoms, this may be due to an additional illness or worsening illness, and you should return to the ER or call 911. You should return if you experience increased fevers, increased or change in color of sputum, changes in vision such as blurry vision, neck stiffness, confusion, or other concerns. You should follow up with your primary care physician in the next week for further evaluation. Call for an appointment today.
Thank you for choosing the George Washington Emergency Department
THROAT PAIN –NON STREP -- Given Benadryl, Ibuprofen, Tessalon 
You were seen today for throat pain, and treated with ______ . You were given prescriptions for Benadryl with swish and spit for pain control, ibuprofen for pain control, and tessalon capsules. Please follow up with your primary doctor in 1 week. If you do not have a primary care doctor, please see below to schedule an appointment. If your pain increases, have problems talking or breathing, experience swelling of your throat, or have any other concerns, please return to the ER for further evaluation

Thank you for choosing the George Washington Emergency Department  
SHINGLES-- Given acyclovir and gabapentin
You were seen today and diagnosed with shingles rash. Take antiviral prescription as directed. Use the Gabapentin if you develop numbness or pain in the area as directed. See your primary doctor within 1 week for follow up and to increase the Gabapentin dose if pain is not relieved. Keep your rash covered if it is in an exposed area. You may be contagious, and it is very important to prevent the spread to pregnant women and those who have never had the chicken pox, or an immunocompromised person. Come back to the ER or call 911 if you develop headaches, vomiting, neck stiffness, changes in vision, or fevers.
Thank you for choosing the George Washington Emergency Department 
• Room 6
LEAVING AMA
You were seen today for XXXXXXXXX. You are requesting to leave against medical advice, before we can complete our necessary evaluation to determine if you are experiencing a medical emergency. Leaving against medical advice may delay treatment for emergent problems, and may worsen an illness or even result in death. You may return to this ER or any emergency department for further evaluation at any time. Please return for further evaluation, especially if you experience any of the following; fever greater than 102F, chest pain, shortness of breath, blood in your stools or urine, confusion, weakness/numbness, or any other concerning symptoms. You should follow up with your primary care doctor as soon as possible to continue your evaluation.
ALCOHOL ABUSE
You were seen in the ER for alcohol abuse. You need to stop drinking alcohol or drink in moderation, as this is dangerous to your health and may lead to future health problems. You should seek out a local alcoholic anonymous meeting group to help stop using alcohol. You should return to the ER with any seizure activity, uncontrolled pain, fevers/chills, suicidal thoughts or symptoms concerning to you. You should follow up with your primary care doctor, or use the below information to find a primary care doctor, to help manage your health.
Thank you for choosing the George Washington Emergency Department.
APRA Information
K2/SPICE
You were seen in the ER after ingesting synthetic marijuana. Synthetic marijuana contains many unknown and dangerous chemicals, and is not a replacement for marijuana. You should stop using synthetic marijuana as it may cause severe bodily harm, including death, and may lead to future health problems. You should return to the ER with any seizure activity, uncontrolled pain, fevers/chills, suicidal thoughts or symptoms concerning to you. You should follow up with your primary care doctor, or use the below information to find a primary care doctor to help manage your health.
Thank you for choosing the George Washington Emergency Department.
Opiate Use
You were seen today after use of an opiate. Opiates are dangerous drugs and can cause respiratory depression and even death, as well as exposes you to infectious diseases including HIV and Hepatitis C. The strength of street drugs is constantly changing, and even using smaller doses in the future can cause death. Use the below information for help quitting. Please return to the ER for trouble breathing, confusion, fevers/chills, or other concerns. 
The Substance Abuse and Mental Health Services Administration has a National Helpline for those with a possible opioid use disorder; 1-800-662-HELP(4357). The helpline is confidential, free, and available 24 hours a day.

Thank you for choosing the George Washington Emergency Department.
Depressive Symptoms
You were seen for depressive symptoms. Your evaluation was XXXXXXX.  As discussed today, your symptoms require follow up within the next 1-2 days, and it is important to know how to keep safe from harming yourself or others. If you notice changes in your eating or sleeping habits, feeling unwilling or unable to communicate with others, discouragement or sadness, reckless behavior or withdrawal from people or activities, it is important to immediately call 911 or return to the ER. If you have any concerns about you or a loved one showing signs for self-harm, immediately call 911. You should abstain from alcohol or other intoxicants before further evaluation by a medical professional. Call the toll free National Suicide Prevention Hotlines if you ever feel the need to talk about your feelings, thoughts, or safety.
          National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
          National Hope Line Network: 1-800-SUICIDE (784-2433)
Your safety is our number one priority, if you ever feel unsafe, fearful, or have any other concerns please immediately call 911 or return to any emergency department.
Thank you for choosing the George Washington University Emergency Room. 
• COVID Macros (discharge & mdm)
DC – Enrolled in Remote Patient Monitoring
You were seen in the emergency department for ________.  You were tested for COVID-19 and your test was positive.  You have COVID-19.  We do not feel that you need to be admitted at this time, but we have enrolled you in our REMOTE PATIENT MONITORING PROGRAM.  This is a way for us to continue to check in on you to make sure that you are getting better, and it is a way that we can get in touch with you if it looks like you are getting worse. 

You will receive a phone call after you are discharged so you may be formally registered for this program.  After that you will get an email each day with a link to a secure survey to answer a few questions about your symptoms and your pulse, temperature, and blood oxygen number (you can measure these with the thermometer and pulse oximeter that we have given to you).  There is more information about this program in the packet that was given to you.  IT IS VERY IMPORTANT THAT YOU RESPOND TO THE SURVEY EACH DAY AND ANSWER YOUR PHONE IF WE CALL SO WE CAN MONITOR YOU.

THIS PROGRAM DOES NOT TAKE THE PLACE OF EMERGENCY CARE IF YOU ARE GETTING WORSE.  If you think you are getting worse, please do not wait for us to call you to come back to the emergency department.  Please return to this or the closest emergency department if you have worsening shortness of breath, nausea or vomiting that do not allow you to eat, belly pain, diarrhea, worsening cough, or any new or worsening symptoms.

Please self isolate at home after you leave the emergency department.  Guidelines for self isolation and when you can be around others can be found on the CDC website here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html.
​
DC -- No Test
You were seen in the emergency department for _______. Your evaluation and testing were reassuring regarding your clinical condition. However, at this time, you have a moderate risk for infection with the 2019 novel coronavirus (2019-nCoV).  Because testing is limited at this point throughout the United States we did not send a test for the coronavirus

You may have heard in the news or elsewhere about the recent outbreak of the coronavirus. Coronaviruses are a large family of viruses best known for causing the “common cold.” 2019-nCoV is a respiratory illness that was first found in Wuhan City, Hubei Province, China but has since spread. New information is being discovered every day. It is thought that the virus is spread much like the flu, from the cough or sneeze of an infected person. 

We are requesting that you self-isolate at your residence.  You should practice good hygiene at home with frequent hand washing and should avoid close contact with other individuals in your residence and avoid public places and using public transportation.  See additional attached instructions. If you do need to leave your home please wear a mask.  For more information on how to prevent disease spread at home, please visit https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html. 

Please return to the emergency department if you experience worsening of your condition, difficulty breathing, high fevers, or for any other worrisome symptoms. If you are interested in learning more about the 2019 novel coronavirus, please refer to the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/index.html.
​
DC -- Tested
You were seen in the emergency department for _______. Your evaluation and testing were reassuring regarding your clinical condition. However, at this time, you have a concern for infection with the 2019 novel coronavirus (2019-nCoV).  Testing has been sent for the coronavirus (COVID-19).  Please ensure we have a good contact number for you prior to leaving and that you call back in 48 hours if you do not hear anything about your results.
 
You may have heard in the news or elsewhere about the recent outbreak of the coronavirus. Coronaviruses are a large family of viruses best known for causing the “common cold.” 2019-nCoV is a respiratory illness that was first found in Wuhan City, Hubei Province, China but has since spread worldwide. New information is being discovered every day. It is thought that the virus is spread much like the flu, from the cough or sneeze of an infected person.
 
Because of your history, you have been tested for 2019-nCoV.  However, you do not meet admission criteria.  You are at high risk for this infection and must isolate yourself at home.  You should practice good hygiene at home with frequent hand washing and avoid close contact with other individuals in your residence and avoid public places and avoid using public transportation.  See additional attached instructions. If you need to leave your home please wear a mask. For more information on how to prevent disease spread at home, please visit https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html.
 
Please return to the emergency department if you experience worsening of your condition, difficulty breathing, high fevers, or for any other worrisome symptoms. If you feel that you need to return to the emergency department, please call to notify us at 202-715-4911 and be sure to wear a mask and identify yourself to the triage nurse.
 
If you are interested in learning more about 2019-nCov, please refer to the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/index.html. 
​

MDM -- No Testing
At the time of my evaluation, the patient does not currently meet COVID testing protocol and is at low clinical suspicion for having the coronavirus/COVID-19 at this time. Discussed with patient the low risk for this at the time, however also discussed specific return precautions including persistent fevers, worsening cough, shortness of breath, or other concerns. The patient is not and does not live with high risk individuals such as those with immunodeficiency, diabetes,  or other risk factors which may put them at greater risk from the current coronavirus pandemic. We also discussed the potential for asymptomatic spread, as well as self-isolation and hand/cough hygiene. 
MDM -- No Testing, Admit
​
On my evaluation, the patient does not current have signs or symptoms of potential coronavirus infection, or a history of exposure concerning for possible infection.. Given this, they do not meet criteria for testing or respiratory isolation. Will continue to treat for their underlying illness and monitor.
MDM -- Non-COVID illness, Discharging in setting of pandemic.
This patient presents with XXXX. Given the current coronavirus pandemic, the risk of nosocomial infection via admission to the hospital far outweighs their risk for deterioration after discharge. They currently have no signs of life-threatening illness and have a safe discharge plan to followup with their outpatient care team. 
MDM -- COVID Discharge
This patient presents with symptoms consistent with possible coronavirus. Given this, a coronavirus test was submitted, however will take 2-3 days to return. We discussed self-isolation, hand and cough hygiene, and the potential for positive test results with the patient. Pt has provided contact information via registration in the event of a positive test. Given the patient is well appearing overall and does not require admission for medical management at this time, will discharge to self quarantine and followup.
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