You are working as an ED physician in a small, single-coverage community ED in a level-5 trauma center. Which of the following scenarios can safely be managed at your facility and should not prompt a transfer?
a. A 33-year-old man involved in a high-speed motorcycle accident with multiple traumatic injuries. You have stabilized his vitals and there is no in-house trauma surgeon, but you have a general surgeon.
b. An 11-day-old girl’s sepsis and your lumbar puncture results are consistent with bacterial meningitis. You have initiated the proper treatment, including antibiotics and the patient has secure IV access and airway
c. A 75-year-old man with a history of atrial fibrillation and heart failure comes in with shortness of breath. He has an implanted pacemaker. He reports palpitations and weakness. His initial troponin is negative and his ECG does not reveal any ST elevations. Other than a heart rate of 55 beats per minute, his vitals are stable, the lung sounds are clear, and he has no dependent edema. You do not have an in-house cardiologist, but one can be called in within an hour.
d. A 42-year-old man who fell 20 ft from his roof. Computed tomographic (CT) scan reveals an epidural hematoma. He is intubated and his vital signs are stabilized.
e. A 22-year-old woman is 29 weeks pregnant and has abdominal pain and vaginal bleeding after being involved in a motor vehicle collision. She has a bruise over her lower abdomen where the seatbelt was applied.
