Diagnosis: Headache, dizziness, nausea, and vomiting. And EKG changes

Treatment: Inpatient admission, diagnostic evaluation and medication management.

The inpatient admission was denied by the insurer. That denial was upheld.

The patient has a history of substance abuse, namely crack cocaine. She presented to the Emergency Room (ER) with complaints of headache, dizziness, nausea, and vomiting. Vital signs noted an initial blood pressure of 125/85 which dropped to 91/61. Her EKG showed normal sinus rhythm with non-specific T wave inversions. Troponin was negative. She was admitted despite her symptoms improving after administration of meclizine, Tylenol, famotidine, and magnesium sulfate. She was evaluated by cardiology who recommended an echocardiogram, however the patient eloped.

The patient presented with a headache and non-specific EKG changes. However, there were no signs or symptoms of hemodynamic instability, myocardial ischemia, arrhythmia, heart failure, cerebrovascular insufficiency or other organ dysfunction requiring inpatient admission status. There were no findings warranting acute neurosurgical intervention. The patient's care could have been provided under observational level of care with up to 23 hours of monitoring. The observational level of care would have been appropriate.