TABLE OF RISK

Level of Presenting Problem(s) Diagnostic Procedure(s) Management Options Risk Ordered Selected

• One self-limited or minor • Laboratory tests requiring • Rest problem, eg cold, insect venipuncture • Gargles bite, tinea corporis • Chest x-rays • Elastic bandages • EKG/EEG • Superficial dressings • Urinalysis • Ultrasound, eg, echocardiography Minimal • KOH prep

• Two or more self-limited or • Physiologic tests not under • Over-the-counter drugs minor problems stress, eg, pulmonary • Minor surgery with no • One stable chronic illness, function tests identified risk factors eg well controlled • Non-cardiovascular • Physical therapy hypertension or non-insulin imaging studies with • Occupational therapy dependent diabetes, contrast, eg, barium enema • IV fluids without additives cataract, BPH • Superficial needle biopsies • Acute uncomplicated illness • Clinical laboratory tests or injury, eg, cystitis, requiring arterial puncture allergic rhinitis, simple • Skin biopsies Low sprain

• One or more chronic • Physiologic tests under • Minor surgery with identified illnesses with mild stress, eg, cardiac stress risk factors exacerbation, progression, test, fetal contraction stress • Elective major surgery (open, or side effects of treatment test percutaneous or endoscopic) • Two or more stable chronic • Diagnostic endoscopies with no identified risk factors illnesses with no identified risk • Prescription drug management • Undiagnosed new problem factors • Therapeutic nuclear medicine with uncertain prognosis, • Deep needle or incisional • IV fluids with additives eg, lump in breast biopsy • Closed treatment of fracture or • Acute illness with systemic • Cardiovascular imaging dislocation without symptoms, eg, studies with contrast and no manipulation pyelonephritis, identified risk factors, eg pneumonitis, colitis arteriogram, cardiac • Acute complicated injury, catheterization eg head injury with brief • Obtain fluid from body loss of consciousness cavity, eg lumbar puncture, Moderate thoracentesis, culdocentesis

• One or more chronic • Cardiovascular imaging • Elective major surgery (open, illnesses with severe studies with contrast with percutaneous or endoscopic) exacerbation, progression, identified risk factors with identified risk factors or side effects of treatment • Cardiac • Emergency major surgery • Acute or chronic illnesses electrophysiological tests (open, percutaneous or or injuries that pose a threat • Diagnostic Endoscopies endoscopic) to life or bodily function, eg with identified risk factors • Parenteral controlled multiple trauma, acute MI, • Discography substances pulmonary embolus, severe • Drug therapy requiring respiratory distress, intensive monitoring for progressive severe toxicity rheumatoid arthritis, • Decision not to resuscitate or psychiatric illness with to de-escalate care because of potential threat to self or poor prognosis others, peritonitis, acute renal failure • An abrupt change in neurologic status, eg seizure, TIA, weakness, or High sensory loss