Taming the SRU

NOVEMBER 14, 2023

A retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011 identified 8.6 B) on right: hand drawn images of layers of ear demonstrating auricular hematoma The epidemiology and incidence of ED presentation for auricular hematomas has not been well-studied because it is a relatively uncommon condition.

Emergency Department 93

Emergency Department Pediatrics Wellness Documentation/Coding 93

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. Sagoschen, I.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Don't Forget the Bubbles

FEBRUARY 26, 2024

Increasing PEEP is thought to cause bronchodilation by providing direct mechanical stimulus as well as secondary stimulation through pulmonary stretch receptors coupled with activation of the non-cholinergic parasympathetic pathway. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. 2018 Jun;54(6):633-7.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

Mind The Bleep

FEBRUARY 29, 2024

This may well seem daunting given how unwell and complex the patients might be but a thorough, well-structured A-E will give you most of the information you need to progress that patient’s care. C Assessment BP and MAP Invasive reading (via an arterial line) or non-invasive (via a BP cuff)?

Documentation/Coding 52

Documentation/Coding Hospitals Wellness Best Practices 52

Don't Forget the Bubbles

MARCH 19, 2024

Just 20% of a person’s health and general well-being is related to access to care and the quality of services. Acknowledging the challenges associated with paediatric social admissions begins with documenting social issues and assessing their social history with the same level of detail as their medical history.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

RebelEM

MARCH 27, 2023

There may have very well been a policy where only RTs can make changes to a ventilator after an order was placed to ensure accurate documentation. Unfortunately, its not clear whether the documentation came from RTs or ED providers. Females and patients with increased BMI are at increased risk of not being placed on LPV.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients. Pediatr Emer Care.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. 2 The astute paramedic recognized this possibility and announced a CODE STEMI. NEJM 362(9):779; March 4, 2009. NEJM 362(9):779; March 4, 2009. Look at the aortic outflow tract.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

PulmCCM

FEBRUARY 19, 2024

Well … no. At Shands (the level 1 trauma center admitting adults), the panel relates the impressive results that mortality fell by 58%, and unplanned codes by 47% “after the widespread implementation of patient/ family activated RRT/MET.” Family-Activated METs in Adults Halves Mortality?

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

PulmCCM

OCTOBER 30, 2023

Then, in 2009, the condition disappeared completely. And maybe, noticing all the fuss, some clinicians might have started coding for VAP slightly less often in equivocal cases. The fact is, large, well-conducted studies with the power to find relatively small effects with high confidence take a long time. Just kidding!

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

Pediatric EM Morsels

OCTOBER 27, 2023

Taking care of a critically ill child can be nerve-racking to say the least, and downright petrifying for those who don’t do it frequently, even if they are well-trained and brilliant clinicians. Rosenberg 2011, Yamamoto 2009] Not as accurate in obese children (physicians were better at estimating). Broselow does not.

Pediatrics 269

Pediatrics Resuscitation Documentation/Coding Wellness 269

Dr. Smith's ECG Blog

APRIL 6, 2023

second that might document underlying SSS. That said — the term, “trifascicular block” is no longer recommended ( Surawicz et al, Circulation — AHA/ACCF/HRS Recs, 2009 ). This English proverb has served me well in the field of arrhythmias. The message is clear: "Birds of a feather flock together".

EKG/ECG 52

EKG/ECG Operations Documentation/Coding Wellness 52

Pediatric Education

NOVEMBER 12, 2023

weeks was seen for well-care. No specific documentation regarding the duration of the car seat testing could be identified in the medical records. 2009-0559 Davis NL. Patient Presentation A former 35 week, appropriate for gestational age male, now 37.5 The pertinent physical exam showed the patient was now 3.34 Pediatrics.

Pediatrics 40

Pediatrics Poisoning Hospitals Documentation/Coding 40

EB Medicine

DECEMBER 1, 2018

Antigen drift refers to small point mutations to the viral genes that code for H and N. Jeff: In fact, a meta-analysis on vaccine effectiveness from 2004-2015 found that the pooled effectiveness against influenza B was 54%, against the H1N1 pandemic in 2009 was 61%, and against the H3N2 virus was 33%. Nachi: Amazing.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 40

ACEP Now

DECEMBER 17, 2024

But we should not have to sacrifice our own well-being in the process. One of the first documented strikes among house staff officers took place in 1974 at Howard University here in Washington, D.C., One of the first documented strikes among house staff officers took place in 1974 at Howard University here in Washington, D.C.,

Burns 105

Burns Hospitals Documentation/Coding Emergency Department 105

Pediatric EM Morsels

AUGUST 18, 2023

None of the patients were documented to have joint disease at follow up. From 2001 to 2009, in a pediatric hospital gram negative culture showed a drop in sensitivity to ciprofloxacin from 96% to 93%. There were 2523 children included. 451 pediatric patients were included. This was similarly seen with levofloxacin.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

Dr. Smith's ECG Blog

JUNE 8, 2023

There were trends toward larger infarct size with delayed angiography, both by cMR and integral high-sensitivity troponin concentration, as well as toward higher rate of major adverse cardiovascular events (MACE) (8.5 Cardiology documented “late presentation STEMI but likely aborted given resolution of ST changes from EMS to hospital.”

EKG/ECG 86

EKG/ECG Documentation/Coding EMS Emergency Department 86

EMDocs

JULY 9, 2024

Insurance companies paying more attention to addressing social needs Medicaid: 1115 Demonstration Waivers, CalAIM in California ICD-10 code modifiers to acknowledge – and compensate—for the added complexity of social needs Additional resources/further reading: Liberman DB, Pham PK, Semple-Hess JE. 2009 Mar;123(3):858-64. JAMA Pediatr.

Pediatrics 64

Pediatrics Emergency Department Research Burns 64

Don't Forget the Bubbles

JUNE 10, 2024

Baby A, a preterm infant, appears to be faring well for the moment—requiring minimal respiratory support, on full feeds, without IV access, and generally in an okay condition. The history of necrotising enterocolitis The earliest documented cases resembling Necrotising enterocolitis (NEC) date back to the late 19th and early 20th centuries.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

A natural one, and especially suited for increasing capability without regard to physician residency program output of graduates, and in less-well-served rural areas. EMS in America: The Foundation Documents. Below, are in my view, the essential conditions and turning points for advancing to the level of care that we now know.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

RebelEM

MAY 15, 2024

The loss of these cells leads to immunosuppression as well as decreased responsiveness of the immune system as a whole Patients with neutropenia will not only get very sick very quickly, but also will have blunted immune response and may not localize signs of infection well Fever or malaise may be their only presenting symptoms.

Infectious Diseases 86

Infectious Diseases Administration Sepsis Anaphylaxis 86

RebelEM

NOVEMBER 11, 2024

Reliance on Electronic Health Records Data : As with many retrospective studies, reliance on EHR data for identifying eligible patients and outcomes is prone to inaccuracies, missing data, and variability in clinical documentation practices. 2009 Dec;37(12):3114-9. 2009 Mar 26;360(13):1283-97. Ann Transl Med. 2018 May;6(10):182.

Sepsis 98

Sepsis Outcomes Administration Shock 98

Dr. Smith's ECG Blog

APRIL 8, 2015

True Syncope: If, on the other hand, the patient is well, had no other serious symptoms , has a normal sinus rhythm, and normal physical exam , then you need to be certain the syncope was not due to a dangerous brady- or tachydysrhythmia that could recur. Arch Intern Med 2009 Jul 27; 169:1262. Arch Intern Med 2009 Jul 27; 169:1305.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

Sensible Medicine

DECEMBER 23, 2024

Despite these issues, clopidogrel has held up well in clinical trials and remains the most common antiplatelet drug in addition to aspirin after coronary stenting. 4 Lack of Replication of Ticagrelor superiority over Clopidogrel PLATO was published in 2009. The public documents from FDA are also available.

Stroke 111

Stroke Documentation/Coding Research Wellness 111

Dr. Smith's ECG Blog

FEBRUARY 4, 2025

Because of its totally unexpected onset and propensity to result in sudden death PAVB is difficult to document and significantly underdiagnosed. This complicates documentation and explains why it is so easy to miss the diagnosis. [link] Connolly, S., Sheldon, R., Roberts, R., & & Gent, M. link] Lee, S., Wellens, H.

EKG/ECG 88

EKG/ECG Documentation/Coding Operations Wellness 88

Advanced Emergency Nursing from AENJ

MARCH 27, 2015

Expiratory airway obstruction may well have been frequently misdiagnosed as it can produce breath-stacking and ball-valve obstruction that impedes any airflow with mask ventilation if neither a nasal nor an oral airway is used and the lips have closed under the mask. Lubricate well. Gerkin] Priceless. Always be gentle! Ludwig’s angina.

Resuscitation 40

Resuscitation Airway Management EMS CPR 40