Northwestern EM Blog

SEPTEMBER 26, 2022

It is well-documented that ED physicians have historically high rates of burnout compared to other specialties as well as a high incidence of post-traumatic stress disorder (PTSD) compared to the general population. PTSD is 2 times more prevalent in physicians (14.8%), with EM resident physicians falling in the range from 11.9%-21.5%.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

ACEP Now

JULY 7, 2023

Mental health evaluation teams can rely on documentation and interviews to understand a patient’s initial agitation level. The article also will not address severe agitation, which is already well covered elsewhere and is the topic of an ACEP clinical policy currently in development. 2012 Feb;13(1):17-25. 2012 Feb;13(1):26-34.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

mEq/L for Mg++ ) — given that ECF levels of these cations comprise only ~1-2% of total body stores ( Jahnen-Dechent and Ketteler — Clin Kidney J 5(Suppl 1):i3-i14, 2012 — and — Udensi and Tchounwou — Int J Clin Exp Physiol 4(3): 111-122, 2017 ). mEq/L for K+ and 1.76 Smith's ECG Blog.

Seizures 108

Seizures EKG/ECG EMS Stroke 108

ACEP Now

MARCH 13, 2024

Consequences of this are well documented and include delayed treatment, exposure to error, increased length of stay, and increased mortality. 2012): 2470-2478. Emergency departments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions.

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

Don't Forget the Bubbles

MARCH 11, 2024

There are many causes, and it is less well understood than plagiocephaly. Recommendations for sudden infant death syndrome prevention: a discussion document. Craniosynostosis Craniosynostosis is rare. It is due to the premature closure of the sutures rather than positional changes to an otherwise normal skull. link] Mitchell, E.

Radiology 59

Radiology Radiology Pediatrics Documentation/Coding 59

Don't Forget the Bubbles

OCTOBER 10, 2024

Adopting this approach would reduce time in surgery for the child as well as the financial cost of nail bed repair. 2012 Aug 15;(8):CD004872. Inclusion criteria required documented acute streptococcal pharyngitis, as per positive throat swab culture or rapid antigen testing, in patients 1-18 years of age. doi: 10.1002/14651858.CD004872.pub3.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. ” Indeed, cause of death is coded differently over time and across counties, states, and countries.

CDC 75

CDC Sepsis Research Pediatrics 75

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. On arrival at hospital the child was well with normal observations. The presence of these pathways is documented inutero and they usually regress by around 20 weeks gestation. Family history. What are the important investigations?

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

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

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

Dr. Smith's ECG Blog

MAY 8, 2023

Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. There is concordant ST elevation in I, aVL with reciprocal concordant STD in inferior leads, as well as excessively discordant TE in V2-V4. Annals of Emergency Medicine 2012; 60(12):766-776.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 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 Cardiol.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Sensible Medicine

MARCH 27, 2024

Peter Attia - From Surgeon to Longevity Guru I first encountered Peter Attia online while researching ketosis , the Atkins diet and low carb diets in 2012 and found his writing to be incredibly well-researched and helpful. To support his Medicine 3.0 2 Apparently, in Attia's practice, "this is my starting point with any patient.

Research 94

Research Documentation/Coding Wellness 94

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present." Smith comment: But the tests (ECG and troponin) are extremely specific and so the post test probability is nearly 100%. Repeat cTnI drawn at around 8 AM was 3.910 ng/mL. This patient was not one of the lucky 6.4%

EKG/ECG 122

EKG/ECG Documentation/Coding Wellness Emergency Department 122

Downeast Emergency Medicine

APRIL 26, 2021

Trauma patients between the ages of 18-90 years had to have either had one documented episode of hypotension (defined as a systolic BP <90 mmHg) or tachycardia (>100 beats/minute) to be included in the study. Arch Surg 2012; 147:113-119.[ J Thromb Haemost 2019;17:852-862.[ Pubmed ] Morrison JJ, Dubose JJ, Rasmussen TE et al.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

RebelEM

DECEMBER 28, 2022

However, the optimal treatment duration for UTI in men is not well studied, and current practice guidelines are based on historical dogma. Conducted at 2 US Veterans Affairs medical centers from 2012–2019. Patients were enrolled after the initiation of treatment through a search for diagnosis codes and antibiotic prescriptions.

Outcomes 52

Outcomes Documentation/Coding Hospitals EMS 52

Dr. Smith's ECG Blog

JULY 22, 2023

The patient did well and was ultimately discharged home. Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon. As for our patient, on discharge, her EKG had completed returned to her baseline morphology and she has been doing well in follow-up.

EKG/ECG 75

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 75

Advanced Emergency Nursing from AENJ

NOVEMBER 20, 2014

It is critically important to document the physical findings in a plain-seeing, plain-speaking, non-judgmental manner that will not color or taint future investigations. Accurate time entries are important to document. If you think your patient is the perpetrator, he may well be an innocent, or even an off-duty or undercover officer.

Military 40

Military Forensics Documentation/Coding Emergency Nursing 40

Advanced Emergency Nursing from AENJ

JULY 9, 2015

Pull out the manikins (or use a volunteer; BVM only) and run some awkward codes! Flexibility of mind and skill bodes well. Wiget, Urs & Torres, Eric. Video] Oct 30, 2012. Pediatric Airway: brief intro for trauma providers} [Video] May 21, 2012. Video] Dec 19, 2012. How versatile are your airway skills?

Airway Management 40

Airway Management Pediatrics Resuscitation Documentation/Coding 40

Dr. Smith's ECG Blog

JANUARY 30, 2019

I remember Allie well from her days in the Research volunteer program at Hennepin. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. A repeat EKG was performed at that time and showed this: The STE had almost completed resolved and the STE depression is improved as well. F (rectal).

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 52

Northwestern EM Blog

MAY 16, 2022

The above study was well summarized and bears repeating that, in this multicenter randomized study assessing CT vs POCUS vs radiology performed US in patients with suspected renal colic in the ED setting, initial US reduced radiation exposure without adversely affecting patient-centered outcomes. Kidney international , 83 (3), 479-486.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Advanced Emergency Nursing from AENJ

SEPTEMBER 4, 2014

It was extremely well-liked by field personnel, but virtually unknown in hospitals. However, they could be used easily and well with the assist of head-straps which were never sold as part of the complete “kit” but only as an uncataloged “spare part.” Accessed July 28, 2014 **Quoting original documents of fascinating history.

Resuscitation 40

Resuscitation CPR Documentation/Coding EMS 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

EB Medicine

MARCH 1, 2019

Nachi: This month’s team parsed through roughly 1200 articles as well as guidelines from the eastern association for surgery in trauma also known as EAST. Post opiate hypotension in prehospital trauma patients is a rare but documented complication. Unfortunately, CT does not perform well for the evaluation of myocardial contusions.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 93

Emergency Department Resuscitation COPD Shock 93

ACEP Now

OCTOBER 9, 2023

percent) do not speak English as a primary language, and 25 million of those speak English less than well (known as “limited English proficiency” or LEP); many indicators show this number will only continue to grow. Physicians should document the interpreter’s name and identification number if available in the patient’s chart.

Emergency Department 64

Emergency Department Documentation/Coding EMS Wellness 64

Ziqitza HealthCare Ltd

JULY 14, 2023

Of these, about 7 lahks, or 30 per cent, were reported under Section 498A of the Indian Penal Code (IPC), the report says. These dedicated numbers are operational 24X7, are toll-free and available to women promptly, and have integrated call centres that operate round-the-clock for providing legal or police aid as well as medical services.

Domestic Violence 52

Domestic Violence Documentation/Coding Operations Ambulance Services 52

Advanced Emergency Nursing from AENJ

MAY 27, 2014

This is a cased kit of a Sparklet Resuscitator (J size), with pressure chamber, regulator, tubing, reservoir bag, flow stopcock, and funnel mask, with associated documents. Henderson , it would seem, was an enthusiast, well-convinced of his opinions, with missionary zeal, who would firmly argue his positions and tirelessly campaign them.

Resuscitation 40

Resuscitation Poisoning Research Administration 40

EMDocs

JULY 3, 2023

All patients with concern for SAH need a rapid primary survey to assess the airway, breathing, and circulation as well as a comprehensive neurologic exam to create a baseline for the patient. This neurological evaluation should include assessment and documentation of the GCS, the presence of any neurologic deficits, and an NIHSS.

Seizures 85

Seizures Stroke Outcomes EMS 85

Don't Forget the Bubbles

JANUARY 22, 2024

The campaign started in the United States in 2012, in Canada two years later, and in the United Kingdom in 2016. Blood cultures are commonly drawn for certain focal infections such as pneumonia , skin and soft tissue infections (SSTIs), asthma , bronchiolitis as well and UTIs.

Emergency Department 90

Emergency Department Best Practices Radiology Radiology 90

The Skeptics' Guide to EM

JUNE 2, 2021

Dr. Wendy Levinson is the Chair of Choosing Wisely Canada (CWC) and a Professor of Medicine, University of Toronto This SGEM Xtra is based on document created by CADTH and presented at Choosing Wisely Canada […] The post SGEM Xtra: High-Value Care Post Covid19 – Did you ever have to make up your mind?

Documentation/Coding 52

Documentation/Coding Hospitals Wellness 52

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Thus, Brugada is the likely diagnosis _ A very nice explanation of this is given in the document quoted below on current ECG criteria for Brugada pattern. J Electrocardiology 45 (2012):433-442. Bayes de Luna, A et al. Current electrocardiographic criteria for diagnosis of Brugada pattern: a consensus report. And another finding.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

EB Medicine

AUGUST 1, 2018

In fact, cannabis use has been documented for medical use dating as far back as 600 BC in West and Central Asia. Jeff: And the etiology of CHS is not well understood. Nachi: There is a well-studied theory here and it relates to the TRPV1 receptor that we talked about earlier.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EB Medicine

JANUARY 2, 2019

For a completed abortion, you would expect a closed OS with no IUP on ultrasound with a previously documented IUP. It’s noteworthy that a 2012 Cochrane review failed to find clear superiority for one strategy over another. For a threatened abortion, the os would be closed with an IUP seen on ultrasound.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

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! Buffington, C.

Resuscitation 40

Resuscitation Airway Management EMS CPR 40