Northwestern EM Blog

MARCH 1, 2025

Document thorough skin assessment every nursing shift, and inspect weight-bearing ventral surfaces. 2013; Mi et. 2013 Jun 6;368(23):2159-68. The PROSEVA study is the most recent and famous randomized control trial. This maneuver improves oxygenation and gas exchange via three main mechanisms (Malhotra, 2022): 1. N Engl J Med.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

EMDocs

SEPTEMBER 23, 2023

Brugada sign refers to the findings on ECG, while Brugada syndrome is the combination of ECG findings with one of the following: documented ventricular tachycardia or fibrillation, syncope, family history of sudden cardiac death at < 45 years old, or inducible ventricular tachycardia with programmed electrical stimulation. Heart Rhythm.

EMS 105

EMS EKG/ECG Documentation/Coding Emergency Department 105

Mind The Bleep

OCTOBER 29, 2024

Provide detailed documentation of the initial assessment, treatment provided, and the patient’s response to interventions. 2013 May;74(5):1363-6. Preparation for Transfer Ensure the patient is hemodynamically stable before transfer. ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS working group.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Pediatric EM Morsels

AUGUST 18, 2023

None of the patients were documented to have joint disease at follow up. Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications. There were 2523 children included. 451 pediatric patients were included.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

Taming the SRU

JULY 25, 2024

Indication - skeletally mature patients with a radiographically documented femur fracture (hip to knee) Contraindications: Patient refusal Allergy to local anesthetic Infection over site of planned injection Obtunded/uncooperative patient Crush injury No available provider or space Medication: 0.5% for obstructive CAD, OR 1.8

Stroke 98

Stroke Fractures Operations Outcomes 98

Don't Forget the Bubbles

DECEMBER 16, 2024

Manual for the laboratory diagnosis of measles and rubella infection Geneva: WHO Documents Production Services, 2007 Available from: [link] [Accessed 4 Oct 2024] Government of the United Kingdom. JOINT committee on vaccination and immunisation code of practice June. European Centre for Disease Prevention and Control. Epidemiol Infect.

Infectious Diseases 59

Infectious Diseases Documentation/Coding Pediatrics CDC 59

EMDocs

AUGUST 8, 2023

Document consideration of torsion in males with abdominal pain. Don’t rely on the Prehn’s sign in your evaluation of torsion. 2016 validation study 0 points for low risk, 1-5 for intermediate risk and 6-7 for high risk. 2022 meta-analysis 0-2 as low risk and ≥5 or higher as high risk = AUC of 0.924.

Ultrasounds 95

Ultrasounds Documentation/Coding Outcomes Emergency Department 95

The Skeptics' Guide to EM

MAY 8, 2021

The issue of whether corticosteroids should be administered is brought up during the code. SGEM#50 looked at a RCT published in JAMA 2013 looking to see if a vasopressin, steroids, and epinephrine (VSE) protocol for IHCAs could improve survival with favorable neurologic outcome compared to epinephrine alone.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

RebelEM

JANUARY 29, 2024

Am J Cardiol 2013. A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Reisk Pulmonary Embolism: The OPTALYSE PE Trial. JACC Cardiovasc Interv 2018. PMID: 30025734 Sharifi M et al. Moderate Pulmonary Embolism Treated with thrombolysis (from the “MOPETT” Trial). Clin Exp Emerg Med 2023.

Stroke 136

Stroke Outcomes Hospitals Administration 136

The Skeptics' Guide to EM

OCTOBER 28, 2017

That rant relied upon a Cochrane SRMA by Stevens B et al 2013 and a randomized clinical trail published in Pediatrics by Gray L et al 2015. Stevens and colleagues updated their review in 2016 and concluded “sucrose is effective for reducing procedural pain” and “no serious side effects or harms have been documented with this intervention”.

Pediatrics 52

Pediatrics Documentation/Coding Emergency Department Hospitals 52

EMDocs

JULY 11, 2023

A 2013 study found oral mucosal and head bleeding due to injury were most common in those < 6 months. 2013 Dec;163(6):1781-3. PMID: 7382250 MASAC Document 257 – Guidelines for Emergency Department Management of Individuals with Hemophilia and Other Bleeding Disorders. PMID: 23968747. Kitchens CS. Occult hemophilia.

Head Injuries 75

Head Injuries Pediatrics Dislocations CDC 75

Taming the SRU

SEPTEMBER 15, 2023

ETT onto a fiberoptic scope.

CPR 90

CPR Burns Airway Management Wellness 90

The Skeptics' Guide to EM

APRIL 24, 2021

Way back in 2013 we looked at haloperidol for agitation due to psychosis ( SGEM#45 ) and concluded that it was an effective treatment but had common side effects. Exclusions: Prisoners or those in police custody, pregnant or breast-feeding, or with documented allergy to any study medications.

Emergency Department 40

Emergency Department Research Outcomes Documentation/Coding 40

The Injectable Orange

JUNE 20, 2017

This is met with resistance, “we’re too busy theirs not enough staff or time”, “the staff have done mock codes before, they really disrupt things and they hated them”. doi: 10.1136/bmjopen-2013-003525 Lorello, G, Hicks, C et al. 2013 Dec;26(6):699-706. Stimulus by Prof. 2016 Mar;18(2):136-42. doi: 10.1017/cem.2015.4.

Head Injuries 52

Head Injuries Documentation/Coding Wellness Resuscitation 52

Taming the SRU

FEBRUARY 5, 2024

1) However, it wasn’t until the 1890s that purposeful, successful, and safe attempts to access this fluid were documented (2). Metropolitan Museum of Art, CC0, via Wikimedia Commons The ancient Egyptian physician Imhotep is often credited with the discovery of cerebral spinal fluid (CSF) —over 5,000 years ago! (1) Clin Infect Dis.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

Pediatric Emergency Playbook

APRIL 1, 2016

for the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. ACCF 2012 Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations. Cardiology in the Young; 2013. 2013; 88(10): 1127–1140. 2013; 29:715-719. Newby KL et al.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

SheMD

OCTOBER 8, 2023

In 2013, a large survey with 7,028 respondents found that 64.8% And if you worry about reporting a program because of retaliation, document all of it and submit after match or anonymously. 2) In 1996, 45% of all respondents to an AAMC questionnaire reported being asked similar questions.

Leadership 105

Leadership Best Practices Academics Documentation/Coding 105

Pediatric Emergency Playbook

AUGUST 1, 2018

0.34) Documented temperature >38° or >38.5°C 2013 Jun; 28(6): 830–834. Use this new post-test probability to help in your decision Your patient has palatal petechiae, which confers a positive likelihood ratio (LR+) of 2.7 7.62) 0.94 (0.90-0.97) 0.97) 0.08 (0.05-0.14) 0.14) 0.98 (0.95-0.99) 0.99) Palatal petechiae 2.69 (1.92-3.77)

Pediatrics 52

Pediatrics Documentation/Coding 52

RebelEM

AUGUST 12, 2024

Contemp Clin Trials. Epub 2022 Aug 28. PMID: 36038001 Levi TM, et al. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients. Rev Bras Ter Intensiva. PMID: 24553510 Iacone R, et al. Macronutrients in Parenteral Nutrition: Amino Acids.

Outcomes 81

Outcomes Hospitals Operations Shock 81

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. Natural psycho-physiological responses may alter perceptions during the life-threatening event. Khoshdel, A.

Military 40

Military Forensics Documentation/Coding Emergency Nursing 40

PHEM Cast

APRIL 21, 2021

Guidance documents College of Paramedics Statement on Intubation, available here. Int J Emerg Med 6, 38 (2013). AAGBI Safer Prehospital Anaesthesia 2017, available here. Positioning From: [link] Recommended Rich Levitan resources Podcast 70 – Airway Management with Rich Levitan Airway axes From: McGuire B, Hodge K. Toda, A.A. &

Airway Management 40

Airway Management Resuscitation EMS Hospitals 40

Pediatric Emergency Playbook

JUNE 1, 2017

The best documented cormorbidity is sickle cell disease, although other pro-thrombotic conditions also put the child at risk. 2013; 34(3):489-491. Myocardial infarction in an adult resulting from coronary aneurysms previously documented in childhood after an acute episode of Kawasaki’s disease. 2013; 34(4). 15:1002-1004.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

PulmCCM

FEBRUARY 19, 2024

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.” Over six years of study (2007-2013): There were 83 MET calls activated by parents (~1.2

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

Northwestern EM Blog

APRIL 25, 2022

Although limited, a 2013 study by Konda et al, where direct arthroscopic visualization or septic arthritis at follow-up were used as the gold standard for diagnosis, found imaging by CT scan to be 100% sensitive and specific for diagnosing traumatic knee arthrotomy. This may bring the wound tract into your field of view.

Soft Tissue Injuries 52

Soft Tissue Injuries Fractures Sepsis Documentation/Coding 52

Don't Forget the Bubbles

MARCH 11, 2024

Recommendations for sudden infant death syndrome prevention: a discussion document. The Radiology Assistant: Craniosynostosis Accessed 10.01.2024 Mawji, A., Vollman, A. Hatfield, J., McNeil, D. A., & Sauvé, R. The Incidence of Positional Plagiocephaly: A Cohort Study. Pediatrics, 132(2), 298–304. link] Mitchell, E.

Radiology 59

Radiology Radiology Pediatrics Documentation/Coding 59

Advanced Emergency Nursing from AENJ

JULY 9, 2015

Pull out the manikins (or use a volunteer; BVM only) and run some awkward codes! Video] Sep 15, 2013. Video] Nov 19, 2013. How versatile are your airway skills? Oh, sure, you can handle any supine situations! Gather everyone. Most airway management is done with the patient supine and on a table. Yaddanapudi, S., & Chari, P.

Airway Management 40

Airway Management Pediatrics Resuscitation Emergency Nursing 40

ACEP Now

DECEMBER 10, 2023

Although cases of human milkweed exposure are rare, a 2013 case reported a 42-year-old man experiencing cardiac symptoms and nausea after consuming fried milkweed pods from a recipe he found online. In the ED, he was found to have a heart rate in the 40s, and a digoxin level of 1.0 ng/mL (cross reactivity of the assay) and a potassium of 4.2

Poisoning 52

Poisoning Seizures Documentation/Coding Emergency Department 52

Dr. Smith's ECG Blog

JULY 22, 2023

Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon. Drugs that have been associated with Brugada ECG patterns include tricyclic antidepressants, anesthetics, cocaine , methadone, antihistamines, electrolyte derangements, and even tramadol. [2].

EKG/ECG 92

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 92

Northwestern EM Blog

SEPTEMBER 12, 2022

Other things listed on tags can be a patient’s name, bar code, MRN or other tracking criteria. Florida Department of Health, www.urmc.rochester.edu/MediaLibraries/URMCMedia/flrtc/documents/WNY-Hospital-Medical-Surge-Planning-For-Mass-Casualty-Incidents.pdf. Epub 2013 Mar 6. EPM , 5 Apr. Institute of Medicine. Greenberg, T.,

Mass Casualty Incidents 52

Mass Casualty Incidents EMS Hospitals Hazardous Materials 52

Dr. Smith's ECG Blog

JUNE 30, 2023

Smith and Meyers containing thousands of tracings with documentation of cardiac catheterization results. Although this is not a common phenomenon — You will see it on occasion ( See the July 24, 2013 post , among others — in Dr. Smith's ECG Blog ).

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Wellness 52

Dr. Smith's ECG Blog

FEBRUARY 16, 2019

Posterior STEMI" may not even technically exist according to the current (2013) ACC/AHA STEMI guidelines, as it is not described as a "STEMI equivalent" and the only relevant statement in the guidelines is: "In addition, ST depression in 2 precordial leads (V1-V4) may indicate transmural posterior injury."

EKG/ECG 52

EKG/ECG Documentation/Coding Stroke 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. Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. Triage ECG: What do you think?

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Documents improvements in BVMs previously investigated and found deficient in FIO2. Classic pre-EMS document describing rescue care by rural volunteer squads. CARDEN, E., & FRIEDMAN, D. Further studies of manually operated self-inflating resuscitation bags. Anesthesia & Analgesia, 56(2), 202-2 06. Abdo Khoury, M. Hugonnot, S.,

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

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. N Engl J Med 2003; 348:1756-1763, 5/1/2013. Look at the aortic outflow tract. What do you see?

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

ACEP Now

AUGUST 1, 2023

Recent data published in Annals showed that between 2013 and 2019, the percentage of clinicians working in rural areas who were emergency physicians actually dropped slightly. emergency department deserves access to an emergency physician no matter their zip code. It is critical for our specialty to work on our rural pipeline.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 98

Pediatric Education

MARCH 10, 2024

Discussion “Gifted individuals are those who demonstrate outstanding levels of aptitude (defined as an exceptional ability to reason and learn) or competence (documented performance or achievement in top 10% or rarer) in one or more domains.” Assouline, Nicholas Colangelo, 2013. – Megan Foley-Nicpon, Susan G.

Leadership 40

Leadership Wellness Pediatrics Documentation/Coding 40

Dr. Smith's ECG Blog

JANUARY 30, 2019

Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon. Drugs that have been associated with Brugada ECG patterns include tricyclic antidepressants, anesthetics, cocaine , methadone, antihistamines, electrolyte derangements, and even tramadol. [2].

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 52