The Skeptics' Guide to EM

JULY 27, 2024

That document tells us “Before widespread implementation, CDRs should be compared to clinical judgement.” [3] Dave Schriger and colleagues reviewed publications in the Annals of Emergency Medicine from 1998 to 2015 and found that only 11% of the studies compared decision aids to clinical judgement [4].

Sepsis 99

Sepsis Outcomes Documentation/Coding Hospitals 99

EMDocs

JUNE 28, 2023

EMS report includes concern for CVA, with variable documentation of face and extremity weakness. Nursing documentation includes the presence of a facial droop. There, his initial neuro exam is documented as normal, but a head CT reveals evidence of a possible acute CVA in the right hemisphere. a stroke or cardiac event).

Documentation/Coding 94

Documentation/Coding EMS Stroke Patient Safety 94

ACEP Now

NOVEMBER 7, 2024

A 2015 study found that psychiatric patients were about twice as likely to be boarded as other medical patients; boarding times for psychiatric patients were close to five times as high as those for the rest of the hospital’s boarders. 1 The problem of psychiatric boarding has gotten worse in the years since it began. West J Emerg Med.

Psychiatric 59

Psychiatric Pediatrics Hospitals Emergency Department 59

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. 2015 Feb;135(2):e296-304. Pediatrics.

Pediatrics 74

Pediatrics Emergency Department Research Burns 74

PulmCCM

JANUARY 6, 2025

Their spread has coincided with the Centers for Medicare and Medicaid’s “sepsis bundle quality measure” (SEP-1) going live in 2015. This was despite a higher intensity of care in the visible-alert patients, who had more rapid responses, ICU transfers, code blues, intubations, and initiation of dialysis.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

Mind The Bleep

OCTOBER 29, 2024

Provide detailed documentation of the initial assessment, treatment provided, and the patient’s response to interventions. 2015 Jun;11(2):227-31. Preparation for Transfer Ensure the patient is hemodynamically stable before transfer. J Toxicol Clin Toxicol. 1993;31(2):307-13. doi: 10.3109/15563659309000397. PMID: 8492343. J Med Toxicol.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Medical Law

FEBRUARY 4, 2021

Santa Barbara also continues to move forward on implementing its 2015 Bicycle Master Plan Update, which will include the construction of several new multiuse bike pathways for bicyclists and pedestrians. In 2015, California updated its bicycle laws to accommodate E-bikes. Vehicle Code Section 312.5(1)-(3)).

Documentation/Coding 52

Documentation/Coding Legal Issues Operations 52

PEMBlog

JUNE 14, 2023

Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document. Prolonged emergency department length of stay for US pediatric mental health visits (2005-2015). Pediatrics March 2023; 151 (3): e2022057383. 10.1542/peds.2022-057383 West J Emerg Med. 2019 Jul 22;20(5):690-695. 2019.6.42422.

Psychiatric 98

Psychiatric Emergency Department Pediatrics Best Practices 98

Don't Forget the Bubbles

NOVEMBER 20, 2023

Document the size, consistency and location in the notes to compare if they represent. They may grow again with subsequent upper respiratory tract infections. This waxing and waning course is normal, and families should be reassured and given red flag features that necessitate further assessment. Physician Assistant Clinics.

Pediatrics 124

Pediatrics Documentation/Coding Emergency Department Ultrasounds 124

PHEM Cast

DECEMBER 12, 2016

For an entertaining and insightful discussion about the impact of undertaking thoracotomy, listen to Dr John Hinds talk from SMACC 2015. Journal of the Royal Society of Medicine 2015. Highly recommended. Traumatic Cardiac Arrest. 108(1): 11-16. Wise et al. Emergency thoracotomy: “how to do it”.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

Don't Forget the Bubbles

JANUARY 22, 2024

2015) highlighted that a poor understanding of statistics often results in a belief that screening is more beneficial than it actually is. 2015 ;24(2):167-74. 2015 May 12;350:h2308 Malhotra A, Maughan D, Ansell J, et al. Malhotra et al. There is limited acknowledgement of the potential harms of any given test. BMJ Qual Saf.

Emergency Department 90

Emergency Department Best Practices Radiology Radiology 90

EMDocs

DECEMBER 4, 2023

Document a risk and benefit discussion with the patient regarding empiric anticoagulation, perhaps even including the HAS-BLED score in the documentation [10]. Thrombosis J 13, 18 (2015). Give the first dose of enoxaparin in the ED: 1 mg/kg subcutaneously for 12 hours or 1.5 mg/kg for 24 hours. 2006;295(2):199-207.

Ultrasounds 96

Ultrasounds Documentation/Coding Wellness EMS 96

ACEP Now

NOVEMBER 7, 2023

The 2015 Edition Cures Act sought to promote “transparency, modern standards, and enhanced health IT capabilities by fostering innovation in the health care technology ecosystem to deliver better information to patients, clinicians, and other users.” Training opportunities for documentation best practices should be employed.

Documentation/Coding 52

Documentation/Coding Best Practices Ethical Issues Academics 52

Downeast Emergency Medicine

DECEMBER 1, 2021

2015; 313(16):1636-1644.[ The investigators used thematic analysis to independently code transcripts using an initial set of deductive codes, followed by inductive codes developed during the coding process. Articles reviewed 1. D’Onofrio, et al. Rosenberg, et al.

Emergency Department 52

Emergency Department Documentation/Coding Leadership Administration 52

PHEM Cast

JANUARY 5, 2016

This is the Step 1,2,3 tool described: For more information on the toxidromes associated with various chemicals, biological agents and radiation sources have a look at this document (admittedly it’s a few years old but the content is still good, especially the flow chart which is pasted below): [link] What is an anti-muscarinic chemical?

Mass Casualty Incidents 52

Mass Casualty Incidents Documentation/Coding 52

Sensible Medicine

AUGUST 7, 2024

A 2015 Nature (Pediatric Research) paper by Nils J. In the resulting document , the working group changed the ages at which children can be expected to reach developmental milestones. To receive new posts and support our work, consider becoming a free or paid subscriber. This may not be true for infants.

CDC 114

CDC Documentation/Coding Research Pediatrics 114

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%

Stroke 98

Stroke Fractures Operations Outcomes 98

Mind The Bleep

SEPTEMBER 14, 2024

References British Society for Surgery of the Hand – Flexor Sheath Infection Document Pang H-N, Teoh L-C, Yam AK, et al. 2015 Sep;40(7):720-8. Epub 2015 Feb 10. This is also a surgical emergency and requires prompt referral to the hand surgery team. Tendon necrosis. Persistent infection. Need for amputation. J Hand Surg Eur Vol.

Operations 52

Operations Sepsis Documentation/Coding 52

RebelEM

JANUARY 29, 2024

JACCC Cardiovasc Interv 2015. A prospective, Single-Arm Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. PMID: 26315743 Tapson VF et al.

Stroke 136

Stroke Outcomes Hospitals Administration 136

Advanced Emergency Nursing from AENJ

AUGUST 2, 2016

All efforts to identify the decedent by hospital staff, law enforcement agencies or social service agencies should be well documented in the medical records. Based upon California Health and Safety Code 102850 and Government Code 27491. Based upon California Health and Safety Code 102850 and Government Code 27491.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

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

Northwestern EM Blog

MARCH 1, 2025

Document thorough skin assessment every nursing shift, and inspect weight-bearing ventral surfaces. Reattach EKG leads to back. Tilt patient into reverse Trendelenburg. Slight, intermittent lateral repositioning (20-30 degrees) should also be used, changing sides at least every 2 hours. American Journal of Emergency Medicine. 32(6): 687.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

Don't Forget the Bubbles

MAY 6, 2024

of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) Data collected were the worst values documented within the same calendar day as the blood cultures were obtained. The data was collected from a cohort from 2011- 2015 (nearly ten years ago). Of the 74.9% showed clinical improvement without antibiotics.

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

Don't Forget the Bubbles

MARCH 19, 2024

adapted from Andrew and Powell, 2015 The literature at a glance It is unclear how many children like ‘Jack’ arrive at the door of paediatric hospitals without placement in appropriate disability, foster or mental health facilities. Key messages Consider social determinants of health and document these in a child’s clinical notes.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

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”. Epub 2015 Apr 10. Cheng (2015). You go back to your office and try to come up with how you will make this happen. Stimulus by Prof. 2016 Mar;18(2):136-42.

Head Injuries 52

Head Injuries Documentation/Coding Wellness Resuscitation 52

RCEM Learning

MAY 20, 2022

Author: Damian Roland / Editor: Govind Oliver / Code: / Published: 06/02/2020 There are many old and unhelpful stereotypes in medicines. Despite this, due to it being a ‘relatively’ new speciality, EM has not had the history to develop a large Royal College (it was only invested in 2015) or a significant academic background.

Academics 52

Academics Research EMS Documentation/Coding 52

PHEM Cast

APRIL 21, 2021

Guidance documents College of Paramedics Statement on Intubation, available here. 2015 Oct 23;10(10):e0141034. Scand J Trauma Resusc Emerg Med 23, 57 (2015). AAGBI Safer Prehospital Anaesthesia 2017, available here. Tracheal intubation. Anaesthesia & Intensive Care Medicine. 20(12);681-686. doi: 10.1371/journal.pone.0141034.

Airway Management 40

Airway Management Resuscitation EMS Hospitals 40

Don't Forget the Bubbles

DECEMBER 13, 2023

Failure to thrive’ has many definitions We use standardized charts to document infant growth. Epub 2015 Dec 9. Infants who are slow to gain weight require early treatment as they are at risk for having a short stature, behavioural and emotional problems, and developmental delays. Eur J Pediatr. 2016 Apr;175(4):573-9. PMID: 26646145.

Dehydration 98

Dehydration CDC Hospitals Wellness 98

Don't Forget the Bubbles

FEBRUARY 26, 2024

In 2015, Silva et al. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. As the airway obstruction resolves and gas trapping improves, the PEEP can be gradually decreased. reviewed the two published randomised control trials. BTS/SIGN British guideline on the management of asthma. Accessed November 2023.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

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) REFERENCES 1.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

Don't Forget the Bubbles

JULY 26, 2023

REVERT trial (adults); Appelboam et al, Lancet 2015 showed that by modifying the traditional valsalva manoeuvre to be done semi-recumbent with a passive leg raise immediately afterwards increased the success from 17% cardioversion to 43%. Image from: [link] with thanks How often does the Valsalva manoeuvre work?

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

RebelEM

MARCH 9, 2023

Barr 2016 , Trevejo-Nunez 2015) Patients are at high risk of bleeding from the GI tract due to clotting factor impairment or devastating hemorrhage from esophageal varices in the setting of portal hypertension. As always, document clinical sobriety before discharge. Epub 2015 Sep 14. Osteopathic Family Physician. 2014 Mar;6(2).

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

Don't Forget the Bubbles

JULY 3, 2023

This data relies heavily on the coding, which we know is not standardized across healthcare sites- and, therefore may not be truly reflective. Four hundred data sets were included, 54% belonging to female patients. Discharge home from ED was the primary. Why does it matter?

Emergency Department 105

Emergency Department Hospitals Domestic Violence Pediatrics 105

Advanced Emergency Nursing from AENJ

NOVEMBER 27, 2017

The following quotes from the ILCOR and AHA documents, under fair-use doctrine, will help summarize for you the changes. In the 2015 CoSTR, this was cited as a strong recommendation but based on very low-quality evidence.19,20 In the 2015 CoSTR, this was cited as a strong recommendation but based on very-low-quality evidence.

CPR 40

CPR Basic Life Support Resuscitation Pediatrics 40

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 131

EKG/ECG Documentation/Coding Wellness Emergency Department 131

Emergency Medicine Ireland

MAY 3, 2021

Now is not the time for permissive hypercapnoea and so for your patients with head injury and ARDS this can be really challenging The BTF guidance is the key guideline document that should be referenced and it is well worth a read for any exam candidate and indeed any clinician dealing with TBI. The following summarises some of the headlines.

Head Injuries 40

Head Injuries Hyperthermia / Hypothermia Documentation/Coding Outcomes 40

Pediatric Education

DECEMBER 10, 2023

The medical record also documented that the family had been provided with education regarding infant safe sleep practices during the newborn period. Overall unintentional suffocation in infants < 1 year old from 1999-2015 in another study increased from 12.4 per 100,000 live births. per 100,000 people. Accessed September 15, 2023.

Pediatrics 40

Pediatrics Documentation/Coding Research Hospitals 40