PEMBlog

JUNE 14, 2023

Thousands of children and adolescents spend days at time in Emergency Departments waiting for definitive mental health disposition. West J Emerg Med. Mental Health Revisits at US Pediatric Emergency Departments. Prolonged emergency department length of stay for US pediatric mental health visits (2005-2015).

Psychiatric 98

Psychiatric Emergency Department Pediatrics Best Practices 98

ACEP Now

NOVEMBER 7, 2024

Elizabeth Wharff was the director of emergency psychiatry at Boston’s Children’s Hospital in the late 1990s when she became concerned about what was, then, a new problem. Maura Kelly , a health writer, is a special contributor to Annals of Emergency Medicine. West J Emerg Med. Reference Nordstrom K, Berlin JS, Nash SS, et al.

Psychiatric 59

Psychiatric Pediatrics Hospitals Emergency Department 59

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

Mind The Bleep

SEPTEMBER 17, 2024

Introduction Patients regularly present to the emergency department with animal bites. Document clearly: The location of all wounds Medical photography or drawn labelled diagrams can aid in explaining the exact location. Always consider an ATLS approach to the assessment. Feel for any swelling/collection/abscess. Oxley, J.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

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. Emergency thoracotomy: “how to do it”. Emergency thoracotomy in thoracic trauma: a review. World Journal of Emergency Surgery; 2006: 1:4.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

RebelEM

NOVEMBER 6, 2024

Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. 2015 Jan;38(1):42-4. Anatomy, Shoulder and Upper Limb, Radial Nerve. 2023 Nov 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30521261 Gottlieb M, Schiebout J. 2018 Jun;54(6):849-854.

Dislocations 59

Dislocations Fractures Soft Tissue Injuries Outcomes 59

Don't Forget the Bubbles

NOVEMBER 20, 2023

Neck lumps are a common presenting complaint to the paediatric emergency department with many aetiologies, sometimes resulting in a diagnostic conundrum. Document the size, consistency and location in the notes to compare if they represent. Thorough history taking and detailed examination can aid in diagnosis.

Pediatrics 124

Pediatrics Documentation/Coding Emergency Department Hospitals 124

RebelEM

MARCH 9, 2023

However, evaluating and managing patients with acute alcohol intoxication in the emergency department can be challenging. 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.

Psychiatric 52

Psychiatric Emergency Department Documentation/Coding Fractures 52

EMDocs

JUNE 16, 2023

And now we’re here at our destination, the place we know and love, the emergency room to talk about what we should be doing for the growing volume of children with mental health problems boarding in the emergency department. McEnany, Olutosin Ojugbele, Julie R. Doherty, Jennifer L. McLaren, JoAnna K. 10.1542/peds.2020-1174

Psychiatric 52

Psychiatric Pediatrics Emergency Department Best Practices 52

EB Medicine

DECEMBER 1, 2018

Antigen drift refers to small point mutations to the viral genes that code for H and N. When cells are infected by 2 or more strains, a new strain can emerge after genetic reassortment. In the emergency department, standard isolation and droplet precautions should be maintained for suspected or confirmed infections.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 40

EMDocs

NOVEMBER 6, 2024

doi:10.1136/bcr-2015-213897 Paterson AW, Ryan W, Rao-Mudigonda VV. He denies any past medical history other than polysubstance abuse and depression. 1992;359(6398):832-835. doi:10.1038/359832a0 Giannini L, Maccari A, Chiesa V, Canevini MP. Trismus, the first symptom in a challenging diagnosis of Tetanus. BMJ Case Rep. 2016;2016:bcr2015213897.

Poisoning 77

Poisoning Airway Management Dislocations Forensics 77

EMDocs

DECEMBER 4, 2023

Johnson, MD ( Community EM, Salina Regional Health Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra, MD (Cleveland Clinic Foundation, EM-CCM); Brit Long, MD (@long_brit) Case A 40-year-old woman presents to a rural emergency department (ED) with left leg pain and swelling for the past 5 days.

Ultrasounds 70

Ultrasounds Documentation/Coding Wellness EMS 70

Don't Forget the Bubbles

MARCH 19, 2024

Becasue paediatric emergency departments are accessible out-of-hours they become the de facto place of safety with access to immediate support. Key messages Consider social determinants of health and document these in a child’s clinical notes. Canadian Journal of General Internal Medicine (2015) 10(4). link] Andrew, P.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications. First up, the kids.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EB Medicine

MARCH 1, 2019

This month, after a few months of primarily medical topics, we’re talking trauma, specifically Blunt Cardiac Injury: Emergency Department Diagnosis and Management. Post opiate hypotension in prehospital trauma patients is a rare but documented complication. Ann Emerg Med. Prospective; 333 patients) 73.* topics.php?paction=showTopic&topic_id=597)

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

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 Outcomes Pediatrics Documentation/Coding 75

PHEM Cast

APRIL 21, 2021

Guidance documents College of Paramedics Statement on Intubation, available here. Emergency tracheal intubation: complications associated with repeated laryngoscope attempts. Association Between Repeated Intubation Attempts and Adverse Events in Emergency Departments: An Analysis of a Multicenter Prospective Observational Study.

Airway Management 52

Airway Management Resuscitation EMS Hospitals 52

Taming the SRU

SEPTEMBER 1, 2023

2015) reported a sensitivity of 98.9% for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al.,

Sepsis 94

Sepsis Documentation/Coding Administration Fractures 94

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. The burly orthopaedic surgeon ignoring everything but the bone, the pipe-smoking, cardigan-wearing psychiatrist and the jack-of-all-trades emergency doctor just looking for the next cool gadget to play with.

Academics 52

Academics Research EMS Documentation/Coding 52

Don't Forget the Bubbles

JULY 3, 2023

This time we have our first group of colleagues from Birmingham Children’s Hospital Emergency Department. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Am J Hematol.

Emergency Department 105

Emergency Department Hospitals Domestic Violence Pediatrics 105

EB Medicine

AUGUST 6, 2019

Jeff: Edoxaban is up next, approved by the FDA in 2015 for similar indications as the other Factor Xa inhibitors. Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 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

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). The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). WHO - Who Needs an LP in the ED? REFERENCES 1. Zambito Marsala, S.,

Infectious Diseases 96

Infectious Diseases Seizures Ultrasounds Sepsis 96

Advanced Emergency Nursing from AENJ

AUGUST 2, 2016

Act V, scene I [Text from Folger Shakespeare Library] [Audio recording of Dramatic Reading; Chapter Vox] [Video recording of Act V, scene1] Most deaths that are brought to, or occur in, an emergency department will require, at least, discussion with the local Coroner or Medical Examiner. Department of the Medical Examiner-Coroner.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

Don't Forget the Bubbles

JULY 26, 2023

Prioritise listening to the first 30 minutes which given a good overview of aetiology and treatment (53 mins) Basics of cardiac rhythm problems in the ED Palpitations are a common reason for children to present to the emergency department, the majority of these will be benign from a cardiac perspective and instead related to stress or anxiety.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. Clinical Cardiology, 45(4), 359–369.

EKG/ECG 117

EKG/ECG Documentation/Coding Wellness Emergency Department 117

Don't Forget the Bubbles

JULY 5, 2023

A 6-year-old girl from Saudi Arabia was referred by her General Practitioner to the local emergency department. However, there are documented adverse events such as haemorrhagic cerebrovascular accidents or recurrence of VOC after drug withdrawal, which represent a drawback in its regular use. Anemia ; 2015.DOI:10.1155/2015/791498.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EMDocs

NOVEMBER 16, 2024

Posterior – Shortened, adducted, internally rotated 5,6 Anterior – Shortened, abducted, externally rotated 5,6 As with all dislocations, perform and document distal neurovascular exam before and after management. 8 Perform and document distal neurovascular exam. 2015 Jun;27(2):63-71. Epub 2015 Jun 30.

EMS 75

EMS Dislocations Fractures Operations 75

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. Choosing Wisely in Paediatric Car e A trainee-led project in a UK tertiary paediatric emergency department looked at the usefulness of blood tests in 101 children. 2015 ;24(2):167-74.

Emergency Department 90

Emergency Department Best Practices Radiology Radiology 90

EB Medicine

JUNE 6, 2019

Jeff: Abdominal pain is the one of most frequent complaint in US emergency departments, representing 8% of all adult ED visits, with admission rates for all patients with abdominal pain ranging between 18-42% and reaching as high as 60% for the elderly. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

RebelEM

MAY 15, 2024

Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents. Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department.

Infectious Diseases 105

Infectious Diseases Administration Sepsis Anaphylaxis 105

Taming the SRU

FEBRUARY 22, 2023

Paske et al.

Hospice 40

Hospice EKG/ECG Wellness Resuscitation 40

Downeast Emergency Medicine

OCTOBER 21, 2021

Background Suicide is disturbingly prevalent among patients we care for in the Emergency Department. Applications were coded as “consistent” with Federation of State Medical Boards (FSBM) if they inquired only about current impairment from a mental health condition or did not ask about mental health conditions.

Documentation/Coding 52

Documentation/Coding Emergency Department Shock Research 52

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. 2015 Dec;23 Suppl 2(Suppl 2):S76-82.

Seizures 85

Seizures Stroke Outcomes EMS 85

Dr. Smith's ECG Blog

APRIL 8, 2015

Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful. The ROSE (Risk Stratification of syncope in the emergency department) Study. Predictors of Short-Term (Seven-Day) Cardiac Outcomes After Emergency Department Visit for Syncope.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52