Downeast Emergency Medicine

DECEMBER 1, 2021

2015; 313(16):1636-1644.[ They conducted semi-structured interviews (n = 11) with ED directors across Maine using an interview guide designed to elicit responses around the reasons for starting or not starting and ED-buprenorphine program as well as barriers and facilitators to ED-based buprenorphine. Articles reviewed 1.

Emergency Department 52

Emergency Department Documentation/Coding Leadership Hospitals 52

Pediatric EM Morsels

OCTOBER 6, 2023

(Forster, 2021) Transmission is by Fecal-Oral route (Chiodini 2018) Incubation period 6-30 days after exposure (Chiodini 2018) Salmonella typhi produces an endotoxin although its clinical significance is not yet well understood (Gibani 2019) Two typhoid vaccines are available for those > 6 m/o and are 50-80% effective. Clin Infect Dis.

Pediatrics 161

Pediatrics CDC Seizures Infectious Diseases 161

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

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 93

Sepsis Administration Documentation/Coding Fractures 93

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 79

CDC Sepsis Research Pediatrics 79

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. In 2015, Silva et al. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

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

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). (And REFERENCES 1. Zambito Marsala, S., Gioulis, M., & Pistacchi, M.

Infectious Diseases 95

Infectious Diseases Seizures Ultrasounds Sepsis 95

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. 2015):157-165. Emergency departments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. 2012): 2470-2478.

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

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.

Head Injuries 40

Head Injuries Hyperthermia / Hypothermia Documentation/Coding Outcomes 40

The Skeptics' Guide to EM

OCTOBER 28, 2017

Case: A 12-day old girl presents with fever and is otherwise well. 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. Anthony is also the creator of SketchyEBM. You wonder whether there is a way to mitigate the painful experience for the child.

Pediatrics 52

Pediatrics Documentation/Coding Emergency Department Hospitals 52

The Injectable Orange

JUNE 20, 2017

While well evaluated, you see the residents go back to the shop floor and struggle to apply any of the lessons that the group agreed had been take homes from the previous sim session. How do they do it so well?” Epub 2015 Apr 10. Well done”……. Cheng (2015). Stimulus by Prof. Check back. Confirmation. Completion.

Head Injuries 52

Head Injuries Wellness Documentation/Coding Resuscitation 52

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

PulmCCM

OCTOBER 30, 2023

And maybe, noticing all the fuss, some clinicians might have started coding for VAP slightly less often in equivocal cases. incidence of VAP has remained stubbornly persistent : though it declined from 20 cases to 15 per 1000 ventilated patients 2008-2015, the rate then crept back up to 17 per 1000 in 2017.

Sepsis 52

Sepsis Shock Hospitals 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. 2015 is the best example of the conventional approach to primordial prevention. To support his Medicine 3.0

Research 99

Research Documentation/Coding Wellness 99

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. American Heart Journal 170(6):1255-1264; December 2015.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52

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

Taming the SRU

FEBRUARY 22, 2023

STEP-UP Self Physical and Psycological IM-SAFE Illness Medications Stress Alcohol Fatigue Eating Psychological Cognitive Threat/Challenge appraisal: PERCEIVED demands vs. resources Threat appraisal - stress levels excessive, performance impaired – vapor lock (autonomic arousal, tunnel vision, auditory exclusion, loss of time awareness, impaired memory (..)

Hospice 40

Hospice EKG/ECG Wellness Resuscitation 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] Jan 28, 2015. How versatile are your airway skills? Oh, sure, you can handle any supine situations! Gather everyone. Before} 19 May 01. Nickson, Chris.

Airway Management 40

Airway Management Pediatrics Resuscitation Emergency Nursing 40

Sensible Medicine

AUGUST 7, 2024

A 2015 Nature (Pediatric Research) paper by Nils J. There is evidence that, for children and adults, elevated cortisol levels and chronic stress can lead to behavioral, mental-health, and mood issues, as well as changes in inflammation and immunity. To receive new posts and support our work, consider becoming a free or paid subscriber.

CDC 110

CDC Documentation/Coding Research Pediatrics 110

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. Blood cultures are commonly drawn for certain focal infections such as pneumonia , skin and soft tissue infections (SSTIs), asthma , bronchiolitis as well and UTIs. 2015 ;24(2):167-74.

Emergency Department 90

Emergency Department Best Practices Radiology Radiology 90

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

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. For the sake of completeness, just be aware that there is also the biliopancreatic diversion with or without a duodenal switch, as well as a vertical banded gastroplasty. First up, the kids.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EB Medicine

AUGUST 6, 2019

Nachi: Well, I’m sure more of those studies are still coming. Jeff: Edoxaban is up next, approved by the FDA in 2015 for similar indications as the other Factor Xa inhibitors. Nachi: Well that was a ton of information and background on the DOACs. Show More v Jeff: Fair enough, we’ll take what we can get. Jeff: Agree.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

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

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. 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%.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Don't Forget the Bubbles

DECEMBER 13, 2023

Failure to thrive’ has many definitions We use standardized charts to document infant growth. Susan had issues initially with ensuring the correct latch, but after a review with a lactation consultant, feeding is going well. Though it has been hard, they have been coping well and enjoying parenthood. Epub 2015 Dec 9.

Dehydration 98

Dehydration CDC Hospitals Wellness 98

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

JUNE 6, 2019

For example, patients with misdiagnosed disease has less RLQ pain and tenderness as well as diminished anorexia, nausea, and vomiting. Jeff: Well that’s scary - I know I’ve already missed a case, but luckily, he returned thanks to good return precautions, which we’ll get to in a few minutes. Jeff: True.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 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 119

EKG/ECG Documentation/Coding Wellness Emergency Department 119

Downeast Emergency Medicine

OCTOBER 21, 2021

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. All other applications were coded as “not consistent.”

Documentation/Coding 52

Documentation/Coding Emergency Department Shock Research 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

EMDocs

JUNE 16, 2023

It’s stressful for the ED clinical staff as well. 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. This has a downstream effect. 10.1542/peds.2022-057383

Psychiatric 52

Psychiatric Pediatrics Emergency Department Best Practices 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. 2015 Oct; 66(4):355-362. Look at the aortic outflow tract. What do you see? Annals of Emergency Medicine.

EKG/ECG 52

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 52

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 96

Infectious Diseases Administration Sepsis Anaphylaxis 96

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Recent studies have shown that low-dose ketamine can reduce pain in acute painful crises of sickle cell patients as well as being an opioid-sparing drug.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126