Pediatric EM Morsels

JULY 5, 2024

We collected data directly from the bedside clinician which enabled us to gather pertinent patient symptoms and physical examination findings that may not be well documented in the medical record, but more accurately identify the child’s injuries.” 2016; Published June 20, 2016. J Spinal Disord Tech. 2015;28(7). PMID: 26165728.

Pediatrics 161

Pediatrics Head Injuries Dislocations Research 161

Don't Forget the Bubbles

AUGUST 23, 2023

2016) “Implementation of a Post-Code Pause: Extending Post-Event Debriefing to Include Silence”. 2012) “Implementation of a Rapid Post-Code Debrief Quality Improvement Project in a Community Emergency Department Setting”. Be kind and care for yourself and those around you. Selected References Copeland, A. & & Liska, H.

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

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. 2016 Nov 7;170(11):e162521.

Pediatrics 71

Pediatrics Emergency Department Research Burns 71

RebelEM

NOVEMBER 6, 2024

2016 Jan 6;17:6-11. 2016 Jul;24(7):413-23. Multiple Concomitant Injuries in One Upper Extremity: A Case Report. Am J Case Rep. doi: 10.12659/ajcr.894984. PMID: 26732673 Akhondi H, Varacallo M. Anterior Interosseous Syndrome. 2023 Aug 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. Shoulder Elbow.

Dislocations 59

Dislocations Fractures Soft Tissue Injuries Outcomes 59

Dr. Smith's ECG Blog

OCTOBER 12, 2024

The providers documented concern for ST elevation in the precordial and lateral leads as well as a concern for hyperkalemic T waves in the setting of succinylcholine administration. Preliminary findings documented in the cath lab were “Anterior STEMI and no significant coronary artery disease.” (!!!) 2016 Nov;34(11):2182-2185.

EKG/ECG 97

EKG/ECG Documentation/Coding Emergency Department COPD 97

The Skeptics' Guide to EM

MAY 11, 2019

Case: An 18-year-old woman presents with a Grade 1 appendicitis (Tominaga et al J Trauma Acute Care Surg 2016). Background: The first documented appendectomy was done by Claudius Amyand in 1735. His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation.

Documentation/Coding 52

Documentation/Coding Operations Academics Ultrasounds 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. Accessed 07/30/2016. Accessed 07/30/2016. Accessed 07/30/2016. Based upon California Health and Safety Code 102850 and Government Code 27491.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

Pediatric EM Morsels

OCTOBER 6, 2023

Mogsale 2016, Shah 2021)Stool cultures are only positive in 30% of cases if collected in 2 nd -3 rd week of illness which makes them a poor choice for definitive diagnosis. Obasi 2020) Hepatic and splenic abscesses have been documented in children, and splenic rupture is particularly associated with cases of MDR typhoid fever.

Pediatrics 161

Pediatrics CDC Seizures Documentation/Coding 161

Total Medical ComplianceHIPAA

NOVEMBER 7, 2022

In its 2016-2017 HIPAA Audits Industry Report, the Office for Civil Rights (OCR) provided a few examples of what a prominent location on a website might be: Through a drop-down menu on the home page. The OCR’s report made it clear that the NPP and general privacy documents should not be combined.

Documentation/Coding 93

Documentation/Coding Wellness 93

The Skeptics' Guide to EM

MAY 2, 2020

The crew then asks if you want them to transport your father Code 3 with full lights and sirens. July 2019 * Population: All dispatches of a transport-capable ground EMS vehicle to a 911 emergency scene from the 2016 National EMS Information System, both the response to the scene and the transport from the scene.

Documentation/Coding 40

Documentation/Coding EMS EKG/ECG Outcomes 40

ACEP Now

OCTOBER 26, 2023

In this case, reasonable would mean that the person requesting PHI confirms that they are the patient’s clinician and that any transmitted documents will have secure receipt, e.g., to the department’s fax machine at the clerk’s desk, away from any general access. Published January 2016. HHS website. Accessed October 9, 2023.

Infectious Diseases 52

Infectious Diseases Documentation/Coding Hospitals Administration 52

Don't Forget the Bubbles

MAY 10, 2023

Then you hear the words coming out of the speaker, “ Paediatric code black. Paediatric code black ”. You’ve heard the phrase code black before – it’s a traumatic cardiac arrest. You know a paediatric code black means paediatric traumatic cardiac arrest. 2016; 24(135): 1-10.DOI: You actually run down the corridor.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

Dr. Smith's ECG Blog

MAY 27, 2024

Since the ECG now meets STEMI criteria, a code STEMI was activated. Am J Emerg Med 2016 5. There was a 99% mid RCA occlusion, and peak troponin was greater than 25,000ng/L (upper limit of assay). Kontos et al. J Am Coll Cardiol 2022 4. Bischof et al. Meyers et al.

EKG/ECG 118

EKG/ECG Documentation/Coding Emergency Department 118

PEMBlog

JUNE 14, 2023

Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document. Children’s Mental Health Emergency Department Visits: 2007-2016. Pediatrics March 2023; 151 (3): e2022057383. 10.1542/peds.2022-057383 2022-057383 Nordstrom K, Berlin JS, Nash SS, Shah SB, Schmelzer NA, Worley LLM.

Psychiatric 98

Psychiatric Emergency Department Pediatrics Best Practices 98

RebelEM

NOVEMBER 30, 2023

Studies without IRB approval Studies older than 2016 Intervention: Administration of <30 mL/kg IV crystalloid fluids within three hours of sepsis identification. Limitations: The investigators excluded studies published before 2016, non-English studies, and non-published studies, potentially missing valuable data.

Sepsis 122

Sepsis Fluid Resuscitation Resuscitation Administration 122

The Skeptics' Guide to EM

OCTOBER 1, 2022

It is not well documented, whether gaps in pain assessment and treatment exist in conditions in which opioids are not indicated, such as migraine headaches. Some groups of patients who are at greater risk than others ( elderly , women , mentally ill , certain ethnic groups, and insurance status ). Brown et al , Selbst and Clark ).

Pediatrics 52

Pediatrics Emergency Department Documentation/Coding Research 52

The Skeptics' Guide to EM

JULY 30, 2022

Somewhat surprisingly, we’ve never covered SBO on the SGEM, although Ped EM Superhero, Dr Anthony Crocco shared his views on the (lack of) utility of abdominal X-rays in paediatric constipation back in 2016 ( SGEM Xtra: RANThony#4 ).

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

Ken Grauer, MD

JULY 29, 2023

The "good news" — is that we clearly see sinus P waves in ECG #1 , that document conversion to sinus rhythm ( ie, upright P waves in lead II that precede each QRS complex with a constant and normal PR interval ). (NOTE: The filter setting used a 150 Hz high-frequency cutoff. ) When I first saw this ECG — I had more questions than answers.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

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). C., & ESCMID Study Group for Infections of the Brain (ESGIB) (2016). Glennie, L., Gaillemin, O., Wyncoll, D., Kaczmarski, E., Thwaites, G., Davies, N. C., & Solomon, T. Mourvillier, B., Ostergaard, C.,

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

Sensible Medicine

AUGUST 14, 2024

” Indeed, cause of death is coded differently over time and across counties, states, and countries. ”) A 2016 study by Lambert et al in The Journal of Pediatrics shows how variable death investigations can be.

CDC 73

CDC Sepsis Research Pediatrics 73

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”. 2016 Mar;18(2):136-42. Debrief2Learn Sept 2016. link] Brazil, Spurr and Eppich, Simulcast Episode 2, August 2016 – Eppich Debriefing [link] Cheng, A.,

Head Injuries 52

Head Injuries Documentation/Coding Wellness Resuscitation 52

The Skeptics' Guide to EM

FEBRUARY 23, 2019

The Surviving Sepsis Campaign makes a number of recommendations in their 2016 guideline. JAMA 2018 * Population: Patients with sepsis identified using the international Statistical Classification of Disease and Related Health Problems, Tenth Revision (ICD-10CA) coding that was modified to be consisten.

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

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. 2016 Feb 4;65:242-51. Osteopathic Family Physician.

Psychiatric 52

Psychiatric Emergency Department Documentation/Coding Fractures 52

Don't Forget the Bubbles

FEBRUARY 26, 2024

2016 Sep 1;20:24-31. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. Cochrane Database of Systematic Reviews. Mayordomo‐Colunga J, Medina A, Rey C, Concha A, Menéndez S, Arcos ML, Vivanco‐Allende A. Non‐invasive ventilation in pediatric status asthmaticus: a prospective observational study. Scotland HI.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

RebelEM

JUNE 8, 2023

2016; PMID: 27720568 Guest Post By: Courney Knieriem, MD PGY-1, Emergency Medicine Resident RWJBH Community Medical Center, Toms River, NJ Courtneyknieriem.md@rutgers.edu 2015;10(3):e0119331. PMID: 25789927 Schwartz MB, et al. The impact of push-dose phenylephrine use on subsequent preload expansion in the ED setting. Am J Emerg Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Mind The Bleep

NOVEMBER 21, 2023

It is important to be accurate when assessing and documenting wounds as it can have medico-legal implications, should your assessment later come up in a court case. Wounds are a very common presentation to A&E and minor injuries departments. Wound management is very clinician dependent and there is a lot of variation in practice.

Fractures 40

Fractures Burns Documentation/Coding Hospitals 40

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

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Triage documented a complaint of left shoulder pain. The neighbor recorded a systolic blood pressure again above 200 mm Hg and advised her to come to the ED to address her symptoms. The patient presented to triage at around 10 PM. The patient said, "I just don't feel good." Circulation , 130 (25). link] Bischof, J. Worrall, C., Thompson, P.,

EKG/ECG 121

EKG/ECG Outcomes Academics Documentation/Coding 121

EMDocs

AUGUST 8, 2023

2016 validation study 0 points for low risk, 1-5 for intermediate risk and 6-7 for high risk. Document consideration of torsion in males with abdominal pain. 2022 meta-analysis 0-2 as low risk and ≥5 or higher as high risk = AUC of 0.924. 0 as low risk, 1-5 points as intermediate risk and ≥6 points as high risk = 99.5%

Ultrasounds 68

Ultrasounds Documentation/Coding Outcomes Emergency Department 68

Don't Forget the Bubbles

JULY 26, 2023

Stredder et al, Archives of Disease in Childhood 2016 we see that 58% were not asked about triggers, 30% were not asked about duration and, importantly for risk stratification, 59% were not asked for a family history of cardiac disease. The presence of these pathways is documented inutero and they usually regress by around 20 weeks gestation.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

PHEM Cast

APRIL 21, 2021

Guidance documents College of Paramedics Statement on Intubation, available here. Cochrane Database of Systematic Reviews 2016, Issue 11. AAGBI Safer Prehospital Anaesthesia 2017, available here. Tracheal intubation. Anaesthesia & Intensive Care Medicine. 20(12);681-686. DOI:10.1002/14651858.CD011136.pub2.

Airway Management 52

Airway Management Resuscitation EMS Hospitals 52

The Skeptics' Guide to EM

OCTOBER 28, 2017

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”. Clinical Question: 1) What is the current evidence for the use of sucrose in neonatal infants undergoing painful procedures?

Pediatrics 52

Pediatrics Documentation/Coding Emergency Department Hospitals 52

RebelEM

JANUARY 29, 2024

Thrombolysis Compared with Heparin for the Initial Treatment of Pulmonary Embolism: A Meta-Analysis of the Randomized Controlled Trials. PMID: 15262836 Sharifi M et al. Pulseless Electrical Activity in Pulmonary Embolism Treated with Thrombolysis (from the “PEAPETT” Study). PMID: 27422214 Wang C et al.

Stroke 137

Stroke Outcomes Hospitals Administration 137

Mind The Bleep

FEBRUARY 29, 2024

It is worth looking through previous documentation to see whether the patient’s team or senior intensivists have set any individual cardiovascular targets. 2016) Oxford Handbook of Anaesthesia. C Assessment BP and MAP Invasive reading (via an arterial line) or non-invasive (via a BP cuff)? Resources and References Singer, M.

Documentation/Coding 52

Documentation/Coding Hospitals Wellness Best Practices 52

The Skeptics' Guide to EM

DECEMBER 2, 2017

Case: You are working a regular shift in the emergency department when you hear a code blue called. The American Heart Association ( AHA ) reports that were 209,000 IHCA arrests in 2016. DISCLAIMER: The views and opinions of this podcast do not represent the United States Government or the US Air Force.

Hospitals 40

Hospitals CPR Resuscitation Documentation/Coding 40

Don't Forget the Bubbles

DECEMBER 13, 2023

Failure to thrive’ has many definitions We use standardized charts to document infant growth. 2016 Apr;175(4):573-9. 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. doi: 10.1007/s00431-015-2676-4.

Dehydration 98

Dehydration CDC Hospitals Wellness 98

ACEP Now

MARCH 14, 2024

McGraw Hill; 2016. Documentation with coronary arteriography within 12 1/2 hours of the onset of symptoms in two cases (three episodes). Treasure Island (FL): StatPearls Publishing; 2023 Jan– PMID: 28846317. Tintinalli JE, Stapczynski J, Ma O, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. Electrical injuries.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52