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. 2016; 15: 32.

Pediatrics 161

Pediatrics CDC Seizures Documentation/Coding 161

Total Medical ComplianceHIPAA

NOVEMBER 7, 2022

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Documentation/Coding 93

Documentation/Coding Wellness 93

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

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 ). This young woman did well for a year — but unfortunately suffered another cardiac arrest, from which she could not be resuscitated.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

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

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

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 ). AEM September 2022.

Pediatrics 52

Pediatrics Emergency Department Documentation/Coding Research 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). (And Glennie, L., Gaillemin, O., Wyncoll, D., Kaczmarski, E., Thwaites, G.,

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

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?” 2016 Mar;18(2):136-42. Well done”……. Debrief2Learn Sept 2016. Stimulus by Prof. link] Petrosoniak, A.,

Head Injuries 52

Head Injuries Documentation/Coding Wellness Resuscitation 52

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

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 73

CDC Sepsis Research Pediatrics 73

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. 2016 Apr;175(4):573-9.

Dehydration 98

Dehydration CDC Hospitals Wellness 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. They have straight and well defines edges. Wounds are a very common presentation to A&E and minor injuries departments. Cut/Incision: Wounds made by sharp objects.

Fractures 40

Fractures Burns Documentation/Coding Hospitals 40

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. 2016 Sep 1;20:24-31. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

Mind The Bleep

FEBRUARY 29, 2024

This may well seem daunting given how unwell and complex the patients might be but a thorough, well-structured A-E will give you most of the information you need to progress that patient’s care. C Assessment BP and MAP Invasive reading (via an arterial line) or non-invasive (via a BP cuff)?

Documentation/Coding 52

Documentation/Coding Hospitals Wellness Best Practices 52

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. 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.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

The Skeptics' Guide to EM

OCTOBER 28, 2017

Case: A 12-day old girl presents with fever and is otherwise well. 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”. Anthony is also the creator of SketchyEBM.

Pediatrics 52

Pediatrics Documentation/Coding Emergency Department Hospitals 52

ACEP Now

MARCH 14, 2024

These can be delayed, up to weeks later, so it’s important to educate patients on the importance of follow-up with burn care well-versed with electrical injuries or neurology if they have or develop these symptoms. McGraw Hill; 2016. 8,9 Disposition Disposition depends on the patient’s clinical status and voltage exposure.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Dr. Smith's ECG Blog

JULY 27, 2023

PEARL #3: The pathophysiologic mechanism for producing amphetamine-induced acute MI is unclear ( Bazmi et al — SQUMJ 17(10); e31-37, 2017 — and — Sinha et al — Case Rep Cardiol, 2016 ). BOTTOM Line in Today’s CASE: I was surprised by the elevated troponins in today’s case. An OMI is always a possibility with acute amphetamine use.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

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. Accessed 2/29/2016. No Author, No Date ©2016] American Association of Emergency Medicine. Accessed 2/29/2016.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

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. Children’s Mental Health Emergency Department Visits: 2007-2016. This has a downstream effect. Pediatrics March 2023; 151 (3): e2022057383. 10.1542/peds.2022-057383

Psychiatric 52

Psychiatric Pediatrics Emergency Department Best Practices 52

RebelEM

DECEMBER 28, 2022

Background: Urinary tract infection (UTI) is one of the most common reasons for anti-microbial use (Tan, 2016). However, the optimal treatment duration for UTI in men is not well studied, and current practice guidelines are based on historical dogma.

Outcomes 52

Outcomes Documentation/Coding Hospitals EMS 52

Dr. Smith's ECG Blog

JULY 22, 2023

The patient did well and was ultimately discharged home. Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon. As for our patient, on discharge, her EKG had completed returned to her baseline morphology and she has been doing well in follow-up.

EKG/ECG 70

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 70

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

RebelEM

SEPTEMBER 26, 2022

What They Did Single-center randomized controlled study design performed by the Department of Hepatology & Liver transplantation in New Delhi Study participants, investigator clinicians, data collectors, and data analysts were blinded Investigators recruited participants from February 27, 2016 – March 3, 2018.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. While it was < 15% in 1990, by 2016 it reached 40%. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications. million adults!!

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Dr. Smith's ECG Blog

JANUARY 30, 2019

I remember Allie well from her days in the Research volunteer program at Hennepin. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. A repeat EKG was performed at that time and showed this: The STE had almost completed resolved and the STE depression is improved as well. F (rectal).

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 52

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients. 2016; 417: 54–56.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

Finally — the same Kosuge group whose ECG findings on the diagnosis of acute PE are summarized above emphasized that in patients with precordial lead T wave inversion — the predictive value of chest lead T wave inversion for acute PE is greatest when the maximal amount of T wave inversion is seen in leads V1,V2 ( Kosuge et al, JACC 67: 528, 2016 ).

EKG/ECG 52

EKG/ECG COPD Documentation/Coding Shock 52

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

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 105

Infectious Diseases Administration Sepsis Anaphylaxis 105

Ziqitza HealthCare Ltd

JULY 14, 2023

In India, In the six years from 2016 to 2021, nearly 22.8 Of these, about 7 lahks, or 30 per cent, were reported under Section 498A of the Indian Penal Code (IPC), the report says. India with the image of diverse cultures and innumerable value lessons, we also recognize as the poorest system for women’s safety and rights.

Domestic Violence 52

Domestic Violence Documentation/Coding Operations Ambulance Services 52

Don't Forget the Bubbles

JANUARY 22, 2024

The campaign started in the United States in 2012, in Canada two years later, and in the United Kingdom in 2016. Choosing Wisely UK was launched in 2016 by the Academy of Medical Royal Colleges to identify tests, treatments, and procedures of questionable value. 2016 ;50(13):826-8. Br J Sports Med. Regan W, Hothi D, Jones K.

Emergency Department 90

Emergency Department Best Practices Radiology Radiology 90

EB Medicine

JUNE 6, 2019

Nachi: For more information on HIV and its management, check out the February 2016 issue of Emergency Medicine Practice , which covered this and more in depth. For example, patients with misdiagnosed disease has less RLQ pain and tenderness as well as diminished anorexia, nausea, and vomiting. Jeff: True.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EB Medicine

OCTOBER 1, 2018

Jeff : So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? In 2014, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine started a task force, and by 2016, updated definitions were out again! Meaning, you’ve tried everything else, so you might as well try.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Dr. Smith's ECG Blog

JUNE 8, 2023

There were trends toward larger infarct size with delayed angiography, both by cMR and integral high-sensitivity troponin concentration, as well as toward higher rate of major adverse cardiovascular events (MACE) (8.5 Cardiology documented “late presentation STEMI but likely aborted given resolution of ST changes from EMS to hospital.”

EKG/ECG 63

EKG/ECG Documentation/Coding EMS Emergency Department 63

Emergency Medicine Ireland

OCTOBER 28, 2020

EF does not correlate with particularly well with mortality in sepsis though diastolic dysfunction does * It may be due to under filling and the reduced diastolic filling due to the ubiquitous tachycardia in sepsis. This has relevance to the ICU population in 2 major ares * Sepsis. *

Sepsis 40

Sepsis Documentation/Coding Ultrasounds Wellness 40