The Skeptics' Guide to EM

MARCH 4, 2018

JAMA May 2017. JAMA May 2017. JAMA May 2017. Exclusions: There were 26 exclusions in their supplemental documentation. [display_podcast] Date: February 27th, 2018 Reference: Moran et al. Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant (PA) working primarily in rural Missouri in community hospitals.

Infectious Diseases 40

Infectious Diseases Documentation/Coding Ultrasounds Outcomes 40

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”. Hicks (2017). The world is a strange place when we can’t do something so simple when it’s critical, but we do it so well when the outcomes are meaningless.

Head Injuries 52

Head Injuries Documentation/Coding Wellness Resuscitation 52

Advanced Emergency Nursing from AENJ

NOVEMBER 27, 2017

On November 6 th , 2017, it was announced in the journal Circulation of the American Heart Association , that ILCOR is converting to an annual cycle to minimize delay in effectuating change in recommendations and practices. The following quotes from the ILCOR and AHA documents, under fair-use doctrine, will help summarize for you the changes.

CPR 40

CPR Basic Life Support Resuscitation Pediatrics 40

PHEM Cast

APRIL 21, 2021

Guidance documents College of Paramedics Statement on Intubation, available here. AAGBI Safer Prehospital Anaesthesia 2017, available here. The Effect of Paramedic Rapid Sequence Intubation on Outcome in Patients with Severe Traumatic Brain Injury. Crit Care 21, 31 (2017). Tracheal intubation. 20(12);681-686. Lockey, D.J.,

Airway Management 40

Airway Management Resuscitation EMS Hospitals 40

PulmCCM

FEBRUARY 8, 2024

Back in 2017, the American Thoracic Society, the European Society of Intensive Care Medicine, and the Society of Critical Care Medicine together issued a clinical practice guideline for the management of acute respiratory distress syndrome (ARDS). You can read the document for all the caveats. This is new.

Research 52

Research Documentation/Coding Fractures Outcomes 52

RebelEM

DECEMBER 28, 2022

One clinical trial demonstrates that afebrile UTI can be treated successfully with antibiotics for seven days in women, but that seven days is inferior to 14 days during short-term follow-up and non-inferior during long-term follow-up (van Nieuwkoop, 2017). No difference in exploratory outcomes. No patients were lost to follow-up.

Outcomes 52

Outcomes Documentation/Coding Hospitals EMS 52

EB Medicine

AUGUST 6, 2019

In the end, they reported similar rates of recurrence and bleeding outcomes for acute treatment. Nachi: Next we have Betrixaban, the latest Factor Xa inhibitor to be approved, back in 2017. Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage.

Emergency Department 40

Emergency Department Stroke Wellness Resuscitation 40

EB Medicine

JULY 8, 2019

Nachi: Taken all together, the rising rates of obesity and the rising success and availability of bariatric procedures has led to an increased number of bariatric procedures, with 228,000 performed in the US in 2017. In 2017, these were performed 60%, 18%, and 3% of the time. Jeff: Still, the complication rate is low - about 2.3%

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

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. 2017 May 26;114(20):347-353. 2015;97(17):1386-1397.

EMS 97

EMS Dislocations Fractures Operations 97

EMDocs

MAY 9, 2024

Exam documents that he is alert and oriented but “tired appearing” and “not appearing post-ictal.” Defense : The EP did address the seizure when he documented “not post-ictal.” There is no negligence, as the documentation supports reasonable judgment. The triage nurse records the event as a “seizure” lasting 7 minutes.

Seizures 104

Seizures Dehydration Documentation/Coding Infectious Diseases 104

Taming the SRU

JULY 25, 2024

More efficacious than parenteral opioids alone Safer than opioids Decreased delirium Patients have been shown to have improved functional outcomes at 30 days Early pain control matters! Currently EVT for large core is being looked at and so far the outcomes seem to be favorable

Stroke 98

Stroke Fractures Operations Outcomes 98

RebelEM

MAY 15, 2024

Epub 2017 Nov 22. 2017 Jun;69(6):755-764. Changing aetiology, clinical features, antimicrobial resistance, and outcomes of bloodstream infection in neutropenic cancer patients. Time to antibiotics and outcomes in cancer patients with febrile neutropenia. Coding for Mucositis. Support Care Cancer. Clarke, R.

Infectious Diseases 98

Infectious Diseases Administration Sepsis Anaphylaxis 98

The Trauma Pro

MAY 10, 2024

And its correlation with outcomes varies. This fills in the code on the second tab which will be added to TraumaBase. J Trauma Nursing 24(3):150-157, 2017. The most important one is that it relies only on the Injury Severity Score (ISS) to judge whether some type of mistriage occurred. What is NFTI, Exactly?

Blood Transfusions 113

Blood Transfusions Radiology Radiology Documentation/Coding 113

Dr. Smith's ECG Blog

JANUARY 17, 2024

This case was one of the 4% of true positive Code STEMI with an initial ECG labeled ‘normal’ by computer interpretation,[2] and there are dozens more such cases detailed here. Here you will sign up for the Queen of Hearts on the Telegram app: [link] Or, you can get the PM Cardio app with Queen of Hearts function through this QR code.

EKG/ECG 117

EKG/ECG Documentation/Coding Emergency Department Wellness 117

PulmCCM

SEPTEMBER 28, 2024

Mmmm… Nectar-Thickened Data Makhnevich et al performed a retrospective matched cohort study of 8,916 patients with Alzheimer-type dementia admitted at 11 hospitals in New York (2017-2022) who had documented clinical suspicion of dysphagia. The primary outcome was death in the hospital. to 1.14).

Outcomes 52

Outcomes Documentation/Coding Hospitals 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. 2017; 55(5); 449-453. You actually run down the corridor.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

PulmCCM

OCTOBER 30, 2023

IDSA cites multiple large observational studies showing no improvement in sepsis outcomes at many centers after SEP-1 implementation. And maybe, noticing all the fuss, some clinicians might have started coding for VAP slightly less often in equivocal cases. Despite all the increased attention, the U.S.

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 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. This retrospective cohort study compared pre- and post-guideline outcomes. Why does it matter? The COVID-19 pandemic is, hopefully, a once-in-a-lifetime historic event.

Emergency Department 105

Emergency Department Hospitals Domestic Violence Pediatrics 105

Don't Forget the Bubbles

JULY 26, 2023

Upside-down position for the out of hospital management of children with SVT, Bronzetti et al, International Journal of Cardiology 2017 this showed that a modified position (upside down) improved cardioversion rates from 33% to 67%. This has been trialled (out of hospital) in known children with SVT.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

RebelEM

SEPTEMBER 26, 2022

A meta-analysis of fifteen RCTs comparing blood product transfusion rates of cardiothoracic and surgery patients found significantly lower transfusion rates of FFP in TEG/ROTEM guided group compared to traditional tests, with no difference in survival rates (Fahrendorff 2017). Article: Kumar M et al. Significant coagulopathy: INR > 1.8

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

RebelEM

MARCH 2, 2023

Essentially there was no difference, meaning we wouldn’t expect to find a difference in outcomes Although not patient oriented, why is there no breakdown of how many patients had cardiogenic shock, congestive heart failure, echocardiographic findings, or even troponin levels. Low O2 protocol: 3.1% aOR 0.96, 95% CI 0.86 Low O2 protocol: 10.6%

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 52

Northwestern EM Blog

SEPTEMBER 26, 2022

It is well-documented that ED physicians have historically high rates of burnout compared to other specialties as well as a high incidence of post-traumatic stress disorder (PTSD) compared to the general population. The hot debrief allowed for concrete actions to be taken about these issues and for a dedicated plan of action for correction.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

The Skeptics' Guide to EM

JANUARY 30, 2021

Steve completed his Sport Medicine fellowship training with the Fowler Kennedy Sport Medicine Clinic in 2017. Steve completed his Sport Medicine fellowship training with the Fowler Kennedy Sport Medicine Clinic in 2017. Date: January 22nd, 2021 Guest Skeptic: Dr. Steve Joseph. Date: January 22nd, 2021 Guest Skeptic: Dr. Steve Joseph.

Fractures 52

Fractures Documentation/Coding Outcomes 52

Don't Forget the Bubbles

JUNE 10, 2024

The history of necrotising enterocolitis The earliest documented cases resembling Necrotising enterocolitis (NEC) date back to the late 19th and early 20th centuries. Let’s delve into the significant challenges posed by small bellies: big battles – the not-so-simple case of necrotising enterocolitis. Can we prevent NEC?

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

The Skeptics' Guide to EM

DECEMBER 2, 2017

[display_podcast] Date: November 24th, 2017 Reference: Andersen et al. JAMA 2017 Guest Skeptic: Dr. Bob Edmonds is an Emergency Physician in the US Air Force. display_podcast] Date: November 24th, 2017 Reference: Andersen et al. JAMA 2017 Guest Skeptic: Dr. Bob Edmonds is an Emergency Physician in the US Air Force.

Hospitals 40

Hospitals CPR Resuscitation Documentation/Coding 40

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. JAMA Neurol.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

EB Medicine

JUNE 6, 2019

Nachi: And remember that hypothermic patients who are septic have worse outcomes than those who are hyperthermic and septic. Nachi: Few things are more important prior to discharge of an abdominal pain patient than documenting repeat exams and a PO trial. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EB Medicine

MAY 3, 2019

Jeff: And finally, how many of you wish there was a clearly outlined evidence-based approach to managing such patients to improve care and outcomes? Jeff: a 2017 ACEP clinical policy also recommends against routine lab testing in those with acute psychiatric complaints. Nachi: That would certainly be helpful.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

EB Medicine

OCTOBER 1, 2018

Nachi : I’m sure there are many trials to come in the future documenting their safety profile, but moving on to the next pressor to discuss. One recent 2017 study examining the role of angiotensin 2 in those with septic shock already on 0.2 But this isn’t limited to the air. vasopressin. Jeff : Next we have epinephrine.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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). 2004 Nov;30(11):2017-20. 2017 Dec;214(6):1067-1072. Epub 2017 Sep 18. Intensive Care Med. 10) Jubran A.

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

EMDocs

JULY 3, 2023

Introduction SAH has the potential for rapid progression and devastating outcomes. This neurological evaluation should include assessment and documentation of the GCS, the presence of any neurologic deficits, and an NIHSS. Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage.  2012;43:1711––1737.

Seizures 98

Seizures Stroke Outcomes EMS 98

Dr. Smith's ECG Blog

APRIL 8, 2015

Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. 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. These premonitory symptoms were negative predictors of adverse outcomes in EGSYS.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

RebelEM

DECEMBER 23, 2024

Background: Sickle cell disease (SCD) affects an estimated 300,000 infants born worldwide each year and has a total estimated prevalence of 100,000 in the United States alone ( Piel 2017 ). VOE is often complicated by hypovolemia, making fluid administration a common intervention ( Lovett 2017 ). Lactated Ringer (LR) and 0.9%

Fluid Resuscitation 128

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 128

EB Medicine

JANUARY 2, 2019

Nachi: This month’s issue was authored by Dr. Ryan Pedigo, you may remember him from the June 2017 episode on dental emergencies, though he is perhaps better known as the director of undergraduate medical education at Harbor-UCLA Medical center. This result was for the most part re-confirmed in a 2017 cochrane review.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

RebelEM

NOVEMBER 11, 2024

Outcomes: Primary outcome: All-cause mortality within 90 days of ED presentation Secondary outcomes: Organ-failure-free days at 28 days, that is how many days in the first 28 after arriving in the ED not requiring mechanical ventilation, vasopressors, or dialysis. Variations in compliance could have impacted patient outcomes.

Sepsis 108

Sepsis Outcomes Administration Shock 108

Dr. Smith's ECG Blog

MARCH 25, 2025

Documentation indicates that the patient was shocked 4 times (with no comment on energy level) and received amiodarone 300 mg IV and magnesium 2 g IV. A 2017 trial named CULPRIT SHOCK found that in patients with cardiogenic shock, a strategy of culprit vessel PCI only was associated with better outcomes than immediate multivessel PCI.

EKG/ECG 62

EKG/ECG Shock Documentation/Coding Hospitals 62

Sensible Medicine

MARCH 11, 2025

Even with meta-analysis, sample sizes may be too small to detect rare outcomes. Unplanned home births will obviously have worse outcomes than either hospital births or planned home births. Similarly, a 2017 study by Grunebaum et al. Critically, studies need to distinguish planned home births from unplanned ones.

Outcomes 92

Outcomes Hospitals Wellness Documentation/Coding 92