Don't Forget the Bubbles

AUGUST 23, 2023

In most Emergency Departments, staff are allotted little of that scarce resource, time, to begin processing what has just occurred. The Pause Jonathon Bartels worked as an Emergency Nurse in America in 2009. After the death of a young person in the Emergency Department, he initiated ‘ The Pause.’ & Liska, H.

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

EMDocs

SEPTEMBER 26, 2024

An unknown EP reviews the report, determines that there is no reason to notify the patient, and documents nothing. It wasn’t, so you weren’t called, nor did the doc need to document anything. This patient’s history was either poorly taken or poorly documented. J Am Coll Rad 15:4;639-647, April 1, 2018.

Radiology 74

Radiology Radiology EKG/ECG Documentation/Coding 74

The Skeptics' Guide to EM

APRIL 13, 2024

He is an assistant professor in Emergency Medicine, Neurology, and Neurosurgery at the School of Medicine at the University of Washington. Case: A 70-year-old woman was brought into the emergency department by EMS after her family reported she was having trouble talking. CT perfusion showed a 10 mL core and 189 mL penumbra.

Stroke 114

Stroke Documentation/Coding Emergency Department EMS 114

Pediatric EM Morsels

OCTOBER 27, 2023

James Broselow, a family medicine-turned-emergency medicine physician from Hickory, North Carolina , recognized that his team spent a lot of time trying to calculate doses of medications rather than spending their mental energy on the actual medical decisions for the resuscitation. Int J Emerg Med. J Emerg Med. Resuscitation.

Pediatrics 269

Pediatrics Resuscitation Documentation/Coding Wellness 269

EMDocs

JULY 9, 2024

The emergency department takes care of some of the highest risk patients with the worst access to health care and social services Over the past 20 years, many researchers have created and validated social needs screeners Some examples: iHELP, WE CARE, SEEK, USDA 2-item food insecurity questionnaire Does screening make a difference?

Pediatrics 71

Pediatrics Emergency Department Research Burns 71

RebelEM

NOVEMBER 6, 2024

Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. 2018 Jun;54(6):849-854. Epub 2018 Apr 19. 2018 Apr 4;100(7):e46. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30521261 Gottlieb M, Schiebout J. doi: 10.1016/j.jemermed.2018.02.011. 2018.02.011.

Dislocations 59

Dislocations Fractures Soft Tissue Injuries Outcomes 59

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. But only 6.4% of such ‘high risk Non-STEMI’ patients get angiography within 2 hours.[2] Take away 1.

EKG/ECG 120

EKG/ECG Documentation/Coding Fractures Emergency Department 120

The Skeptics' Guide to EM

JULY 30, 2022

Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Case: A 63-year-old woman presents to your emergency department (ED) with two-day history of nausea, vomiting and constipation. She is also the creator of all those wonderful Paper in a Pictures. sensitivity and 96.6%

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

EB Medicine

DECEMBER 1, 2018

Nachi: And just last year we saw the 2017-2018 influenza epidemic with record-breaking ED visits. 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. Jeff: The reason for this is multifactorial.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 40

Taming the SRU

NOVEMBER 14, 2023

Chief complaints involving the ear are a common occurrence in Emergency Departments across the US and include presenting symptoms such as ear pain or fullness, hearing loss, redness, trauma, vertigo, and foreign bodies. A retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011 identified 8.6

Emergency Department 93

Emergency Department Pediatrics Wellness Documentation/Coding 93

PEMBlog

MAY 11, 2023

These were used by two independent reviewers to determine Neonatal Facial Coding System with pain scores. Acad Emerg Med, 2017 This was a single-center (one academic Pediatric Emergency Department) randomized double-blind trial of J-Tip versus EMLA – topical anesthetic (TA) cream for pain relief in 66 infant LPs.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Outcomes 52

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. Dermatopathology.

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. Klein 2018) Despite the high risk of pathology and decompensation, many patients with presumed alcohol intoxication can be evaluated and discharged without any labs or imaging. Annals of Emergency Medicine.

Psychiatric 52

Psychiatric Emergency Department Documentation/Coding Fractures 52

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

EMDocs

NOVEMBER 6, 2024

He denies any past medical history other than polysubstance abuse and depression. tetani infection is also indicated.

Poisoning 77

Poisoning Airway Management Dislocations Forensics 77

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. Tulloch, J.S.P.,

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

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. Child & adolescent emergency mental health crisis: a neglected cohort.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 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). Int J Emerg Med. The role of venous blood gas in the emergency department: a systematic review and meta-analysis.

Emergency Department 93

Emergency Department Resuscitation COPD Shock 93

EB Medicine

AUGUST 6, 2019

Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. Nachi: Next up is recombinant coagulation factor Xa (brand name Andexxa), which was approved in 2018 for the FXa inhibitors. 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

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Electrical injuries in the emergency department: an evidence-based review. Emerg Med Pract.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

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

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? A., & Koehler, P.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

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

ACEP Now

OCTOBER 9, 2023

However, actual increases in available services in emergency departments based on prior state-level requirements have been mixed. Physicians should document the interpreter’s name and identification number if available in the patient’s chart. Published Feb 8, 2018. Department of Health and Human Services website.

Emergency Department 64

Emergency Department Documentation/Coding EMS Wellness 64

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.

EKG/ECG 122

EKG/ECG Documentation/Coding Wellness Emergency Department 122

Dr. Smith's ECG Blog

DECEMBER 14, 2018

The pain resolved as he arrived to the emergency department. Pseudonormalization of Wellens' Waves Pseudonormalization of T-waves Anterior pseudonormalization = Comment by K EN G RAUER, MD ( 12/14/2018 ): = Interesting case that brings up a number of important concepts regarding Wellens’ Syndrome.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Wellness 52

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. Hospitals, 2018. 2018 Fall;18(3):242-252.

EMS 75

EMS Dislocations Fractures Operations 75

Dr. Smith's ECG Blog

DECEMBER 27, 2018

This ECG comes from Pierre Taboulet ( [link] /)( [link] ) an ECG whiz who codes a lot of ECGs for Cardiologs' Artificial Intelligence Deep Neural Network algorithm ( [link] ). A Deep Neural Network learning algorithm outperforms a conventional algorithm for emergency department electrocardiogram interpretation.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Wellness 52

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. Check out the August 2018 EMP or EMplify for more details if you’re curious.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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. Macharia AW et al. 2014; 349–356.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Don't Forget the Bubbles

JANUARY 22, 2024

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. You receive a referral for a 7-year-old Josh, who presented to the emergency department (ED) with a 5-day history of fever, cough, and borderline oxygen saturation.

Emergency Department 90

Emergency Department Best Practices Radiology Radiology 90

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. 2018 May;26(5):1465-1470. Ann Emerg Med. Coding for Mucositis. Support Care Cancer. doi: 10.1007/s00520-017-3985-0. Epub 2017 Nov 22.

Infectious Diseases 105

Infectious Diseases Administration Sepsis Anaphylaxis 105

The Skeptics' Guide to EM

SEPTEMBER 15, 2018

[display_podcast] Date: September 10th, 2018 Reference: Gurley et al. Comparison of Emergency Medicine Malpractice Cases Involving Residents to Non-Resident Cases. AEM September 2018 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario.

Documentation/Coding 40

Documentation/Coding Teamwork Hospitals Emergency Department 40

Don't Forget the Bubbles

AUGUST 10, 2023

Descriptive Terms When describing injuries of the hand for documentation or referral purposes it is important to know the terminology that is widely in use in order to convey an accurate description to others. We will focus on the most important structures when assessing paediatric hands in the emergency department.

Fractures 52

Fractures Soft Tissue Injuries Emergency Department Operations 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. 2018 Mar 5;6:17. Neurocrit Care.

Seizures 85

Seizures Stroke Outcomes EMS 85

RebelEM

NOVEMBER 11, 2024

What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018. 2018 May;6(10):182. Kidney Int. 2021 Jun;99(6):1303-1308. PMID: 33811980 Zhang Z, Uddin MJ, Cheng J, Huang T. Ann Transl Med. Crit Care Med.

Sepsis 84

Sepsis Outcomes Administration Shock 84

Don't Forget the Bubbles

NOVEMBER 5, 2023

They analysed the French National Health Insurance registry of all pregnancies and births from 2010 to 2018 and found that there was an increased risk of hospitalization in children who had had a PPI (with adjusted hazard ratios between 1.34 They identified 392 cases and selected 3637 sex- and year of birth matched controls. Persaud N, et al.

Pediatrics 105

Pediatrics Hospitals Infectious Diseases Outcomes 105