The Skeptics' Guide to EM

JULY 30, 2022

CT is generally the first choice of imaging, the “abdominal series” of plain X-rays have been demonstrated to have poor predictive value, but a 2018 meta-analysis found 92.4% AEM July 2022 * Population: Patients with ICD-10 coding “intestinal obstruction” from 2018 National Hospital Ambulatory Medical Care Survey.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

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. 2018 May;84(5):718-726. 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? J Trauma Acute Care Surg.

Blood Transfusions 147

Blood Transfusions Documentation/Coding Radiology Radiology 147

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 137

Stroke Outcomes Hospitals Administration 137

Sensible Medicine

AUGUST 7, 2024

Research by Collett et al (2018) shows that, despite some improvement in PP by 18 months, the deformations persist beyond 36 months. There are few studies about crawling, but all of them show positive outcomes from achieving the skill: shoulder stability, abdominal and hip strength, hand-eye coordination, and joint stability.

CDC 107

CDC Documentation/Coding Research Pediatrics 107

The Skeptics' Guide to EM

FEBRUARY 23, 2019

JAMA 2018 Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service. JAMA 2018 Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service. This was updated in 2018 with the 3-hour and 6-hour bundles combined into a single 1-hour bundle.

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

PEMBlog

MAY 11, 2023

These were used by two independent reviewers to determine Neonatal Facial Coding System with pain scores. The primary outcome was the difference between the Neonatal Faces Coding Scale (NFCS) before the procedure and during LP needle insertion. 2018 Mar;25(3):310-316. for the lidocaine group and 4.8 (0.5) Acad Emerg Med.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Outcomes 52

Sensible Medicine

SEPTEMBER 26, 2023

As background, a 2018 article in Health Affairs tried to look at the issue of how to best communicate with patients after a problem or adverse event; the paper studied what happened before and after a new communications program was implemented at 4 Massachusetts hospitals. Not so, unfortunately.

Research 125

Research Hospitals Documentation/Coding Outcomes 125

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. Eur Heart J 2018. Low O2 protocol: 3.1%

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 52

Don't Forget the Bubbles

JULY 26, 2023

Cardiac testing and outcomes in infants after an ALTE, Hoki et al, Archives of Disease in Childhood 2012 showed significant cardiac disease was present in <1% of patients presenting with ALTE (although cardiac abnormalities were found in 4% overall). A 12 year old girl was heard to be coughing in the middle of the night.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

RCEM Learning

JANUARY 23, 2024

I had completed the ELECT feasibility study successfully in 2018, with a Pathway to Portfolio grant (only available in Wales). There was nothing further I could do at that point to change the outcome of the trial. The purpose of a feasibility study is to test the methods of the future trial, to work out what processes work best.

Research 72

Research Wellness Outcomes Documentation/Coding 72

The Skeptics' Guide to EM

MARCH 4, 2018

[display_podcast] Date: February 27th, 2018 Reference: Moran et al. display_podcast] Date: February 27th, 2018 Reference: Moran et al. Exclusions: There were 26 exclusions in their supplemental documentation. JAMA May 2017.

Infectious Diseases 40

Infectious Diseases Documentation/Coding Outcomes Ultrasounds 40

RebelEM

DECEMBER 28, 2022

The investigators in this trial attempt to address the lengthy duration of antibiotics recommended and routinely prescribed among stable males with UTIs (Kang, 2018). No difference in exploratory outcomes. Patients were enrolled after the initiation of treatment through a search for diagnosis codes and antibiotic prescriptions.

Outcomes 52

Outcomes Documentation/Coding Hospitals EMS 52

PHEM Cast

APRIL 21, 2021

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

Airway Management 52

Airway Management Resuscitation EMS Hospitals 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

Sensible Medicine

SEPTEMBER 26, 2023

As background, a 2018 article in Health Affairs tried to look at the issue of how to best communicate with patients after a problem or adverse event; the paper studied what happened before and after a new communications program was implemented at 4 Massachusetts hospitals. Not so, unfortunately.

Research 52

Research Hospitals Documentation/Coding Outcomes 52

Taming the SRU

NOVEMBER 14, 2023

Complications of auricular hematoma drainage include pain, paresthesia, bleeding, infection, poor cosmetic outcome, scar formation, and re-accumulation of hematoma after the procedure. Elsevier; 2018. Updated 2018 Dec 16]. Roberts JR, Custalow CB, Thomsen TW, eds. Seventh edition. Krogmann RJ et al. Auricular Hematoma.

Emergency Department 93

Emergency Department Pediatrics Wellness Documentation/Coding 93

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. Queen of Hearts Interpretation: Would 20 minutes earlier diagnosis have made a difference in his clinical outcome? Triage ECG: What do you think? This is diagnostic of proximal LAD occlusion. I cannot be anything else.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52

Don't Forget the Bubbles

FEBRUARY 26, 2024

Outcomes of paediatric critical care asthma patients. 2018 Jun;54(6):633-7. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. Paediatric respiratory reviews. 2016 Sep 1;20:24-31. Rampersad N, Wilkins B, Egan JR. Journal of Paediatrics and Child Health. Scotland HI. A national clinical guideline.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

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." Comparative early and late outcomes after primary percutaneous coronary intervention in st-segment elevation and Non–St-segment elevation acute myocardial infarction (from the Cadillac trial). Stuckey, T.,

EKG/ECG 122

EKG/ECG Documentation/Coding Wellness Emergency Department 122

Sensible Medicine

FEBRUARY 28, 2024

Criticisms of CAC The arguments frequently presented by the anti-CAC side of the this topic—typically from doctors who consider themselves medical conservatives—involve pointing at perceived downsides of CAC testing plus the absence of RCT level data that shows cardiac outcomes are improved.

Stroke 45

Stroke Documentation/Coding Outcomes Wellness 45

Dr. Smith's ECG Blog

JUNE 20, 2018

The medicine note documents that the patient had worsening pain with lying flat and relief with leaning forward. Also, the ST elevation has diminished as myocardium infarcts Outcome and comments by the source of the case: "The following morning the cardio consult service saw the patient. Journal of Electrocardiology 2018.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness Ultrasounds 52

Don't Forget the Bubbles

JULY 5, 2023

Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. Incentive spirometry has also demonstrated to improve outcomes in SCD without respiratory symptoms and with back pain. J Hematol 2018; 93: 363-370 Rubin LG, Schaffner W. 2014; 349–356.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

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

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). 2018 Mar;33(3):176-181. Notably, in the initial analysis of blunt chest trauma (i.e. J Intensive Care Med.

Emergency Department 93

Emergency Department Resuscitation COPD Shock 93

EB Medicine

AUGUST 6, 2019

In the end, they reported similar rates of recurrence and bleeding outcomes for acute treatment. Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. This strategy reduces hospital days and costs with otherwise similar outcomes - total win all around.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EB Medicine

JUNE 6, 2019

Nachi: And remember that hypothermic patients who are septic have worse outcomes than those who are hyperthermic and septic. A 2018 study involving 288 women 14-20 years old found that the pelvic didn’t increase sensitivity or specificity of diagnosis of chlamydia, gonorrhea, or trichomoniasis when compared with history alone.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

ACEP Now

OCTOBER 9, 2023

This demographic is higher risk of adverse events during hospital encounters, often due to communication issues, leading to tragic outcomes and malpractice suits including cases of missed intracerebral hemorrhages, unnecessary or incorrect surgeries, misused medical devices, and fatal medication dosing. Published Feb 8, 2018.

Emergency Department 64

Emergency Department Documentation/Coding EMS Wellness 64

Dr. Smith's ECG Blog

OCTOBER 6, 2018

Diagnosis of acute myocardial infarction in angiographically documented occluded infarct vessel: limitations of ST-segment elevation in standard and extended ECG leads. Angiographic and clinical outcomes among patients with acute coronary syndromes presenting with isolated anterior ST-segment depressions. mm for women, 2.0 Pride et al.

EKG/ECG 52

EKG/ECG Seizures Documentation/Coding Outcomes 52

RebelEM

MAY 15, 2024

2018 May;26(5):1465-1470. 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. doi: 10.1007/s00520-017-3985-0.

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. AEM September 2018 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. display_podcast] Date: September 10th, 2018 Reference: Gurley et al.

Documentation/Coding 40

Documentation/Coding Teamwork Hospitals Emergency Department 40

Sensible Medicine

NOVEMBER 21, 2024

Colton Lipfert A prior post by science journalist Benjamin Ryan critiques how gender researchers caved to political pressure and suppressed data showing that puberty blockers failed to improve psychological outcomes for gender distressed minors. I have several concerns with his piece.

64

64

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. Be careful just sending a patient who is on the fence to the floor because several studies have demonstrated that patients who are later upgraded have worse outcomes. vasopressin.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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 85

Seizures Stroke Outcomes EMS 85

Dr. Smith's ECG Blog

JULY 19, 2024

Unfortunately, no futher outcome is known (echo, survival, etc.) That said — as we have shown in multiple posts on Dr. Smith’s ECG Blog ( See My Comments in the October 5, 2020 and the October 3, 2018 posts) — there will often be clues to OMI on a paced ECG — IF you know how to look for them. Final diagnosis: NSTEMI.

EKG/ECG 107

EKG/ECG Documentation/Coding Outcomes Wellness 107

EMDocs

DECEMBER 5, 2023

4,5 A majority of voters support the President’s latest actions on AI, with 69% of voters across the political spectrum indicating their approval of the document. Association Between Individual Primary Care Physician Merit-based Incentive Payment System Score and Measures of Process and Patient Outcomes.” Why does this matter?

Administration 65

Administration Best Practices Research Documentation/Coding 65

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. Comparator: Empiric therapy with piperacillin-tazobactam and vancomycin for treatment of suspected sepsis.

Sepsis 84

Sepsis Outcomes Administration Shock 84

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. Hand dominance, mechanism of injury and vascular, neurological, and musculoskeletal status should all be evaluated and documented.

Fractures 52

Fractures Soft Tissue Injuries Emergency Department Operations 52