The Skeptics' Guide to EM

NOVEMBER 21, 2020

Date: November 19th, 2020 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. AEM November 2020. Date: November 19th, 2020 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. AEM November 2020. AEM November 2020. Reference: Pines et al. Reference: Pines et al.

Emergency Department 52

Emergency Department Telemedicine Academics Outcomes 52

ACEP Now

OCTOBER 30, 2023

One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. This makes documentation and communication of the utmost importance for these patients for their health and safety. Published September 16, 2020.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

RebelEM

AUGUST 12, 2024

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

Outcomes 81

Outcomes Hospitals Operations Shock 81

Downeast Emergency Medicine

DECEMBER 1, 2021

The primary outcome was enrollment in and receiving addiction treatment at 30-days post-randomization. Additional outcomes included self-reported days of illicit opioid use, urine testing for illicit opioids, HIV risk, and use of addiction treatment services. Annals of Emergency Medicine. 2021; 78(3): 434-442.[

Emergency Department 52

Emergency Department Documentation/Coding Leadership Administration 52

Don't Forget the Bubbles

JANUARY 1, 2024

During the COVID-19 pandemic (2020-2021), the incidence of IPD reached its lowest level in 20 years. Outcomes From a Randomized Clinical Trial. Two-Year Autism Risk Screening and 3-Year Developmental Outcomes in Very Preterm Infants. Cannabis Exposure and Adverse Pregnancy Outcomes Related to Placental Function.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

Sensible Medicine

SEPTEMBER 26, 2023

adults say they have a great deal of confidence in medical scientists to act in the best interests of the public, down from 40% who said this in November 2020.” Researchers would know that whatever they publish is eventually going to be linked to a list of replication attempts and their outcomes.” Overall, 29% of U.S.

Research 124

Research Hospitals Documentation/Coding Outcomes 124

The Skeptics' Guide to EM

JULY 30, 2022

A 2020 national UK report into patients treated for bowel obstruction found delays in imaging and diagnosis and recommended CT with IV contrast as the first-line investigation [2]. 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 Skeptics' Guide to EM

JANUARY 30, 2021

2020 Case: A healthy 55-year-old woman was out for a walk and had a FOOSH (fall on outstretched hand) of her dominant arm. 2020 * Population: Adults (18 years and older) inpatient or outpatients with a diagnosis of certain long bone fractures (neck of femur/tibia/fibula/tibia and fibula/radius/ulna/humerus/clavicle) based on ICD-9 codes.

Fractures 52

Fractures Documentation/Coding Outcomes 52

The Skeptics' Guide to EM

MAY 2, 2020

Date: April 24th, 2020 Reference: Watanabe et al. Date: April 24th, 2020 Reference: Watanabe et al. The crew then asks if you want them to transport your father Code 3 with full lights and sirens. Yes * Was the outcome accurately measured to minimize bias? Annals of Emergency Medicine.

Documentation/Coding 40

Documentation/Coding EMS EKG/ECG Outcomes 40

Emergency Medicine Journal

NOVEMBER 28, 2023

It can be challenging and time consuming to access the information required to reflect upon their clinical practice by reviewing the outcomes of their individual patients, referred to as patient follow-up. Patient outcomes are commonly documented in electronic health records (EHR). It was implemented in December 2020.

EMS 40

EMS Documentation/Coding Outcomes Hospitals 40

The Skeptics' Guide to EM

JANUARY 23, 2021

The SGEM bottom line was that increasing APP coverage has minimal effect on ED flow and safety outcomes based on the data. A joint statement on the issue was published in 2020 by AAEM/RSA, ACEP, ACOEP/RSO, CORD, EMRA, and SAEM/RAMS. Intervention: Evaluated by an APP * Comparison: Evaluated a physicial * Outcome:

Poisoning 52

Poisoning Research Documentation/Coding Operations 52

The Skeptics' Guide to EM

NOVEMBER 13, 2021

Case: A code blue is called for a 71-year-old male in-patient that is boarding in the emergency department (ED). A SRMA published in 2020 on the use of steroids after cardiac arrest reported an increase in ROSC and survival to discharge but was limited by the availability of adequately powered high-quality RCTs ( Liu et al JIMR 2020 ).

Advances Cardiac Life Support (ACLS) 40

Advances Cardiac Life Support (ACLS) Hospitals Emergency Department Resuscitation 40

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. Any team member of the resuscitation may lead the hot debrief. References 1. 2021, August 16). Www.Heart.Org. Gilmartin, S.,

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

SheMD

JULY 27, 2023

What were their outcomes: Physician mothers report having more domestic responsibilities than their partners. Unequal distribution of domestic responsibility has been documented as a factor in the underrepresentation in female physicians in leadership roles in academic medicine as well as contributing to career satisfaction.

Academics 52

Academics Leadership Documentation/Coding Research 52

The Skeptics' Guide to EM

DECEMBER 5, 2020

Date: November 30th, 2020 Reference: Ohle R et al. AEM 2020 Guest Skeptic: Dr. Mary McLean is an Assistant Program Director at St. Date: November 30th, 2020 Reference: Ohle R et al. AEM 2020 Guest Skeptic: Dr. Mary McLean is an Assistant Program Director at St. A Systematic Review and Meta-analysis.

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Ongoing pain noted throughout all documentation, but after nitro drip and prn morphine, "pain improved to 2/10." Long term outcome unknown but obviously bleak. Association of intravenous morphine use and outcomes in acute coronary syndromes: Results from the CRUSADE Quality Improvement Initiative. Repeat trop 150 ng/L.

EKG/ECG 81

EKG/ECG Outcomes Academics Documentation/Coding 81

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. Do nebulized antibiotics result in lower use of systemic antibiotics?

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

Mind The Bleep

OCTOBER 29, 2024

Provide detailed documentation of the initial assessment, treatment provided, and the patient’s response to interventions. Proper stabilization and detailed communication with the burns centre are essential for optimal patient outcomes. Preparation for Transfer Ensure the patient is hemodynamically stable before transfer. 2019.00647.

Burns 52

Burns Fluid Resuscitation PPE Hyperthermia / Hypothermia 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. Treatment - How to Drain Auricular hematomas are treated with evacuation and compression to prevent re-accumulation of hematoma.

Emergency Department 94

Emergency Department Pediatrics Wellness Fractures 94

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

When Pendell and I are coding ECGs for the Queen's training, this is one category: "Definite ischemia, difficult to differentiate between posterior OMI and subendocardial ischemia." Yet this is rarely followed, and patient outcomes like this are the result once in a while. Academic Emergency Medicine 27(S1): S220; May 2020.

EKG/ECG 86

EKG/ECG Shock Documentation/Coding Academics 86

Dr. Smith's ECG Blog

OCTOBER 2, 2021

We assume that at some point the patient's pain returned, but it is not documented, so exactly when this happened is uncertain. Failure to consider the disease based on a patient's age will lead to missed diagnoses and worse outcomes. 1] Wereski, R., Chapman, A. Gray, A., & & Mills, N.

EKG/ECG 52

EKG/ECG Ultrasounds EMS Documentation/Coding 52

ACEP Now

JULY 7, 2023

However, rapid initiation of treatment is actually patient-centered care that can both lead to better outcomes and limit ED boarding. Mental health evaluation teams can rely on documentation and interviews to understand a patient’s initial agitation level. 2020 Jul 3;1(5):898-907. J Am Coll Emerg Physicians Open.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

Sensible Medicine

SEPTEMBER 26, 2023

adults say they have a great deal of confidence in medical scientists to act in the best interests of the public, down from 40% who said this in November 2020.” Researchers would know that whatever they publish is eventually going to be linked to a list of replication attempts and their outcomes.” Overall, 29% of U.S.

Research 52

Research Hospitals Documentation/Coding Outcomes 52

RebelEM

NOVEMBER 30, 2023

Outcomes: Primary Outcome: In-hospital mortality. Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. There was no specified time-frame for the primary outcome, potentially affecting the precision of the findings. Mayo Clin Proc Innov Qual Outcomes. 2.89, p = 0.01.

Sepsis 118

Sepsis Fluid Resuscitation Resuscitation Administration 118

EM Updates

JUNE 15, 2021

Every patient admitted to the EDAT was followed to the conclusion of their hospital course; the development of this unit and patient outcomes resulting from its execution are presented here. From April 6 to May 3, 2020, 90 patients were admitted to the EDAT. The study was approved by the MMC institutional review board.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

Don't Forget the Bubbles

MAY 31, 2023

What outcomes did they look at? Was the outcome accurately measured to minimise bias? The inability to test for SARS-CoV-2 antibodies may have led to an underestimation of the impact of the virus on the reported outcomes. Mintegi, S., & Country Leads (2020). Was the follow-up of subjects complete enough? Bressan, S.,

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Don't Forget the Bubbles

JUNE 5, 2023

Outcomes of the PREFER pre-post intervention study. This study examined the developmental outcomes of 12 months olds from a “pandemic” cohort of babies ( 309 babies ). Babies born between March-May 2020 were compared with a historic baseline” cohort of babies (1 629 babies ) born between 2008-2011. BMJ Sex Reprod Health.

Outcomes 124

Outcomes Research Wellness Documentation/Coding 124

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 133

EKG/ECG Documentation/Coding Wellness Emergency Department 133

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Triage documented a complaint of left shoulder pain. We have shown that morphine is associated with worse outcomes (see learning points below) and have published many blog posts about it , such as this one: Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mass delusion (and Opiate pain relief). Milasinovic, D.,

EKG/ECG 126

EKG/ECG Outcomes Academics Documentation/Coding 126

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. What are the next steps in the management of this patient? What other examination findings are expected?

Seizures 97

Seizures Stroke Outcomes EMS 97

ACEP Now

AUGUST 1, 2023

Evidence shows that their presence has been increasing in rural EDs, and ACEP’s own Rural Task Force identified in 2020 that some rural EDs may not have sufficient volume to support dedicated ED physician staffing. emergency department deserves access to an emergency physician no matter their zip code. Every patient in a U.S.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 98

Sensible Medicine

SEPTEMBER 24, 2023

Anyone who works in a hospital will say, ‘we are no longer living in the dark days of 2020’— and ‘this is not the same disease’ This is also why I think all therapeutic data needs repeat RCTs. Run a randomized trial showing testing (however you like) improves clinical outcomes. This is just how life works.

Hospitals 141

Hospitals Documentation/Coding Outcomes Wellness 141

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A Rising Troponin That afternoon, he complained of increased shortness of breath and was noted to have oxygen saturations in the 70s, prompting a mini code to be called. JAMA Cardiol [Internet] 2020;Available from: [link] 4. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19).

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

ACEP Now

DECEMBER 11, 2023

Recently, the 2020 Coronavirus Aid, Relief, and Economic Security Act provided resources and processes to relieve some of the burden for review of these monographs. 2 With a primary outcome of “daily reflective nasal congestion score,” there was no difference in the primary outcome. References U.S. Food and Drug Administration.

Administration 64

Administration Outcomes Research Stroke 64

Cook County EM Blog

MARCH 20, 2023

Further document handedness, occupation, site of injury, and thorough review of systems to evaluate for potential complications ○ Complications as distant as pneumomediastinum following air injection of the hand have been reported5,6. ➢ 2020 Nov;26(6):899-904. Latex paint-gun injuries of the hand: are the outcomes better?

Fractures 52

Fractures Documentation/Coding Operations Research 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

Sensible Medicine

SEPTEMBER 24, 2023

Anyone who works in a hospital will say, ‘we are no longer living in the dark days of 2020’— and ‘this is not the same disease’ This is also why I think all therapeutic data needs repeat RCTs. Run a randomized trial showing testing (however you like) improves clinical outcomes. This is just how life works.

Hospitals 52

Hospitals Documentation/Coding Outcomes Wellness 52