The Skeptics' Guide to EM

MAY 8, 2021

Date: May 7th, 2021 Guest Skeptic: Dr. Ryan Stanton is a community emergency physician with Central Emergency Physicians in Lexington, KY. Date: May 7th, 2021 Guest Skeptic: Dr. Ryan Stanton is a community emergency physician with Central Emergency Physicians in Lexington, KY. first appeared on The Skeptics Guide to Emergency Medicine.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

Don't Forget the Bubbles

JANUARY 1, 2024

Data collected from 2002 to 2021 revealed a 72% decline in IPD incidence among children (<18 years), with continued reductions after the transition from PCV7 to PCV13. During the COVID-19 pandemic (2020-2021), the incidence of IPD reached its lowest level in 20 years. Outcomes From a Randomized Clinical Trial. JAMA Pediatr.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

PulmCCM

JANUARY 15, 2025

Draft Guidance Document Wong et al. Clinical Outcomes Associated With Overestimation of Oxygen Saturation by Pulse Oximetry in Patients Hospitalized With COVID-19. Analysis of Discrepancies Between Pulse Oximetry and Arterial Oxygen Saturation Measurements by Race and Ethnicity and Association With Organ Dysfunction and Mortality.

Documentation/Coding 81

Documentation/Coding Academics Administration Research 81

Don't Forget the Bubbles

MAY 6, 2024

This multicentre retrospective cohort study looked at 202 children in California aged 1- 24 months who presented acutely between 2010 and 2021. Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. Of the 74.9% Why does it matter?

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

The Skeptics' Guide to EM

JANUARY 23, 2021

Date: January 20th, 2021 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. AEM January 2021 Case: A 50-year-old male presents to the Emergency Department (ED) with left lower quadrant abdominal pain. Reference: Pines et al.

Poisoning 52

Poisoning Research Documentation/Coding Operations 52

EMDocs

AUGUST 8, 2023

Bimodal age of distribution: at birth and 12-18 years 14% of cases occur in adults; older patients have worse outcomes Bell clapper deformity – bilateral in 80% of patients Prior episode of torsion Family history Trauma (can be minor) Clinical Presentation: Sudden/severe testicular pain Often unilateral, may radiate.

Ultrasounds 79

Ultrasounds Documentation/Coding Outcomes Emergency Department 79

PulmCCM

JANUARY 6, 2025

A 2021 analysis of Epic’s sepsis model revealed atrocious false positive and negative rates. A cluster randomized trial using all-cause mortality as an outcome was always needed to determine whether EMR alerts improve outcomes for suspected severe infection. And have they fired. But for whom, and to what end?

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

The Skeptics' Guide to EM

JANUARY 30, 2021

Date: January 22nd, 2021 Guest Skeptic: Dr. Steve Joseph. Date: January 22nd, 2021 Guest Skeptic: Dr. Steve Joseph. 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

NOVEMBER 13, 2021

Date: November 10th, 2021 Reference: Andersen, et al: Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest. JAMA Sept 2021. JAMA Sept 2021. He had been admitted the night before for a new diagnosis of rapid atrial fibrillation.

Advances Cardiac Life Support (ACLS) 40

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

RCEM Learning

JANUARY 23, 2024

This can include randomisation procedures, recruitment and follow-up response rates, what outcome measures patients will prefer, whether patients agree to complete the intervention (in this case the exercise programme) and so on. The ELECT2 Trial as it was to be called, was to start on October 2021.

Research 72

Research Wellness Outcomes Documentation/Coding 72

The Skeptics' Guide to EM

APRIL 24, 2021

Date: April 19th, 2021 Guest Skeptic: Dr. Kirsty Challen (@KirstyChallen) is a Consultant in Emergency Medicine and Emergency Medicine Research Lead at Lancashire Teaching Hospitals Trust (North West England). Exclusions: Prisoners or those in police custody, pregnant or breast-feeding, or with documented allergy to any study medications.

Emergency Department 40

Emergency Department Research Outcomes Documentation/Coding 40

PulmCCM

JANUARY 16, 2024

You can read the document for all the caveats. Their effects on meaningful patient outcomes are unclear, though, and their appropriate use continues to be debated. Neither document commented on treating ARDS patients with statins, which seemed very likely to have benefited some patients with hyperinflammatory ARDS in past trials.

Research 87

Research Documentation/Coding Outcomes Fractures 87

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

Dr. Smith's ECG Blog

JULY 7, 2024

But because Code STEMI was cancelled on arrival and the patient had delayed angiography, the discharge diagnosis was 'non-STEMI' despite having the exact same pathology. The patient also had a 100% proximal LAD occlusion, with a peak troponin of 100,000 ng/L.

EKG/ECG 69

EKG/ECG Documentation/Coding EMS Wellness 69

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

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. 2021 Jan 1;32(1):37-43.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 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. 2021, August 16). References 1. Get With The Guidelines - Resuscitation Clinical Tools. Www.Heart.Org. Gilmartin, S.,

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

RebelEM

DECEMBER 28, 2022

No difference in exploratory outcomes. Low rates of missing data allowed other exploratory outcomes Included a diverse and potentially high-risk group, including patients with indwelling catheters and intermittent catheter use. Article: Drekonja DM et al. Appropriately used a noninferiority study design.

Outcomes 52

Outcomes Documentation/Coding Hospitals EMS 52

PulmCCM

OCTOBER 30, 2023

IDSA cites multiple large observational studies showing no improvement in sepsis outcomes at many centers after SEP-1 implementation. The Society for Critical Care Medicine and Chest together opposed IDSA’s 2021 appeal of SEP-1, and generally support the Surviving Sepsis Campaign framework that SEP-1 grew from.

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

Don't Forget the Bubbles

FEBRUARY 26, 2024

Outcomes of paediatric critical care asthma patients. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. Tesela Ediciones 2021 Williams AM, Abramo TJ, Shah MV, Miller RA, Burney-Jones C, Rooks S, Estrada C, Arnold DH. Paediatric respiratory reviews. 2016 Sep 1;20:24-31. 2018 Jun;54(6):633-7.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

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. Philadelphia PA: Elsevier/Saunders; 2021. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Cummings CW Flint PW. Seventh ed.

Emergency Department 93

Emergency Department Pediatrics Wellness Fractures 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. Annals of Emergency Medicine 2021. 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 a huge anterolateral OMI.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52

Taming the SRU

FEBRUARY 22, 2023

doing the little things right, with the understanding that small gains are additive, and that details can be the difference between a good outcome and a poor one. Lesson 11 Find what you love to do and surround yourself with people who make you better at doing it. Paske et al.

Hospice 40

Hospice EKG/ECG Resuscitation Wellness 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. 2021; 164: 70-78. You actually run down the corridor.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

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. All ED visits that met the criteria for ‘new onset diabetes’ or DKA (‘decompensation’) were included.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

PulmCCM

FEBRUARY 17, 2025

But the range was broad: 25% were coded for less than 13 minutes, and 25% for more than 30 minutes. But if longer CPR does lead to improved survival with acceptable neurologic outcomes, should a specific duration of CPR be recommended? who died) was 21 minutes. BMJ 2024 ) of a large registry of ~350,000 hospitalized U.S. survived CPR).

CPR 71

CPR Hospitals Resuscitation Documentation/Coding 71

Don't Forget the Bubbles

JUNE 5, 2023

Outcomes of the PREFER pre-post intervention study. doi: 10.1136/bmjsrh-2021-201301. This study examined the developmental outcomes of 12 months olds from a “pandemic” cohort of babies ( 309 babies ). This prospective cohort study tried to document the effectiveness of antibiotics prescribed for chest infections in children.

Outcomes 124

Outcomes Research Wellness Documentation/Coding 124

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 95

Seizures Stroke Outcomes EMS 95

ACEP Now

AUGUST 1, 2023

However, both the Rural Task Force (2020) and the Telehealth Task Force (2021) agreed that telehealth supervision of NPs and PAs in rural practice environments by board-certified emergency physicians is a viable model for improving patient safety and extending the reach of the BC EP through the use of a physician-led team.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 98

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

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). 2021 Aug 1;133(2):374-378. Notably, in the initial analysis of blunt chest trauma (i.e. PMID: 23903783. (4)

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

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. 2021 Aug 31. 5 CT if concern for occult fracture.

EMS 88

EMS Dislocations Fractures Operations 88

Mind The Bleep

FEBRUARY 27, 2024

The children who received no bolus had significantly better outcomes and reduced mortality compared to the two bolus group. [2] Maintenance Fluids In 1957, Malcolm Holliday and William Segar published an article in the Journal of Paediatrics, which claimed to be a simple scheme that could be easily remembered to calculate fluid requirements.

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

Dr. Smith's ECG Blog

JULY 19, 2024

Unfortunately, no futher outcome is known (echo, survival, etc.) 2021;Available from: [link] Other references: Lindow T, Mokhtari A, Nyström A, Koul S, Smith SW, Ekelund U. Here is the ECG several hours after PCI: Reconstitution of expected appropriate discordant STE in V2-V3, resolving STD in V4. Final diagnosis: NSTEMI.

EKG/ECG 118

EKG/ECG Documentation/Coding Outcomes Wellness 118

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 121

EKG/ECG Documentation/Coding Wellness Emergency Department 121

RebelEM

NOVEMBER 11, 2024

In 2021, Buckley et. 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. 3 The same year, Ross et.

Sepsis 98

Sepsis Outcomes Administration Shock 98

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 76

Administration Best Practices Research Documentation/Coding 76