Total Medical ComplianceHIPAA

JANUARY 12, 2023

The NPRM was published in 2021 for public comments. Many comments to the NPRM noted that this would be an operational and compliance risk issue for providers. TMC clients have access to ready to use forms, as well as expert support, white-glove service, and first-class training!

Operations 104

Operations Best Practices Documentation/Coding Administration 104

Taming the SRU

MAY 13, 2024

The patient is a well-appearing male who is awake, alert, and oriented. There is also a well-appearing, healed surgical scar. There is also a well-appearing, healed surgical scar. The skin is warm and well perfused with brisk capillary refill. 2021; 9:e04871. Respiratory and cardiovascular exams are normal.

Ultrasounds 96

Ultrasounds Emergency Department Wellness Operations 96

PulmCCM

APRIL 18, 2024

The real world success rates by operators experienced with intubation remained unknown. In the relatively few studies comparing video to direct laryngoscopy, intubations were usually performed by inexperienced trainees, and sample sizes were small.

Airway Management 98

Airway Management Operations EMS Research 98

Dr. No

DECEMBER 1, 2021

A week ago , the familiar high profile double humped weekly deaths chart got disappeared, perhaps because the 2021 line was misbehaving. The way to get round this slippery data problem, as regular readers of this blog will know only too well, is to look at all cause mortality. Go figure, as they say.

Forensics 52

Forensics Wellness Operations 52

EMDocs

AUGUST 12, 2023

He presented to the emergency department because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. Management consists of intravenous antibiotics , and hand surgery should be consulted to consider operative debridement.

EMS 69

EMS Fractures Operations Ultrasounds 69

ACEP Now

MARCH 13, 2024

Consequences of this are well documented and include delayed treatment, exposure to error, increased length of stay, and increased mortality. Conclusion/Recommendation ED crowding is a national patient safety issue driven by hospitals routinely operating over capacity. Published online 2021:26. ED crowding impairs this mission.

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

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.

Research 52

Research Poisoning Documentation/Coding Outcomes 52

Downeast Emergency Medicine

DECEMBER 17, 2021

Since its early days of small and scattered residency programs, EM has burgeoned to nearly 3,000 residency positions according to the 2021 Report on Residents published by the Association of American Medical Colleges (AAMC). Retrieved October 30, 2021, from [link]. Association of American Medical Schools 2021 Report on Residents.

EMS 52

EMS Academics Emergency Department Operations 52

PulmCCM

APRIL 1, 2024

That could (and should) change if improved functional outcomes, persisting for months after hospital discharge, are ever confirmed in large, well-conducted trials. Authors also had no information on operators’ experience levels. In skilled hands using ultrasound, CVC complications are much lower than 3%.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

Taming the SRU

MAY 22, 2023

Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. weight-bearing status, operative vs. non-operative) If necessary/helpful to ensure adequate follow-up At time of discharge: Counsel on expected course of injury, supportive care (e.g., 12): e0244291. 9(1):31-36.

Fractures 75

Fractures Dislocations Operations Radiology 75

EMDocs

MAY 25, 2024

McGraw Hill; 2021. Am Fam Physician. 2014;89(11):882-888. Jauch EC, Hall G, Knoop KJ. Sialadenitis. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. The Atlas of Emergency Medicine, 5e. Accessed June 22, 2023. link] Haidar H, Menon A, Al Duhirat E. Diseases of the salivary glands. In: Textbook of Clinical Otolaryngology.

EMS 80

EMS Dehydration Operations Hospitals 80

Don't Forget the Bubbles

JANUARY 17, 2024

2021 A plain abdominal X-ray shows multiple dilated loops of bo wel. Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. 2021 These beads, once hydrated inside the body, reached considerable sizes.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Don't Forget the Bubbles

MAY 24, 2023

Crouzon syndrome, Pierre-Robin sequence, Down syndrome, Beckwith-Wiedemann syndrome) I njuries to the face, mandible, pharynx, or neck S leeping issues such as snoring due to adenotonsillar hypertrophy It’s essential to have a well-planned approach to managing the difficult airway. difficult intubations in neonates and infants. Simul Healthc.

Airway Management 98

Airway Management Teamwork Pediatrics Emergency Department 98

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. 2021 PMID: 34273470 12 Petitpas F et al. Resusc Plus. 2023 PMID: 37502742 11 Schwalbach KT et al.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

Don't Forget the Bubbles

MAY 10, 2023

A study in Denmark in 2021 explored barriers to effective resuscitation in over 900 in-hospital resuscitations across six hospitals in Denmark. Then the patient is rapidly moved to the operating theatre. 2021; 164: 70-78. StatPearls Publishing, Treasure Island (FL) ; 2021. But crowd control can still be an issue.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

33 Charts

SEPTEMBER 21, 2021

And uncertainty is the new core operating condition for healthcare leaders. As doctors and healthcare leaders we have traditionally operated in a field of relative certainty. Here we could refer to technology itself as well as the information it generates. Uncertainty Complexity breeds uncertainty. This is new territory for us.

Leadership 57

Leadership Operations Hospitals Wellness 57

Intensive Blog

AUGUST 17, 2023

Major bleeding (Arachchilage et al, 2021) 1. 2021 Apr;35(4):1192-1202. Approximately half of these cases meet the criteria for major bleeding as established by the International Society on Thrombosis and Haemostasis (Kalbhenn and Zieger, 2022). Fatal bleeding, and/or 2. Cannula site bleeding. J Cardiothorac Vasc Anesth. 2020.08.068.

Blood Transfusions 52

Blood Transfusions Operations Wellness 52

Don't Forget the Bubbles

JANUARY 1, 2024

However, children who had an operation experienced improvements in behaviour, symptoms, and quality of life and had lower blood pressure. While adenotonsillectomy may not directly impact cognitive functions, it can benefit other aspects of health and well-being in children with mild sleep-disordered breathing.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

ALiEM

OCTOBER 30, 2023

The same goes for clinical operations and research – interesting, but there hasn’t been any “a ha” moment to illuminate her calling. Well, instead of passively waiting for Godot, you can seize the initiative and bend the arc of your career into alignment with your values, strengths, and passions, and, by extension, toward fulfillment.

Academics 64

Academics Leadership Wellness Research 64

PulmCCM

JANUARY 8, 2024

But apparently, few centers use them, because … well, no one can give a good reason why. Twenty-five ICUs in Canada were switched to small-volume blood collection tubes at randomly assigned times (a so-called stepped-wedge cluster design) from 2019-2021. In one of those “how has this not been done already?”

Blood Transfusions 96

Blood Transfusions Hospitals Outcomes Operations 96

EMDocs

DECEMBER 11, 2023

In addition to a posterior ECG, the ACC’s new recommendations emphasize consideration of an emergent TTE, though lack clarity in defining who should be the operator, stating “a clinician qualified in echocardiography” is necessary, without providing specific definitions. 2021 Mar;60(3):273-284. J Emerg Med.

EKG/ECG 110

EKG/ECG Emergency Department Academics Operations 110

Dr. Smith's ECG Blog

DECEMBER 19, 2023

Unfortunately, we do not have those images for review, but the operators described a ruptured LAD plaque and they stented this area, which ensures the stability of the plaque. The patient did well afterward without any recurrence of symptoms. Fortunately, that is exactly what happened. His echocardiogram showed normal wall motion.

EKG/ECG 122

EKG/ECG EMS Wellness Operations 122

Pediatric EM Morsels

AUGUST 4, 2023

England, 2021) The third portion of the duodenum courses between the SMA and the aorta, which can lead to external compression of the duodenum. England, 2021) In SMA syndrome the angle is decreased to < 22 o and the normal distance <8 mm. England, 2021) This condition is often attributed to rapid weight loss.

Pediatrics 246

Pediatrics Burns Operations Ultrasounds 246

EMDocs

SEPTEMBER 9, 2023

McGraw Hill; 2021. Results of primary extensor tendon repair in relation to the zone of injury and pre-operative outcome estimation. Rosh Review Website Link References Park CW, Juliano ML, Woodhall D. Tendon Lacerations. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. The Atlas of Emergency Medicine, 5e. Accessed June 24, 2023.

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

Taming the SRU

MARCH 14, 2023

He appears well and is triaged to an ESI 4. Ultimately, definitive management is in the operating room with revision or replacement of the VP shunt. She was doing well, but recently has had the “stomach flu” with a couple weeks of abdominal pain, nausea and vomiting. More on this below as we work through a few cases….

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

Northwestern EM Blog

DECEMBER 20, 2021

Typically well appearing with normal labs, however, this is a diagnosis of exclusion and a septic joint should be ruled out. Management is orthopedic consultation for operative stabilization [12]. 2021, Dec 20). Affects ages 3-8, males to females 2:1 [3]. Management includes NSAID use and return to activity as tolerated [4].

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

Taming the SRU

MARCH 12, 2024

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. as well as patients less than 18 years old were excluded from analysis. The study’s primary outcomes were the operational impacts of the SQuID protocol on EDLOS and ICU admission rates. Acad Emerg Med 2023;30(8):800–8.

Operations 95

Operations Hospitals Best Practices Wellness 95

Pediatric EM Morsels

NOVEMBER 3, 2023

Both have a range of detection limits, which can be greatly dependent on operator. With concern for malaria, it is very important to identify who is non-immune and semi-immune as this can affect both the timeframe for illness after departure from the endemic country as well as severity of illness. Third times the charm!

Seizures 277

Seizures Pediatrics CDC Infectious Diseases 277

RebelEM

AUGUST 22, 2024

1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Patients whose last known well (LKW) time was within 24 hours of presentation. Published 2021 Feb 16. Clin Ophthalmol.

Stroke 80

Stroke Administration Outcomes Documentation/Coding 80

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. In 2021, Evans and colleagues (1) compared adolescent mortality rates in adult, children’s and mixed major trauma centres across the UK. These procedures require an experienced operator. These procedures require an experienced operator.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

EMDocs

SEPTEMBER 25, 2023

They increase the risks of hypoxia and acidosis during the apneic period as well as hypotension and hypoperfusion caused by the abrupt transition from negative-pressure to positive-pressure ventilation (10). ” The American Journal of Emergency Medicine 49 (2021): 48-51. 2021 Mar;60(3):265-272. J Emerg Med. 2020.10.042.

Emergency Department 65

Emergency Department Soft Tissue Injuries Operations Airway Management 65

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

See Costagliola et al — Ann Clin Transl Neurol 8(7): 1557-1568, 2021 — for more on the complex "Brain-Heart Interaction" in Epilepsy ). Regarding my Systematic assessment of ECG #1: There is significant baseline artifact , as well as baseline wander. mEq/L for K+ and 1.76 Nossen — results of genetic testing for LQTS are pending.

Seizures 106

Seizures EKG/ECG EMS Documentation/Coding 106

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. This finding was not significantly different among operators with different levels of experience, or between adults and children. 2021; 93: 4358–4369. 2021 Jan;25(1):466-479. Epub 2021 Oct 1. J Med Virol. doi: 10.1097/MD.0000000000023315.

Infectious Diseases 86

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 86

EMDocs

JUNE 3, 2023

4 This is the framework the ED resuscitationist should be operating under, as hemodynamically unstable pelvic trauma patients require a different approach compared to stable patients who will undergo CT, routine pelvic fixation, and definitive surgical repair. Figure 5: Pelvic binding with a sheet.

Fractures 54

Fractures Resuscitation Operations EMS 54

Don't Forget the Bubbles

JANUARY 31, 2024

This was compared to a mixed reference standard that included the results of ultrasound by radiologists, intra-operative findings, and clinical follow-up. Scand J Trauma Resusc Emerg Med 29, 170 (2021) What’s it about? The authors looked for common agents and their ability to reduce pain as well as any associated adverse events.

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

Northwestern EM Blog

SEPTEMBER 12, 2022

This post will discuss a brief overview of hospital planning and operational setup with key elements of a disaster response from events that cause high numbers of blunt trauma, penetrating trauma, burns or crush injuries that may be seen following explosive events, mass shootings, or large scale motor vehicle collisions, to name a few.

Mass Casualty Incidents 52

Mass Casualty Incidents Hospitals EMS Operations 52

RebelEM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. Point-of-care ultrasound (PoCUS) is inherently operator-dependent, which may have led to inconsistencies in the quality and findings of the ultrasound exams across different operators.

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122