Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk. Am J Emerg Med.

Infectious Diseases 161

Infectious Diseases Pediatrics Sepsis Documentation/Coding 161

RebelEM

DECEMBER 23, 2024

Reliance on ICD-10 and billing codes: Because this study was performed retrospectively using a national database, data on eligibility, types and quantity of fluid received, and patient outcomes were all assessed using ICD-10 and billing codes.

Fluid Resuscitation 123

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 123

ACEP Now

MAY 5, 2023

What is your role as the emergency physician? Introduction Law enforcement officers frequently accompany emergency department (ED) trauma patients or patients who are under arrest or require assistance. Law enforcement gathering in the emergency department: Legal and ethical background and practical approaches.

Emergency Department 52

Emergency Department Documentation/Coding 52

RebelEM

MARCH 27, 2023

Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. The effect of emergency department crowding on lung-protective ventilation utilization for critically ill patients. Unfortunately, its not clear whether the documentation came from RTs or ED providers.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

PEMBlog

JUNE 14, 2023

Thousands of children and adolescents spend days at time in Emergency Departments waiting for definitive mental health disposition. Alice Kuo and Ilene Claudius Podcast EIIC: Safe Control of the Agitated Patient Webinar Series with Dr. Zima; Follow-up After Pediatric Mental Health Emergency Visits. West J Emerg Med.

Psychiatric 98

Psychiatric Emergency Department Pediatrics Best Practices 98

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? 13 Interventions may include: Ascertaining a patient’s preferred language early in the clinical encounter (during registration, for instance), and clearly documenting this preference in a place that is visible to all providers.

Documentation/Coding 82

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 82

Don't Forget the Bubbles

DECEMBER 2, 2024

This single-centre prospective study focused on a quality improvement (QI) project to reduce the overuse of chest X-rays (CXR) in paediatric patients with acute asthma exacerbations (AAE) arriving at the emergency department (ED ). Arch Acad Emerg Med. Pediatric Emergency Medical Journal 2023;10(4):109-117. 95% CI 1.01

Documentation/Coding 98

Documentation/Coding Pediatrics Emergency Department Fractures 98

Dr. Smith's ECG Blog

MAY 27, 2024

Inferior hyperacute T waves, which have been added to the 2022 ACC consensus on chest pain as a “STEMI equivalent”[3] 3. Since the ECG now meets STEMI criteria, a code STEMI was activated. J Am Coll Cardiol 2022 4. But STEMI criteria is only 43% sensitive for OMI.[1] Conduction disorders in the setting of acute STEMI.

EKG/ECG 116

EKG/ECG Documentation/Coding Emergency Department 116

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. Clin Cardiol 2022 4. But only 6.4% of such ‘high risk Non-STEMI’ patients get angiography within 2 hours.[2]

EKG/ECG 116

EKG/ECG Documentation/Coding Fractures Emergency Department 116

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. 3 : September 2022. Baccei SJ et al. Tyler W et al.

Radiology 75

Radiology Radiology EKG/ECG Documentation/Coding 75

EMDocs

SEPTEMBER 19, 2023

Reference: emDOCs – NCSE Journal of Emergency Medicine – Review Case 4: 52-year-0ld male brought in by EMS with “code STEMI” ECG demonstrates ST depressions with rocket like T waves in V2-V4. This document covers high sensitivity troponin, risk disposition pathways, and STEMI equivalents.

Seizures 72

Seizures Documentation/Coding EKG/ECG Emergency Department 72

Emergency Medicine Journal

JUNE 20, 2024

Emergency departments (ED) represent a promising setting to address preventive health measures like CRC screening. We evaluated feasibility of identification, provided preliminary effect size estimates and documented participant acceptability.

Emergency Department 40

Emergency Department Documentation/Coding Outcomes 40

RebelEM

JUNE 8, 2023

Am J Emerg Med. 2022 Sep 5. If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergency department pharmacist. Clinical Bottom Line: Acute hypotension must be treated emergently in order to decrease morbidity and mortality. Am J Emerg Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

EB Medicine

JANUARY 3, 2023

2) 2023 E/M coding guidelines are in effect. 2) 2023 E/M coding guidelines are in effect. Announcements: 1) The interactive Clinical Pathways have launched and they are available for free!

Shock 52

Shock Pediatrics Airway Management Sepsis 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Patients assessed by an Emergency Department (ED) based Frailty Intervention Team (FIT) are routinely asked ‘What Matters To You’ (WMTY). Methods A thematic analysis of WMTY over a 12 month period from 1st January to 31st December 2022 was performed. 468 (79%) patients had documentation of WMTY.

Emergency Department 40

Emergency Department Documentation/Coding Administration Hospitals 40

EB Medicine

SEPTEMBER 1, 2022

In this episode, Sam Ashoo, MD interviews Lela Bachrach, MD, MS, Larissa Truschel, MD, MPH, and Makini Chisolm-Straker, MD, MPH - the authors of the July 2022 PEMP article on Human Trafficking of Children and Adolescents: Recognition and Response in the Emergency Department. Do you find this dissuades patients form reporting?

Emergency Department 52

Emergency Department Documentation/Coding EMS Best Practices 52

RebelEM

NOVEMBER 6, 2024

2022 Aug 2. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 1998 Jan-Feb;6(1):15-23. doi: 10.5435/00124635-199801000-00002. PMID: 9692937 Decker N, Norse A. Anterior Elbow Dislocation. Shoulder Elbow.

Dislocations 109

Dislocations Fractures Soft Tissue Injuries Outcomes 109

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 55

Pediatrics Emergency Department Research Burns 55

The Skeptics' Guide to EM

AUGUST 10, 2024

He is an assistant professor in Emergency Medicine, Neurology, and Neurosurgery at the School of Medicine at the University of Washington. Case: A 65-year-old man is brought into the emergency department (ED) by emergency medical services (EMS) after his family saw him slump over at the dinner table.

Stroke 69

Stroke Airway Management Documentation/Coding Outcomes 69

The Skeptics' Guide to EM

OCTOBER 1, 2022

Date: September 28th, 2022 Reference: Hartford et al. Disparities in the emergency department management of pediatric migraine by race, ethnicity, and language preference. AEM September 2022. Date: September 28th, 2022 Reference: Hartford et al. AEM September 2022. AEM September 2022.

Pediatrics 52

Pediatrics Emergency Department Documentation/Coding Research 52

ALiEM

MARCH 11, 2024

In July 2022, a 32-year-old male with a past medical history of HIV (on antiretroviral therapy, CD4 390, viral load undetectable) presented to the emergency department with constitutional symptoms and a rash for 4-5 days. There is limited literature documenting eye involvement and pictographic examples of its presentation.

Documentation/Coding 56

Documentation/Coding Academics Emergency Department Hospitals 56

EMDocs

NOVEMBER 6, 2024

StatPearls Publishing; 2022. Accessed April 27, 2022. 2022 Annual Report of the National Poison Data System ® (NPDS) from America’s Poison Centers ® : 40th Annual Report. Accessed April 27, 2022. Accessed April 27, 2022. He denies any past medical history other than polysubstance abuse and depression.

Poisoning 78

Poisoning Airway Management Dislocations Forensics 78

Emergency Medicine Journal

NOVEMBER 28, 2023

Results and Conclusion Since go–live (August 2022) electronic resources have become the standard first offer for families 44 core electronic ED resources cover safety net advice for common conditions, health promotion and signposting links to support health inequalities Sharing options: scanned via QR code (see figure 1 ), sent via text/SMS or (..)

Emergency Department 40

Emergency Department Head Injuries Documentation/Coding 40

Northwestern EM Blog

OCTOBER 31, 2022

Written by: Mike Tandlich, MD (NUEM ‘24) Edited by: David Feiger, MD (NUEM ‘22) Expert Commentary by : Michael Schmidt, MD Expert Commentary While EMTALA was first enacted to address issues with “patient dumping”, it has had broad influence on how patients are treated, dispositioned, and transferred in emergency department and hospital settings.

Emergency Department 52

Emergency Department Administration Documentation/Coding Hospitals 52

The Skeptics' Guide to EM

JULY 30, 2022

Date: July 28th, 2022 Reference: Brower et al. AEM July 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Date: July 28th, 2022 Reference: Brower et al. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

Dr. Smith's ECG Blog

JUNE 27, 2024

Smith comment: Go here for a comprehensive blog post on syncope and link to the most detailed version of the Canadian Syncope Rule: Emergency Department Syncope Workup. I suspect there is LA-RA Lead Reversal ( See My Comment in the August 17, 2022 post of Dr. Smith's ECG Blog for review of the effects of LA-RA reversal ).

EKG/ECG 117

EKG/ECG Documentation/Coding Emergency Department Wellness 117

EMDocs

JUNE 2, 2023

Document what you gave and why, as well as the impact. Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry. Erratum in: West J Emerg Med. 2019 Jul;20(4):688-689. Acad Pediatr.

Psychiatric 66

Psychiatric Pediatrics Emergency Department Administration 66

JournalFeed

MARCH 26, 2022

The JournalFeed podcast for the week of March 21-25, 2022. For continued access to all the JournalFeed has to offer will require you to be a member as of April 4th, 2022. Check out journalfeed.org for details.

Stroke 40

Stroke Documentation/Coding Emergency Department Resuscitation 40

Northwestern EM Blog

SEPTEMBER 26, 2022

Written by: Diana Halloran (NUEM ‘24) & Andrew Long (NUEM ‘25) Edited by: Nick Wleklinski (NUEM ‘22) Expert Commentary by : John Bailitz, MD Introduction The Emergency Department is a challenging work environment for a variety of reasons. Promoting hot debriefing in an emergency department. 2021, August 16).

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

RebelEM

MARCH 9, 2023

However, evaluating and managing patients with acute alcohol intoxication in the emergency department can be challenging. Document at each reassessment and always have a low threshold to add on a CTH or labs if the patient is not progressing appropriately. As always, document clinical sobriety before discharge.

Psychiatric 52

Psychiatric Emergency Department Documentation/Coding Fractures 52

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. Shmueli, H., Borohovitz, A.,

EKG/ECG 113

EKG/ECG Documentation/Coding Wellness Emergency Department 113

EMDocs

JUNE 16, 2023

And now we’re here at our destination, the place we know and love, the emergency room to talk about what we should be doing for the growing volume of children with mental health problems boarding in the emergency department. McEnany, Olutosin Ojugbele, Julie R. Doherty, Jennifer L. McLaren, JoAnna K. 10.1542/peds.2020-1174

Psychiatric 52

Psychiatric Pediatrics Emergency Department Best Practices 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

She presented to the emergency department after a couple of days of chest discomfort. As I discussed in My Comment at the bottom of the page in the April 2, 2022 post in Dr. Smith's ECG Blog — I am aware of many cases of sustained VT in which the patient remained awake and alert for hours. The ECG below was recorded.

EKG/ECG 97

EKG/ECG Stroke Hospitals Documentation/Coding 97

EMDocs

AUGUST 8, 2023

2022 meta-analysis 0-2 as low risk and ≥5 or higher as high risk = AUC of 0.924. Document consideration of torsion in males with abdominal pain. Just the facts: assessment and management of testicular torsion in the emergency department. 0 as low risk, 1-5 points as intermediate risk and ≥6 points as high risk = 99.5%

Ultrasounds 68

Ultrasounds Outcomes Documentation/Coding Emergency Department 68

ACEP Now

JULY 6, 2023

Emergency physicians have earned the right to “re-brand” ourselves as indispensable, money-saving change agents in the health care enterprise. Of course, the bill for any episode of emergency department (ED) care can be substantial, exceeding the billed charges for equivalent care provided in some primary care offices.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 52

Dr. Smith's ECG Blog

DECEMBER 14, 2022

I am going to code this as an acute STEMI as he had transient ST elevation which started to evolve in the emergency department but I think this is most appropriately termed STEMI." With nitroglycerin there is improvement in the 90% stenosis but still persistent stenosis consistent with the dynamic nature of his presentation.

EKG/ECG 52

EKG/ECG EMS Documentation/Coding Emergency Department 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. Available at: [link] ) Ombudsman for Children (2022). What can clinicians do?

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52