ACEP Now

AUGUST 1, 2023

In late June, ACEP organized a congressional briefing with the Emergency Nurses Association (ENA) and the National Alliance on Mental Illness (NAMI) to express strong concerns to legislators about the impact of emergency department boarding on our health care safety net. Read more at acep.org/boarding-briefing.

Documentation/Coding 52

Documentation/Coding Emergency Department Emergency Nursing Research 52

RebelEM

NOVEMBER 6, 2024

2023 Aug 4. 2023 Nov 5. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. Multiple Concomitant Injuries in One Upper Extremity: A Case Report. Am J Case Rep. 2016 Jan 6;17:6-11. doi: 10.12659/ajcr.894984. PMID: 26732673 Akhondi H, Varacallo M. In: StatPearls [Internet].

Dislocations 103

Dislocations Fractures Soft Tissue Injuries Outcomes 103

EM Literature of Note

OCTOBER 9, 2024

This exploration of LLMs in the emergency department is a bit unique in its conceptualization. emergency departments are general cesspools of aggressive empiric antibiotic coverage, driven by CMS regulations – so it may in fact be the LLM displaying astute clinical judgement, here. For what its worth, of course, U.S.

Radiology 86

Radiology Radiology Emergency Department Documentation/Coding 86

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

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. But only 6.4% of such ‘high risk Non-STEMI’ patients get angiography within 2 hours.[2] Take away 1.

EKG/ECG 124

EKG/ECG Documentation/Coding Fractures Emergency Department 124

EMDocs

SEPTEMBER 30, 2024

Inhaled Corticosteroids Rarely Prescribed at Emergency Department Discharge Despite Low Rates of Follow-Up Care. J Emerg Med. 2023 May;64(5):555-563. Among patients with a primary provider documented in the chart, 30-day outpatient follow-up rate was 21.3% (n = 313).

Outcomes 95

Outcomes Academics Documentation/Coding Administration 95

EMDocs

JUNE 9, 2023

We’re defining “protocol” here as a written document that provides oversight from the medical director about how to assess and treat patients. Reassessment and Documentation After any type of restraint is instituted, careful assessment, re-assessment, and documentation is required. Was the documentation complete?

EMS 89

EMS Documentation/Coding Pediatrics Psychiatric 89

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

PulmCCM

JUNE 12, 2023

Temperature management (or fever avoidance) should begin immediately after cardiac arrest (ideally in the emergency department, for out-of-hospital arrests) and continued for at least 72 hours. Read in Nature Don’t forget to register for the Hospitalist and Resuscitationist 2023 conference Sepetmber 27-30 in Montreal.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 105

Taming the SRU

NOVEMBER 14, 2023

Chief complaints involving the ear are a common occurrence in Emergency Departments across the US and include presenting symptoms such as ear pain or fullness, hearing loss, redness, trauma, vertigo, and foreign bodies. A retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011 identified 8.6

Emergency Department 93

Emergency Department Pediatrics Wellness Documentation/Coding 93

EMDocs

MAY 26, 2023

Emerg Med Clin North Am. Structured team approach to the agitated patient in the emergency department. Emerg Med Australas. Use and avoidance of seclusion and restraint: consensus statement of the american association for emergency psychiatry project Beta seclusion and restraint workgroup. doi: 10.1016/j.emc.2009.07.003.

Pediatrics 88

Pediatrics Emergency Department Psychiatric Documentation/Coding 88

ALiEM

JANUARY 22, 2024

A 40-year-old male, tailor by occupation, was brought to the Emergency Department with complaints of high-grade fever for the past 11 days. Fever was documented to be 102°F and was not associated with any chills or rigors. Epub 2011 Sep 12. PMID: 21911554; PMCID: PMC3193135.

Documentation/Coding 64

Documentation/Coding Academics Emergency Department Hospitals 64

Don't Forget the Bubbles

OCTOBER 10, 2024

2023 Mar 30;110(4):432-438. Exploring communication preferences and risk thresholds of clinicians and parents of febrile infants under 90 days presenting to the emergency department: a qualitative study. 2024 Jul 10:archdischild-2023-326727. doi: 10.1136/archdischild-2023-326727. Arch Dis Child. Arch Dis Child.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

ALiEM

JANUARY 10, 2025

A 3-month-old male with no past medical history was brought to the emergency department for evaluation of newly asymmetric pupils. Other documented pharmacological causes of anisocoria include nebulized ipratropium bromide and scopolamine (14-19). Anisocoria. Int Ophthalmol Clin. 2019;59(3):125-39. Payne WN, Blair K, Barrett MJ.

Pediatrics 64

Pediatrics Academics Documentation/Coding Administration 64

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.

Academics 56

Academics Documentation/Coding Emergency Department Hospitals 56

RebelEM

JULY 3, 2023

Impact of intravenous calcium with diltiazem for atrial fibrillation/flutter in the emergency department. Am J Emerg Med. What They Did: Researchers conducted a multicenter, retrospective cohort study in three community hospitals and two freestanding emergency departments. Article: Rossi N et al.

Administration 88

Administration Outcomes Documentation/Coding Emergency Department 88

Dr. Smith's ECG Blog

SEPTEMBER 5, 2023

(including Pendell and Smith) just published this article: Emergency department Code STEMI patients with initial ECG labeled ‘normal’ by computer interpretation: a 7-year retrospective review Among 394 True positive cath lab activations, 16 (4.1%) had computer "normal" ECGs. == MY Comment , by K EN G RAUER, MD ( 9/5 /2023 ): == When I first saw today’s (..)

EKG/ECG 98

EKG/ECG Documentation/Coding Emergency Department 98

ACEP Now

NOVEMBER 7, 2023

3 These regulations have led to widespread practices of EHI, such as test results and clinical documentation, being shared with patients in real time. In turn, concerns have arisen regarding when information blocking is appropriate and what ethical issues emergency department (ED) physicians must consider prior to information blocking.

Documentation/Coding 52

Documentation/Coding Best Practices Ethical Issues Academics 52

ACEP Now

NOVEMBER 7, 2024

Elizabeth Wharff was the director of emergency psychiatry at Boston’s Children’s Hospital in the late 1990s when she became concerned about what was, then, a new problem. Boarding of mentally ill patients in emergency departments: American Psychiatric Association resource document. West J Emerg Med. Pediatrics.

Psychiatric 59

Psychiatric Pediatrics Hospitals Emergency Department 59

The Skeptics' Guide to EM

MARCH 31, 2023

Date: March 28, 2023 Reference: Fowler et al. Objective assessment of sleep and fatigue risk in emergency medicine physicians. You find her at […] The post SGEM#399: I’m So Tired – Emergency Medicine and Fatigue first appeared on The Skeptics Guide to Emergency Medicine. Date: March 28, 2023 Reference: Fowler et al.

Academics 52

Academics Documentation/Coding Emergency Department Outcomes 52

Dr. Smith's ECG Blog

JANUARY 27, 2024

, tells us that we physicians do not need to even look at this ECG until the patient is placed in a room because the computer says it is normal: Validity of Computer-interpreted “Normal” and “Otherwise Normal” ECG in Emergency Department Triage Patients I reviewed this article for a different journal and recommended rejection and it was rejected.

EKG/ECG 120

EKG/ECG Emergency Department Outcomes Documentation/Coding 120

Don't Forget the Bubbles

MAY 6, 2024

of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) Factors that impact second attempt success for neonatal intubation following first attempt failure: a report from the National Emergency Airway Registry for Neonates. 2024 Feb 28:fetalneonatal-2023-326501. doi: 10.1136/archdischild-2023-326501.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

ACEP Now

JUNE 14, 2024

1 As fresh challenges of the pandemic and hospital operations changed emergency medicine practice, one of the more challenging areas was the movement of admitted patients out of the first emergency department (ED). emergency departments. in 2023 will be reported at around 160 million patients. percent).

Emergency Department 52

Emergency Department Operations Hospitals Leadership 52

ACEP Now

MAY 6, 2023

Case A 35-year-old male is brought to the emergency department (ED) following a single-motor-vehicle collision in which two people were ejected and pronounced dead at the scene. Updated January 20, 2023. Accessed April 3, 2023. He is completely amnestic to the events of the accident. Discussion There were over 2.1

Forensics 52

Forensics Documentation/Coding Fractures Head Injuries 52

ACEP Now

DECEMBER 10, 2023

In January 2023, the state of Maryland launched the first-ever government-based emergency medicine alternative payment model. Broad categories of diagnoses in the 2023 model are listed on the related chart. 2 More than 600 emergency department (ED) clinicians in the state are participating in the program.

Emergency Department 52

Emergency Department Hospitals Documentation/Coding 52

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

ACEP Now

OCTOBER 26, 2023

The Case A two-year-old female, seen three days ago at different local emergency department (ED)—Children’s General—presents with fever, headache, and neck pain. Accessed October 9, 2023. Accessed October 9, 2023. DR. TALAN is professor of emergency medicine and infectious diseases at UCLA. Published 2011.

Infectious Diseases 52

Infectious Diseases Documentation/Coding Hospitals Administration 52

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

ACEP Now

SEPTEMBER 5, 2024

While some issues are handled locally, many issues cannot be solved in our emergency department or hospital. As a community “pit doctor,” I believe I have a good understanding of the needs of emergency physicians. We must have a community of like-minded individuals working towards shared goals.

Leadership 98

Leadership PPE EMS Wellness 98

Dr. Smith's ECG Blog

DECEMBER 29, 2023

It was ongoing on arrival in the emergency department. Am J Emerg Med 2023 2. Eur Heart J Dig Health 2023 == MY Comment , by K EN G RAUER, MD ( 12/27 /2023 ): == Superbly documented case by Dr. McLaren — in which the unfortunate details of opportunities missed are sequentially recounted.

EKG/ECG 73

EKG/ECG Documentation/Coding Emergency Department 73

Don't Forget the Bubbles

DECEMBER 16, 2024

A Decline in Vaccination Coverage: A Global Issue In 2023, the World Health Organisation (WHO) reported that worldwide immunization rates for key vaccines, including the diphtheria-tetanus-pertussis (DTP3) series, had dropped to 84% from pre-pandemic rates of 86%. 2023 UK Government. have completed their preschool DTaP/IPV booster.

Infectious Diseases 59

Infectious Diseases Documentation/Coding Pediatrics CDC 59

Mind The Bleep

MAY 16, 2023

When prescribing drugs off licence, ensure you explain this to the patient/career and gain and document verbal consent. [8] SM, “Paediatric Constipation Differential Diagnoses,” 5 March 2023. Kahana DD, “Constipation,” 5 March 2023. Management of Constipation in CED,” 5 March 2023.

Dehydration 52

Dehydration Best Practices Documentation/Coding Emergency Department 52

ACEP Now

APRIL 4, 2024

A 59-year-old male with a past medical history of a repaired ventricular septal defect (VSD), dextrocardia, hypertension, hyperlipidemia, and current smoker presented to the emergency department (ED). However, the patient had known dextrocardia based on documented medical history and was confirmed with a recent chest x-ray.

EKG/ECG 40

EKG/ECG Burns Documentation/Coding Emergency Department 40

Dr. Smith's ECG Blog

APRIL 17, 2023

The remainder of his Emergency Department stay was uneventful. Here is the clinical informaton on ECG 2: A man in his 50s presented to the Emergency Department with acute chest pain that started within the past few hours. The patient was transferred to the PCI center non-emergently over the next few hours.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Psychiatric 52

ACEP Now

FEBRUARY 11, 2024

1,2 In the emergency department (ED), the focus of treatment is pain control and immobilization unless there is a clear indication for surgery, such as open fractures, skin tenting, or neurovascular compromise. Clavipectoral plane block performed in the emergency department for analgesia after clavicular fractures: A case series.

Ultrasounds 52

Ultrasounds Fractures Emergency Department Hospitals 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. What can clinicians do? Journal of Clinical Nursing, 3222-3235, 29(17-18).

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

Pediatric EM Morsels

OCTOBER 27, 2023

James Broselow, a family medicine-turned-emergency medicine physician from Hickory, North Carolina , recognized that his team spent a lot of time trying to calculate doses of medications rather than spending their mental energy on the actual medical decisions for the resuscitation. Available at: [link] (Accessed: 26 October 2023).

Pediatrics 269

Pediatrics Resuscitation Documentation/Coding Wellness 269