Pediatric EM Morsels

JULY 28, 2023

A critical MORSEL is that every child you treat for DKA needs to have an initial thorough neuro exam including cranial nerves and then frequent neuro reassessments … and document it ( so your colleagues who take over care for the kid can know if there has been a change )! Is your patient hyperglycemic, acidotic, with ketonuria?

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

Sensible Medicine

OCTOBER 19, 2023

We wrote this letter and submitted it to the journal, documenting that the trial violated ethical codes. Kids are a vulnerable population— subject to teasing and bullying— and frankly the dogs were not that good at sniffing COVID19. Lots of false positives and negatives. Yet the journal refuses to print it.

Documentation/Coding 86

Documentation/Coding Pediatrics Research Outcomes 86

EMDocs

MAY 9, 2024

Exam documents that he is alert and oriented but “tired appearing” and “not appearing post-ictal.” Defense : The EP did address the seizure when he documented “not post-ictal.” There is no negligence, as the documentation supports reasonable judgment. The triage nurse records the event as a “seizure” lasting 7 minutes.

Seizures 83

Seizures Dehydration Documentation/Coding Infectious Diseases 83

Dr. Smith's ECG Blog

JUNE 13, 2024

Her first set of vitals were documented: BP 116/57 Pulse 94bpm Respiratory rate 24/min O2 sat 90% on room air Temp 97F She had been cleaning a Jeep in the sun, and was sunburned. The physician documented “normal sinus rhythm”. The physician documented that she was “improved” and the patient was discharged. CK MB was 1.9

EKG/ECG 96

EKG/ECG Documentation/Coding EMS Burns 96

Dr. Smith's ECG Blog

JUNE 7, 2024

What was the outcome and final diagnosis? The discharge diagnosis was STEMI based on the STEMI positive ECG and code STEMI activation, with culprit lesion on angiography. Despite this clinical reality — all too many clinicians still fail to document the presence and relative severity of CP at the time each serial ECG is recorded.

EKG/ECG 108

EKG/ECG Documentation/Coding EMS Outcomes 108

RebelEM

JUNE 22, 2023

Population: Adults aged 30-85 years of age with BMI > 25 ( > 23 in those identifying as Asian or Latino) who had COVID-19 symptoms for fewer than 7 days and a documented SARS-CoV-2 positive PCR or antigen test within 3 days of enrollment without prior SARS-CoV-2 infection. Prior vaccination was not an exclusion criteria.

Outcomes 145

Outcomes Research Documentation/Coding Wellness 145

The Trauma Pro

MAY 9, 2023

” This concept served as the basis of the [poorly documented] “Golden Hour” and for decades has directed our efforts at getting patients to a center with an immediately available OR as quickly as possible. The Pennsylvania Trauma Outcomes Study database contains a huge amount of data.

Head Injuries 130

Head Injuries Operations Documentation/Coding Outcomes 130

EMDocs

AUGUST 22, 2024

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. Utilizing certified interpreters and documenting their use. Educating patients on their rights.

Documentation/Coding 83

Documentation/Coding Emergency Department Best Practices Federal Emergency Management Agency 83

PulmCCM

JANUARY 29, 2024

Read the document for all the details (it’s not long). No strong evidence exists to suggest that detecting and treating nonconvulsive seizures improves neurologic outcomes after arrest, but there’s a compelling pathophysiologic rationale to prevent further brain injury. Here’s PulmCCM’s take on the new changes.

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

ACEP Now

OCTOBER 3, 2023

This document is an update of guidelines first published in 2000, and then updated in 2007. These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

Dr. Smith's ECG Blog

OCTOBER 18, 2023

1-3] But these studies were very short duration and used cardiology interpretation of ECGs or emergent angiography rather than patient outcomes. 4,5] We have now formally studied this question: Emergency department Code STEMI patients with initial electrocardiogram labeled ‘normal’ by computer interpretation: a 7-year retrospective review.[6]

EKG/ECG 124

EKG/ECG Documentation/Coding Emergency Department Outcomes 124

American Medical Compliance

NOVEMBER 8, 2024

Proper injury reporting protects patients, supports a safe workplace, and shields healthcare providers from potential legal issues that may arise due to negligence or lack of documentation. Scenario-based training adds real-world relevance.

Documentation/Coding 83

Documentation/Coding Legal Issues Operations Incident Reporting 83

EMDocs

SEPTEMBER 26, 2024

This story, while unlikely to reflect the standards of most readers, has a somewhat surprising outcome. 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.

Radiology 75

Radiology Radiology EKG/ECG Documentation/Coding 75

RebelEM

JULY 3, 2023

Pregnant or incarcerated patients Documentation for systolic BP is incomplete Intervention: Administration of IV calcium within 60 min prior to or 30 min after IV diltiazem administration in patients with AF/AFL with RVR. Limitations: The primary and secondary outcomes were nearly all disease oriented and not patient oriented.

Administration 98

Administration Outcomes Documentation/Coding Emergency Department 98

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 137

Stroke Outcomes Hospitals Administration 137

Sensible Medicine

NOVEMBER 4, 2024

The glucagon-like peptide-1 receptor agonists (GLP1a) improve hard clinical outcomes in patients with diabetes and obesity. The study team also measured numerous other qualitative outcomes which generally favored semaglutide. Sensible Medicine is a reader-supported publication. The primary endpoints were positive.

Outcomes 138

Outcomes Documentation/Coding 138

Total Medical ComplianceHIPAA

APRIL 14, 2023

On April 11, 2023, the HHS published a notice on upcoming new rules to add greater protection to reproductive health care because of new state laws passed due to the outcome of the Supreme Court ruling on Roe v. You can even call and talk to your patient and document this. New HIPAA rules proposed by Health and Human Services (HHS).

Documentation/Coding 83

Documentation/Coding Outcomes Wellness 83

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

The paramedic called the EM physician ahead of arrival and discussed the case and ECGs, and both agreed upon activating "Code STEMI" (even though of course it is not STEMI by definition), so that the acute LAD occlusion could be treated as fast as possible. Long term outcome is unavailable. So the cath lab was activated.

EKG/ECG 125

EKG/ECG EMS Documentation/Coding Shock 125

EMDocs

OCTOBER 10, 2024

Exam is normal except for tenderness as documented in the diagram. She never had a documented abdominal exam. I just failed to document it. The EP documented seeing the patient and agreed with the ARNP’s plan. Takeaways : There are more questions than answers in this case, but: This is a common outcome.

Documentation/Coding 76

Documentation/Coding Hospitals Sepsis Infectious Diseases 76

EMDocs

JUNE 8, 2023

and 9 hours after onset of symptoms, with non-infarcted brain tissue, does the administration of alteplase improve functional outcome at 90 days? Subsequently reduced enrollment to 310 patients because no patients had been lost to follow-up or had insufficient data documented. Intervention: Alteplase 0.9 in alteplase group versus 0.9%

Stroke 79

Stroke Administration Documentation/Coding Outcomes 79

PulmCCM

FEBRUARY 5, 2024

You can read the document here. Also, many patients with infection won’t have fevers, and those that don’t may be at the highest risk for poor outcomes. Read the original document here. Please comment below if you have any suggested additions or edits to this document. What’s a Fever?

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

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 122

Sepsis Fluid Resuscitation Resuscitation Administration 122

RebelEM

JUNE 8, 2023

Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

RebelEM

AUGUST 22, 2024

hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. Outcomes: Primary Outcome: Visual Acuity (VA) Improvement Measured using logarithm of the minimum angle of resolution (logMAR). Within 24 hours after treatment. 1 week after treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

Don't Forget the Bubbles

JUNE 19, 2024

A proportion of the patients who were initially missed using the CDR were found to actually have risk factors documented in EMS reports or the medical record. Were the predictor variables and the outcome evaluated in a blinded fashion? Were the predictor variables and the outcome evaluated in the initial sample?

CPR 124

CPR Research Outcomes Documentation/Coding 124

RebelEM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

Dislocations 119

Dislocations Fractures Soft Tissue Injuries Outcomes 119

The Skeptics' Guide to EM

JULY 27, 2024

It is a medical emergency that requires prompt recognition and treatment to improve patient outcomes. The primary outcome reported was no statistical difference in mortality at 28 days (8% in both groups) despite giving antibiotics 96 minutes earlier [2].

Sepsis 73

Sepsis Outcomes Documentation/Coding Hospitals 73

EMDocs

SEPTEMBER 30, 2024

Primary outcome: Prescription of ICS on ED discharge from the index visit Secondary outcomes: ICS prescription rates in high-risk subgroups Rates of outpatient follow-up within 30 days of an ED visit for asthma Variation in ICS prescription rates among attending ED physicians. The primary outcome was hospital admission rates.

Outcomes 84

Outcomes Academics Documentation/Coding Administration 84

ACEP Now

NOVEMBER 7, 2024

Wound management in the ED is only a starting point, and appropriate referral and follow-up are key to an improved outcome. Photographic documentation of the wound is helpful to enhance continuity of care. Additionally, lower leg edema invokes consideration for applying compression dressings or stockings. Back to the patient.

Burns 97

Burns Documentation/Coding Outcomes Emergency Department 97

Mind The Bleep

NOVEMBER 21, 2023

Unless you’re documenting something hilarious, please keep it brief and to the point. History of Presenting Complaint In this section use SOCRATES to document the pain. Drugs/Allergies When documenting drugs – try to get the dose and frequency (this can be found on Summary Care Records from the GP if you have access).

Documentation/Coding 52

Documentation/Coding COPD EKG/ECG Wellness 52

Emergency Medicine Journal

MARCH 21, 2024

’ –Audre Lorde It has been over 4 years since 14 November 2019 when the first documented case of COVID-19 emerged. This has exposed deep-seated racial inequalities that persist in disease burden, healthcare access and outcomes in patients and healthcare professionals alike. ‘It is not our differences that divide us.

Documentation/Coding 52

Documentation/Coding Outcomes 52

Sensible Medicine

AUGUST 7, 2024

And while PP is mostly aesthetic, severe cases are usually prescribed physical therapy and sometimes orthosis (helmets), although Collett et al shows that the outcome is the same with or without physical therapy, and with or without orthotic treatment. There is some evidence that PP may increase the need for orthodontic treatment.

CDC 119

CDC Documentation/Coding Research Pediatrics 119

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 94

Sepsis Fractures Documentation/Coding Administration 94

American Medical Compliance

APRIL 16, 2024

Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve healthcare outcomes. Furthermore, advance directives are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your wishes.

Documentation/Coding 67

Documentation/Coding Research Outcomes 67

American Medical Compliance

JUNE 24, 2024

Within this training, we will explore the understanding of skin conditions regarding elderly patients, plan of action in case a skin breakout occurs, identify residents who are vulnerable to certain skin conditions, and how accurate documentation is crucial in keeping patients healthy.

Documentation/Coding 52

Documentation/Coding Outcomes 52

American Medical Compliance

AUGUST 7, 2024

For example, CMS requires accurate and timely documentation of patient care to ensure proper billing and reimbursement. By following these guidelines, healthcare providers secure the necessary funding, improve patient outcomes, and foster trust within the healthcare system, ultimately enhancing the overall quality and efficiency of care.

Hazardous Materials 80

Hazardous Materials Documentation/Coding Legal Issues Patient Safety 80

American Medical Compliance

JUNE 28, 2024

Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve patient care outcomes. Languages: American English Key features: Audio narration, learning activity, and post-assessment.

Teamwork 63

Teamwork Documentation/Coding Outcomes 63