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. 45:446-458. Taira B, et al.

Documentation/Coding 82

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

AENJ: Current Issue

SEPTEMBER 30, 2023

The overuse of computed tomographic (CT) scans for patients who present to the emergency department (ED) after mild traumatic brain injury (mTBI) has been well-documented. The Canadian Computed Tomography Head Rule (CCHR) is a validated tool to guide ED providers in determining the need for emergent CT of mTBI patients.

Emergency Department 52

Emergency Department Documentation/Coding Outcomes Wellness 52

ACEP Now

DECEMBER 17, 2024

But we should not have to sacrifice our own well-being in the process. We deal with difficult and traumatizing situations daily, and nowhere is this more apparent than in the emergency department, where sickness, violence, and death are routine. In Washington, D.C., died by suicide.

Burns 105

Burns Hospitals Documentation/Coding Emergency Department 105

Pediatric EM Morsels

JULY 5, 2024

We collected data directly from the bedside clinician which enabled us to gather pertinent patient symptoms and physical examination findings that may not be well documented in the medical record, but more accurately identify the child’s injuries.” Indian J Orthop. 2018;52(5):489-500. PMID: 30237606. Lancet Child Adolesc Health.

Pediatrics 161

Pediatrics Head Injuries Dislocations Research 161

EM Literature of Note

OCTOBER 1, 2023

” This brief report in Annals describes a retrospective experiment in which 30 written case summaries lifted from the electronic documentation system were fed to either clinician teams or ChatGPT. Each case was tested both solely on the recorded narrative, as well as with laboratory results added.

Documentation/Coding 88

Documentation/Coding Operations Emergency Department Wellness 88

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. There are well preserved R-waves in Wellens waves. What do you think? ng/mL, BNP 2790, and lactate 3.7.

EKG/ECG 135

EKG/ECG Emergency Department Shock Ultrasounds 135

EM Updates

JUNE 15, 2021

Maimonides Medical Center (MMC) is Brooklyn’s largest hospital, an academic quaternary care center with, in normal times, 711 total beds, 66 intensive care beds, and an Emergency Department that treats approximately 120,000 patients per year. On March 9, the first patient with a novel coronavirus infection was admitted to MMC.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

EMDocs

JULY 25, 2024

The nurse completes the Columbia-Suicide Severity Rating Scale (C-SSRS) and documents that the patient’s recent thoughts of killing himself and his detailed plan makes him “High Risk” for suicide. There is no documented handoff to the on-coming emergency physician (EP) who assumes care. ” (See reference #1 below.)

Documentation/Coding 82

Documentation/Coding Hospitals Patient Safety Emergency Department 82

EMDocs

OCTOBER 3, 2023

Emergency Physician and founder of Orman Physician Coaching Host of the Stimulus Podcast Learn more at roborman.com If you want to hear the coaching session where Brit and Rob deconstructed his shift and came up with this strategy, it’s here. Episode 87: Conquering Mid-Shift Overwhelm Mid-shift in an emergency department is a special beast.

Documentation/Coding 98

Documentation/Coding EMS Operations Emergency Department 98

RebelEM

JUNE 8, 2023

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. J Med Toxicol. Epub 2019 Jul 3. Intensive Care Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Don't Forget the Bubbles

JUNE 19, 2024

Well-designed multicentre large studies in children were warranted; cue Leonard et al. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. Lancet Child Adolesc Health. 2024 Jun 3:S2352-4642(24)00104-4.

CPR 124

CPR Research Outcomes Documentation/Coding 124

Dr. Smith's ECG Blog

OCTOBER 18, 2023

If you were working in a busy emergency department, would you like to be interrupted to interpret these ECGs or can these patients safely wait to be seen because of the normal computer interpretation? Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. Am J Emerg Med.

EKG/ECG 118

EKG/ECG Documentation/Coding Emergency Department Outcomes 118

ACEP Now

NOVEMBER 7, 2024

About three percent of emergency department (ED) visits are due to skin and soft tissue infections, but data are lacking on the contribution of chronic wounds to this number. Photographic documentation of the wound is helpful to enhance continuity of care.

Burns 97

Burns Outcomes Documentation/Coding Emergency Department 97

EMDocs

FEBRUARY 13, 2024

You can’t control the influx, but you can control how you approach it, how you document, your own internal triage, team communication. What goes well, what could go better, and how can you tweak it? What happens in the emergency department impacts your life outside the emergency department.

Emergency Department 74

Emergency Department Hospitals Documentation/Coding Wellness 74

EMDocs

DECEMBER 4, 2023

Johnson, MD ( Community EM, Salina Regional Health Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra, MD (Cleveland Clinic Foundation, EM-CCM); Brit Long, MD (@long_brit) Case A 40-year-old woman presents to a rural emergency department (ED) with left leg pain and swelling for the past 5 days.

Ultrasounds 71

Ultrasounds Documentation/Coding Wellness EMS 71

Dr. Smith's ECG Blog

OCTOBER 12, 2024

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. Vital signs were within normal limits on arrival to the Emergency Department. Written by Bobby Nicholson What do you think of this “STEMI”? Blood glucose was not low at 162 mg/dL.

EKG/ECG 94

EKG/ECG Documentation/Coding Emergency Department COPD 94

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. The patient during his hospital stay developed ARDS and was on mechanical ventilation for 20 days.

Documentation/Coding 64

Documentation/Coding Academics Emergency Department Hospitals 64

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 92

Emergency Department Pediatrics Wellness Fractures 92

RebelEM

JULY 3, 2023

Currently, the infusion of IV calcium before diltiazem is not well understood, and more studies have focused on administering IV calcium prior to verapamil than diltiazem. Impact of intravenous calcium with diltiazem for atrial fibrillation/flutter in the emergency department. Am J Emerg Med. Article: Rossi N et al.

Administration 93

Administration Outcomes Documentation/Coding Emergency Department 93

EB Medicine

MARCH 1, 2019

This month, after a few months of primarily medical topics, we’re talking trauma, specifically Blunt Cardiac Injury: Emergency Department Diagnosis and Management. Nachi: This month’s team parsed through roughly 1200 articles as well as guidelines from the eastern association for surgery in trauma also known as EAST.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

The Skeptics' Guide to EM

OCTOBER 1, 2022

Disparities in the emergency department management of pediatric migraine by race, ethnicity, and language preference. Guest Skeptic: Dr. Lauren Westafer is an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. AEM September 2022. AEM September 2022.

Pediatrics 52

Pediatrics Emergency Department Documentation/Coding Research 52

EMDocs

JUNE 2, 2023

You should always follow your local practice guidelines and recommendations as well as adhere to approved medications in your facility. Document what you gave and why, as well as the impact. If a patient has a PRN on their med list do that! Route of administration If the patient is cooperative, offer oral medications first.

Psychiatric 66

Psychiatric Pediatrics Emergency Department Administration 66

Don't Forget the Bubbles

OCTOBER 10, 2024

Adopting this approach would reduce time in surgery for the child as well as the financial cost of nail bed repair. Exploring communication preferences and risk thresholds of clinicians and parents of febrile infants under 90 days presenting to the emergency department: a qualitative study. Arch Dis Child. Epub ahead of print.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

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.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

All Ohio EM

JULY 15, 2019

By Christy Rukamp DO and Zachary Hampton DO At times, documentation feels like the bane of existence. In residency, we practice resuscitations, rehearse critical procedures, and review in-service test questions; however, we rarely learn key components of documentation. CT scan was performed, as well as urinalysis and lab work.

Documentation/Coding 52

Documentation/Coding Wellness Emergency Department Resuscitation 52

Taming the SRU

AUGUST 4, 2024

We discussed some practices to push learners outside of their comfort zone and promote learning, based on their level as well as their goals for the shift.

Dislocations 84

Dislocations Emergency Department Documentation/Coding Burns 84

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. Constitutional : No distress, well appearing. Other documented pharmacological causes of anisocoria include nebulized ipratropium bromide and scopolamine (14-19). EOM intact bilaterally.

Pediatrics 64

Pediatrics Documentation/Coding Academics Administration 64

EB Medicine

MAY 3, 2019

This month, we’re moving into uncharted territories for the podcast… we’re talking psychiatry Nachi: Specifically, we’ll be discussing Depressed and Suicidal Patients in the emergency department. The PSS-3 assesses for depression/hopelessness and suicidal ideations in the past 2 weeks as well as lifetime history of suicide attempt.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

Dr. Smith's ECG Blog

MAY 13, 2024

Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain. The ECG shows sinus rhythm and relatively normal QRS morphology.

EKG/ECG 104

EKG/ECG Emergency Department Ultrasounds Documentation/Coding 104

Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. He had no previously documented medical problems except polysubstance use. The LCx and OM vessels are not as well visualized.

EKG/ECG 84

EKG/ECG EMS Emergency Department Outcomes 84

EMDocs

SEPTEMBER 23, 2023

Physical exam reveals a well-appearing female in no acute distress. A 23-year-old man with no significant medical history presents to the emergency department for evaluation of a syncopal episode. The patient states that this has never happened before. Neurological exam is also unremarkable. Mayo Clin Proc 2000;2013:845.

EMS 84

EMS EKG/ECG Documentation/Coding Emergency Department 84

Taming the SRU

SEPTEMBER 1, 2023

Shewakramani Sepsis is associated with 20-40% mortality Screening tools for detecting patient at risk for sepsis in the ED SIRS Criteria (more sensitive tool) Temp <36C (96.8F) or >38C (100.4F) HR >90 RR >20 WBC <4k or >12k (or >10% bands) qSOFA Score GCS <15 RR >22 SBP <100mmHg Overall, SIRS Criteria remains (..)

Sepsis 94

Sepsis Fractures Documentation/Coding Administration 94

Taming the SRU

FEBRUARY 5, 2024

(1) However, it wasn’t until the 1890s that purposeful, successful, and safe attempts to access this fluid were documented (2). The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). WHO - Who Needs an LP in the ED?

Infectious Diseases 96

Infectious Diseases Seizures Ultrasounds Sepsis 96

EB Medicine

AUGUST 6, 2019

Nachi: Well, I’m sure more of those studies are still coming. Nachi: Well that was a ton of information and background on the DOACs. Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. Show More v Jeff: Fair enough, we’ll take what we can get.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Don't Forget the Bubbles

MAY 6, 2024

of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) Data collected were the worst values documented within the same calendar day as the blood cultures were obtained. While the use of oral corticosteroids to treat wheeze in asthma is well-established, evidence for their benefit in viral-induced wheeze is mixed.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

The Skeptics' Guide to EM

JANUARY 23, 2021

Emergency Physician and Advanced Practice Provider Diagnostic Testing and Admission Decisions in Chest Pain and Abdominal Pain. AEM January 2021 Case: A 50-year-old male presents to the Emergency Department (ED) with left lower quadrant abdominal pain. The patient is seen by an advanced practice provider (APP).

Poisoning 52

Poisoning Research Documentation/Coding Outcomes 52