The Trauma Pro

OCTOBER 31, 2023

If you believe that harm will occur, here are your options, from least to most damaging to your professional status at the hospital: Contact another consultant in the same or overlapping specialty (if there is one). Contact the trauma medical director, service chief, or hospital administrator and see if they can intervene.

Risk Management 113

Risk Management Fractures Documentation/Coding Hospitals 113

The Trauma Pro

DECEMBER 26, 2023

Everyone knows that venous thromboembolism (VTE) is a potential problem in hospitalized patients, and especially so in trauma patients. Screening looks at patient factors such as age, obesity, and previous VTE, as well as injury risk factors like spine and pelvic fractures and decreased mobility. And we probably won’t, ever.

Fractures 124

Fractures Documentation/Coding Hospitals Research 124

ACEP Now

DECEMBER 6, 2024

1 Relatively little literature on the clinical characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) patients complicated by coronary vasospasm exists beyond anecdotal reports, however. Cardiac arrest secondary to myocardial ischemia from coronary vasospasm is well documented. Angina pectoris. 1959;27:375-388.

Resuscitation 98

Resuscitation EKG/ECG Documentation/Coding COPD 98

EMDocs

DECEMBER 4, 2023

The facility does not have ultrasound (US) availability at the time of the patient’s presentation, as the sonographer comes to the hospital only 2 days a week. The Wells’ Criteria for DVT can help risk stratify [2,3]. In those with a high-risk Wells’ score (>2), a negative D-dimer has less clinical utility.

Ultrasounds 97

Ultrasounds Documentation/Coding Wellness EMS 97

Ken Grauer, MD

FEBRUARY 28, 2023

As a result — IF the 1 lead you are monitoring happens to be one in which P waves are not well seen — then you might assume the irregular rhythm in front of you was AFib. Remember — 12 leads are better than one! Microvascular dysfunction — cardiac vasculitis — intravascular thrombosis.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

ACEP Now

JULY 7, 2024

My current practice is a hybrid of academic and community sites, and I have worked in myriad community hospitals from busy ones to single coverage critical access hospitals. You are well prepared for this. Lead your room well. If the resuscitation does not go as well as you wanted, learn from it and move on.

Resuscitation 98

Resuscitation Risk Management Critical Access Hospitals 98

Don't Forget the Bubbles

MARCH 19, 2024

This has coincided with a widespread shortage of specialist placements for children facing behavioural, psychiatric, and child protection challenges, leading to an over-reliance on the placement of these children in hospitals. A paediatric social admission is one where a child is admitted to the hospital but not for a medical reason.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

American Medical Compliance

AUGUST 7, 2024

It protects the health and well-being of staff. For example, CMS requires accurate and timely documentation of patient care to ensure proper billing and reimbursement. Adhering to CMS quality measures, such as reducing hospital readmission rates and improving patient safety protocols, helps maintain high standards of care.

Hazardous Materials 105

Hazardous Materials Documentation/Coding Legal Issues Patient Safety 105

EMDocs

FEBRUARY 13, 2024

If tomorrow, CMS came out with a new pay-for-performance metric that tied hospital reimbursement with clinician work satisfaction, what do you think would happen? The hospital would move heaven and earth to improve your satisfaction scores. Maybe your group or hospital has something to this effect and, if so, embrace it.

Emergency Department 98

Emergency Department Documentation/Coding Hospitals Wellness 98

Clinical Correlations

NOVEMBER 1, 2024

By Chloe Fong Peer Reviewed The correlation between vitamin deficiency and alcohol use disorder (AUD) has been well documented in the literature, with a study from 1963 finding that 70% of patients admitted to the hospital.

Documentation/Coding 52

Documentation/Coding Hospitals Wellness 52

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. First aid done pre-hospital. Provide detailed documentation of the initial assessment, treatment provided, and the patient’s response to interventions.

Burns 52

Burns Fluid Resuscitation PPE Hyperthermia / Hypothermia 52

Pediatric EM Morsels

AUGUST 18, 2023

None of the patients were documented to have joint disease at follow up. Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications. There were 2523 children included. 451 pediatric patients were included. J Pediatric Infect Dis Soc.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

Sensible Medicine

APRIL 12, 2024

For probably the twelfth time on Sensible Medicine, I’ll reference Lisa Rosenbaum’s essay, Being Well while Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training which brought some of the current inter-generational angst to the fore. That 95-hour work week was not all work.

Radiology 82

Radiology Radiology Hospitals Documentation/Coding 82

Don't Forget the Bubbles

JUNE 19, 2024

Well-designed multicentre large studies in children were warranted; cue Leonard et al. This may limit the generalisability of the results in regional/community hospital settings. 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.

CPR 124

CPR Research Documentation/Coding Outcomes 124

PulmCCM

FEBRUARY 5, 2024

You can read the document here. Depends On the Patient, and Who You Ask The Centers for Disease Control and Prevention defines a fever (for general hospitalized patients) as >38°C. Read the original document here. Ultrasound is well-suited for identifying most serious biliary system abnormalities.

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

RebelEM

JUNE 8, 2023

The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study. PMID: 31270748 Maheshwari K, et al. Intensive Care Med. 2018;44(6):857–67. PMID: 29872882 Jones AE, et al. 2006;130(4):941–6.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

American Medical Compliance

JANUARY 25, 2024

The CDC’s FluSurv-NET system, a sentinel network of healthcare facilities, documented over 104,000 flu-related hospitalizations across 13 states during past flu seasons. The year 2024 marks another significant chapter in the healthcare industry’s ongoing battle against infectious diseases, and the numbers speak volumes.

Infectious Diseases 111

Infectious Diseases PPE CDC Documentation/Coding 111

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. What They Did: Researchers conducted a multicenter, retrospective cohort study in three community hospitals and two freestanding emergency departments.

Administration 96

Administration Outcomes Documentation/Coding Emergency Department 96

Northwestern EM Blog

MARCH 1, 2025

In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. Position arms in a comfortable position, avoiding any position that could cause a brachial plexus injury, and ensure they are well-supported to avoid pressure ulcers.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

Sensible Medicine

AUGUST 7, 2024

This is an astounding difference in the quality of sleep, and to this day, premature infants in the hospital are slept on their stomachs. There is evidence that, for children and adults, elevated cortisol levels and chronic stress can lead to behavioral, mental-health, and mood issues, as well as changes in inflammation and immunity.

CDC 111

CDC Documentation/Coding Research Pediatrics 111

The Skeptics' Guide to EM

JUNE 2, 2021

Dr. Wendy Levinson is the Chair of Choosing Wisely Canada (CWC) and a Professor of Medicine, University of Toronto This SGEM Xtra is based on document created by CADTH and presented at Choosing Wisely Canada […] The post SGEM Xtra: High-Value Care Post Covid19 – Did you ever have to make up your mind?

Documentation/Coding 52

Documentation/Coding Hospitals Wellness 52

Don't Forget the Bubbles

DECEMBER 13, 2023

It is commonly seen in the first couple of years of life and accounts for 1-5% of paediatric hospital admissions for those under two. Failure to thrive’ has many definitions We use standardized charts to document infant growth. Though it has been hard, they have been coping well and enjoying parenthood. It is not a diagnosis.

Dehydration 98

Dehydration CDC Hospitals Wellness 98

ALiEM

JANUARY 22, 2024

Fever was documented to be 102°F and was not associated with any chills or rigors. The patient also complained of shortness of breath for one week associated with a dry cough, as well as an altered sensorium for one day. The patient during his hospital stay developed ARDS and was on mechanical ventilation for 20 days.

Academics 64

Academics Documentation/Coding Emergency Department Hospitals 64

RebelEM

AUGUST 22, 2024

1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. Finally, most hospitals lack the necessary protocols and processes to coordinate the complex interdisciplinary care patients with RAO may require. Patients whose last known well (LKW) time was within 24 hours of presentation. 1 week after treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

Mind The Bleep

SEPTEMBER 1, 2024

A clinical attachment is a short period of time (can be anywhere from a month up to a year) where a qualified medical graduate, i.e., having sat their PLAB 2 and in the process of getting GMC registered, is attached to a trust hospital in the NHS with the primary purpose of gaining NHS experience. Is it a requirement to work in the NHS?

Hospitals 52

Hospitals Documentation/Coding Administration Wellness 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 95

Psychiatric Pediatrics Emergency Department Administration 95

ACEP Now

JUNE 7, 2023

Whereas previous versions of GPT were unable to pass the medical examinations, GPT-4 demonstrated scores of approximately 85 percent correct on each Step of USMLE, well above the passing threshold. Future versions are likely to have greater accuracy and error-checking abilities, as well as improved domain-specific generative abilities.

Documentation/Coding 78

Documentation/Coding Wellness Administration Research 78

Medagadget

MAY 23, 2023

This task can be complex and very time-consuming.Resource utilization: treating transplant rejection may need hospitalization, additional diagnostic tests, etc. It requires the integration of data from a kidney transplant biopsy ( i.e. , histological lesions scores), as well as clinical, immunological, and transcriptomic data.

Research 83

Research Hospitals Documentation/Coding Operations 83

Mind The Bleep

FEBRUARY 27, 2024

This is hospital dependent and you should be told about which fluid to prescribe at your induction (or I’m sure the nurses will tell you!) 1] It is worth mentioning this formula was designed for well, euvolaemic children, which does not represent the popluation of children who require IV fluids. How much fluid? 0 Magnesium 0.7-1

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

The Skeptics' Guide to EM

OCTOBER 28, 2017

Pediatrics 2017 Guest Skeptic: Dr. Anthony Crocco is a Pediatric Emergency Physician and is the Medical Director & Division Head of the Division of Pediatric Emergency at McMaster’s Children’s Hospital. Case: A 12-day old girl presents with fever and is otherwise well. Anthony is also the creator of SketchyEBM.

Pediatrics 52

Pediatrics Documentation/Coding Emergency Department Hospitals 52

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. 1 Hospital boarding is the main driver of ED crowding, with patients nearly always awaiting transfer to inpatient beds and now more commonly, to other hospitals.

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

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). (And Journal of the history of the neurosciences, 6(2), 147–153.

Infectious Diseases 98

Infectious Diseases Seizures Ultrasounds Sepsis 98

Don't Forget the Bubbles

MAY 6, 2024

of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) 807 patients between the ages of 7 days to 17 years, from the ED, ward and PICU, were included across ten hospitals in Switzerland. Data collected were the worst values documented within the same calendar day as the blood cultures were obtained. Of the 74.9%

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

SheMD

OCTOBER 8, 2023

My life outside of the hospital has always served to make me more balanced and I hope to continue to foster that in residency.” “You Actually, I wanted to ask what supports the program has in place for parents (male and female) as well as people increasing their families, be it biologically or through adoption?”

Leadership 105

Leadership Best Practices Academics Documentation/Coding 105

Don't Forget the Bubbles

JANUARY 22, 2024

Repeated GP and hospital attendance might stimulate increased testing and unnecessary prescriptions. Blood cultures are commonly drawn for certain focal infections such as pneumonia , skin and soft tissue infections (SSTIs), asthma , bronchiolitis as well and UTIs. Families and patients may drive over-investigation. Alasdair Munro.

Emergency Department 90

Emergency Department Best Practices Radiology Radiology 90

Cook County EM Blog

MARCH 10, 2022

Neurosurgery was not consulted, as there was not a well visualized syrinx or epidural hematoma to be evacuated. Chronic compressive or mechanical stress on the spinal cord has been well documented to increase the risk of syrinx and secondary spinal cord changes. C4 sensory distribution was also reduced in our patient.

Emergency Department 52

Emergency Department Hospitals Documentation/Coding Wellness 52

EMDocs

FEBRUARY 9, 2024

Authors: Adam Roussas, MD, MBA, MSE // Reviewed by: Jamie Santistevan, MD ( @jamie_rae_EMdoc, EM Physician, Presbyterian Hospital, Albuquerque, NM); Manpreet Singh, MD ( @MPrizzleER ); and Brit Long, MD ( @long_brit ) Case A 40-year-old female presents to the emergency department for palpitations and lightheadedness.

EKG/ECG 98

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 98