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.

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation EMS 98

Mind The Bleep

NOVEMBER 21, 2023

” Yes, I have seen clerking look like this and I can confirm, it does not go down well. 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.

Documentation/Coding 52

Documentation/Coding COPD EKG/ECG Wellness 52

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. Secondary outcome All secondary outcomes were found to be similar (Not statistically significant) between groups (See table above). Article: Rossi N et al.

Administration 97

Administration Outcomes Documentation/Coding Emergency Department 97

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 outcomes measured were the number of CT scans ordered, ED length of stay, and the cost of avoidable CT scans. Cost of care was also estimated.

Emergency Department 53

Emergency Department Documentation/Coding Outcomes Wellness 53

ACEP Now

OCTOBER 9, 2023

percent) do not speak English as a primary language, and 25 million of those speak English less than well (known as “limited English proficiency” or LEP); many indicators show this number will only continue to grow. Physicians should document the interpreter’s name and identification number if available in the patient’s chart.

Emergency Department 64

Emergency Department Documentation/Coding EMS Wellness 64

Don't Forget the Bubbles

JUNE 19, 2024

Well-designed multicentre large studies in children were warranted; cue Leonard et al. 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?

CPR 121

CPR Research Outcomes Documentation/Coding 121

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

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) The primary outcome was the successful intubation on the second attempt. Of the 74.9% Why does it matter?

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

Taming the SRU

APRIL 22, 2023

If untreated, atrial fibrillation can increase clot formation and lead to an increased risk for heart attack and stroke as well as development of congestive heart failure. There were similar lengths of say overall and no significant difference in safety outcomes. The diltiazem group had greater reduction in HR at 30 and 60 minutes.

Outcomes 52

Outcomes Documentation/Coding Stroke Fractures 52

ACEP Now

OCTOBER 30, 2023

One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. This makes documentation and communication of the utmost importance for these patients for their health and safety.

Sexual Assault 98

Sexual Assault Teamwork Outcomes Dehydration 98

RCEM Learning

JANUARY 23, 2024

This can include randomisation procedures, recruitment and follow-up response rates, what outcome measures patients will prefer, whether patients agree to complete the intervention (in this case the exercise programme) and so on. There was nothing further I could do at that point to change the outcome of the trial.

Research 72

Research Wellness Outcomes Documentation/Coding 72

American Medical Compliance

JULY 9, 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. Observe and document any signs of abuse, such as unexplained injuries or changes in behavior.

Elder Abuse 52

Elder Abuse Documentation/Coding Outcomes Wellness 52

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. What could possibly go wrong?

Radiology 78

Radiology Radiology Hospitals Documentation/Coding 78

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

Dr. Smith's ECG Blog

AUGUST 9, 2024

He had no previously documented medical problems except polysubstance use. The LCx and OM vessels are not as well visualized. Opioids associate with worse outcomes in myocardial infarction , probably because they eliminate the pain signal that informs the clinician of the urgency of revascularization. Do not treat AIVR.

EKG/ECG 88

EKG/ECG EMS Emergency Department Outcomes 88

American Medical Compliance

JULY 2, 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. Document observations consistently to identify patterns and trends over time.

Patient Safety 73

Patient Safety Documentation/Coding Outcomes Wellness 73

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. Ultrasound is well-suited for identifying most serious biliary system abnormalities. What’s a Fever?

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

Sensible Medicine

JUNE 16, 2023

This can happen while watching my daughter’s track meet; during a swim; even while documenting another patient’s visit. I may be unaware of bad outcomes, and, like most doctors, without this knowledge I assume good outcomes rather than bad. A patient joins the ghost-patient panel when I realize I no longer see them.

Outcomes 86

Outcomes Documentation/Coding Wellness 86

PulmCCM

JULY 31, 2023

severe hypoxemia not doing well or on a bad trajectory while receiving conventional care). To make that leap, I for one would need to see improved outcomes with caloric restriction in patients with less-severe shock. Extracorporeal membrane oxygenation (ECMO) was encouraged, based largely on the EOLIA trial.

Shock 98

Shock Documentation/Coding Outcomes Wellness 98

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

SheMD

JULY 27, 2023

What were their outcomes: Physician mothers report having more domestic responsibilities than their partners. Unequal distribution of domestic responsibility has been documented as a factor in the underrepresentation in female physicians in leadership roles in academic medicine as well as contributing to career satisfaction.

Academics 52

Academics Leadership Documentation/Coding Research 52

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Long term outcome is unavailable. RED dotted lines in ECG #2 that mark the ST segment baseline in lead V2 , and leads V4 , V5 , V6 — document new ST elevation that was not present in ECG #1. Post cath EF was estimated at 15% with severe global hypokinesis, and akinesis of the apex.

EKG/ECG 86

EKG/ECG EMS Documentation/Coding Shock 86

Northwestern EM Blog

SEPTEMBER 26, 2022

It is well-documented that ED physicians have historically high rates of burnout compared to other specialties as well as a high incidence of post-traumatic stress disorder (PTSD) compared to the general population. PTSD is 2 times more prevalent in physicians (14.8%), with EM resident physicians falling in the range from 11.9%-21.5%.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

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 93

Sepsis Administration Fractures Documentation/Coding 93

The Skeptics' Guide to EM

JANUARY 23, 2021

The SGEM bottom line was that increasing APP coverage has minimal effect on ED flow and safety outcomes based on the data. The American College of Emergency Physicians ( ACEP ) also has a number of documents discussing APPs in the ED. The difference in training between and emergency medicine physician and APPs is well recognized.

Research 52

Research Poisoning Documentation/Coding Outcomes 52

AED Leader

JULY 3, 2024

When it comes to ensuring the safety and well-being of your business and its employees, having a reliable automated external defibrillator (AED) is essential. With a Cardiac Science AED defibrillator, you can have confidence that your CPR efforts are optimized for the best possible outcome.

CPR 52

CPR Resuscitation Pediatrics Operations 52

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. Delays in care, as seen in our patient, can lead to poor neurological outcomes (1,2). Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome. J Neurosurg.

Emergency Department 52

Emergency Department Hospitals Wellness Outcomes 52

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

It radiated to both shoulders and both upper extremities, and there was shortness of breath and diaphoresis as well. Ongoing pain noted throughout all documentation, but after nitro drip and prn morphine, "pain improved to 2/10." Long term outcome unknown but obviously bleak. He reported a normal stress test a few years ago.

EKG/ECG 82

EKG/ECG Outcomes Academics Documentation/Coding 82

EMDocs

JULY 3, 2023

Introduction SAH has the potential for rapid progression and devastating outcomes. All patients with concern for SAH need a rapid primary survey to assess the airway, breathing, and circulation as well as a comprehensive neurologic exam to create a baseline for the patient. What are the next steps in the management of this patient?

Seizures 85

Seizures Stroke Outcomes EMS 85

Sensible Medicine

JUNE 30, 2023

1] Would the outcomes be different? On the other hand, KW was a middle-aged American man with chest pain and significant risk factors for coronary artery disease – hypertension and diabetes – neither of which had ever been terribly well-controlled. She was well hydrated and her vital signs were normal.

Hospitals 94

Hospitals Hospice Resuscitation COPD 94

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. JAMA Neurol.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Sensible Medicine

SEPTEMBER 26, 2023

Researchers would know that whatever they publish is eventually going to be linked to a list of replication attempts and their outcomes.” ” As well, such a rule “would also increase accountability for journals. ” It's time to adopt the Pottery Barn rule.

Research 128

Research Hospitals Documentation/Coding Outcomes 128

The Skeptics' Guide to EM

MAY 11, 2019

Background: The first documented appendectomy was done by Claudius Amyand in 1735. Secondary Outcomes: “Length of stay during index hospitalization, cost of index hospitalization, number of follow-up visits required in the following year, and the total cost of appendicitis-associated care in the year after diagnosis. .

Documentation/Coding 52

Documentation/Coding Operations Academics Ultrasounds 52

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. Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. have published a number of warnings about the previous reassuring studies.[4,5]

EKG/ECG 121

EKG/ECG Documentation/Coding Emergency Department Outcomes 121

Taming the SRU

NOVEMBER 14, 2023

B) on right: hand drawn images of layers of ear demonstrating auricular hematoma The epidemiology and incidence of ED presentation for auricular hematomas has not been well-studied because it is a relatively uncommon condition. Courtesy of wiki commons under CC Attribution 3.0 germany File:Hematoma ear.jpg - Wikimedia Commons.

Emergency Department 91

Emergency Department Pediatrics Wellness Documentation/Coding 91

Don't Forget the Bubbles

JUNE 10, 2024

Baby A, a preterm infant, appears to be faring well for the moment—requiring minimal respiratory support, on full feeds, without IV access, and generally in an okay condition. The history of necrotising enterocolitis The earliest documented cases resembling Necrotising enterocolitis (NEC) date back to the late 19th and early 20th centuries.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

Emergency Medicine Ireland

MAY 3, 2021

Now is not the time for permissive hypercapnoea and so for your patients with head injury and ARDS this can be really challenging The BTF guidance is the key guideline document that should be referenced and it is well worth a read for any exam candidate and indeed any clinician dealing with TBI.

Head Injuries 40

Head Injuries Hyperthermia / Hypothermia Documentation/Coding Outcomes 40