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

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. Real-Time CPR Feedback Performing cardiopulmonary resuscitation (CPR) correctly is crucial for the success of a resuscitation attempt.

CPR 52

CPR Resuscitation Pediatrics Operations 52

RebelEM

JUNE 8, 2023

Epinephrine – 10ug/mL, 10mL syringe Phenylephrine – 100ug/mL, 10mL syringe Phenylephrine bolus doses from 100-200ug and epinephrine 10-20ug administered every 2-5 minutes pursuant to provider order Inclusion Criteria: Adults age >18 years old Received at least one bolus dose of phenylephrine or epinephrine pre-filled syringes Exclusion (..)

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

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. The mean time to randomisation was 2 hours, which excludes the initial resuscitation window. Of the 74.9% 1872 children (mean age 2.5

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

Mind The Bleep

MAY 1, 2024

If the limb is pale and pulseless this needs urgent referral to vascular as well as orthopaedics and the fracture needs reducing immediately. Appropriate first line management will help protect and resuscitate the soft tissues and keep the fracture still either to allow healing or until definitive management (operative fixation) is possible.

Fractures 52

Fractures Head Injuries Documentation/Coding Dislocations 52

Mind The Bleep

FEBRUARY 27, 2024

There could be any number of reasons for this but some examples are: they have severe D&V and aren’t keeping fluids down, or because they are pre or post-op, or have presented very unwell and need fluid resuscitation. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose.

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

RebelEM

MARCH 27, 2023

What They Did: Retrospective, observational cohort study in a single high-volume academic hospital The ED had a 5 bed area used for ongoing management and resuscitation of patients who clinically deteriorate while boarding or while actively undergo a workup in other sections of the ED. J Crit Care.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Mind The Bleep

FEBRUARY 29, 2024

This may well seem daunting given how unwell and complex the patients might be but a thorough, well-structured A-E will give you most of the information you need to progress that patient’s care. C Assessment BP and MAP Invasive reading (via an arterial line) or non-invasive (via a BP cuff)? (See

Documentation/Coding 52

Documentation/Coding Hospitals Wellness Best Practices 52

EMDocs

JANUARY 11, 2024

Cardiac Management Takeaway : Perform an echo as soon as you can to guide resuscitation. Individualize MAP targets based on the patient, as well as treatments (inotropes, vasopressors, and fluids) for hypotensive patients. Validated illness severity scores may be used to optimize therapeutic interventions (88.2%, 15/17).

Seizures 97

Seizures Shock Infectious Diseases CPR 97

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients. Am J Cardiol.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Advanced Emergency Nursing from AENJ

NOVEMBER 20, 2014

It is critically important to document the physical findings in a plain-seeing, plain-speaking, non-judgmental manner that will not color or taint future investigations. Accurate time entries are important to document. Natural psycho-physiological responses may alter perceptions during the life-threatening event.

Military 40

Military Forensics Documentation/Coding Emergency Nursing 40

ACEP Now

FEBRUARY 11, 2024

4 It is believed that substantial gastrointestinal loss causes chloride and potassium depletion, as well as hypovolemia, acute kidney injury, and renal potassium loss. There have been documented cases of overdose, and of note, there is no known antidote. Patients may consequently present with vague symptoms of weakness and fatigue.

Seizures 52

Seizures Fluid Resuscitation Poisoning EKG/ECG 52

Ken Grauer, MD

JULY 29, 2023

The ECG in Figure-1 was obtained from an 18-year old woman — who moments before been resuscitated from out-of-hospital cardiac arrest. How would YOU interpret her post-resuscitation ECG? Figure-1: The initial ECG in today's case — obtained following resuscitation from cardiac arrest of an 18-year old woman. About A RVC/ A RVD.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

This patient was reported to have distant heart sounds but was not hypotensive and did not have JVD according to documentation. There appears to be some ST elevation in leads II and aVF, as well as to a lesser extent in the lateral chest leads. Beck’s triad only happens all 3 together in approximately 1/3rd of patients.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

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 Resuscitation 40

EB Medicine

JULY 8, 2019

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. For the sake of completeness, just be aware that there is also the biliopancreatic diversion with or without a duodenal switch, as well as a vertical banded gastroplasty.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

ACEP Now

OCTOBER 3, 2023

This document is an update of guidelines first published in 2000, and then updated in 2007. Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

Advanced Emergency Nursing from AENJ

SEPTEMBER 4, 2014

This is the fifth part of our series on "Early Modern Resuscitation." " Part I: Oral Airways, early resuscitation, and recognition of airway care. It was not a practical resuscitative aid until production could be commercially successful (~1895) and made portable in compressed form.

Resuscitation 40

Resuscitation CPR Documentation/Coding Military 40

Advanced Emergency Nursing from AENJ

MAY 27, 2014

This is the fourth part of our series on "Early Modern Resuscitation." " Part I: Oral Airways, early resuscitation, and recognition of airway care. The select bibliography will provide ample links to extend your reading. “Carbon Dioxide Resuscitation?” You think to yourself, “ What could that be?” In 1927, H.W.

Resuscitation 40

Resuscitation Poisoning Research Administration 40

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Although told several times, the story of the development by Henning Ruben of the prototypical modern manual resuscitator, the self-refilling bag with unidirectional non-rebreathing valves which now dominate the world of resuscitation, is still not well-known. Czech Military resuscitation kit, 1969, mfr.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

RebelEM

SEPTEMBER 26, 2022

Patients from both groups are well balanced regarding results from a wide range of coagulation studies. Rezaie, MD (Twitter: @srrezaie ) The post TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding appeared first on REBEL EM - Emergency Medicine Blog. Significant coagulopathy: INR > 1.8

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

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. Any team member of the resuscitation may lead the hot debrief.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

Dr. Smith's ECG Blog

APRIL 8, 2016

He had significant history of CAD with CABG x5, and repeat CABG x 2 as well as a subsequent PCI of the graft to the RCA (twice) and of the graft to the Diagonal. After resuscitation, he was found to have a 90% thrombotic lesion in the same saphenous vein graft to the right posterior descending artery. Most recent echo showed EF of 60%.

Resuscitation 52

Resuscitation EKG/ECG Hospitals Administration 52

Sensible Medicine

JUNE 30, 2023

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. PH is a woman I have written about in the past.

Hospitals 98

Hospitals Hospice Resuscitation COPD 98

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Taming the SRU

MAY 30, 2023

Generally accepted (and some airlines spell it out) that they are assuming the liability even for you helping Documentation: To protect yourself (and the airline), will/should make documentation of what happened. Legal implications vary from country to country. Airline companies have been sued.

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52

Downeast Emergency Medicine

APRIL 26, 2021

Trauma patients between the ages of 18-90 years had to have either had one documented episode of hypotension (defined as a systolic BP <90 mmHg) or tachycardia (>100 beats/minute) to be included in the study. Military application of tranexamic acid in trauma emergency resuscitation (MATTERs)study. Arch Surg 2012; 147:113-119.[

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

The latter 1950s and 1960s, quested for nerve gas defense studying expired air resuscitation and modern resuscitology; developing intensive care units. To me, it harkens a new scientific renaissance of resuscitation science, emergency care, and creating systems for care. 1950s & 1960s Resuscitation Research. 10/20/2013.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

ACEP Now

MARCH 14, 2024

Treatment for burns should focus on fluid resuscitation as appropriate based on your institution’s burn protocol per Brooke, Parkland, Rule of 10s etc. Documentation with coronary arteriography within 12 1/2 hours of the onset of symptoms in two cases (three episodes). Emerg Med Pract. 2018 Nov;20(11):1-20. Oliva PB, Breckinridge JC.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

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

Northwestern EM Blog

SEPTEMBER 12, 2022

It is well known that most hospitals in large population centers already operate at or near full capacity [4]. These patients are expected to decompensate within the hour but did not need immediate resuscitation [2]. This makes it even more challenging when presented with an acute influx of patients in a short period of time.

Mass Casualty Incidents 52

Mass Casualty Incidents EMS Hospitals Hazardous Materials 52

EM Updates

JUNE 15, 2021

Any patient requiring high acuity care not thought to be infected with coronavirus was cared for in a different area that had previously been a low acuity zone, but which was subsequently equipped for resuscitation. and Emergency Medicine residents, in 12 hour shifts. Of these, 10 patients did not have curative goals of care (i.e.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

AED Leader

AUGUST 22, 2024

Using an AED within minutes greatly enhances outcomes for victims and underscores the importance of being trained in CPR as well. Knowing how to perform cardiopulmonary resuscitation effectively can double or even triple a victim’s chances of survival before an AED arrives. Sudden cardiac arrest (SCA) can happen without warning.

CPR 52

CPR Shock Operations Outcomes 52

EB Medicine

OCTOBER 1, 2018

Jeff : So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? And sepsis-3 redefined septic shock as “hypotension not responsive to fluid resuscitation” with the added requirement of vasopressors to maintain a MAP greater than or equal to 65 and with a lactate > 2. So quite a few changes!

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

EB Medicine

MARCH 1, 2019

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. Post opiate hypotension in prehospital trauma patients is a rare but documented complication. Unfortunately, CT does not perform well for the evaluation of myocardial contusions.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. For example, patients with misdiagnosed disease has less RLQ pain and tenderness as well as diminished anorexia, nausea, and vomiting. Jeff: True.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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 98

Emergency Department Resuscitation COPD Shock 98