Don't Forget the Bubbles

JUNE 19, 2024

Children in the validation cohort were admitted to the intensive care unit or operating room less frequently than those in the derivation cohort. 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

RebelEM

AUGUST 22, 2024

Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Documented at the following time points: Before treatment. Time from Presentation to Treatment: The duration from when the patient arrived at the ED and the stroke code was called to the administration of tPA.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

ACEP Now

SEPTEMBER 5, 2024

Our state chapter members and leaders are uniquely positioned to follow EMRA’s lead in partnering with local EM residency programs to improve communication of ACEP’s value to EM-bound medical students and EM residents by hosting residency visits or local events relevant to our shared mission.

Leadership 98

Leadership PPE EMS Wellness 98

Taming the SRU

AUGUST 4, 2024

Know your audience, and tailor your presentation to them in terms of humor, pop culture references, and dress code Err on the side of making your presentation slightly shorter than the alloted time to allow room for questions. The largest retrospective cohort study to date (Beyde et al.) shows that most will improve with empiric antibiotics.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

PHEM Cast

DECEMBER 12, 2016

Joint Position Statement of Nat Assoc EMS Physicians and ACS Committee on Trauma. pdf Equipment required for resuscitative thoracotomy: Surface anatomy: Appearance of pericardial clot A foley catheter being used to fill a cardiac wound – note how easily this could be pulled out. J Am Coll Surg. 2001, 193 (3): 303-309.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Her husband called EMS when the patient experienced new onset seizures accompanied by micturition. The ECG below was recorded by EMS. I therefore feel it relevant to document ( in your dictation/on the medical chart ) when significant artifact potentially impairs the accuracy of your interpretation. What is your assessment?

Seizures 114

Seizures EKG/ECG EMS Stroke 114

The Skeptics' Guide to EM

JULY 30, 2022

Background: Somewhere between two and four percent of patients presenting to US EDs with abdominal pain have a small bowel obstruction (SBO) – those who are managed operatively (who are only 20-30%) account for 60,000 hospitalizations and 565,000 inpatient care days per year. Also joining us is Dr. Andrew Goldsmith.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

She took an oxycodone and called EMS. The cut points for what constitute OMI and not OMI as well as confidence levels are calibrated to maximize sensitivity and specificity according to the receiver operating characteristic. In a large proportion of cath labs, the operator would probably have ended the case at this point.

EKG/ECG 67

EKG/ECG Operations Wellness Ultrasounds 67

RebelEM

JUNE 8, 2023

Rezaie, MD (Twitter: @srrezaie ) The post The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults appeared first on REBEL EM - Emergency Medicine Blog. Am J Emerg Med. 2016; PMID: 27720568 Guest Post By: Courney Knieriem, MD PGY-1, Emergency Medicine Resident RWJBH Community Medical Center, Toms River, NJ Courtneyknieriem.md@rutgers.edu

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Northwestern EM Blog

SEPTEMBER 12, 2022

This post will discuss a brief overview of hospital planning and operational setup with key elements of a disaster response from events that cause high numbers of blunt trauma, penetrating trauma, burns or crush injuries that may be seen following explosive events, mass shootings, or large scale motor vehicle collisions, to name a few.

Mass Casualty Incidents 52

Mass Casualty Incidents EMS Hospitals Hazardous Materials 52

ACEP Now

JUNE 14, 2024

Two years ago, an ACEP Now article covered the issue of transfer challenges resulting from early pandemic operations. 1 As fresh challenges of the pandemic and hospital operations changed emergency medicine practice, one of the more challenging areas was the movement of admitted patients out of the first emergency department (ED).

Emergency Department 52

Emergency Department Operations Hospitals Leadership 52

ACEP Now

JUNE 6, 2023

A medical student reports a murmur, not documented by either the emergency physician or the cardiologist. EMS is called and finds his blood pressure 175/100. Trap #1: Walks like a duck, quacks like a duck, but it’s not a duck. Then what? A 42-year-old male develops sudden anterior chest pain radiating to his jaw while eating.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

RebelEM

AUGUST 12, 2024

2020 Mar 14; PMID: 32183395 Post Peer Reviewed By : Salim Rezaie, MD (Twitter/X: @Srrezaie ) The post The PROTECTION Trial – A Randomized Trial of Intravenous Amino Acids for Kidney Protection appeared first on REBEL EM - Emergency Medicine Blog.

Outcomes 81

Outcomes Hospitals Operations Shock 81

ACEP Now

NOVEMBER 7, 2023

3 These regulations have led to widespread practices of EHI, such as test results and clinical documentation, being shared with patients in real time. Training opportunities for documentation best practices should be employed. Code of federal regulations eCFR website. substance use disorder” rather than “drug addict”).

Documentation/Coding 52

Documentation/Coding Best Practices Ethical Issues Academics 52

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm. Emerg Med Pract.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

RebelEM

MARCH 27, 2023

First ED-based study to evaluate how operational effects such as crowding can affect patient care in the form of LPV Included ARDS criteria relating to the usage of LPV in the ED allowing evaluation as to whether patients with ARDS were more likely to receive LPV settings. Prior studies have used annual census or shift level crowding.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Taming the SRU

JULY 31, 2024

However, believers in this superstition will perceive crazier shifts if the word is uttered so you probably shouldn’t say it, or use cautiously Full moons have no impact on ED, EMS, or HEMS volumes or acuity. Nice people are not more likely to get cancer.

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Review of the Wellcome Library movies on YouTube (1945) [ links below in references ] is instructive as to resuscitative methods of the 1930s and 1940s: Manual methods; gas bag or bellows operated by hand or machine; an anesthesia gas machine; or iron lung. Evaluation: Manually Operated Resuscitators (1971) Emergency Care Research Institute.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

Taming the SRU

OCTOBER 30, 2024

Debrief codes and odd encounters for yourself, your team, and your hospital system. Factors contributing to healthcare deserts in rural settings include poor insurance payments from predominantly private insurers, "rural bypass", fixed operational costs with low volume, and difficulty recruiting medical staff.

Hospitals 52

Hospitals Emergency Department EKG/ECG Documentation/Coding 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Farrington] Rebuilding of outdated hospitals put emergency rooms on ground level with nearby X-ray service, and, ideally, sometimes closer to the Blood Bank and the Operating Rooms. Advocacy for Trauma Care and EMS Development. Development of EM Residencies. EM begins to "Own the Airway" (emergent). EDNA->ENA.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Northwestern EM Blog

MAY 16, 2022

Follow up CT should depend on the patient and ultrasound operator. Lastly the POCUS operators were ED physicians with training “recommended by ACEP.” Please ensure that you document and discuss with the patient accordingly. In this study, 40.7% J Urol 2019. 202(3):475-483.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 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. hours earlier and went to OR 3.5 Respiratory symptoms: 12.1% Nausea and vomiting: 9.5% Diversion occurs 7.3%

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52

EMDocs

NOVEMBER 16, 2024

We’ll keep it short, while you keep that EM brain sharp. 4 Pain is the most common reason for presentation in the early post operative period. 5 Highest risk of dislocation early in the post operative course due to laxity of the soft tissue after surgery. 2% of THA will have a post operative deep space infection.

EMS 94

EMS Dislocations Fractures Operations 94

RebelEM

MARCH 9, 2023

Document at each reassessment and always have a low threshold to add on a CTH or labs if the patient is not progressing appropriately. As always, document clinical sobriety before discharge. Operational criteria for the classification of chronic alcoholics: identification of Wernicke’s encephalopathy. Alcohol Alcohol.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 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. 8, 2012 12:12 a.m.

Military 40

Military Forensics Documentation/Coding Emergency Nursing 40

EB Medicine

JULY 8, 2019

Jeff: And while it’s not exactly core EM, we’re going to briefly discuss indications for bariatric surgery, as this is something we don’t often review even in academic training programs. 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

EB Medicine

MARCH 1, 2019

Post opiate hypotension in prehospital trauma patients is a rare but documented complication. Jeff: And don’t forget to get the crash details from the EMS crew before they depart! As a side note, for anyone taking oral boards in a few months, don’t forget to ask the EMS crew for the details!!! for pericardial effusion.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Advanced Emergency Nursing from AENJ

JULY 9, 2015

Pull out the manikins (or use a volunteer; BVM only) and run some awkward codes! They may be entrapped; have limited access; may be midway in an operating position that can’t be changed; may need to be sitting due to pulmonary edema, morbid obesity, aspiration prevention or for awake intubation. Lee, Daniel E., Video] Nov 19, 2013.

Airway Management 40

Airway Management Pediatrics Resuscitation Emergency Nursing 40

EB Medicine

JUNE 6, 2019

Most EM training programs certainly emphasize the importance of the the pelvic exam for women with lower abdominal pain, but some recent papers have questioned its role. Nachi: Few things are more important prior to discharge of an abdominal pain patient than documenting repeat exams and a PO trial. Jeff: True.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

RebelEM

SEPTEMBER 11, 2023

Similarly, surgeons might hesitate to operate on older patients with multiple comorbidities due to higher associated risks. Moreover, surgeons may seek “official” documentation in a patient’s chart before surgery. appeared first on REBEL EM - Emergency Medicine Blog.

Ultrasounds 68

Ultrasounds Radiology Radiology Emergency Department 68

EB Medicine

DECEMBER 4, 2019

The authors note that the air is actually comparable to that of an operating room. Physicians reportedly respond 44% of the time, followed by nurses at 20% and EMS providers at about 4%. Nachi: And we alluded to this earlier - Physicians advise diversion more frequently at 9% of the time followed by EMS providers and nurses.

Dehydration 40

Dehydration EMS Wellness Burns 40

Advanced Emergency Nursing from AENJ

SEPTEMBER 4, 2014

It wrongly frightened some medical personnel as it was operated by a 50 psi wall source or from a step-down regulator from a tank (some thought the patient received wall 50 psi or 1500 psig from the tank directly to the lung. Accessed July 28, 2014 **Quoting original documents of fascinating history. Grainge, C. Filbrun, T.,

Resuscitation 40

Resuscitation CPR Documentation/Coding Military 40

EB Medicine

AUGUST 1, 2018

Nachi: Sometimes… Jeff: This month’s issue was authored by Mollie Williams, who is the EM residency program director at the Brooklyn Hospital Center. In fact, cannabis use has been documented for medical use dating as far back as 600 BC in West and Central Asia. Discharge home should be in the care of a sober family member or friend.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EB Medicine

JANUARY 2, 2019

I know this is a HOTLY debated topic among EM Docs. Jeff: Perhaps most importantly, no history or physical alone can rule in or out an ectopic pregnancy, for that you’ll need testing and imaging or operative findings. For a completed abortion, you would expect a closed OS with no IUP on ultrasound with a previously documented IUP.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

Dr. Smith's ECG Blog

APRIL 8, 2015

Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful. Syncope and cause of death were identified by codes from the International Classification of Disease, Ninth Revision. Logistic regression was used to identify predictors for the risk-score system.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

Don't Forget the Bubbles

AUGUST 10, 2023

Descriptive Terms When describing injuries of the hand for documentation or referral purposes it is important to know the terminology that is widely in use in order to convey an accurate description to others. Discussion (from Orthobullets, Relias media & EM News blog) What does this x-ray show? What should you do with it?

Fractures 52

Fractures Soft Tissue Injuries Emergency Department Operations 52

ACEP Now

FEBRUARY 19, 2025

Emergency medicine (EM) is a team-based specialty, where a diverse group works together to rapidly deliver acute, unscheduled patient care. As mentioned, AI has tremendous potential for automating non-teaming tasks such as documentation and data retrieval, and for managing ED workflow processes. Harvard professor Amy C.

Teamwork 51

Teamwork Clinical Decision Support Systems Administration Radiology 51