Taming the SRU

DECEMBER 8, 2023

EMS had reported she had coded en route. ED providers should be familiar with several extraction techniques for foreign bodies in the external auditory canal including the use of manual extractors, irrigation, and other methods such as adhesives and acetone. She regained pulses with warming on arrival.

Hyperthermia / Hypothermia 89

Hyperthermia / Hypothermia Head Injuries Resuscitation Documentation/Coding 89

RebelEM

JUNE 8, 2023

Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

The Skeptics' Guide to EM

MAY 8, 2021

He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR […] The post SGEM#329: Will Corticosteroids Help if…I Will Survive a Cardiac Arrest? He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR Safety Team. first appeared on The Skeptics Guide to Emergency Medicine.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

The Skeptics' Guide to EM

MAY 2, 2020

A Contemporary Analysis Using National EMS Information System (NEMSIS) Data. A Contemporary Analysis Using National EMS Information System (NEMSIS) Data. The EMS crew arrives and performs a 3 lead EKG that does not show an ST elevated myocardial infarction. Date: April 24th, 2020 Reference: Watanabe et al.

Documentation/Coding 40

Documentation/Coding EMS EKG/ECG Outcomes 40

RebelEM

MARCH 13, 2024

This was not a Code 3 respiratory distress, fentanyl overdose with minimal response to Narcan or even an unconscious stroke patient with the blood pressure of a giraffe. How does “resulting” or the tendency to equate a decision’s quality with its outcome affect learning in and after residency? How would the hemodynamics respond to RSI?

Documentation/Coding 58

Documentation/Coding Outcomes EMS Stroke 58

PHEM Cast

DECEMBER 12, 2016

Emergency Department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. Joint Position Statement of Nat Assoc EMS Physicians and ACS Committee on Trauma. Emergency thoracotomy in thoracic trauma: a review. Injury; 2006 (37): 1-19. Clay et al. World Journal of Emergency Surgery; 2006: 1:4. Rhee et al.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

The Skeptics' Guide to EM

JULY 30, 2022

Somewhat surprisingly, we’ve never covered SBO on the SGEM, although Ped EM Superhero, Dr Anthony Crocco shared his views on the (lack of) utility of abdominal X-rays in paediatric constipation back in 2016 ( SGEM Xtra: RANThony#4 ). Charles Brower is a second-year resident training in Emergency Medicine at the University of Cincinnati.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

Dr. Smith's ECG Blog

JULY 7, 2024

Written by Jesse McLaren A previously healthy 60 year old developed exertional chest pain with diaphoresis, and called EMS. Here’s the EMS ECG, digitized with PM cardio. What do you think? There’s sinus arrhythmia with normal conduction, normal axis and normal voltages. There’s loss of R waves in V2-3 with hyperacute waves V1-5.

EKG/ECG 65

EKG/ECG Documentation/Coding EMS Wellness 65

ACEP Now

AUGUST 1, 2023

Factoring such, an order to transfer the patient immediately by ground or air EMS is the only actual support per se these non-physicians receive. Quillen College of Medicine (2003) Response The workforce study shook the foundation of emergency medicine (EM). Three take home points for what I believe. Every patient in a U.S.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 98

The Skeptics' Guide to EM

FEBRUARY 23, 2019

The study by Alam et al took adult patients with a diagnosis of suspected infection and randomized them to ceftriaxone 2g IV started pre-hospital or usual care with a primary outcome of all-cause mortality at 28 days. The Surviving Sepsis Campaign makes a number of recommendations in their 2016 guideline.

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

The Skeptics' Guide to EM

NOVEMBER 16, 2019

NEJM Oct 2019 Guest Skeptic: Dr. Laura Melville (@lmelville535) is an emergency physician in Brooklyn, New York, is a part of the New York ACEP Research Committee, ALL NYC EM, and is the NYP-Brooklyn Methodist Resident Research Director. Case: A 59-year-old woman comes is brought into your emergency department (ED) by EMS in cardiac arrest.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia EMS Research Documentation/Coding 40

EMDocs

JUNE 22, 2023

I have been a part of many traumatic codes and resuscitations during my training, but I knew this one would probably be my most difficult one. Early contact with Medcom ensured that they would be able to activate one of the most effective and competent air EMS teams in the state – AirCare. Should be here in 5 minutes.” She was calm.

Resuscitation 98

Resuscitation Ultrasounds Critical Access Radiology 98

Taming the SRU

OCTOBER 30, 2024

Despite adherence to strict ACLS protocols, neurologic outcomes remain poor.​ The VA-ECMO set-up is specifically used for eCPR​ Meta-analyses for eCPR have shown aggregate survival rates with good neurologic outcomes up to 21.3% Debrief codes and odd encounters for yourself, your team, and your hospital system. R2 CPC: WITH drs.

Hospitals 52

Hospitals Emergency Department EKG/ECG Documentation/Coding 52

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. This is a critical error that leads to poorer outcomes for patients in need of critical care. Unfortunately, its not clear whether the documentation came from RTs or ED providers.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

The Skeptics' Guide to EM

APRIL 24, 2021

On investigating you find a collection of nursing, EMS and hospital security personnel surrounding an obviously agitated patient with blood on his head who is attempting to punch them. Exclusions: Prisoners or those in police custody, pregnant or breast-feeding, or with documented allergy to any study medications.

Emergency Department 40

Emergency Department Research Outcomes Documentation/Coding 40

The Skeptics' Guide to EM

MARCH 4, 2018

He also hosts a great #FOAMed blog and podcast called TOTAL EM. Exclusions: There were 26 exclusions in their supplemental documentation. Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant (PA) working primarily in rural Missouri in community hospitals.

Infectious Diseases 40

Infectious Diseases Documentation/Coding Ultrasounds Outcomes 40

PHEM Cast

APRIL 21, 2021

Guidance documents College of Paramedics Statement on Intubation, available here. The Effect of Paramedic Rapid Sequence Intubation on Outcome in Patients with Severe Traumatic Brain Injury. Difficult prehospital endotracheal intubation – predisposing factors in a physician based EMS. Tracheal intubation. 20(12);681-686.

Airway Management 40

Airway Management Resuscitation EMS Hospitals 40

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

It is well documented with continuous 12-lead monitoring that acute re-occlusion is frequently asymptomatic. It shows that on a 7 day angiogram, only 58% of re-occlusions were symptomatic: Ohman EM, Califf RM, Topol EJ et al. Silent ischemia as a marker for early unfavorable outcomes in patients with unstable angina.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Wellness 52

RebelEM

DECEMBER 28, 2022

No difference in exploratory outcomes. Low rates of missing data allowed other exploratory outcomes Included a diverse and potentially high-risk group, including patients with indwelling catheters and intermittent catheter use. Appropriately used a noninferiority study design. Performed an intention-to-treat and per-protocol analysis.

Outcomes 52

Outcomes Documentation/Coding Hospitals EMS 52

RebelEM

SEPTEMBER 11, 2023

Outcomes: Primary: Percent change in management decisions after introducing the Radiology Department RUQ US. 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

Advanced Emergency Nursing from AENJ

NOVEMBER 27, 2017

The following quotes from the ILCOR and AHA documents, under fair-use doctrine, will help summarize for you the changes. AHA statements are labeled with" [AHA]" We can now expect more frequent and closer cycling and knowledge translation from the laboratory workbench or studies of cases and outcomes to our own practice.

CPR 40

CPR Basic Life Support Resuscitation Pediatrics 40

The Skeptics' Guide to EM

DECEMBER 5, 2020

She is the New York ACEP liaison for the Research and Education Committee and is a past ALL NYC EM Resident Education Fellow. Over the past decade, some emergency physicians have adopted this examination into their own bedside clinical assessment and documentation. Mary McLean is an Assistant Program Director at St.

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

When Pendell and I are coding ECGs for the Queen's training, this is one category: "Definite ischemia, difficult to differentiate between posterior OMI and subendocardial ischemia." Yet this is rarely followed, and patient outcomes like this are the result once in a while.

EKG/ECG 81

EKG/ECG Shock Documentation/Coding Academics 81

ACEP Now

JULY 7, 2023

However, rapid initiation of treatment is actually patient-centered care that can both lead to better outcomes and limit ED boarding. Mental health evaluation teams can rely on documentation and interviews to understand a patient’s initial agitation level. Wilson MP, Chen N, Vilke GM, Castillo EM, MacDonald KS, Minassian A.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

EMDocs

NOVEMBER 16, 2024

We’ll keep it short, while you keep that EM brain sharp. Posterior – Shortened, adducted, internally rotated 5,6 Anterior – Shortened, abducted, externally rotated 5,6 As with all dislocations, perform and document distal neurovascular exam before and after management. 8 Perform and document distal neurovascular exam.

EMS 97

EMS Dislocations Fractures Operations 97

EB Medicine

AUGUST 6, 2019

In the end, they reported similar rates of recurrence and bleeding outcomes for acute treatment. Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. of patients per year. Nachi: Next we have apixaban, tradename Eliquis.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 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

RebelEM

JUNE 29, 2023

Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? REBEL EM Blog, June 1, 2023. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. Below you will find some of the points we discussed.

CPR 145

CPR EMS Documentation/Coding Outcomes 145

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.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation Pediatrics 98

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Written by Pendell Meyers A man in his 40s called EMS for acute chest pain that awoke him from sleep, along with nausea and shortness of breath. Long term outcome is unavailable. For clarity in Figure-1 — I've labeled the 2 EMS ECGs and the baseline ECG recorded ~1 month earlier.

EKG/ECG 120

EKG/ECG EMS Documentation/Coding Shock 120

Pediatric EM Morsels

JULY 28, 2023

A critical MORSEL is that every child you treat for DKA needs to have an initial thorough neuro exam including cranial nerves and then frequent neuro reassessments … and document it ( so your colleagues who take over care for the kid can know if there has been a change )! Is your patient hyperglycemic, acidotic, with ketonuria?

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

EMDocs

MAY 9, 2024

Exam documents that he is alert and oriented but “tired appearing” and “not appearing post-ictal.” Defense : The EP did address the seizure when he documented “not post-ictal.” There is no negligence, as the documentation supports reasonable judgment. EM is a “team sport.” VS are normal with a temp of 97.3.

Seizures 104

Seizures Dehydration Documentation/Coding Infectious Diseases 104

The Skeptics' Guide to EM

AUGUST 10, 2024

Case: A 65-year-old man is brought into the emergency department (ED) by emergency medical services (EMS) after his family saw him slump over at the dinner table. A code stroke is activated, and a CT head shows a left basal ganglia hemorrhage with no vascular lesions on CT angiography. Reversal of Warfarin: Freeman et al.

Stroke 90

Stroke Airway Management Documentation/Coding Outcomes 90

Dr. Smith's ECG Blog

JUNE 13, 2024

Her first set of vitals were documented: BP 116/57 Pulse 94bpm Respiratory rate 24/min O2 sat 90% on room air Temp 97F She had been cleaning a Jeep in the sun, and was sunburned. The physician documented “normal sinus rhythm”. The physician documented that she was “improved” and the patient was discharged. CK MB was 1.9

EKG/ECG 91

EKG/ECG Documentation/Coding EMS Burns 91

RebelEM

NOVEMBER 30, 2023

Outcomes: Primary Outcome: In-hospital mortality. Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. There was no specified time-frame for the primary outcome, potentially affecting the precision of the findings. Mayo Clin Proc Innov Qual Outcomes. 2.89, p = 0.01.

Sepsis 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

Don't Forget the Bubbles

DECEMBER 2, 2024

This study relied on coding, and if the patient had not been coded as asthma, for example, and coded as pneumonia instead, these patients would not have been included in the study set. Most QIs focus on the care process; however, there is a lack of QIs that assess clinical outcomes. and 16.7% , respectively.

Documentation/Coding 98

Documentation/Coding Pediatrics Emergency Department Fractures 98

Dr. Smith's ECG Blog

AUGUST 9, 2024

He had no previously documented medical problems except polysubstance use. About 2 hours later the patient arrived at a PCI-capable center and repeat ECG was obtained: The transferring EMS crew noted “runs of VT” during transport. FINAL Point: During transport to the PCI center — the EMS crew noted, "runs of VT". Washam, J.

EKG/ECG 106

EKG/ECG EMS Emergency Department Wellness 106