EM Literature of Note

OCTOBER 9, 2024

and GPT-4T – is asked: Should this patient be admitted to the hospital? while also relying upon finished human documentation for its “decision-support” The prompts – “should”/”does” – replicate the intent of the decision-support concept of the exploration, but not the retrospective nature of the content.

Radiology 86

Radiology Radiology Emergency Department Documentation/Coding 86

Mind The Bleep

FEBRUARY 2, 2025

Hospital/NHS number is 1234. could it be driven by a much more pressing sepsis ). If the aim is for someone to take over care then an explanation of why they can provide better care often works better than why you can’t look after them Outline the purpose of your referral early. It does not ask a question (management of what?

Radiology 96

Radiology Radiology Sepsis Documentation/Coding 96

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. Please comment below if you have any suggested additions or edits to this document. °C (100.9°F).

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

Don't Forget the Bubbles

MAY 6, 2024

of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) Reviewed by: Tasnim Ransome and Spyridon Karageorgos Article 3: Which Sepsis Scoring Tools Perform Best? Organ Dysfunction in Children With Blood Culture-Proven Sepsis: Comparative Performance of Four Scores in a National Cohort Study. Of the 74.9% Hagenbuch, N.,

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

The Skeptics' Guide to EM

FEBRUARY 23, 2019

Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. Date: February 22nd, 2019 Reference: Lane et al.

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

Don't Forget the Bubbles

JANUARY 1, 2024

The Bubble Wrap Plus is a monthly paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital). 2023 Dec 12 Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes. Can’t get enough of Bubble Wrap? Pawlowski TW, et al. Eur J Pediatr.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. We have a special episode for you this month… We’ve brought Dr. Jeremy Rose, one of the peer reviewers, and a sepsis expert, on with us to talk through the content this month. Jeff : Sepsis chair. We like it that way.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 130

Stroke Outcomes Hospitals Administration 130

PulmCCM

MARCH 4, 2024

About half of participants had had documented prior Covid infection. New criteria for diagnosis of pediatric sepsis The diagnosis of pediatric sepsis will abandon the so-called SIRS criteria in favor of a simple organ-failure score. standard deviation). The model was validated using electronic medical record data including 3.6

Sepsis 52

Sepsis CDC Pediatrics Documentation/Coding 52

PulmCCM

MARCH 11, 2024

You probably don’t ever see this–you bill as usual, but CMS reportedly doesn’t pay your hospital for any of your 99292s until billed time goes over 104 minutes. About 544,000 99292 codes were billed to CMS in 2021, according to ACCP , reportedly stable at about 10% of the total bills.

Hospice 52

Hospice Documentation/Coding Administration Hospitals 52

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

Sensible Medicine

AUGUST 14, 2024

This sort of sepsis would produce many of the common autopsy findings. ” Indeed, cause of death is coded differently over time and across counties, states, and countries. Most SIDS babies have congested lungs, and 75% have a history of a recent cold, or an existing cold.

CDC 95

CDC Sepsis Research Pediatrics 95

RebelEM

AUGUST 12, 2024

Hospitals should be cautious in deciding to put their efforts towards them when the data from this trial has actually shown that it works in a diversified patient population such as that which exists in the United States.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Dr. Smith's ECG Blog

JULY 21, 2024

The patient was extubated on Day-3 of the hospital stay. The stay in the cardiac intensive care unit (CICU) was further complicated by sepsis, delirium, GI bleeding, and anuric renal failure with need for renal replacement therapy. In both tracings — an exceedingly fast PMVT is documented.

EKG/ECG 134

EKG/ECG Shock Hospitals Sepsis 134

Pediatric Emergency Playbook

APRIL 1, 2016

Lactate A sick child with sepsis syndrome? In the adult literature, we know that a lactate level above 4 mmol/L in patients with severe sepsis was associated with the need for critical care. The acute recognition and treatment of sepsis is first and foremost, clinical. The short answer – yes.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 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). 2018) Epidemiology of lumbar punctures in hospitalized patients in the United States. Journal of the history of the neurosciences, 6(2), 147–153. Vickers A, Donnelly JP, Moore JX, Barnum SR, Schein TN, et al.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

PulmCCM

FEBRUARY 19, 2024

Let Families Activate Rapid Response Teams, Says SCCM The Society of Critical Care Medicine (SCCM) issued a new guideline on how hospitals and care teams should respond to emergencies outside the ICU or ED (i.e., SCCM now suggests this should be a standard practice at most hospitals. on the medical and surgical wards). Read it here.

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

RebelEM

MARCH 9, 2023

Pain / Additional Complaints : Alcohol can weaken the immune system with only moderate use, predisposing individuals to pneumonia, soft tissue infections, and sepsis. Document at each reassessment and always have a low threshold to add on a CTH or labs if the patient is not progressing appropriately. Annals of Emergency Medicine.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

RebelEM

MARCH 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. 4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. Unfortunately, its not clear whether the documentation came from RTs or ED providers.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

Northwestern EM Blog

MAY 16, 2022

were hospitalizations during f/u period; 26.4% were hospitalizations during f/u period; 26.4% were hospitalizations during f/u period; 26.4% There also were no significant differences in pain scores, hospitalizations, ED readmissions among the groups. vs. US 31.2%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Northwestern EM Blog

APRIL 25, 2022

Violation of the joint capsule exposes the sterile intra-articular space to the environment which can result in a deep infection and sepsis. Ideally your exploration should be in a bloodless, painless field and documented as such. The knee joint is the most common joint to be affected, followed by the ankle. Herndon, A. 2022, Apr 25).

Soft Tissue Injuries 52

Soft Tissue Injuries Fractures Sepsis Documentation/Coding 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58). What do you see?

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

RebelEM

NOVEMBER 30, 2023

For those with sepsis, the administration of intravenous fluids (IVF) at the volumes recommended in the Surviving Sepsis Campaign (SSC) requires careful consideration of an individual’s chronic medical conditions and subsequent sensitivity to IVF. Outcomes: Primary Outcome: In-hospital mortality. Am J Emerg Med.

Sepsis 116

Sepsis Fluid Resuscitation Resuscitation Administration 116

Don't Forget the Bubbles

JULY 5, 2023

GPs and local hospitals should provide easy access to medication and vaccinations to ensure good compliance. Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis. What medications would you give to control pain in hospital?

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

ACEP Now

OCTOBER 29, 2024

Our nurse did not study Paul Ekman’s Facial Action Coding System for Action Units to code “fear” in the patient’s face. This means deviating from protocols (when warranted) for sepsis because your initial impression is the patient would be harmed with that much fluid. Mary’s Hospital in Leonardtown, Maryland.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

EMDocs

OCTOBER 10, 2024

Exam is normal except for tenderness as documented in the diagram. Hospital Inpatient : R thigh is indurated and blistered but abdomen is all but ignored. On the 2nd hospital day, she becomes obtunded and is intubated. Sepsis is diagnosed and antibiotics started for the first time. I just failed to document it.

Documentation/Coding 87

Documentation/Coding Hospitals Sepsis Infectious Diseases 87

EM Updates

JUNE 15, 2021

Maimonides Medical Center (MMC) is Brooklyn’s largest hospital, an academic quaternary care center with, in normal times, 711 total beds, 66 intensive care beds, and an Emergency Department that treats approximately 120,000 patients per year. Treatment protocols changed rapidly and were devised by departmental and hospital consensus.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

Mind The Bleep

SEPTEMBER 17, 2024

Epidemiology The number of animal bites presented to A&E is largely underestimated, as many who are bit don’t present to receive medical care 1 or won’t receive treatment in a hospital setting so they are not counted in the statistics for bites 2. Always consider management as per ATLS protocol and SEPSIS 6 if relevant.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

Taming the SRU

JUNE 6, 2023

Allows for the patient to be held for a psychiatric evaluation Varies greatly based on state laws In OH, this means patient can be held for 24h prior to being evaluation by a psychiatrist & may be held for additional 72h after that initial evaluation is performed In OH, can be signed by physician, psychologist, mental health NP, mental health clinical (..)

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

RebelEM

OCTOBER 5, 2023

Background: Community-acquired pneumonia (CAP) can lead to pulmonary and systemic inflammation, resulting in impaired gas exchange, sepsis, organ failure, and an increased risk of death. Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial.

Research 94

Research Outcomes Administration Shock 94

EB Medicine

JUNE 6, 2019

Taylor and Shaukat of Emory and Coney Island Hospital respectively for their efforts in peer reviewing this huge topic. Jeff: An interesting question for your abdominal pain patient is to ask about the ride to the hospital. was sensitive for 28-day mortality in sepsis. So fairly sensitive, but not too specific.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Don't Forget the Bubbles

JUNE 10, 2024

The history of necrotising enterocolitis The earliest documented cases resembling Necrotising enterocolitis (NEC) date back to the late 19th and early 20th centuries. Systemic Infections : Sepsis and other systemic infections can predispose infants to NEC by compromising the gut barrier and promoting inflammation.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

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!) 3] The type of IV fluid you use will vary depending on which hospital you are working in and what is available. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose. How much fluid?

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

RebelEM

MAY 15, 2024

Antibiotics are effectively the only thing standing between these patients and overwhelming sepsis. Follow your hospital’s protocol (if available). High Risk Patients will need hospitalization and IV antibiotics. Improving the immediate management of neutropenic sepsis in the UK: Lessons from a national audit. Clarke, R.

Infectious Diseases 86

Infectious Diseases Administration Sepsis Anaphylaxis 86

RebelEM

NOVEMBER 11, 2024

Background: Patients with sepsis are routinely treated with empiric broad-spectrum antibiotics while awaiting source identification, as recommended by the surviving sepsis campaign.2 Mortality of Patients With Sepsis Administered Piperacillin-Tazobactam vs Cefepime. address in the article discussed below. JAMA Intern Med.

Sepsis 98

Sepsis Outcomes Administration Shock 98

EMDocs

DECEMBER 9, 2024

2 Beginning in January 2023, the DRC documented a record number of annual suspected cases of clade 1 mpox, specifically classified as Clade 1b. By 2024, over 17,000 suspected cases (2,863 confirmed) were documented across Africa, with the majority in the DRC. encephalitis, sepsis, or conditions requiring hospitalization).

CDC 68

CDC Documentation/Coding Infectious Diseases Dehydration 68

Dr. Smith's ECG Blog

DECEMBER 27, 2024

Documentation lists a diagnosis of "sinus tachycardia." This demands an explanation -- sepsis, hemorrhage, withdrawal, etc. I'm also aware a number of cases ( including one at my former hospital ) where the patient was awake and alert in sustained VT for several days. Serial troponin was undetectable.

EKG/ECG 124

EKG/ECG Hospitals Sepsis Documentation/Coding 124