The Skeptics' Guide to EM

OCTOBER 1, 2022

Disparities in the emergency department management of pediatric migraine by race, ethnicity, and language preference. She is the cofounder of FOAMcast and is a pulmonary embolism […] The post SGEM#378: Keepin’ It REaL when Treating Pediatric Migraine Patients first appeared on The Skeptics Guide to Emergency Medicine.

Pediatrics 52

Pediatrics Emergency Department Documentation/Coding Research 52

Don't Forget the Bubbles

MAY 31, 2023

The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. Which patients were involved? How good was this paper? Do you believe the results?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

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

EMDocs

JULY 9, 2024

The emDOCs.net team is very happy to collaborate with PECARN STELAR (Seattle, Dallas/Texas, and Los Angeles) Node and the Emergency Medical Services for Children Innovation and Improvement Center (EIIC) in presenting high-yield pediatric topics that highlight evidence based medicine with solid research. Acad Pediatr. Acad Pediatr.

Pediatrics 70

Pediatrics Emergency Department Research Burns 70

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. 2016) “Implementation of a Post-Code Pause: Extending Post-Event Debriefing to Include Silence”. 2014) “Death of a child in the emergency department” American Academy of Pediatrics. Psychological harm occurs. & Liska, H. 23 (2), pp.

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

Taming the SRU

FEBRUARY 22, 2024

M&M - Arterial Lines - Fat Embolism Syndrome - CPC Morbidity & Mortality WITH Dr. Finney Case 1: MVC AMA, especially in pediatrics, is a high-risk disposition that requires thorough discussion and documentation Approach pediatric blunt abdominal trauma with a thorough physical exam and consider decision making tools when applicable Case 2 & (..)

Pediatrics 82

Pediatrics Documentation/Coding Wellness 82

EMDocs

JUNE 2, 2023

You should always follow your local practice guidelines and recommendations as well as adhere to approved medications in your facility. Document what you gave and why, as well as the impact. Pediatric Agitation in the Emergency Department: A Survey of Pediatric Emergency Care Coordinators. Acad Pediatr.

Psychiatric 85

Psychiatric Pediatrics Emergency Department Administration 85

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. In practice, questions remain about who applies the CDR and the inter-rater reliability.

CPR 124

CPR Research Documentation/Coding Outcomes 124

Sensible Medicine

AUGUST 7, 2024

A 2015 Nature (Pediatric Research) paper by Nils J. There is evidence that, for children and adults, elevated cortisol levels and chronic stress can lead to behavioral, mental-health, and mood issues, as well as changes in inflammation and immunity. This may not be true for infants.

CDC 114

CDC Documentation/Coding Research Pediatrics 114

Taming the SRU

MAY 11, 2024

Validity Evidence for a Team-Leading Assessment Tool in Pediatric Emergency Resuscitation Using Video Review (Hartwell et al.) Assessed and provided feedback of pediatric resuscitations based on video review. Of note, HTS is more effective in trauma patients because it is used as a resuscitative fluid as well.

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

ACEP Now

JANUARY 30, 2024

Be Prepared for All Pediatric Challenges Whether you want to brush up on your pediatric EM skills or take your dual-boarded training to the next level, the Advanced Pediatric EM Assembly helps you be prepared for any pediatric patient you may treat. Learn more at acep.org/accelerate. Discover more at acep.org/MOC.

Pediatrics 52

Pediatrics EMS Documentation/Coding Stroke 52

Don't Forget the Bubbles

MAY 10, 2023

Then you hear the words coming out of the speaker, “ Paediatric code black. Paediatric code black ”. You’ve heard the phrase code black before – it’s a traumatic cardiac arrest. You know a paediatric code black means paediatric traumatic cardiac arrest. You’re just about aware of the tannoy in the background.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

ACEP Now

OCTOBER 10, 2024

The reason I think orthopedists have done so well because they’ve been involved, they’ve been politically engaged, they’ve used their assets to preserve their assets. Another is to deliver the best patient care you possibly can, and those things don’t work very well together. MCCORMICK: Don’t lose your way. So I’ll stick to rugby.

Telemedicine 105

Telemedicine Critical Access Hospitals Emergency Department 105

The Skeptics' Guide to EM

OCTOBER 28, 2017

Pediatrics 2017 Guest Skeptic: Dr. Anthony Crocco is a Pediatric Emergency Physician and is the Medical Director & Division Head of the Division of Pediatric Emergency at McMaster’s Children’s Hospital. Case: A 12-day old girl presents with fever and is otherwise well. Anthony is also the creator of SketchyEBM.

Pediatrics 52

Pediatrics Documentation/Coding Emergency Department Hospitals 52

Don't Forget the Bubbles

MAY 6, 2024

Acad Pediatr. of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) Pediatric Critical Care Medicine , 25 (3), pp.e117-e128. Data collected were the worst values documented within the same calendar day as the blood cultures were obtained. 2024;24(1):111-118. doi:10.1016/j.acap.2023.06.023 Of the 74.9%

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

Taming the SRU

SEPTEMBER 15, 2023

Limited availability of radiology-performed US services in certain hospitals, especially overnight Can avoid unnecessary anticoagulation in patients Reduce time in ED to disposition In terms of workflow, when there is suspicion for a DVT, you need to first calculate a Wells’ Score for a DVT If low/moderate risk, can start with a D-dimer prior to committing (..)

CPR 90

CPR Burns Airway Management Wellness 90

Taming the SRU

NOVEMBER 14, 2023

million visits resulting in otologic diagnoses, encompassing about 1.01% of all adult visits and 6.79% of pediatric visits (1). Therefore, both of these should be important considerations as well when evaluating swollen ears in the emergency department. Courtesy of wiki commons under CC Attribution 3.0

Emergency Department 94

Emergency Department Pediatrics Wellness Fractures 94

ACEP Now

JUNE 14, 2024

The inaugural ACEP Accelerate conference – which combined the ED Director’s Academy, the Advanced Pediatrics EM Assembly, Reimbursement & Coding, and Teaching Fellowship—took place in Arlington, TX in March 2023. There were some ACEP business decisions at the April Board meeting, as well.

Sexual Assault 52

Sexual Assault Seizures Documentation/Coding EMS 52

Pediatric Emergency Playbook

APRIL 1, 2016

Read on to go from bread-and-butter pediatric blood work to answer the question – what’s up with troponin, lactate, d-dimer, and BNP in kids? This is especially true in children – the majority of pediatric ambulatory visits do not require blood work to make a decision about acute care. The punchline is, use a pediatric reference.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Taming the SRU

AUGUST 4, 2024

We discussed some practices to push learners outside of their comfort zone and promote learning, based on their level as well as their goals for the shift. It is better to finish early than rushing through your presentation

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

Don't Forget the Bubbles

FEBRUARY 26, 2024

Increasing PEEP is thought to cause bronchodilation by providing direct mechanical stimulus as well as secondary stimulation through pulmonary stretch receptors coupled with activation of the non-cholinergic parasympathetic pathway. Noninvasive positive-pressure ventilation in pediatric status asthmaticus. Frontiers in Pediatrics.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

Advanced Emergency Nursing from AENJ

MAY 2, 2017

Consider the traumas and medical emergencies that have a seasonal prominence in your locality, then prepare topical presentations in formats that work well with your group. As with a well-run ‘mega-code’, these are rehearsals for future events that may present suddenly. Readers must verify validity to their own practice.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Emergency Nursing Documentation/Coding Pediatrics 40

EMDocs

JUNE 16, 2023

Pediatric Mental Health Specifically within the pediatric population, there has been a steady rise in mental health concerns and suicide in children. As these sites face an increase in pediatric mental health visits, more efforts need to be directed at preparing community EDs to be pediatric ready. Doherty, Jennifer L.

Psychiatric 52

Psychiatric Pediatrics Emergency Department Best Practices 52

Don't Forget the Bubbles

DECEMBER 13, 2023

Failure to thrive’ has many definitions We use standardized charts to document infant growth. Susan had issues initially with ensuring the correct latch, but after a review with a lactation consultant, feeding is going well. Though it has been hard, they have been coping well and enjoying parenthood. Eur J Pediatr.

Dehydration 98

Dehydration CDC Hospitals Wellness 98

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. On arrival at hospital the child was well with normal observations. Claudius et al, Pediatrics 2007 here a US-based study showed that of all admitted patients only 14% had a subsequent clinical course requiring admission.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

PEMBlog

MAY 11, 2023

Injectable lidocaine, when done well, is reliable – but it can take years to master the ideal technique that doesn’t create a giant mound of subcutaneous lidocaine that can impact needle entry and landmarks. These were used by two independent reviewers to determine Neonatal Facial Coding System with pain scores.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Academics 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. Yes, Cardiac Science AEDs have pediatric capabilities. They come equipped with pediatric pads or electrodes that are specifically designed for use on children.

CPR 52

CPR Resuscitation Pediatrics Operations 52

Pediatric Education

AUGUST 6, 2023

The pediatrician noted generalized facial redness on the left half of the face which created a well-demarcated line down the center of the patient’s face. and said she was otherwise well. On the unaffected, or non-pathological half of the face, there is well-demarcated facial flushing which can be intense and the skin perspires.

Pediatrics 40

Pediatrics Wellness Documentation/Coding 40

Taming the SRU

OCTOBER 30, 2024

Case #2: Facial Swelling CT imaging has seen a significant increase in the last 20 years. ​ Although there has been an increase in imaging, diagnostic yield has remained relatively stable​ Factors the impact imaging decision includes reliability of the physical exam as well as extrinsic factors such as consultants and admitting services.​

Hospitals 52

Hospitals Emergency Department EKG/ECG Documentation/Coding 52

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

Don't Forget the Bubbles

MARCH 11, 2024

There are many causes, and it is less well understood than plagiocephaly. References The ISPN Guide to Pediatric Neurosurgery (USA): Positional Plagiocephaly in Children Homepage. New York, USA: The International Society for Pediatric Neurosurgery, 2024 (Accessed January 9, 2024). Pediatrics, 132(2), 298–304. Hatfield, J.,

Radiology 59

Radiology Radiology Pediatrics Documentation/Coding 59

Advanced Emergency Nursing from AENJ

AUGUST 2, 2016

All efforts to identify the decedent by hospital staff, law enforcement agencies or social service agencies should be well documented in the medical records. Based upon California Health and Safety Code 102850 and Government Code 27491. Based upon California Health and Safety Code 102850 and Government Code 27491.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

EMDocs

FEBRUARY 9, 2024

She is well appearing, and while being placed on the monitor becomes anxious stating the symptoms are recurring. The same principles can be applied to pediatric patients with modified doses. The literature base for the use of lidocaine for torsade storm is documented primarily by case studies in drug-induced TdP.

EKG/ECG 91

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 91

Advanced Emergency Nursing from AENJ

JANUARY 9, 2017

Medical emergency personnel prepare well for their work: preplanning, checking equipment, reserve supplies, drills to varied scenarios. One of the most important steps to take is redundant documentation: identity; money, credit, finances, ownership, documents. Was the car actually packed for evacuation?

Documentation/Coding 40

Documentation/Coding Emergency Nursing Wellness Pediatrics 40

Don't Forget the Bubbles

MARCH 19, 2024

Just 20% of a person’s health and general well-being is related to access to care and the quality of services. Acknowledging the challenges associated with paediatric social admissions begins with documenting social issues and assessing their social history with the same level of detail as their medical history.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

Pediatric Education

MARCH 10, 2024

She was doing well and but was having problems with her math and some reading. “She’s doing well socially and developing pretty normally, so that is good. They learn or do some things exceptionally well, but they also are exceptional in that they have problems learning too.

Leadership 40

Leadership Wellness Pediatrics Documentation/Coding 40

Taming the SRU

MAY 30, 2023

Comiskey Hyperammonemia 10% of of patient presenting with hepatic encephalopathy do not have elevated ammonias Most commonly seen in adults is secondary to liver dysfunction with cirrhosis or portal venous system shunting. Each airline generally has their own protocol.

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52