Taming the SRU

SEPTEMBER 1, 2023

Shewakramani Sepsis is associated with 20-40% mortality Screening tools for detecting patient at risk for sepsis in the ED SIRS Criteria (more sensitive tool) Temp <36C (96.8F) or >38C (100.4F) HR >90 RR >20 WBC <4k or >12k (or >10% bands) qSOFA Score GCS <15 RR >22 SBP <100mmHg Overall, SIRS Criteria remains (..)

Sepsis 94

Sepsis Fractures Documentation/Coding Administration 94

ACEP Now

FEBRUARY 11, 2024

Patient C, a 27-year-old female with a history of epilepsy, taking valproate and endorsing adherence, is then brought in by ambulance for a witnessed seizure. This is her first seizure in six years. There have been documented cases of overdose, and of note, there is no known antidote.

Seizures 52

Seizures Fluid Resuscitation Poisoning EKG/ECG 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 80

Hospitals Hospice Resuscitation COPD 80

Emergency Medicine Journal

NOVEMBER 28, 2023

SEIZURE (FIT) 715 16 250 35 2.24[1.4 SOCIAL PROBLEM (MEDICALLY WELL) 58 1 27 46.6 Abstract 2086 Table 1 Presentations Total first presentation over 2021 Total deaths (within 30 days ) Admission Admission (%) Percentage of deaths [CI ] INJURY OF SHOULDER/ARM/ELBOW/WRIST/HAND 8416 4 424 5 0.05[0.018 ABDOMINAL PAIN 5629 48 2473 43.9

Documentation/Coding 40

Documentation/Coding Sexual Assault Hyperthermia / Hypothermia Head Injuries 40

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. Some families have unexplained deaths during sporting events, an unusual number of car accidents, seizures in someone without a formal diagnosis of epilepsy. On arrival at hospital the child was well with normal observations.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

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. This includes subdural hematomas, comas, paraplegia, quadriplegia, fractures and seizure disorders, regardless of the time interval between the injury and death.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

Sensible Medicine

SEPTEMBER 13, 2024

She presents with a folder of records and codes for outside EMRs. ” This suggested partial, complex seizures with a post-ictal period. Accept that the patient knows more about his symptoms, and may very well know more about his disease, than you do. 1 This never works out well. PJ is the exception.

Psychiatric 53

Psychiatric Radiology Documentation/Coding Radiology 53

ACEP Now

APRIL 2, 2024

1 In severe cases altered mental status, seizures, coma, or even death have been observed. 4 The association between ackee ingestion and the illness was initially recognized in 1875 and officially documented in 1904. Similarly, death is more prevalent in children with Toxic Hypoglycemic Syndrome compared to adults.

Poisoning 40

Poisoning Administration Documentation/Coding Urgent Care 40

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11].

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Downeast Emergency Medicine

APRIL 26, 2021

We know that if administered too rapidly, it can lead to hypotension and other adverse effects including seizures, headaches, backache, abdominal pain, nausea, vomiting, diarrhea, fatigue, pulmonary embolism, deep vein thrombosis, anaphylaxis, impaired color vision, and other visual disturbances.[1] Lastly, the use of TXA is not without risk.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

ACEP Now

DECEMBER 10, 2023

5 Symptoms of milkweed poisoning may include abdominal discomfort, nausea, vomiting, diarrhea, weakness, lethargy, and confusion, progressing to seizures, heart rhythm changes, and bradycardia. He was observed for several hours and eventually discharged with minimal intervention.

Poisoning 52

Poisoning Seizures Documentation/Coding Emergency Department 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

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

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Do not use pethidine since it can cause seizures and CNS hyperexcitability. In addition, free haem and haemoglobin contribute to the vascular damage.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Mind The Bleep

FEBRUARY 7, 2024

meningitis), intractable seizures, low GCS, increased risk of aspiration or airway obstruction such as pathological obstruction (e.g. Should also document presence of shunt, size and direction. This means that SIMV does not work as well as AC with VG. hypoxic ischaemic encephalopathy), metabolic disorders, or muscular problems.

Wellness 52

Wellness Seizures Documentation/Coding Operations 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. Airline companies have been sued. Each airline generally has their own protocol.

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52

Taming the SRU

FEBRUARY 22, 2023

STEP-UP Self Physical and Psycological IM-SAFE Illness Medications Stress Alcohol Fatigue Eating Psychological Cognitive Threat/Challenge appraisal: PERCEIVED demands vs. resources Threat appraisal - stress levels excessive, performance impaired – vapor lock (autonomic arousal, tunnel vision, auditory exclusion, loss of time awareness, impaired memory (..)

Hospice 40

Hospice EKG/ECG Wellness Resuscitation 40

Dr. Smith's ECG Blog

OCTOBER 6, 2018

The patient was in his 50s with history of hypertension, diabetes, seizure disorder, and smoking, but no known coronary artery disease. The patient did well at least in the short term. EF was 55%. High Lateral OMI: The high lateral wall is often aptly called "electrocardiographically silent."

EKG/ECG 40

EKG/ECG Seizures Documentation/Coding Outcomes 40

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 63

Documentation/Coding Seizures Psychiatric Wellness 63

EMDocs

JULY 3, 2023

4 Common symptoms of SAH on presentation include vomiting, neck stiffness, altered mental status or decreased level of consciousness, hemiparesis, and seizure-like activity. This neurological evaluation should include assessment and documentation of the GCS, the presence of any neurologic deficits, and an NIHSS.

Seizures 85

Seizures Stroke Outcomes EMS 85

EB Medicine

AUGUST 1, 2018

Jeff: Medicinally, cannabinoids are currently used in the treatment of chronic pain syndromes, complications of multiple sclerosis and paraplegia, weight loss due to appetite suppression in HIV/aids, chemotherapy-induced nausea and vomiting, seizures, and many other neuropsychiatric disorders.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Thus, Brugada is the likely diagnosis _ A very nice explanation of this is given in the document quoted below on current ECG criteria for Brugada pattern. This shows that much of the apparent R'-wave in V1 and V2 is really a downsloping ST segment. Bayes de Luna, A et al. Syncope and ST Segment Elevation. And another finding.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

Dr. Smith's ECG Blog

APRIL 8, 2015

First: Are you sure it was syncope, and not SEIZURE? Conversely , frequently syncope has a short episode of tonic-clonic activity that mimics seizure. 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. ED diagnosis of vasovagal syncope (-1) 8.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

JANUARY 6, 2025

She presents with a seven-day history of fever, fatigue, and myalgias associated with decreased oral intake and an episode of seizure-like activity three hours prior to arrival. Additionally, there is no family history of seizure disorders. A review of systems is notable for nausea and vomiting but no diarrhea.

Infectious Diseases 57

Infectious Diseases CDC PPE Rapid Diagnostic Testing 57

Don't Forget the Bubbles

DECEMBER 9, 2024

It is well-recognised that the environment in the PICU can negatively affect children and their parents/caregivers, increasing the probability of delirium. Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document.

Pediatrics 59

Pediatrics Hospitals Sepsis Administration 59