Critical Care Scenarios

JANUARY 31, 2024

Review the chart (or ask the patient) for prior documentation of intubation or anesthesia to determine if they have a history of a difficult airway. Good practice when documenting: write exactly what you did, and if it was difficult, write why! This can require some interpretation of the context and who was intubating previously.

OR 286

OR 286

University of Maryland Department of Emergency Med

NOVEMBER 2, 2023

BACKGROUND: Prehospital (EMS) clinicians are positioned on the front lines of health care. With respect to stroke identification and treatment, ea. Click to view the rest

EMS 64

EMS 64

ESO

JANUARY 31, 2024

According to a recent study from ESO , decontamination procedures were only documented in 82% of all working fires incidents, and out of those exposures, only 4% documented all on-scene decontamination procedures. This leaves significant of room for improvement. What can the industry do?

Firefighter 105

Firefighter OR 105

Clinical Correlations

NOVEMBER 1, 2024

By Chloe Fong Peer Reviewed The correlation between vitamin deficiency and alcohol use disorder (AUD) has been well documented in the literature, with a study from 1963 finding that 70% of patients admitted to the hospital.

52

52

EMCrit Project

DECEMBER 10, 2023

Some authors on the ATS document were from Europe, and similarly some authors […] EMCrit Project by Josh Farkas. Within the past year, two major societies have released guidelines on ARDS: the ATS (American Thoracic Society) and the ESICM (European Society of Intensive Care Medicine).

132

132

EMDocs

JULY 25, 2024

The nurse completes the Columbia-Suicide Severity Rating Scale (C-SSRS) and documents that the patient’s recent thoughts of killing himself and his detailed plan makes him “High Risk” for suicide. There is no documented handoff to the on-coming emergency physician (EP) who assumes care. ” 0700 : The PA-C goes off-shift.

ED 81

ED ALS Emergency Department OR 81

NVFC

OCTOBER 22, 2024

Course attendees received an instructor guide, slides, an Emergency Response Guide (ERG), and a resource drive with dozens of forms and documents to assist in local hazmat response planning. Nearly 500 individuals were trained through almost 4,000 contact hours.

First Responder 116

First Responder Emergency Response EMS OR 116

The Curious Clinicians

OCTOBER 8, 2024

Sponsor Freed is an AI scribe that listens, transcribes, and writes medical documentation for you. It turns clinicians’ patient conversations into accurate documentation – instantly. [link] Watch the episode on YouTube! Freed is a solution that could help alleviate the daily burden of overworked clinicians everywhere.

52

52

International Journal of Paramedicine

OCTOBER 8, 2024

Assessment tools utilized by HEMS included the Cincinnati stroke scale (4%) and the FAST-ED (37%); most cases (59%) did not document a stroke assessment tool. The current HEMS triage, although not consistently documented, appropriately selects stroke victims, but not necessarily those who need air transport to a higher care level.

Emergency Medical Services 52

Emergency Medical Services EMS ED 52

Critical Care Scenarios

AUGUST 22, 2021

What are some of the particulars and caveats surrounding credentialing, documentation, and billing? What are some of the particulars and caveats surrounding credentialing, documentation, and billing? All that and more… We chat about focused, clinician-performed point-of-care ultrasound (POCUS) in the ICU. How do you learn it?

ICU 100

ICU 100

EMDocs

SEPTEMBER 26, 2024

An unknown EP reviews the report, determines that there is no reason to notify the patient, and documents nothing. It wasn’t, so you weren’t called, nor did the doc need to document anything. This patient’s history was either poorly taken or poorly documented. Too much weight was given to the EKG, CXR, and labs.

Emergency Department 74

Emergency Department ED ALS Coronary 74

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. The triage nurse records the event as a “seizure” lasting 7 minutes.

ED 82

ED EMS OR 82

NVFC

FEBRUARY 13, 2024

The Notice of Funding Opportunity, guidance documents, and other materials are available on the AFG web site. The application period for the FY 2023 Assistance to Firefighters Grant (AFG) is now open. These grants provide funding to fire departments for needed resources such as equipment, gear, vehicles, and training.

Firefighter 122

Firefighter 122

EMS 12-Lead

SEPTEMBER 8, 2024

Paramedics increase the current slowly over nearly 3 minutes to 100ma where a documented mechanical capture (pulse palpation site not specified) was noted. Figure 2: Current started at 50 ma without electrical capture, with several native beats signified by the triangle annotated by the cardiac monitor. The ECG strip shown in Figure 3.

Paramedic 299

Paramedic EMT EMT EMS 299

American Burn Association

OCTOBER 2, 2024

However, it can only be received by the hospital if the patient’s medical record documents inadequate housing or housing instability, and the coder assigns the secondary ICD-10-CM diagnosis Z-codes.

OR 52

OR 52

EMOttawa

OCTOBER 3, 2024

” However, when we combine POCUS images with clinical documentation, we are telling a story — and every good story has a beginning, middle, and end. Point-of-care ultrasound (POCUS) is often taught to answer binary questions, like, “Is there free fluid in the abdomen?”

50

50

ALiEM

JANUARY 26, 2024

Ciprofloxacin has been documented as a cause of IgA vasculitis. Case Question: What are common triggers for this diagnosis? Common triggers include infection, drugs, and autoimmune. Case Discussion Take-Home Points Consider IgA vasculitis, even in an older patient. References Gamboa F, Rivera JM, Gómez Mateos JM, Gomez-Gras E.

EMS 183

EMS OR 183

EM Literature of Note

OCTOBER 9, 2024

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.

Emergency Department 84

Emergency Department OR ED 84

EMOttawa

DECEMBER 28, 2023

There is a well-documented correlation amongst EMS and adult ED physicians who provide less pediatric care to […] The post Pediatric Traumatic Cardiac Arrest appeared first on EMOttawa Blog. Trauma is the leading cause of child and youth mortality globally (1). Pediatric trauma is a high acuity but low frequency event (2).

EMS 78

EMS ED Critical Care 78

EMDocs

OCTOBER 10, 2024

Exam is normal except for tenderness as documented in the diagram. She never had a documented abdominal exam. I just failed to document it. The EP documented seeing the patient and agreed with the ARNP’s plan. If you take a history or examine a body part, document it. Temp is 98.7 and pulse 121.

ED 71

ED OR ICU 71

The Curious Clinicians

OCTOBER 2, 2024

Sponsor Freed is an AI scribe that listens, transcribes, and writes medical documentation for you. It turns clinicians’ patient conversations into accurate documentation – instantly. Due to system constraints, VCU Health Continuing Education cannot offer subscription services at this time but hopes to do so in the future.

ACS 105

ACS ALS OR 105

EMDocs

JUNE 13, 2024

We just don’t document it. If we don’t use printed instructions, document our verbal instructions regarding the most common side effects of the drug(s) being prescribed. Documenting our warnings should be standard care. Giving written instructions about a drug is the pharmacist’s job.

Emergency Department 77

Emergency Department ED EMS OR 77

EMDocs

OCTOBER 3, 2023

This is also where keeping up with documentation starts to slip. You’ll need to put the following tasks in a rank order list: new patient evaluations, dispositions, managing critical or potentially critical patients, results review, team huddle, running the board, calling consults, doing procedures, and documentation. It’s up to you.

EMR 97

EMR EMS OR Emergency Department 97

EMDocs

OCTOBER 11, 2023

.” The tech cleans the wound and documents it as 2cm long and “ dirty.” The ED physician documents suturing a 3 cm laceration in a single layer, omitting any reference to any wound exploration, cleansing or debridement. I thought they were incidental “ bone islands” so I didn ’ t document them. Negligence was present.

ED 69

ED EMS OR 69

EMS 12-Lead

MAY 15, 2024

The crew increases this current to 75mA and documents an “improvement in patient status” with palpated pulses and a BP of 115/60. As seen in Figure 4, the current is higher, the phantom complexes are larger, but they do not have true electrical capture. Figure 4 : Pacer set to 60 mA with false electrical capture and native beats.

Epinephrine 331

Epinephrine Paramedic CPR ED 331

The Skeptics' Guide to EM

JULY 27, 2024

That document tells us “Before widespread implementation, CDRs should be compared to clinical judgement.” [3] There is an article published in AEM, with an author list that includes the who’s who of decision rules – from Jeff Kline to Nathan Kupperman to my BFF Chris Carpenter.

ICU 187

ICU ALS Ambulance OR 187

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

Defibrillator 89

Defibrillator STEMI EMT EMT 89

ESO

SEPTEMBER 24, 2024

The data in the 2024 EMS Index shows that nearly 88% of all patient transfers documented had an offload time of 20 minutes or less, which fell within NFPA guidelines. Due to this, the 2024 EMS Index set out to use data to measure the ir frequenc y and seek out solutions for lowering wall times. Does your department stack up?

MIH 59

MIH NFPA Ambulance EMS 59

ALiEM

JANUARY 22, 2024

Fever was documented to be 102°F and was not associated with any chills or rigors. A 40-year-old male, tailor by occupation, was brought to the Emergency Department with complaints of high-grade fever for the past 11 days.

Emergency Department 161

Emergency Department OR 161

EMDocs

JUNE 28, 2023

EMS report includes concern for CVA, with variable documentation of face and extremity weakness. Nursing documentation includes the presence of a facial droop. There, his initial neuro exam is documented as normal, but a head CT reveals evidence of a possible acute CVA in the right hemisphere.

EMS 68

EMS ED OR 68

EMDocs

AUGUST 22, 2024

13 Interventions may include: Ascertaining a patient’s preferred language early in the clinical encounter (during registration, for instance), and clearly documenting this preference in a place that is visible to all providers. Utilizing certified interpreters and documenting their use. Educating patients on their rights.

Emergency Department 81

Emergency Department ALS E-9-1-1 ED 81

International Journal of Paramedicine

APRIL 3, 2024

The primary outcome was caregiver decision not to transport patient (per EMS documentation) compared to EMS-initiated non-transport. Conclusions: In this large national dataset, pediatric non-transport by EMS was common, and in most cases non-transport was documented to result from a caregiver decision.

Emergency Medical Services 52

Emergency Medical Services EMS OR 52

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

These “allergies” are often poorly documented and could potentially be more accurately described as intolerance [1]. Background: Penicillin allergies are among the most reported drug allergies, with estimates suggesting that up to 10% of the US population claims to have a penicillin allergy.

ICU 136

ICU Emergency Department ALS ED 136

NVFC

FEBRUARY 27, 2024

Application tools and resources, including the Notice of Funding Opportunity and guidance documents, are available on the AFG web site. These federal grants provide funding to fire departments for necessities including equipment, gear, vehicles, and training.

Firefighter 52

Firefighter 52

Pulsara

APRIL 1, 2024

This integration aims to offer a hybrid solution that respects the preferences of all users, combining the immediacy of digital alerts with the physical presence of sticky notes and faxed documents.

87

87

ESO

DECEMBER 14, 2023

Documentation is key Since you can’t predict what will turn into PTEs, and each person reacts differently to the same critical events, it is important to document each and every one. Then follow up with those who made reports.

Firefighter 52

Firefighter Public Safety EMS OR 52

ESO

JANUARY 19, 2024

Gender, race, ethnicity, and socioeconomic disparities are well-documented within the healthcare system. While stroke assessment is documented 38% of the time for patients overall, it is only documented 32% of the time for Hispanic/Latino patients. However, in reality, that’s not always the case.

CPR 52

CPR Advanced Life Support STEMI Life Support 52