tag:blogger.com,1999:blog-166492102011-10-11T20:03:28.559-04:00pandrusnoreply@blogger.comBlogger381100tag:blogger.com,1999:blog-16649210.post-28067206628613634582009-07-12T15:22:00.002-04:002009-07-12T15:23:02.936-04:00

New Digs will be at mssmem.com

pandrusnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-28542053471808257192008-01-04T12:05:00.002-05:002009-07-12T15:24:55.316-04:00

This post is now hosted at mssmem.com-------------------------------------------------------------------Tips on Advancing the Endotracheal TubeNew GlideScope® users often achieve an excellent view with the GlideScope® but may experience some difficulty advancing the endotracheal tube. This may be caused by two factors: The first factor is excessive lifting or pushing of the glottis by the

pandrusnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-30358505262406101962007-12-13T13:48:00.000-05:002008-12-13T05:54:16.592-05:00

Atul Gawande's article in the New Yorker, "The Checklist", is a gread read. Scot was nice enough to make a copy for me.He introduces the complexity of critical care medicine by giving the accounts of two survivors - one of accidental hypothermia and the other of intraoperative hemorrhage, sepsis and line infection. He then descirbes how the concept of checklists to manage such complexity came

pandrusnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-26672849301470818422007-09-08T11:40:00.000-04:002007-09-08T11:42:15.550-04:00

Skin and Soft Tissue1. Moran, Gregory J., Krishnadasan, Anusha, Gorwitz, Rachel J., Fosheim, Gregory E., McDougal, Linda K., Carey, Roberta B., Talan, David A., the EMERGEncy ID Net Study Group, Methicillin-Resistant S. aureus Infections among Patients in the Emergency Department N Engl J Med 2006 355: 666-6742. Gabillot-Carré M, Roujeau JC. Acute bacterial skin infections and cellulitis. Curr

pandrusnoreply@blogger.com1tag:blogger.com,1999:blog-16649210.post-59971336883413972952007-08-10T10:22:00.000-04:002007-08-30T15:59:36.472-04:00

Mark your calendars, Ted's episode of Diagnosis X on The Learning Channel "Jumping the Gun" will air on Wednesday, Sept 19 at 10pm. If you miss it, it will come on later that night at midnight,

pandrusnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-42756413390608385352007-06-20T13:59:00.000-04:002008-01-04T12:07:41.677-05:00

We had poor communication in one case that had a central line placed in emergently in the ED but was not documented as such. The ICU did not replace this line and the patient developed an infection within 4 days.Please document if you did or did not use MAXIMAL STERILE BARRIER precautions in the procedure note and also please communicate this to the accepting service. This is vitally important.

pandrusnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-5721991977307529342007-05-23T00:16:00.000-04:002007-08-16T16:20:26.919-04:00

Ambesh Manuever Volume 95(6), December 2001, pp 1377-1379.Costantino TG et al. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med 2005 Nov; 46:456-61.Brannam L et al. Emergency Nurses Utilization of Ultrasound Guidance for Placement of Peripheral Intravenous Lines in Difficult-access Patients Academic

pandrusnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-10323306524110097672007-03-18T09:59:00.000-04:002007-08-16T16:21:04.520-04:00

If you aren't reading Nick Genes' EM Journal Club Blog, then you ought to be. The comments section on each article reviewed contain great discussions, mostly by our residents. It was great to see Ron Walls chime in from Boston. Check out the comments on Dexamethasone for Headache here.

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1170909951626857532007-02-07T23:45:00.000-05:002008-01-04T12:07:41.678-05:00

If a patient left before being triaged or put into a bed: Dispo and condition = LWBT. This will probably be diagnosis too. They never made it to a treatment area.A patient had an AMA discussion and chooses to leave against advice: Dispo and condition= AMA. The Diagnosis is whatever the diagnosis is.A patient left from the treatment area before completion of treatment, but there was no

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1170796432067071362007-02-06T16:09:00.000-05:002008-02-05T14:39:47.449-05:00

Some highlights from the ED Antibiogram:MSSA: cefazolin 100% sensitiveMRSA: vancomycin 100% sensitiveStrep Pneumo: Ceftriaxone 100% sensitiveStrep Pneumo (meningitis): Vanco 100% sensitiveE Coli: macrobid 98% sensitive ceftriaxone 97% sensitive zosyn 97% sensitivePseudomonas: cefepime 100% sensitive zosyn 100% sensitive

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1170163897734881622007-01-30T08:30:00.000-05:002008-02-05T14:34:00.308-05:00

2+ of the following:Abnormal CXRTemp >101Lives in Homeless ShelterHx of TB/PPD+

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1169126734791282082007-01-18T08:25:00.000-05:002008-02-05T14:34:30.104-05:00

1. Medical Decision Making: Coders look for MDM first... They use a point system that adds up based on how many tests you order AND documentation of your gathering of information and analysis of information. In other words use the “DOCTORS NOTES” section. The more boxes you check in this section, (greater that 4 is “high”) the more MDM points you get. Below in addendum A is the coding

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1165355191258889442006-12-05T16:26:00.000-05:002006-12-05T16:46:31.320-05:00

Some Reading:TREATMENT OF COMATOSE SURVIVORS OF OUT-OF-HOSPITAL CARDIAC ARREST WITH INDUCED HYPOTHERMIA NEJM 2002 Therapeutic Hypothermia Study GroupEKG Findings in Hypothermia

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1163609968982824932006-11-15T11:58:00.000-05:002008-02-05T14:36:48.745-05:00

The latest updates to the Sinai EM Blogs are here:feed://app.feeddigest.com/digest3/UKCIR7WUIU.rssFor those who tried this link and it didn't work -- here is a quick explanation of RSS and advice on an RSS feed reader. RSS feeds are a great way of disseminating information, but are not supported by Internet Explorer. If your webrowser is Safari or Firefox, you probably do not have this problem.

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1163529764671741642006-11-14T13:42:00.000-05:002008-02-05T14:39:47.449-05:00

Kumar A et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006 Jun; 34:1589-96. [Medline abstract]Time to First Dose of Antibiotics Is Critical in Septic Shock Early administration of effective agents saves lives. Data regarding the benefit of rapid time to first antibiotic dose in

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1160617523308160652006-10-11T21:45:00.000-04:002008-02-05T14:37:16.552-05:00

· Gloves do not replace the need for hand washing! Please be sure to wash your hands (or use Purell) before and after every patient encounter. The Infection Control department is collecting observational data as to our practices in the ED for the hospital. Please do your best to comply.· There are new ACIP guidelines which recommend the usage of Tdap rather than Td for patients

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1160497984011768852006-10-10T12:31:00.000-04:002007-08-16T16:20:26.919-04:00

References: Van Herick Angle Estimation Method Thanks Chad.Lateral Canthotomy VideoManagement of Ocular Emergencies and Urgent Eye Problems. American Family Physician 2/1/96.The Red Eye. Davey C, British Journal of Hospital Medicine 1996 Feb 7-20;55(3):89-94.An investigation into the mechanism of orbital blowout fractures. Waterhouse N, British Journal of Plastic Surgery 1999 Dec;52(8):607-12.

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1160335614883204742006-10-08T15:26:00.000-04:002008-01-04T12:07:41.679-05:00

Bret's Recommendation is to simply make IBEX Macros of the following:1. ***ULTRASOUND GUIDANCE FOR VASCULAR ACCESS*** Ultrasound was used to assess potential access sites and guide needle placement for procedure in real time. Electronic images were saved. [Use this for central venous access and peripheral venous access]2. ***ULTRASOUND GUIDANCE FOR NEEDLE PLACEMENT*** Ultrasound was used to

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1158606249266921182006-09-18T15:03:00.000-04:002008-02-05T14:37:30.367-05:00

Dear HAN Subscriber:We have just released a DOHMH Alert concerning E. coli O157:H7 Infections Associated with Bagged, Fresh Spinach in Multiple States. It is available on the HAN home page , is appended to this email, and is also attached as a pdf file. To read the attachment, you will need the Adobe reader. If you do not have that software, it can be downloaded at no cost at http://www.adobe.com

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1157645296034120182006-09-07T12:07:00.000-04:002008-02-05T14:37:16.553-05:00

Plaster traps have been installed in: the resus room sink by bed D, the pediatric treatment room, and the ortho room in UC.Please use these sinks for your plaster needs, and avoid plaster in all other sinks.(For those of you that don't know- plaster builds up in plumbing and eventually causes high grade obstruction in sinks. Plaster traps solve this problem.)

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1153969950937103022006-07-26T23:11:00.000-04:002008-02-05T14:39:47.449-05:00

Reference:Severe sepsis and septic shock: review of the literature and emergency department management guidelines.Ann Emerg Med. 2006 Jul;48(1):28-54.

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1153959976637325022006-07-26T20:21:00.000-04:002007-08-16T16:20:26.919-04:00

ReferencesSevere Sepsis and Septic Shock: Review of the Literature and Emergency Department Management Guidelines [Ann Emerg Med. 2006;48:28-54.]Setting up a pressure bag for CVP/HD monitoring: ehcedARDSnet info at: ARDSnet.org

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1152723034258263372006-07-12T12:47:00.000-04:002008-01-04T12:07:41.680-05:00

1. Purpose of this Protocol The purpose of this protocol is to ensure the safe and effective use of PROPOFOL in the ED. This protocol is not intended to replace the full prescribing information but to supplement that information with further details from practical experience. Because of the potential for adverse events and the differences between PROPOFOL and other agents used for sedation, the

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1152289440948751612006-07-07T12:17:00.000-04:002007-08-16T16:22:53.852-04:00

FROM THE ED: - In an emergency call 4HELP and ask for the IBEX SUPPORT PERSON ON CALL (Roberson, Badia or Baumlin) - the HELP DESK doesn't understand what this meansFROM THE OFFICE: - FROM HOME: - Screen resolution in IBEX has changed -> FIX THIS IN CITRIX (Start Menu -> CITRIX -> MetaFrame Access Clients -> Program Neighborhood --> Then select the "Settings" button in the toolbar -> Default

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1151691238679010612006-06-30T14:13:00.000-04:002008-02-05T14:35:42.578-05:00

Starting July 1 AMAC will check on call schedules, age of patient and code 11 as listed in complaint column.If it is weekdays between 8A and 6 PM they will call the social worker for adult or peds code 11s and connect to the charge nurse in the area.Off these hours and on weekends they will page the SAVI advocate on call and connect to the charge nurse in the area. SAVI can also be activated thru

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1151256304586303152006-06-25T13:24:00.000-04:002008-01-04T12:07:41.682-05:00

Sepsis ProtocolCentral Line ConfirmationUnder ConstructionPost-Intubation ProtocolED Capnometry ProtocolPost Resuscitation Hypothermia Protocol

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1151256242068828382006-06-25T12:55:00.000-04:002008-02-05T14:35:42.578-05:00

The possibility of arterial cannulation during attempted central venous access is well recognized. Classic findings of arterial cannulation such as pulsatile bright red blood are notoriously unrelieable markers of catheter location. When unwanted arterial cannulation is suspected, the catheter should be removed and a new attempt at venous cannulation made. To reduce the possiblity of

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1150330231100766482006-06-14T20:09:00.000-04:002008-02-05T14:35:42.579-05:00

atomic wings 4103800 BC Deli . Restaurants/Take Out 212-996-0649 Caribeano Resturant Restaurants/Take Out 831-3906 Dump. King . Restaurants/Take Out 212-410-2700 El Paso restaurant Restaurants/Take Out 996-1509 Famiglia . Restaurants/Take Out 212-996-9797 Ferny Deli Restaurants/Take Out

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1150141196972585652006-06-12T15:39:00.000-04:002008-02-05T14:35:42.579-05:00

Indications for ReferralPregnancyThreatened abortionDysfunctional uterine bleeding (H/H>30)Post-partum patientsVaginitisUrinary tract infectionPelvic inflammatory diseaseSexually transmitted diseasesContraception (all forms)Routine Gyn examPelvic painRefer to Specialty ClinicsColposcopy (Abnormal PAP) -> Pt with abnormal PAP smearMenopause Cystometrics (Urinary Incontinence) Speciality clinics

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1149770338078334072006-06-08T08:33:00.000-04:002008-02-05T14:35:42.580-05:00

This info graciously borrowed from AAEM Dollars and Sense. Thanks Shkelzen.Critical Care CodesMany emergency physicians still struggle with what type of patient presentations constitute critical care. The average ED patient is very ill compared to the average patient in the big house of medicine. I tell my physicians to picture the scenario as if the patient were presenting to an office-based

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1158882845729537372006-06-01T19:49:00.000-04:002008-12-13T05:54:17.128-05:00

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1149019580198946282006-05-30T16:02:00.000-04:002008-02-05T14:35:04.334-05:00

Very Abbreviated conversation between Matt Denny and Scott Weingart:Matt: I've been reading a few articles arguing against using etomidate, even as a single dose for induction, on the grounds that it suppresses cortisone production. The alternatives were giving steroids to all such patients post etomidate, or using alternative agents such as thiopental or dexmedetomidine. What's your take on

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1148582650508738892006-05-25T14:36:00.000-04:002008-02-05T14:39:00.759-05:00

Portable Ventilator Options1. Tyco/Puritan Bennett - Achieva - LP20 - LP10 - Companion 2801 - Lifecare Plv-102 - Lifecare Plv-100 - Bear 332. Impact - Uni-Vent Eagle Model 754 - Univent Model 750 - Univent Model 706

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1148052964466167582006-05-25T13:30:00.000-04:002008-01-04T12:07:41.682-05:00

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1148395350509205812006-05-23T10:40:00.002-04:002008-02-13T06:36:23.989-05:00

Sinai specific resources that we use both frequently and infrequently to make your shift go a little bit smoother.Resus Room - Resus Criteria - Critical Care Supplies - Ultrasound Documentation - MI Team Activation: see info here. When in doubt, call AMAC. - STROKE Team Activation: Call AMAC who will notify Stroke, CT, Lab. - Central Line Documentation: be sure to document Maximal Sterile

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1148101464320642292006-05-20T01:03:00.000-04:002008-02-05T14:38:43.351-05:00

General EM Linksncemi.orgCyber SchoolEM UltrasoundER StatEM CasesemedicineHopkins ABX GuideER WorldEM GuidelinesembbsTrauma.orgJeff Mann's GuidemapsVent WorldCritical Care LinksSCCM CalendarSocietiesABEMAHAAMIACORDEMFEMRAENAFERNEJCAHONAEMSPSAEMSCCMACEPJournals

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1126545325662913522005-09-12T13:13:00.000-04:002008-02-05T14:39:47.450-05:00

SepsisEGDT Implementation Gaeski/Goyal - Letter to editor re: EGDT+rhAPCSevere Sepsis and Septic Shock: Review of the Literature and Emergency Department Management Guidelines ED-SEPSIS Group - EBM Sepsis UpdateBlueprint for a Sepsis Protocol Nate Shapiro - Sepsis Blueprint.Early Goal Directed Therapy Emmanuel Rivers - EGDTInfectious DiseaseMiscellaneousWeingart Reading ListAdrenal

pandesignnoreply@blogger.com0tag:blogger.com,1999:blog-16649210.post-1148091888978853262005-01-01T22:24:00.000-05:002006-11-15T12:01:29.556-05:00

pandesignnoreply@blogger.com0