March Quick Hits

Documentation AMA conversation Administrative discharge Policy forthcoming Document explicitly; use quotes Fill out RL Do not copy and paste your note If done, document a po trial in abdominal pain/vomiting patients prior to discharge Ambulatory pulse ox in COPD/asthma patients; tachypnea also

Clinical management Infected/complicated burnstransfer to burn center Kcentra is used for warfarin reversal; no current recommendations for other uses Single dose of IV antibiotic (ceftriaxone) prior to d/c in pyelonephritis patients Infection is a cause of DKA; look for it You MUST check your Xrays EMS EKGsif possible STEMIroom 2

Clinical Management Consider observation after Narcan administration (even if going to the floor) Consider ACS involvement in massive, unstable GI bleeds If disposition changes that can change a consultant’s plan, keep the consultant in the loop Psych patients Don’t forget daily medications Manage agitation appropriately

Influenza treatment On the basis of epidemiologic studies of patients with seasonal influenza or 2009 H1N1, persons at higher risk for influenza complications who are recommended for antiviral treatment for suspected or confirmed influenza [11] include: children aged younger than 2 years; adults aged 65 years and older; persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus) or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury); persons with immunosuppression, including that caused by medications or by HIV infection; women who are pregnant or postpartum (within 2 weeks after delivery); persons aged younger than 19 years who are receiving long-term aspirin therapy; American Indians/Alaska Natives; persons who are morbidly obese (i.e., BMI is 40 or greater); and residents of nursing homes and other chronic-care facilities.

Pediatric patients Do not use SIDS as diagnosis or tell family that was cause of death Pediatric deaths Mandatory reporters Security calls DPD; make sure this happens NICU—Call them!! Bilirubin checks NICU has a bilirubinometer Correct blood test is TOTAL bilirubin Bronchiolitis treatment recommendations See Dr. Hays email

Bronchiolitis Not all bronchiolitis is RSV No evidence to support albuterol or steroids Albuterol may be harmful If mild-moderateoral hydration, nebulized saline If severenebulized saline +/- decadron (IV, po, IM), racemic epi Automatic admission criteria for bronchiolitis: Witnessed apneic spell FT < 1 mo old Preterm infant < 48 wks corrected age Respiratory distress or hypoxia,  

Bronchiolitis Neonates DON’T cough! (< 3 mos) Increased risk of pertussis even if they got their 2 mo shot; consider doing a pertussis swab (in cat 3 storeroom) Low threshold for admitting neonates with a cough, especially if tachypneic Children < 4 months do not have bronchospasm Not enough lung smooth muscle Albuterol under age 4 mo is useless