1. March Quick Hits

2. 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

3. 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

4. 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

6. Influenza treatment
On the basis of epidemiologic studies of patients with seasonal influenza or 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.

7. 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

8. 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,  

9. 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