Brief Resolved Unexplained Events (BRUE)

ALTE has been deprecated and replaced with BRUE. Apparent Life-Threatening Events scared parents and led physicians to unnecessary testing. The American Academy of Pediatrics has issued the following guideline. Continue reading “Brief Resolved Unexplained Events (BRUE)”

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Brief Resolved Unexplained Events (BRUE)

Maximizing Charting Points

Several years ago I spent a couple of hours with our head coder to come up with a macro that would make us “compliant” with all the “points” that billers care about. I don’t remember what “points” are, but I know that when I use this macro I get a lot of RVU’s out of each chart. It’s also helpful for a quick summary at the end. Continue reading “Maximizing Charting Points”

Maximizing Charting Points

Low Risk Chest Pain (HEART score)

Chest pain is one of the more common presenting complaints to our Emergency Department. We daily tease out those who require further testing for acute coronary syndromes vs those who can be safely discharged home. If we approaching these patients in a consistent way, we can hopefully create a consistent and safe process for evaluating these patients. I propose the HEART score. Unlike the other scores (PURSUIT, TIMI, GRACE, FRISC), HEART performs well and was tested in the ED. Continue reading “Low Risk Chest Pain (HEART score)”

Low Risk Chest Pain (HEART score)

Suicide Risk

Here is a suicide checklist I created after listening to Rob Orman’s ER CAST. He reviewed the literature, and while there is no checklist that can predict anyone’s behavior, this seemed like a good list of things to document in those who are potentially at risk for suicide.

Risk Factors:
– Trigger (Events leading up to this episode): ***
– Rational thinking loss (Anxiety, psychosis, agitation, etc): ***
– Age and gender (15-24, >65 are at higher risk, male higher risk): ***
– Access to means (Firearms, medications, etc.): ***
– Previous attempts (number, lethality, < 1 year since last attempt): ***
– Prev psychiatric care (Recent psych admit increases acute risk): ***
– Excessive EtOH or drug use: ***
– Depression and hopelessness: ***
– Sickness (functional impairment, chronic pain, increased dependence on others): ***
– Ideation (more intense thought, completed or lethal plan are higher risk): ***
– Lack of social support, isolation: (friends, family, coworkers, get collateral info): ***
– Organized or serious attempt: ***

***Protective Factors:
– Support (family, friends, religion, etc):***
– Awareness (insight, coping skills, decision making):***
– Future oriented (Planning/looking forward to future events):***
– Engaged (not withholding information, lying, or resisting evaluation):***

Estimated suicide risk (Low, medium or high): ***
Plan: ***

Suicide Risk