Moderator EMEDPA Posted September 30, 2017 Moderator Share Posted September 30, 2017 Many common ER scenarios have rules that have been tested to help with decision making. using these in your notes helps bolster your medical decision making and can protect you in the event of a later poor outcome. Ones I use frequently: Nexxus and Canadian c-spine Pecarn for peds head injuries Perc for PE Heart score for ACS abcde2 for tia risk of progression Port score for pneumonia Chad score for anticoagulation of afib. Ottawa ankle rules Canadian head ct rules those are the ones I use the most. there are others. most on mdcalc website most of you seasoned ER folks probably already know this and many of you likely do it. please feel free to add to my list. 2 Quote Link to comment Share on other sites More sharing options...
sk732 Posted September 30, 2017 Share Posted September 30, 2017 CURB-65 (pneumonia) Wells TIMI (and not the guy from South Park, though I do love to yell TIMI!!) - with HEART on our algorithm/check list for cath lab referral You've taken a lot of mine already so no use repeating. SK 1 Quote Link to comment Share on other sites More sharing options...
Johnson2018pac Posted September 30, 2017 Share Posted September 30, 2017 Just out of curiosity how much weight do these actually carry in the event of a misdiagnosis and some bad outcome assuming you calculated it correctly?Sent from my iPhone using Tapatalk Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 30, 2017 Author Moderator Share Posted September 30, 2017 10 hours ago, radioman said: Just out of curiosity how much weight do these actually carry in the event of a misdiagnosis and some bad outcome assuming you calculated it correctly? Sent from my iPhone using Tapatalk good question. couldn't hurt to have a well-respected diagnostic tool quoted appropriately in your note if the perc neg pt has a PE or the abcd2 pt has a cva the same day they are d/c after a TIA. I think it would be easy to find professional witnesses who would say they did the same thing, assuming no gross negligence. 1 Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 30, 2017 Share Posted September 30, 2017 I have frequently listed documentation references to “patient doesn’t meet criteria for x based on y guidelines.” Playing devils advocate, regardless of your resource, if the standard of care in your community is different then you could be on the hook. Ex.-MMG, PSA screening, failure to check one month CXR after pneumonia dx. Quote Link to comment Share on other sites More sharing options...
sk732 Posted October 1, 2017 Share Posted October 1, 2017 I do it a lot simply because we have 100% sign off on charts and I work for some folks that have trust issues...I also do it a lot on imaging requests - "Ottawa Rules (+) for XYZ or Head CT Rules (+) in case someone balks. SK Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 1, 2017 Author Moderator Share Posted October 1, 2017 I have 0% chart review and still do it as a favor to my partners who might see a bounce back a few days later and might otherwise wonder "why wasn't xyz done" and then they see "Pecarn predicts risk of ICH to be 0.9%". Oh, that's why. 1 Quote Link to comment Share on other sites More sharing options...
just_nelle Posted October 4, 2017 Share Posted October 4, 2017 Great list! Don't forget Alvarado score when you're consulting the surgeon in the middle of the night for an acute appy...not really a rule, but a helpful decision tool. 1 Quote Link to comment Share on other sites More sharing options...
medic25 Posted October 4, 2017 Share Posted October 4, 2017 It doesn't have a catchy name like PECARN or PERC, but the Acute Gout Rule (Nijmegen study rule) is nice when documenting why you aren't performing a joint tap on a hot joint. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 4, 2017 Author Moderator Share Posted October 4, 2017 25 minutes ago, medic25 said: It doesn't have a catchy name like PECARN or PERC, but the Acute Gout Rule (Nijmegen study rule) is nice when documenting why you aren't performing a joint tap on a hot joint. don't know that one, will have to look it up, thanks! Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 4, 2017 Author Moderator Share Posted October 4, 2017 https://www.mdcalc.com/acute-gout-diagnosis-rule cool, thanks! Quote Link to comment Share on other sites More sharing options...
narcan Posted November 27, 2017 Share Posted November 27, 2017 New one I heard about recently: Ottawa Subarachnoid Headache Rule to rule out testing for SAH in acute headache. Pretty helpful. https://www.mdcalc.com/ottawa-subarachnoid-hemorrhage-sah-rule-headache-evaluation Validation: https://www.ncbi.nlm.nih.gov/pubmed/29133539 Also, I don't use this one often because I find it redundant, but it's a good reminder for newbies who are still figuring out who needs to be admitted: San Francisco Syncope Rule https://www.mdcalc.com/san-francisco-syncope-rule Quote Link to comment Share on other sites More sharing options...
kargiver Posted November 28, 2017 Share Posted November 28, 2017 I take a bit of a contrarian approach, as I tend not to use rules as they are protocol driven and unless something is absolutely straight-forward, I am a touch reserved such that my reliance on something like the PERC rule (which allows for about a 1.7% miss rate on PEs) will come back to bite me in the buttocks. There are times I do use them of course, but patient presentation first and if anything is amiss (and I think about it from someone else looking at - it's too easy to fall into a cognitive bias of what we want to see vs. what is objective) I investigate and treat regardless of the rule. The only ones I use are: PERC or Wells (or together) HEART Score PORT Score Peds Appendicitis Score FENa Scores CENTOR Criteria (even though ABX now recommended for hold until positive culture - meh) Working in ski country has taught me the Ottawa rules for orthopedic extremity trauma are pretty meaningless so I have stopped relying on them. Worked great when I worked at an academic medical center. Following them in ortho trauma heaven leads you to miss a lot. All else is look at the patient and treat them... G Quote Link to comment Share on other sites More sharing options...
dphy83 Posted October 14, 2018 Share Posted October 14, 2018 Most of the above are good. I also like to reference the San Francisco Syncope Rule. Also, keep in mind that the ABCD2 score hasn't been validated, particularly for ED use, so I wouldn't use this - just admit all TIAs for workup or discharge AMA if they refuse. Our EM group actually wants us to reference HEART scores for all chest pain patients. Quote Link to comment Share on other sites More sharing options...
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