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EMEDPA

quoting "rules" in your note

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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.

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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

 

 

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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?




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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?




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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.

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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.

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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

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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.

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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. 

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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.

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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!

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