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psnet.ahrq.gov/primer/adverse-events-near-misses-and-errors
March 30, 2022 - adverse events from the Harvard Medical Practice Study: "Case 1: During angiography to evaluate coronary artery
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psnet.ahrq.gov/issue/complication-rates-central-venous-catheters-systematic-review-and-meta-analysis
December 07, 2016 - Review
Complication rates of central venous catheters: a systematic review and meta-analysis.
Citation Text:
Teja B, Bosch NA, Diep C, et al. Complication rates of central venous catheters: a systematic review and meta-analysis. JAMA Intern Med. 2024;184(5):474-482. doi:10.1001/jamainter…
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psnet.ahrq.gov/node/49585/psn-pdf
May 01, 2009 - Delirium or Dementia?
May 1, 2009
Rudolph JL. Delirium or Dementia? PSNet [internet]. 2009.
https://psnet.ahrq.gov/web-mm/delirium-or-dementia
Case Objectives
State the key diagnostic differences between delirium and dementia.
Describe the Confusion Assessment Method for workup of suspected delirium.
Explain the…
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psnet.ahrq.gov/issue/review-patient-safety-incidents-submitted-critical-care-units-england-wales-uk-national
July 16, 2008 - Study
Review of patient safety incidents submitted from critical care units in England & Wales to the UK National Patient Safety Agency.
Citation Text:
Thomas AN, Panchagnula U, Taylor RJ. Review of patient safety incidents submitted from Critical Care Units in England & Wales to the U…
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psnet.ahrq.gov/issue/emergency-intubation-children-outside-operating-room
May 27, 2011 - Study
Emergency intubation of children outside of the operating room.
Citation Text:
Long E, Barrett MJ, Peters C, et al. Emergency intubation of children outside of the operating room. Paediatr Anaesth. 2020;30(3):319-330. doi:10.1111/pan.13784.
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Format:
DOI G…
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psnet.ahrq.gov/issue/nature-response-airway-management-incident-reports-high-income-countries-scoping-review
December 15, 2014 - Review
The nature of the response to airway management incident reports in high income countries: a scoping review.
Citation Text:
Endlich Y, Davies EL, Kelly J. The nature of the response to airway management incident reports in high income countries: a scoping review. Anaesth Intensive…
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psnet.ahrq.gov/node/49753/psn-pdf
February 01, 2016 - He was taken
back to the operating room where it was noted the inferior epigastric artery (a key artery
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psnet.ahrq.gov/web-mm/too-much-too-fast
June 14, 2019 - by ventilator-dependence requiring a tracheostomy, along with comorbidities that included coronary artery
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.14_slideshow.ppt
May 01, 2003 - Benefit of heparin use in central venous and pulmonary artery catheters: a meta-analysis of randomized
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psnet.ahrq.gov/web-mm/bleeding-risk
November 01, 2003 - Her past medical history included atrial fibrillation, hypertension, coronary artery disease, and stroke
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psnet.ahrq.gov/node/49653/psn-pdf
May 01, 2012 - https://psnet.ahrq.gov/web-mm/forgotten-line
The Case
An 81-year-old man with a history of coronary artery … The patient underwent successful stenting of his coronary arteries and was discharged to an assisted
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psnet.ahrq.gov/issue/uncovering-system-errors-using-rapid-response-team-cross-coverage-caught-crossfire
April 24, 2018 - Study
Uncovering system errors using a rapid response team: cross-coverage caught in the crossfire.
Citation Text:
Kaplan LJ, Maerz LL, Schuster KM, et al. Uncovering System Errors Using a Rapid Response Team: Cross-Coverage Caught in the Crossfire. The Journal of Trauma: Injury, Infect…
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psnet.ahrq.gov/issue/nicu-medication-errors-identifying-risk-profile-medication-errors-neonatal-intensive-care
September 21, 2008 - Study
NICU medication errors: identifying a risk profile for medication errors in the neonatal intensive care unit.
Citation Text:
Stavroudis TA, Shore AD, Morlock L, et al. NICU medication errors: identifying a risk profile for medication errors in the neonatal intensive care unit. J Pe…
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psnet.ahrq.gov/web-mm/delirium-or-dementia
September 27, 2023 - SPOTLIGHT CASE
Delirium or Dementia?
Citation Text:
Rudolph JL. Delirium or Dementia?. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009.
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Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7…
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psnet.ahrq.gov/node/846169/psn-pdf
March 15, 2023 - Distraction of the Anesthesiologist and Lack of
Resuscitation Drugs Resulting in Delayed Treatment of
Laryngospasm.
March 15, 2023
Bohringer C. Distraction of the Anesthesiologist and Lack of Resuscitation Drugs Resulting in Delayed
Treatment of Laryngospasm. PSNet [internet]. 2023.
https://psnet.ahrq.gov/web-mm/…
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.206_slideshow.ppt
October 01, 2009 - Spinal anesthesia can cause unexpected and sudden hypotension resulting in hypoperfusion of the coronary arteries
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psnet.ahrq.gov/web-mm/hidden-danger-unseen-intravenous-catheters
October 04, 2023 - There is also a risk of accidental carotid artery puncture and hematoma formation, which may decrease
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psnet.ahrq.gov/web-mm/errors-managing-open-wound-elbow-leading-multiple-complications-and-operations
September 27, 2023 - removal of the foreign body itself must be considered because damage to important structures (e.g., arteries … damage to a vital structure from chronic irritation (e.g., a sharp metallic fragment adjacent to a major artery
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psnet.ahrq.gov/node/49447/psn-pdf
June 01, 2004 - Dangerous Dapsone
June 1, 2004
Bookwalter T. Dangerous Dapsone. PSNet [internet]. 2004.
https://psnet.ahrq.gov/web-mm/dangerous-dapsone
The Case
A 78-year-old woman with newly diagnosed multiple myeloma on corticosteroids presented to the
emergency department with dyspnea. Upon admission, she was found to be hypo…
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psnet.ahrq.gov/node/49431/psn-pdf
January 01, 2004 - They would arrive at this diagnosis knowing that
coronary artery disease is common in the aging population … Analysis of probability as an aid in the clinical diagnosis of coronary-artery
disease.