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Showing results for "deaths".

5201. PowerPoint Presentation (ppt file)
      psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.329_slideshow.ppt
      August 01, 2014 - PowerPoint Presentation Spotlight Pitfalls in Diagnosing Necrotizing Fasciitis This presentation is based on the July/August 2014 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Terence Goh, MBBS, Department of Plastic Surgery, Singapore General Hos…

5202. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49462/psn-pdf
      October 01, 2004 - Thin Air October 1, 2004 Gaba DM. Thin Air. PSNet [internet]. 2004. https://psnet.ahrq.gov/web-mm/thin-air Case Objectives Identify the gas-specific non-interchangeable connectors used for bulk gas supply outlets in hospitals. Define forcing function, both in engineered safety devices and in human procedures. R…

5203. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49817/psn-pdf
      January 01, 2018 - Slow Down: Right Drug, Wrong Formulation January 1, 2018 Amato MG, Schiff G. Slow Down: Right Drug, Wrong Formulation. PSNet [internet]. 2018. https://psnet.ahrq.gov/web-mm/slow-down-right-drug-wrong-formulation The Case A 65-year-old man presented to his primary care clinic for follow-up after a recent hospitaliz…

5204. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/852699/psn-pdf
      August 30, 2023 - Beyond the Pandemic: Creating Total Systems Safety August 30, 2023 Van CM, Mossburg S, McGaffigan P. Beyond the Pandemic: Creating Total Systems Safety. PSNet [internet]. 2023. https://psnet.ahrq.gov/perspective/beyond-pandemic-creating-total-systems-safety The COVID-19 pandemic necessitated a shift in operations …

5205. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49481/psn-pdf
      May 01, 2005 - Discharge Against Medical Advice May 1, 2005 Hwang SW. Discharge Against Medical Advice. PSNet [internet]. 2005. https://psnet.ahrq.gov/web-mm/discharge-against-medical-advice The Case A 50-year-old man with a history of alcohol abuse and alcohol-induced dementia was admitted to the medical service with mild alco…

5206. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49529/psn-pdf
      February 01, 2007 - Crossed Coverage February 1, 2007 Kayser SR. Crossed Coverage. PSNet [internet]. 2007. https://psnet.ahrq.gov/web-mm/crossed-coverage The Case A 27-year-old woman with a history of congenital heart disease was admitted for cardiac transplantation evaluation. She had already undergone multiple surgeries, including…

5207. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49638/psn-pdf
      January 01, 2012 - Communication Failure—Who's in Charge? October 1, 2011 Fackler J, Schwartz JM. Communication Failure—Who's in Charge? PSNet [internet]. 2011. https://psnet.ahrq.gov/web-mm/communication-failure-whos-charge The Case A 20-month-old boy was admitted to the intensive care unit (ICU) following a Fontan surgical procedu…

5208. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49665/psn-pdf
      September 01, 2012 - Undetected Foreign Object September 1, 2012 Cima RR. Undetected Foreign Object. PSNet [internet]. 2012. https://psnet.ahrq.gov/web-mm/undetected-foreign-object The Case A 75-year-old man with a past medical history of end-stage renal disease (on hemodialysis), hypertension, and diabetes was found to have obstruct…

5209. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49489/psn-pdf
      September 01, 2005 - Double Trouble September 1, 2005 Gurwitz JH. Double Trouble. PSNet [internet]. 2005. https://psnet.ahrq.gov/web-mm/double-trouble Case Objectives Appreciate the incidence of adverse drug events in older persons List preventative measures that can be used to minimize medication errors in this population Encourage…

5210. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49593/psn-pdf
      October 01, 2009 - Who Nose Where the Airway Is? October 1, 2009 Lee CR. Who Nose Where the Airway Is? PSNet [internet]. 2009. https://psnet.ahrq.gov/web-mm/who-nose-where-airway The Case A 70-year-old man with peripheral vascular disease was brought to the operating room to undergo vascular bypass surgery on his right upper extrem…

5211. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49554/psn-pdf
      January 01, 2008 - Chemotherapy Extravasation January 1, 2008 Schulmeister L. Chemotherapy Extravasation. PSNet [internet]. 2008. https://psnet.ahrq.gov/web-mm/chemotherapy-extravasation The Case A 73-year-old woman with no past medical history was diagnosed with stage IIIA breast cancer. She and her oncologist decided to begin sys…

5212. Pharmacist Role in Patient Safety | PSNet
      psnet.ahrq.gov/perspective/pharmacist-role-patient-safety
      June 29, 2020 - Annual Perspective Pharmacist Role in Patient Safety February 21, 2020  View more articles from the same authors. Citation Text: Dopp AL, Hall KK. Pharmacist Role in Patient Safety. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality,…

5213. Diagnostic Failure: The Growing Deficit | PSNet
      psnet.ahrq.gov/web-mm/diagnostic-failure-growing-deficit
      June 01, 2005 - Diagnostic Failure: The Growing Deficit Citation Text: Chang R, Flanders S. Diagnostic Failure: The Growing Deficit. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2019. Copy Citation Format: Google Scholar BibTeX EndNo…

5214. I Just Want to Go Home: Understanding Delirium’s Impact on Treatment Preferences | PSNet
      psnet.ahrq.gov/web-mm/i-just-want-go-home-understanding-deliriums-impact-treatment-preferences
      December 18, 2019 - I Just Want to Go Home: Understanding Delirium’s Impact on Treatment Preferences Citation Text: Steinberg K. I Just Want to Go Home: Understanding Delirium’s Impact on Treatment Preferences. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Servi…

5215. Hiding in Plain Sight | PSNet
      psnet.ahrq.gov/web-mm/hiding-plain-sight
      April 24, 2019 - Hiding in Plain Sight Citation Text: Weinberg JM. Hiding in Plain Sight. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2009. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMe…

5216. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33697/psn-pdf
      June 01, 2010 - What Do We Know About Emergency Department Safety? June 1, 2010 Sklar DP, Crandall CS. What Do We Know About Emergency Department Safety? PSNet [internet]. 2010. https://psnet.ahrq.gov/perspective/what-do-we-know-about-emergency-department-safety Perspective Emergency medicine has evolved from a location, with var…

5217. Microsoft PowerPoint - FINAL Spotlight Case_Medication Error During Procedural Sedation in the Pediatric ED_03.27.2023.pptx (pdf file)
      psnet.ahrq.gov/sites/default/files/2023-04/april_2023_spotlight_the_dose_makes_the_poison.pdf
      January 01, 2023 - hospital admission was only 1 in 1500, only one case required cardiopulmonary resuscitation, and no deaths

5218. Spotlight
      psnet.ahrq.gov/sites/default/files/2024-12/spotlight_case_csf_leak_after_elective_spine_surgery_slides_-_final.pptx
      January 01, 2024 - Spotlight Spotlight Management of CSF Leaks After Elective Spine Surgery: Routine Laminectomy Leads to Fatal Discitis and Sepsis 1 Source and Credits This presentation is based on the December 2024 AHRQ WebM&M Spotlight Case See the full article at https://psnet.ahrq.gov/webmm  CME credit is available  Comment…

5219. What Do We Know About Emergency Department Safety? | PSNet
      psnet.ahrq.gov/perspective/what-do-we-know-about-emergency-department-safety
      June 01, 2010 - What Do We Know About Emergency Department Safety? David P. Sklar, MD; Cameron Crandall, MD | June 1, 2010  Also Read a Conversation View more articles from the same authors. Citation Text: Sklar DP, Crandall CS. What Do We Know About Emergency Department Safety…

5220. EMS Perils from Hospital Overcrowding | PSNet
      psnet.ahrq.gov/web-mm/ems-perils-hospital-overcrowding
      November 25, 2020 - EMS Perils from Hospital Overcrowding Citation Text: Brown S, Rose JS, Barnes DK. EMS Perils from Hospital Overcrowding. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2022. Copy Citation Format: Google Scholar BibTeX E…