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psnet.ahrq.gov/web-mm/acute-respiratory-arrest-pregnancy
August 15, 2018 - Two days prior to admission, the patient presented to the obstetrics clinic with blood pressures (BPs … marked increase in her plasma volume with resultant increase in her preload (increased left atrial pressure … orders for type and frequency of blood tests, fetal monitoring, and surveillance of symptoms and blood pressure … Criteria for E stablishing Severe Preeclampsia.* • Persistent blood pressure above 160/110 mm … Related Resources
WebM&M Cases
Uterine Artery Injury
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psnet.ahrq.gov/node/837660/psn-pdf
July 08, 2022 - The trauma team was called to assist and the patient was given additional sedation and opioid analgesia … The trauma surgeon then manipulated both TMJs and was finally able to unloose the locked jaw. … diagnosis and a physician experienced in
reducing the TMJ should be consulted to minimize the risk of injury … Placing staff under too much time pressure can, at
times, be counterproductive and can adversely affect
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psnet.ahrq.gov/web-mm/physical-diagnosis-lost-art
January 17, 2018 - Case & Commentary: Part 1 A 57-year-old male with T8 paraplegia from a remote gunshot wound, hypertension … as follows: General: Mild respiratory distress with audible wheezing Vitals: Blood pressure … In one study, 90% of patients expected their blood pressure to be measured and their heart, lungs, abdomen … One of us (G.R.T.) has seen a patient with spinal cord injury who was transferred from an outside hospital … Clinical assessment of central venous pressure in the critically ill.
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psnet.ahrq.gov/periodic-issue/periodic-issue-469
December 31, 2024 - On arrival at the emergency department, she had severely elevated blood pressure and hypoxemia. … continuing challenge of preventing falls and explores strategies for preventing falls and falls with injury
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psnet.ahrq.gov/node/837324/psn-pdf
July 08, 2022 - A 2014 study of
women who gave birth found that 14.8% of respondents perceived pressure from a clinician … riskier.13 Babies delivered via
cesarean section are at risk for respiratory problems and surgical injury … www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655#:~:text=A%20C%2Dsection%20might%20increase,Wound … www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655#:~:text=A%20C%2Dsection%20might%20increase,Wound … Patient-perceived pressure from clinicians for labor
induction and cesarean delivery: a population-based
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psnet.ahrq.gov/web-mm/delayed-evaluation-abdominal-pain-elderly-patient
February 26, 2020 - The patient remained alert and cooperative until 2350H when her blood pressure fell to 90/58. … Nevertheless, every patient deserves to be provided with the best opportunity to survive an illness or injury … that permits all necessary interventions to be provided commensurate with the degree of illness or injury … Consulting Editor, AHRQ’s Patient Safety Network (PSNet) Professor Department of Surgery Division of Trauma … 2022
WebM&M Cases
Errors in Managing an Open Wound
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psnet.ahrq.gov/web-mm/who-nose-where-airway
May 01, 2016 - how a safety pin could be aspirated, or a non-deformable endotracheal tube connector might cause a pressure … injury to the nares if left in place for more than a brief period.
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psnet.ahrq.gov/node/49639/psn-pdf
November 01, 2011 - On further history, he revealed that he had recently increased his beta-
blocker, a blood pressure medication … In case of injury, there may have been no attempt at recovery,
or the attempts may have been unsuccessful
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psnet.ahrq.gov/web-mm/defensive-medicine-glowing-pain
November 01, 2012 - medicine can be found in the field of neurosurgery where many hospitals refuse to treat closed head injuries … because of liability concerns.( 13 ) In complex patients, vaginal delivery may increase the risk of injury … to the mother or fetus; injuries in this setting often lead to malpractice claims. … Are evidence-based practices associated with effective prevention of hospital-acquired pressure
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psnet.ahrq.gov/node/851971/psn-pdf
July 31, 2023 - with factitious disorder consciously and manipulatively (usually
surreptitiously) produce illness or injury … advocated by most experienced practitioners.20 Applying cricoid pressure compresses the esophagus and … this communication error because the foreign
body likely traversed the gastrointestinal tract without injury … Scand J
Trauma Resusc Emerg Med. 2021;29(1):64. [Free full text]
20. … The clinical use of cricoid pressure: first, do no harm. Anesth Analg.
2021;132(1):261-267.
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psnet.ahrq.gov/node/33765/psn-pdf
April 01, 2014 - reason for us to make sure, at least from Leapfrog's spot,
that there's a continued laser focus and pressure … We
graded every hospital for which there's adequate data on errors, accidents, and injuries. … Then hopefully they will go to the hospital and put some pressure on them to elevate the
priority of … How do I protect them from the errors and injuries that are rampant? What can I do better?
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psnet.ahrq.gov/node/49772/psn-pdf
October 01, 2016 - Upon further evaluation, she was noted to have a rapid heart rate
and low blood pressure. … Several
hours later, the patient was noted to be lethargic with a low blood pressure. … While the inpatient care team discussed possible causes for her low blood pressure, the microbiology … Automated, electronic alerts for acute kidney injury: a single-
blind, parallel-group, randomised controlled
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psnet.ahrq.gov/node/49765/psn-pdf
August 21, 2016 - The patient ultimately regained a pulse but required two vasopressors
to maintain her blood pressure … Bedside cannulation of the central circulation for measurement of central
venous pressure and for vasopressor … The patient immediately
responded, with improved oxygenation and blood pressure. … radiograph provided reassurance that the central line was in the correct position without
evidence of lung injury … Relative value of central-venous-pressure monitoring and blood-volume measurement in the
management
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psnet.ahrq.gov/issue/policies-and-practices-related-role-board-certification-and-recertification-pediatricians
February 03, 2011 - September 29, 2017
Medical injuries among hospitalized children.
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psnet.ahrq.gov/perspective/remote-patient-monitoring
March 15, 2023 - We monitored the blood pressures of home peritoneal dialysis patients. … We knew their trends and that some of them had typically higher blood pressures and some of them had … typically lower blood pressures, so we created individual thresholds. 1 , 3 , 4
Sarah Mossburg: It … Historically, these are acute problems that arise where there is illness or injury. … We knew there were hospital capacity problems and a lot of different pressures and stakeholders that
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psnet.ahrq.gov/perspective/conversation-dr-neal-sikka-and-dr-colton-hood-about-remote-patient-monitoring
March 15, 2023 - We monitored the blood pressures of home peritoneal dialysis patients. … We knew their trends and that some of them had typically higher blood pressures and some of them had … typically lower blood pressures, so we created individual thresholds. 1 , 3 , 4
Sarah Mossburg: It … Historically, these are acute problems that arise where there is illness or injury. … We knew there were hospital capacity problems and a lot of different pressures and stakeholders that
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psnet.ahrq.gov/web-mm/good-catch-operating-room
August 27, 2017 - About halfway through the procedure, the anesthesiologist noticed that the patient's blood pressure was … anesthesiologist administered a bolus of intravenous fluids, but over the next few minutes the patient's blood pressure … The patient required transfusion of multiple units of blood, and fortunately the injury was repaired … first challenge occurred when the anesthesiologist alerted the surgeon during the initial drop in blood pressure … Paige, MD Professor of Clinical Surgery Director of Wound Care LSU Health New Orleans Health Sciences
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psnet.ahrq.gov/perspective/doctors-multiple-malpractice-claims-disciplinary-actions-and-complaints-what-do-we-know
July 01, 2017 - this area from personal acquaintance with physicians and understanding their narratives of how legal pressures … That caring relationship doesn't end when an injury occurs, particularly if the injury is our fault. … They reduce the underlying safety problems that can lead to injuries that lead to claims. … Then, we have a few cases in which EHR systems themselves have had problems that have led to injuries … May 20, 2015
Medical monitoring for pharmaceutical injuries: tort law for the public's
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psnet.ahrq.gov/node/49673/psn-pdf
December 01, 2012 - On physical
examination, his initial blood pressure was elevated at 192/100 mm Hg, but his heart rate … Bilateral upper-extremity blood pressures were equal. … oral
antacid/anesthetic combination) was given, and the patient reported symptom relief; his blood pressure … ECG interpretation: sinus tachycardia, with posterolateral injury
pattern.
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psnet.ahrq.gov/web-mm/cognitive-overload-icu
June 01, 2005 - The patient ultimately regained a pulse but required two vasopressors to maintain her blood pressure … Bedside cannulation of the central circulation for measurement of central venous pressure and for vasopressor … The patient immediately responded, with improved oxygenation and blood pressure. … radiograph provided reassurance that the central line was in the correct position without evidence of lung injury … Relative value of central-venous-pressure monitoring and blood-volume measurement in the management of