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  1. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49605/psn-pdf
    June 01, 2010 - Acute Respiratory Arrest in Pregnancy June 1, 2010 Sibai B. Acute Respiratory Arrest in Pregnancy. PSNet [internet]. 2010. https://psnet.ahrq.gov/web-mm/acute-respiratory-arrest-pregnancy The Case A 35-year-old woman was 38 weeks pregnant with twins (G3P2). When she developed acute onset of shortness of breath an…
  2. psnet.ahrq.gov/web-mm/abnormal-volunteer-results
    July 18, 2016 - Abnormal Volunteer Results Citation Text: Fernandez C. Abnormal Volunteer Results. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2007. Copy Citation Format: Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote ta…
  3. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49613/psn-pdf
    November 01, 2010 - Mother's Milk, but Whose Mother? November 1, 2010 Dougherty D. Mother's Milk, but Whose Mother? PSNet [internet]. 2010. https://psnet.ahrq.gov/web-mm/mothers-milk-whose-mother The Case A 2-month-old otherwise healthy infant was admitted to the hospital to rule out sepsis. The infant had been exclusively breastfed…
  4. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49620/psn-pdf
    February 01, 2011 - Silent Pain in the Neck February 1, 2011 Bittner EA. Silent Pain in the Neck. PSNet [internet]. 2011. https://psnet.ahrq.gov/web-mm/silent-pain-neck The Case A 60-year-old man with no significant past medical history underwent an elective anterior cervical discectomy for persistent right arm weakness due to cervi…
  5. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60543/psn-pdf
    May 27, 2020 - Wrong Catheter in the Right Patient May 27, 2020 Chia C, Molla M. Wrong Catheter in the Right Patient. PSNet [internet]. 2020. https://psnet.ahrq.gov/web-mm/wrong-catheter-right-patient The Case  A 55-year-old man with history of emphysema was admitted to the hospital for pneumonia. The patient had two?peripheral…
  6. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49728/psn-pdf
    March 01, 2015 - Medication Mix-Up: From Bad to Worse March 1, 2015 Wollitz A, O'Connor MF. Medication Mix-Up: From Bad to Worse. PSNet [internet]. 2015. https://psnet.ahrq.gov/web-mm/medication-mix-bad-worse The Case A 69-year-old man with chronic kidney disease and essential hypertension was admitted to the hospital with chest …
  7. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49856/psn-pdf
    March 01, 2019 - Premature Extubation March 1, 2019 Sagana R, Hyzy RC. Premature Extubation. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/premature-extubation The Case A 73-year-old woman with a history of carotid artery stenosis was admitted for an elective carotid endarterectomy. The procedure was initially thought to …
  8. 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…
  9. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/60652/psn-pdf
    June 29, 2020 - In Conversation With... Anna Legreid Dopp, Pharm. D June 29, 2020 In Conversation With.. Anna Legreid Dopp, Pharm. D. PSNet [internet]. 2020. https://psnet.ahrq.gov/perspective/conversation-anna-legreid-dopp-pharm-d Editor’s note: Anna Legreid Dopp, Pharm. D is the Senior Director of Clinical Guidelines and Quality…
  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49809/psn-pdf
    October 01, 2017 - Hyperbilirubinemia Refractory to Phototherapy October 1, 2017 Bhutani VK, Wong RJ. Hyperbilirubinemia Refractory to Phototherapy. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/hyperbilirubinemia-refractory-phototherapy The Case A 1-day-old full-term infant was noted to have elevated total serum bilirubin (…
  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/33733/psn-pdf
    July 01, 2012 - Patient Safety and Health Information Technology: Learning from Our Mistakes July 1, 2012 Koppel R. Patient Safety and Health Information Technology: Learning from Our Mistakes. PSNet [internet]. 2012. https://psnet.ahrq.gov/perspective/patient-safety-and-health-information-technology-learning-our-mistakes Perspe…
  12. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49433/psn-pdf
    June 23, 2021 - Environmental Safety in the OR February 1, 2004 Linkin DR, Lautenbach E. Environmental Safety in the OR . PSNet [internet]. 2004. https://psnet.ahrq.gov/web-mm/environmental-safety-or The Case The infection control department of a hospital noticed a marked increase in the rates of post-operative sternal wound inf…
  13. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49863/psn-pdf
    May 01, 2019 - Good Catch in the Operating Room May 1, 2019 Day J, Paige JT. Good Catch in the Operating Room. PSNet [internet]. 2019. https://psnet.ahrq.gov/web-mm/good-catch-operating-room The Case A 46-year-old woman with extensive history of back pain from lumbar stenosis was scheduled for an elective laminectomy and spinal…
  14. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/73998/psn-pdf
    October 27, 2021 - The Hidden Danger of Unseen Intravenous Catheters October 27, 2021 Vadi MG, Malkin MR. The Hidden Danger of Unseen Intravenous Catheters. PSNet [internet]. 2021. https://psnet.ahrq.gov/web-mm/hidden-danger-unseen-intravenous-catheters The Case A 6-week-old infant underwent a craniotomy and excision of abnormal bra…
  15. 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…
  16. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49535/psn-pdf
    May 01, 2007 - Production Pressures May 1, 2007 Carayon P. Production Pressures. PSNet [internet]. 2007. https://psnet.ahrq.gov/web-mm/production-pressures The Case A 65-year-old man with bipolar disorder was scheduled for maintenance electroconvulsive therapy (ECT), a procedure he had received dozens of times before. These pro…
  17. psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.323_slideshow.ppt
    May 01, 2014 - PowerPoint Presentation Spotlight Medication Reconciliation With a Twist (or Dare We Say, a Patch?) This presentation is based on the May 2014 AHRQ WebM&M Spotlight Case See the full article at http://webmm.ahrq.gov CME credit is available Commentary by: Janice Kwan, MD, Department of Medicine, University of Tor…
  18. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/50929/psn-pdf
    February 26, 2020 - Discharged with IV antibiotics: When issues arise, who manages the complications? February 26, 2020 Donnelley M, Gintjee TJ, Go J. Discharged with IV antibiotics: When issues arise, who manages the complications? PSNet [internet]. 2020. https://psnet.ahrq.gov/web-mm/discharged-iv-antibiotics-when-issues-arise-who-…
  19. 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…
  20. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/49778/psn-pdf
    December 01, 2016 - One Dose, Two Errors December 1, 2016 Filice GA. One Dose, Two Errors. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/one-dose-two-errors The Case A 65-year-old woman was admitted to the intensive care unit (ICU) with severe sepsis and respiratory failure secondary to community-acquired pneumonia. The pati…