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Biomedical subjects

S M Schexnayder

Publications and source records attributed to S M Schexnayder.

6 recordsLinked to original sources

Coding and billing in the pediatric intensive care unit.

Physicians need to be proficient in their use of CPT codes and ICD-9 codes. They must participate actively and be knowledgeable of their billing process. An organized approach to coding and billing has been suggested by the American Academy of Pediatrics, as outlined in the following box. Physicians are ultimately responsible for any bill submitted in their name. Therefore, close scrutiny of the coding and billing procedures is paramount. Even if mistakes are made in the billing process beyond physicians' input, physicians still may be held responsible. If physicians do their own coding, the bills become more accurate, which can result in higher reimbursement. Physicians also should have a functional compliance plan in place, whether practicing in a large faculty group practice or practicing solo, with the ability to audit the coding and billing process and respond to variances if they are found. By being more involved in the process, physicians can have a more efficient billing system that avoids the potential for fraud and abuse and improves collections.

Forms and Records Control↗

Fatal cerebral edema and intracranial hemorrhage associated with hypernatremic dehydration.

We report neuroimaging findings of intracranial hemorrhage and cerebral edema in an infant with obtundation and seizures, initially suspected to be secondary to non-accidental trauma but finally attributed to hypernatremic dehydration. Neuroimaging findings due to hypernatremic dehydration have not been previously described in the radiologic literature. Hypernatremia should be included in the differential diagnosis of intracranial hemorrhage in the infant without evidence of nonaccidental trauma.

Brain Edema↗

911 in your office: preparations to keep emergencies from becoming catastrophes.

Emergencies are more common in the day-to-day pediatric practice than generally appreciated. Knowledge of the types of emergencies that may be encountered, obtaining and organizing the necessary equipment and medications, training staff, and developing a plan for disposition of the patients are all required to effectively manage these situations. A well thought-out plan is not prohibitively expensive, but is necessary to ensure proper patient care.

Child↗

Flexible fiberoptic bronchoscopy in children on extracorporeal membrane oxygenation.

Bleeding is one of the most feared complications of veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO), and is also a potential complication of flexible fiberoptic bronchoscopy (FFB). We retrospectively reviewed 14 patients who underwent FFB procedures with bronchial washings (BW) and bronchoalveolar lavage (BAL) to evaluate the safety of this procedure in children on ECMO. Standard FFB with BAL/BW technique was used after stabilization on ECMO. Three patients underwent two procedures each, and one patient underwent three, for a total of 19 procedures. No significant complications, such as bleeding have occurred. Three patients required additional ECMO support shortly after FFB. After the 16 procedures done for atelectasis, seven patients improved radiographically, three had increased opacifications, and six were unchanged. The remaining three patients had suspected pulmonary infections, and in each, therapeutic decisions were guided by the BAL results. Lung compliance was unchanged or improved after 11 of 13 procedures. We conclude that FFB with BAL/BW in children on ECMO is safe and may benefit certain patients.

Bronchoalveolar Lavage Fluid↗