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domingo, 29 de mayo de 2016

Air Ambulance Top Medical Codes

Air Ambulance Top Medical Codes 
Air Ambulance Top Medical Codes 
Air Ambulance services are usually furnished to those beneficiaries who need immediate medical attention, and where other means of transportation are not probable. An air ambulance service includes fixed (aircraft) and rotary (helicopter) wing services and are used mostly in emergency situations. Insurance payers generally do cover air ambulance services; only if certain terms and conditions are met as those above mentioned; and if the treatment is not given, it could seriously endanger the patient’s health/life. The costs are acknowledged as per the two different payment amounts for air ambulance mileage. The mileage rate is calculated per actual loaded (patient onboard) miles flown, and expressed in statute miles (not nautical miles).
As per the documentation, the ambulance supplier must do the apt billing and coding for reimbursements while describing the services rendered. While entering the codes, origin and destination modifier combinations must be added to the procedure code. These services are covered when the vehicle and crew conditions are also met.
HCPCS/CPT procedure codes for air ambulance:
A0430: Ambulance service, conventional air services, transport, one way (fixed wing) (FW)
A0431: Ambulance service, conventional air services, transport, one way (rotary wing) (RW)
A0435: Fixed wing air mileage, per statute mile
A0436: Rotary wing air mileage, per statute mile
A0424: Extra ambulance attendant, ground (ALS or BLS) or air (fixed or rotary winged); (requires medical review)
Modifiers:
I: Site of transfer (airport/helicopter pad) between modes of ambulance transport.
QL: Used if the person is dead after the ambulance is called but before transport. Modifier can be used by air providers as per the appropriate air base rate code (fixed wind or rotary wing). No rural allowance or mileage is billed.
GM: Document details and use it when more than one patient is being transported in the same ambulance.
A0430 – This refers to transportation by an aircraft that is certified by Federal Aviation Administration (FAA) as a fixed wing air ambulance, and includes medical services and supplies.  It is used when the patient cannot be moved by ground transport; is stated to be medically necessary; immediate treatment is required at another healthcare facility which is too far; or due to other obstructions (e.g. heavy traffic, limited time frame e.g. for a transplant, the nearest facility does not have the required medical services, inaccessible pick-up point, unapproachable by land or water). Mileage is identified with A0435 Fixed wing air mileage, per statute mile.
A0431 – This refers to transportation by a helicopter certified by FAA as a rotary wing ambulance, and includes medical supplies and services. This mode is used for the same reason as above i.e. speedy transportation is required due to medical requirement and inaccessibility due to traffic, distance etc. Mileage is identified with A0436 Rotary wing air mileage, per statute mile.
A few reasons for using air transport are: intracranial bleeding, cardiogenic (heart) shock, multiple injuries, life threatening trauma, extreme burns, or patient requiring aid in a hyperbaric oxygen unit. Non-emergency services are usually not covered unless the patient is “bed confined.”
- See more at: http://www.medicalbillersandcoders.com/blog/top-medical-codes-for-air-ambulance.html#sthash.gVwcTb7l.dpuf

FareTec CT-EMS Leg Splint / FÉRULA DE DE TRACCIÓN "FareTec CT-EMS Leg Splint"

FareTec CT-EMS Leg Splint
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INSTRUCCIONES SOBRE FÉRULA DE DE TRACCIÓN "FareTec CT-EMS Leg Splint"
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Alex Pacheco
Faculty
PreHospital Trauma Life Support Republica Dominicana

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miércoles, 25 de mayo de 2016

Improved Traction Device tm ITD. Video



Improved Traction Device tm ITD. Video

SEGURIDAD VIAL. INFOGRAFIAS

Fuente Imagenes SEGURIDAD VIAL ENTRE TODOS
ANGULOS DE VISION SEGUN LA VELOCIDAD. INFOGRAFIA
ACORDATE CUANTO TE DOLIO ESA CERVEZA


CONSEJOS PARA CIRCULAR EN BICICLETA DE MANERA SEGURA POR LA CIUDAD

CONSEJOS PARA CIRCULAR EN BICICLETA DE MANERA SEGURA POR LA CIUDAD

EL ALCOHOL AL VOLANTE MATA

LA SEGURIDAD VIAL NO ES ACCIDENTAL

UBICACION DE LAS LESIONES EN ACCIDENTES MORTALES

EL UNICO REPUESTO QUE SEGURO NO CONSEGUIS...
DISTANCIAS DE FRENADO
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PREVENCION DE ACCIDENTES EN MOTOS / CASCOS EN MOTOCICLETAS / TRAUMA EN MOTOCICLETAS


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martes, 24 de mayo de 2016

¿Qué es la Gota? ARTRITIS GOTOSA

¿Qué es la Gota?
Gota aguda; Artritis gotosa de tipo agudo; Hiperuricemia; Gota tofácea; Gota crónica; Tofos; Podagra; Gota de tipo crónico; Gota de tipo agudo; Artritis gotosa aguda


¿Qué es la Gota?

La gota es un tipo de artritis. Ocurre cuando el ácido úrico se acumula en la sangre y causa inflamación en las articulaciones.

La gota aguda es una afección dolorosa que normalmente afecta solo una articulación. La gota crónica se refiere a episodios repetitivos de dolor e inflamación. Más de una articulación puede verse afectada.

Causas

La gota es causada por tener un nivel de ácido úrico superior a lo normal en el cuerpo. Esto puede ocurrir si:

El cuerpo produce demasiado ácido úrico.
El cuerpo tiene dificultad para deshacerse del ácido úrico.
Si se acumula demasiado ácido úrico en el líquido alrededor de las articulaciones (líquido sinovial), se forman cristales de ácido úrico. Estos cristales hacen que la articulación se hinche y resulte inflamada.

La causa exacta se desconoce. La gota puede ser hereditaria. El problema es más común en los varones, las mujeres posmenopáusicas y las personas que beben alcohol. A medida que las personas envejecen, la gota se vuelve más común.

La enfermedad también se puede presentar en personas con:

Diabetes
Enfermedad renal
Obesidad
Anemia drepanocítica y otras anemias
Leucemia y otros cánceres de la sangre
La gota puede ocurrir después de tomar medicamentos que interfieran con la eliminación del ácido úrico del cuerpo. Las personas que toman ciertos medicamentos, como hidroclorotiazida y otros diuréticos, pueden tener un nivel más alto de ácido úrico en la sangre.

Síntomas

Síntomas de gota aguda:

Sólo una o unas cuantas articulaciones están afectadas. Las articulaciones del dedo gordo del pie, la rodilla o el tobillo resultan afectadas con mayor frecuencia.
El dolor comienza súbitamente, a menudo durante la noche. El dolor a menudo se describe como pulsátil, opresivo o insoportable.
La articulación luce caliente y roja. Por lo regular, está muy sensible e hinchada (duele al ponerle una sábana o cobija encima).
Puede haber fiebre.
El ataque puede desaparecer luego de algunos días, pero puede retornar de vez en cuando. Los ataques adicionales por lo regular duran más tiempo.
Después de un primer ataque de gota, las personas no tendrán ningún síntoma. Muchas personas tendrán otro ataque en los próximos 6 a 12 meses.

Algunas personas pueden desarrollar gota crónica. Esto se denomina artritis gotosa. Esta afección puede llevar a daño articular y pérdida de movimiento en las articulaciones. Las personas con gota crónica tendrán dolor articular y otros síntomas la mayor parte del tiempo.

Los tofos son protuberancias debajo de la piel alrededor de las articulaciones o en otros lugares como los codos, las puntas de los dedos y las orejas. Los tofos se pueden desarrollar sólo después de que una persona haya tenido la enfermedad durante muchos años. Estas protuberancias pueden supurar una sustancia blanquecina.

Pruebas y exámenes
Los exámenes que se pueden hacer incluyen:

Análisis del líquido sinovial (muestra cristales de ácido úrico)
Ácido úrico en la sangre
Radiografía de la articulación (puede ser normal)
Biopsia sinovial
Ácido úrico en la orina
Un nivel de ácido úrico en la sangre de más de 7 mg/dL es alto. Sin embargo, no toda persona con un nivel alto de ácido úrico tiene gota.

Tratamiento

Tome las medicinas para la gota lo más pronto posible si tiene un ataque repentino.

Tome antinflamatorios no esteroides (AINE), como ibuprofeno, naproxeno o indometacina tan pronto como los síntomas empiecen. Hable con su proveedor de atención médica acerca de la dosis correcta. Usted necesitará dosis más fuertes durante unos días.

Su proveedor de atención puede prescribir analgésicos fuertes como codeína, hidrocodona y oxicodona.
Un medicamento de venta con receta llamado colchicina ayuda a reducir el dolor, la hinchazón y la inflamación.
Los corticosteroides (como la prednisona) también pueden ser muy eficaces. Su proveedor de atención puede inyectar esteroides en la articulación inflamada para aliviar el dolor.
El dolor con frecuencia desaparece al cabo de 12 horas de empezar el tratamiento. La mayoría de las veces, el dolor ha desaparecido al cabo de 48 horas.
Es posible que tenga que tomar medicinas diariamente, como alopurinol, febuxostat o probenecida para disminuir los niveles del ácido úrico en la sangre.

Usted puede necesitar estos medicamentos si:

Tiene varios ataques durante el mismo año o sus ataques son muy intensos.
Tiene daño en las articulaciones.
Tiene tofos.
Tiene nefropatía o cálculos renales de ácido úrico.
Los cambios en la dieta y en el estilo de vida pueden ayudar a prevenir los ataques de gota:

Disminuya el consumo de alcohol, especialmente cerveza (algo de vino puede ser útil).
Baje de peso.
Haga ejercicio diariamente.
Reduzca el consumo de carnes rojas y bebidas azucaradas.
Escoja alimentos saludables como productos lácteos, verduras, nueces, legumbres, frutas (las menos azucaradas) y granos integrales.
Beba café y tome suplementos de vitamina C (puede ayudarle a algunas personas).

Expectativas (pronóstico)

El tratamiento adecuado de los ataques agudos y la reducción del ácido úrico a un nivel menor a 6 mg/dL permiten que la gente lleve una vida normal. Sin embargo, la forma aguda de la enfermedad puede progresar a gota crónica si no se trata.

Posibles complicaciones
Las complicaciones pueden incluir:

Artritis gotosa crónica
Cálculos renales
Depósitos en los riñones, que llevan a insuficiencia renal crónica
Cuándo contactar a un profesional médico
Llame a su proveedor de atención médica si presenta síntomas de artritis gotosa aguda.

Prevención
Si bien es posible que la gota no se pueda prevenir, usted probablemente pueda evitar los factores que desencadenan los síntomas. Tomar medicinas para reducir el ácido úrico puede prevenir el avance de la gota.

Nombres alternativos
Gota aguda; Artritis gotosa de tipo agudo; Hiperuricemia; Gota tofácea; Gota crónica; Tofos; Podagra; Gota de tipo crónico; Gota de tipo agudo; Artritis gotosa aguda

U.S. National Library of Medicine


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lunes, 23 de mayo de 2016

THE TRAUMA CHAIN OF SURVIVAL / Cadena de Supervivencia en el Trauma


THE TRAUMA CHAIN OF SURVIVAL / Cadena de Supervivencia en el Trauma

THE TRAUMA CHAIN OF SURVIVAL / Cadena de Supervivencia en el Trauma


Strengthening the trauma chain of survival

  1. K. Søreide*
Version of Record online: 22 DEC 2011
DOI: 10.1002/bjs.7795








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This special issue on trauma highlights established and emerging areas in injury care ranging from epidemiology to epigenetics. It does not attempt to cover the complete trauma chain of survival (Fig.1); rather, the collection reflects areas of current and ongoing interest, explores translational aspects of pathophysiology in trauma care, discusses changes in concepts and paradigms, and gives ‘best evidence’ even where this is still guided largely by expert opinion and limited data. Randomized clinical trials, systematic reviews and meta-analyses demonstrate that rigorous methodology can, however, be applied in trauma studies resulting in better quality evidence. Mathematical modelling and narrative review of experimental research with translational applications also show that research in trauma care can move from the laboratory to the bedside.


A mix of commissioned and unsolicited material has been evaluated and edited for inclusion. Several papers are followed by expert commentaries that may foster further reflection and discussion. Interest in publication has been enormous. Following a call for papers on this topic, those selected represent only 10 per cent of all submissions.
The care of injured patients is based on appropriate, timely and correct intervention through each link in the trauma chain of survival (Fig.1). Breaks in the chain result in suboptimal outcomes. A systems approach to the injured patient ensures appropriate care at each level. This involves many clinicians and management plans that defy specialty-drawn borders1. The potential benefits with appropriate care are substantial. Many injured patients are young with many working years ahead and a considerable number of life-years to gain if death and disability can be avoided2. Evaluation of outcomes other than mortality is urgently needed, although few trauma registries contain such information3. Exactly which link in the chain has the greatest influence on outcome for each injured patient is largely unknown. Strengthening one part of the chain may have greater benefits in certain situations than others, but the surgeon has much to offer both in maintaining the chain and in making it stronger. While focus on optimizing resuscitative strategies and training of surgical technique may be important in areas with mature systems with few breaks in the chain, focus on logistics and resource allocation may be the cornerstone in other settings, such as in disaster management or the development of strategies in resource-poor locations.
Despite a global rise in trauma and an increasing volume of surgical work, trauma care seems poorly represented in most federal funding programmes, global organizations and patient interest groups. The lack of global and uniform standards for collecting, reporting and auditing data is in stark contrast to other health problems, for instance relating to cancer or cardiovascular disease. There are no agreed uniform standards for measuring the various relevant outcomes other than death, but attempts to harmonize definitions are in development4 and hopefully these will enable improved European and global networks for data collection, sharing and comparison.
The surgeon has always played an important role in the care of the injured patient. Indeed trauma has been a part of BJS publishing history since the first volume in 1913. It is interesting to see how surgeons understood shock in the past5, and reassuring to see the change in knowledge of its pathophysiology a century later, as reviewed in this supplement. It is disturbing to note, however, that management is still often based on expert opinion and emerging concepts. The reviews in this series are intended both to instruct where evidence is available and to highlight gaps in knowledge.
Research in difficult environments and urgent situations where there is a need for rapid decisions and interventions is particularly challenging in terms of methodology, logistics, practicality and ethics. Not every new theory and principle can be tested in a controlled environment before being brought to clinical use. It should not be forgotten, however, that surgeons have adopted experimental approaches to common injuries in the past6 and have brought these concepts to saving life and limbs for better outcomes. This supplement points to clinical challenges with vascular and extremity injuries with novel approaches likely to result in further advances and better outcomes in years to come. At the other end of the scale, gaining experience in understanding and dealing with rare, complex and highly lethal injuries, such as those of the pancreas7, is always likely to have its basis in the realities of clinical practice. The series of over 200 penetrating pancreas injuries managed in Cape Town, described in this supplement, is one of the largest of its kind and represents a compelling experience8. Most surgeons will see few, if any, such injuries during a lifetime.
Hippocrates urged surgeons who wanted to learn about wounds and injuries to follow the army into war. While all surgeons cannot go to war to learn, recent acts of civilian terror remind us of the need for domestic preparedness. Knowledge of patterns of injury seen in warfare has become important even for civilian surgeons9. The unpredictable events of nature also call on surgeons to respond following earthquakes, floods and other natural disasters. Unintentional injuries, dominated by road traffic accidents, are responsible for an increasing number of deaths and disability, particularly in a young population210. Despite all of this, the shift towards specialized modern surgery has left trauma in many countries as a Cinderella activity within general surgery. William Halsted once stated that every hospital should have at least one surgeon who was particularly adept with all surgical emergencies and injuries. In many healthcare systems this is no longer the case, owing to subspecialization, yet it behoves the surgical community to face up to the demands of modern trauma care.
The potential for research in trauma to spill over into care of the elective surgical patient should not be overlooked. This may be true for clinical experience, but also for understanding mechanisms of disease. Understanding the ways in which a single-nucleotide polymorphism makes patients respond to a traumatic insult in different ways and react to therapies that affect outcome11 leads the researcher to investigate cellular pathways involved, potentially applying new knowledge in a non-trauma context as well. Advances in blood component therapy and increased understanding of the activated coagulation system are now used in several situations. Military drivers for the development of artificial or haemoglobin-based oxygen carriers and dried blood products stored at ambient temperatures12may be used to replace human blood transfusions in civilian medicine. Studies in the laboratory may translate into new modes of haemostatic resuscitation and protection for cellular damage, including epigenetic manipulation at the DNA level13. A better understanding of the potential value of fluids that preserve cellular functions and avoid secondary organ reperfusion injury or exploration of the role of deep therapeutic hypothermia may lead to applications valuable for a number of clinical disciplines. Damage considered irreparable, such as complete spinal cord injuries, may be viewed differently in the future, for example by using neuronal stem cells14 and engineering nanostructured matrices into neuroprosthetics15 to regenerate axons for eventual neurological recovery. Inevitably, the results of some of these studies will challenge existing concepts regarding human physiology and cellular biology, and change our views of possible outcomes and potential in rehabilitation.
It is hoped that that this supplement will be thought-provoking and stimulate ideas and new research in trauma. BJS welcomes future submissions of papers that are likely robustly to confirm, translate, change or redirect the thinking and care of injured patients. In doing so, it is hoped that this reinforces the role of the surgeon in the trauma chain of survival.

  • 1
    Davenport RATai NWest ABouamra OAylwin CWoodford M et al. A major trauma centre is a specialty hospital not a hospital of specialtiesBr J Surg 201097109117.
  • 2
    Mock CAbantanga FGoosen JJoshipura MJuillard CStrengthening care of injured children globallyBull World Health Organ200987382389.
  • 3
    Sleat GKArdolino AMWillett KMOutcome measures in major trauma care: a review of current international trauma registry practiceEmerg Med J 2011; [Epub ahead of print].
  • 4
    Ringdal KGLossius HMJones JMLauritsen JMCoats TJPalmer CS et al. Collecting core data in severely injured patients using a consensus trauma template: an international multicentre studyCrit Care 201115R237.
  • 5
    Rendle Short AThe nature of surgical shockBr J Surg 19131(1): 114127.
  • 6
    Hey Groves EWAn experimental study of the operative treatment of fracturesBr J Surg 19131(4): 438501.
  • 7
    Grey Turner GTwo cases of injury to the pancreasBr J Surg 19131(4): 637643.
  • 8
    Chinnery GEKrige JEJKotze UKNavsaria P and Nicol ASurgical management and outcome of civilian gunshot injuries to the pancreasBr J Surg 201299(Suppl 1): 140148.
  • 9
    Owers CMorgan JLGarner JPAbdominal trauma in primary blast injuryBr J Surg 201198168179.
  • 10
    Gore FMBloem PJPatton GCFerguson JJoseph VCoffey C et al. Global burden of disease in young people aged 10–24 years: a systematic analysisLancet 201137720932102.
  • 11
    Chen KHZeng LGu WZhou JDu DYJiang JXPolymorphisms in the toll-like receptor 9 gene associated with sepsis and multiple organ dysfunction after major blunt traumaBr J Surg 20119812521259.
  • 12
    Holcomb JBReconstitution: reverse engineeringJ Trauma 201170(Suppl): S65S67.
  • 13
    Li YAlam HBModulation of acetylation: creating a pro-survival and anti-inflammatory phenotype in lethal hemorrhagic and septic shockJ Biomed Biotechnol 20112011523481.
  • 14
    Abematsu MTsujimura KYamano MSaito MKohno KKohyama J et al. Neurons derived from transplanted neural stem cells restore disrupted neuronal circuitry in a mouse model of spinal cord injuryJ Clin Invest 201012032553266.
  • 15
    Gelain FPanseri SAntonini SCunha CDonega MLowery J et al. Transplantation of nanostructured composite scaffolds results in the regeneration of chronically injured spinal cordsACS Nano 20115227236.

  • THE TRAUMA CHAIN OF SURVIVAL / Cadena de Supervivencia en el Trauma


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