Doing a coding refresher while my kids were watching a movie, resulted in an epic crossover: Home Alone ICD10
First the title. 3 options:
Z62.29 Other upbringing away from parents
Z60.2 Problems related to living alone
T76.02XA Child neglect or abandonment, initial encounter 1/
The movies opens with household chaos. The protagonist (Kevin) is bullied by his older Brother “Buzz”.
Don’t worry there’s not one but two ICD10 codes for this:
1️⃣Y07.41 Sibling, perpetrator of maltreatment
2️⃣F93.9 Childhood emotional disorder, unspecified 2/
Kevin fears that Fuller (played by his real life brother Kieran) will wet the bed.
You can code this concern from Fuller’s perspective or from Kevin’s:
1️⃣N39.44 Nocturnal enuresis
2️⃣W55. contact with urine of unspecified mammal
3/
Buzz further torments his little brother by eating all his plain cheese pizza. This backfires on Buzz leading to:
🍕R63.2 Excessive eating
🤮R11.10 Vomiting, unspecified
4/
Kevin retaliates against buzz leading to
🥊 Z62.891 Sibling rivalry
(Eagle eyed fans will note that Kevins passport/ticket get accidentally thrown out with the milk stained napkins; this kinda explains how his terrible parents forget him)
5/
In the resulting fracas, Fuller gets smooshed by a chair causing:
👃S09.92 Unspecified injury of nose
(don’t worry he turns out OK, just watch Succession)
6/
The next morning:
F51.12 Insufficient sleep syndrome
Z63.79 Other stressful life events affecting family and household 7/
After rushing to the airport and boarding a flight to Paris, the family realizes they made a terrible mistake:
Z62.0 Inadequate parental supervision and control
F48.8 Psychogenic Syncope 8/
Z63.1: Problems in relationship with in-laws
Meanwhile
Z63.6 absence of family member due to disappearance
Skipping ahead to act 5, Kevin has to defend his house from the Wet Bandits. This entails:
🏠 F02ZBFZ Environmental, Home and Work Barriers Assessment
👨🔧Y93.D: Activities involved arts and handcrafts
🔨Z99.89: Dependence on enabling machines and devices, not elsewhere classified.
X95.01XA Assault by airgun discharge, initial encounter
S39.94XA Unspecified injury of external genitals, initial encounter
X95.01XD Assault by airgun
discharge, subsequent encounter
W00.1 Fall from stairs and steps due to ice and snow
W00.2XXA Other fall from one level to another due to ice and snow, initial encounter
T45.4X3 Poisoning by iron and its compounds, assault
W92.x18 Exposure to excessive heat of man-made origin, initial encounter, Contact with hot metals
X97 Assault by smoke, fire and flames
L64.8 Other androgenic alopecia
W45.0 Nail entering through skin
S91.331A Puncture wound without foreign body, right foot, initial encounter
Brief aside from grievous bodily injury GIFs to repeat what my dad said to me after we saw Home Alone in theaters: “you know not to try any of this at home right?”
J30.89 Allergic rhinitis due to feathers
Z18.81 Retained glass fragments
R46.1: Bizarre personal appearance
W30 fall involving recreational machinery
T65.6X3A Toxic effect of paints and dyes, not elsewhere classified, assault, initial encounter
T65.6X3D Toxic effect of paints and dyes, not elsewhere classified, assault, subsequent encounter
Every year, there is a predictable spike in fatal car accidents, medical errors, & heart attacks.
It’s estimated that there are thousands of excess deaths, a 1% increase in energy consumption, & billions of dollars in lost GDP.
The cause? Daylight savings transitions.
🧵
1/
Earth's axis of rotation and orbital axis are not precisely aligned. The 23.5 degree difference - 'axis tilt' - gives us our seasons and a noticeable difference in day length over the course of the year.
2/
For millennia this seasonal variation was an accepted fact of life.
In 1895, George Hudson, a New Zealand entomologist, was annoyed that less afternoon light meant less time for bug collecting.
He realized that clocks could be adjusted seasonally to align with daylight.
Unlike other Trump moves, this is arguably GOOD news for researchers!
If the NIH budget is unchanged (a big if), this allocates more money to researchers; if you go from an indirect of 75% to 15% it means you can fund 3 grants instead of 2.
Between 1947 and 1965, indirect rates ranged from 8% to 25% of total direct costs. In 1965, Congress removed most caps. Since then indirects have steadily risen.
2/
A lot of indirects go to thing like depreciation of facilities not paying salaries of support staff.
This accounting can be a little misleading.
If donors build a new $400m building, the institution can depreciate it & “lose” $20m/year over 20 years. Indirects pay this.
3/
🚨Apparently all NIH Study Sections have been suspended indefinitely.
For those who don’t know, this means there won’t be any review of grants submitted to NIH
Depending on how long this goes on for, this could lead to an interruption in billions in research funding.
With a budget of ~$47.4B, the NIH is by far the biggest supporter of biomedical research worldwide.
Grants are reviewed periodically by committees of experts outside of the NIH.
When these study sections are cancelled, it prevents grants from being reviewed & funded.
Hopefully this interruption will be brief (days)
A longer interruption in study sections (months) will inevitably cause an interruption in grant funding. This means labs shutdown, researchers furloughed/fired, & clinical trials suspended. This will harm progress & patients!
#HurricaneHelene damaged the factory responsible for manufacturing over 60% of all IV fluids used in the US, leading to a major national shortage.
As clinicians what can we do to about the #IVFluidShortage and how can we prevent this crisis from happening again?
A thread 🧵 1/
There are many things we can do as clinicians to improve ICU care & reduce IVF use.
1️⃣Don't order Maintenance IV Fluid!
Almost no patient actually needs continuous IV fluids.
Most either need resuscitation (e.g. boluses) or can take fluid other ways (PO, feeding tube, TPN).
2/
Frequently if someone is NPO overnight for a procedure, MIVF are ordered.
This is wrong for two reasons.
We are all NPO while asleep & don't need salt water infusions!
We should be letting people drink clears up to TWO HOURS before surgery, per ASA.
New favorite physiology paper: Central Venous Pressure in Space.
So much space & cardio physiology to unpack here including:
- effects of posture, 3g shuttle launch, & microgravity on CVP
- change in the relationship between filling pressure (CVP) & LV size
- Guyton curves! 1/
To measure CVP in space they needed two things:
📼 an instrument/recorder that could accurately measure pressure despite g-force, vibration, & changes in pressure. They built & tested one!
🧑🚀👩🚀👨🚀 an astronaut willing to fly into space with a central line! 3 volunteered! 2/
The night before launch they placed a 4Fr central line in the median cubital vein & advanced under fluoro.
🚀The astronauts wore the data recorder under their flight suit during launch.
🌍The collected data from launch up to 48 hrs in orbit. 3/