ACEP Now

OCTOBER 3, 2023

This document is an update of guidelines first published in 2000, and then updated in 2007. Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented. 2019;154(7):e191152.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

Taming the SRU

NOVEMBER 14, 2023

B) on right: hand drawn images of layers of ear demonstrating auricular hematoma The epidemiology and incidence of ED presentation for auricular hematomas has not been well-studied because it is a relatively uncommon condition. Courtesy of wiki commons under CC Attribution 3.0 germany File:Hematoma ear.jpg - Wikimedia Commons. 25(1):23-39.

Emergency Department 93

Emergency Department Pediatrics Wellness Documentation/Coding 93

Cook County EM Blog

MAY 15, 2023

His EKG suggested a posterior MI as well as other signs of ischemia. A code STEMI was activated, and the patient was given sublingual nitroglycerin and morphine for his pain. Repeat EKGs continued to show ST depression in V2, as well as a new q wave in lead II, and deeper, wider q waves in lead III and aVF. 2007 Jan;15(1):16-21.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

Sensible Medicine

JULY 24, 2023

At the time, in 2007, the cardiology world was stunned to learn that opening partially blocked coronary arteries—in stable patients—did not lead to fewer heart attacks or less cardiac death compared to tablets alone. But there had been two placebo-controlled drug trials that documented a 45-55 second increase in exercise time.

Academics 92

Academics Documentation/Coding Ultrasounds Wellness 92

PulmCCM

FEBRUARY 19, 2024

Well … no. At Shands (the level 1 trauma center admitting adults), the panel relates the impressive results that mortality fell by 58%, and unplanned codes by 47% “after the widespread implementation of patient/ family activated RRT/MET.” Family-Activated METs in Adults Halves Mortality?

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

Northwestern EM Blog

SEPTEMBER 12, 2022

It is well known that most hospitals in large population centers already operate at or near full capacity [4]. Other things listed on tags can be a patient’s name, bar code, MRN or other tracking criteria. This makes it even more challenging when presented with an acute influx of patients in a short period of time. What did happen?

Mass Casualty Incidents 52

Mass Casualty Incidents EMS Hospitals Operations 52

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. On arrival at hospital the child was well with normal observations. Claudius et al, Pediatrics 2007 here a US-based study showed that of all admitted patients only 14% had a subsequent clinical course requiring admission.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Don't Forget the Bubbles

FEBRUARY 26, 2024

Increasing PEEP is thought to cause bronchodilation by providing direct mechanical stimulus as well as secondary stimulation through pulmonary stretch receptors coupled with activation of the non-cholinergic parasympathetic pathway. 2007 Jan 1;25(1):6-9. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

EMDocs

JUNE 16, 2023

It’s stressful for the ED clinical staff as well. Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document. Children’s Mental Health Emergency Department Visits: 2007-2016. This has a downstream effect. Pediatrics March 2023; 151 (3): e2022057383. 10.1542/peds.2022-057383

Psychiatric 52

Psychiatric Pediatrics Emergency Department Best Practices 52

Dr. Smith's ECG Blog

JULY 22, 2023

The patient did well and was ultimately discharged home. Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon. As for our patient, on discharge, her EKG had completed returned to her baseline morphology and she has been doing well in follow-up.

EKG/ECG 75

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 75

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

I remember Allie well from her days in the Research volunteer program at Hennepin. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. A repeat EKG was performed at that time and showed this: The STE had almost completed resolved and the STE depression is improved as well. F (rectal).

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 52

Sensible Medicine

APRIL 29, 2024

You can assess how well (or poorly) a practicing cardiologist did analyzing a paper in the Journal of Clinical Epidemiology. In this section, they documented the variations in analytic method (for instance, the choice of model and co-variates). It’s the Methods ! Allow me an experiment this week.

Stroke 137

Stroke Documentation/Coding Shock Research 137

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 93

Emergency Department Resuscitation COPD Shock 93

EB Medicine

MAY 3, 2019

The PSS-3 assesses for depression/hopelessness and suicidal ideations in the past 2 weeks as well as lifetime history of suicide attempt. Next, schedule a follow up appointment, ideally within a week of discharge, and lastly, document the patient’s preferred follow up resources and steps taken to get them there. Talk to you next month!

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

EB Medicine

DECEMBER 1, 2018

Antigen drift refers to small point mutations to the viral genes that code for H and N. Jeff: Of note, EMS providers should use face masks themselves and place them on patients as well. Jeff: Viral culture and RT-PCR remain the gold standard, but both require more time and money, as well as a specialized lab. Nachi: Amazing.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 40

EB Medicine

JUNE 6, 2019

For example, patients with misdiagnosed disease has less RLQ pain and tenderness as well as diminished anorexia, nausea, and vomiting. Jeff: Well that’s scary - I know I’ve already missed a case, but luckily, he returned thanks to good return precautions, which we’ll get to in a few minutes. Jeff: True. The max score is therefore 10.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

ACEP Now

AUGUST 1, 2023

A rural ED staffed by a well-trained EP is an essential resource in small communities that may be otherwise lacking in readily available healthcare resources. emergency department deserves access to an emergency physician no matter their zip code. When those same fundamentals done right achieve great success, they aren’t little at all.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 98

Dr. Smith's ECG Blog

APRIL 8, 2015

True Syncope: If, on the other hand, the patient is well, had no other serious symptoms , has a normal sinus rhythm, and normal physical exam , then you need to be certain the syncope was not due to a dangerous brady- or tachydysrhythmia that could recur. 2007 Oct; 33(3): 233–239. Vasovagal syncope is generally benign.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52