The Skeptics' Guide to EM

MAY 11, 2019

Background: The first documented appendectomy was done by Claudius Amyand in 1735. Omar et al (2008) showed just how safe laparoscopic appendectomies have become. Exclusion: Patients with co-occurring diagnosis or procedure codes consistent with complicated appendicitis and patients lacking appendectomy codes.

Documentation/Coding 40

Documentation/Coding Operations Academics Ultrasounds 40

EMDocs

JULY 9, 2024

Insurance companies paying more attention to addressing social needs Medicaid: 1115 Demonstration Waivers, CalAIM in California ICD-10 code modifiers to acknowledge – and compensate—for the added complexity of social needs Additional resources/further reading: Liberman DB, Pham PK, Semple-Hess JE. link] Dubowitz H, Feigelman S, Lane W, Kim J.

Pediatrics 74

Pediatrics Emergency Department Research Burns 74

PHEM Cast

DECEMBER 12, 2016

Injury; 2008 (39): 967-969. pdf Equipment required for resuscitative thoracotomy: Surface anatomy: Appearance of pericardial clot A foley catheter being used to fill a cardiac wound – note how easily this could be pulled out. Practice Management guidelines for ED Thoracotomy. J Am Coll Surg. 2001, 193 (3): 303-309.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

ACEP Now

JUNE 7, 2023

ED leaders worked to develop new physician documentation and coding guidelines that needed to be implemented at the beginning of 2023. Long-term trends of improving ED patient intake remain intact, as times decreased in most years since 2008, when the intake time was about 41 minutes.

Emergency Department 52

Emergency Department Documentation/Coding Operations EMS 52

Cook County EM Blog

MARCH 20, 2023

Further document handedness, occupation, site of injury, and thorough review of systems to evaluate for potential complications ○ Complications as distant as pneumomediastinum following air injection of the hand have been reported5,6. ➢ 2008 Apr;3(1):27-33. Epub 2008 Feb 2. 2008 Jan;12(1):33-6. 2008 Dec;3(4):340-5.

Fractures 52

Fractures Documentation/Coding Operations Research 52

Dr. Smith's ECG Blog

APRIL 17, 2023

His HEAR score (before troponin resulted) was documented at 3, with documentation stating "low suspicion for ACS." Chest pain is documented as ongoing. Emergency providers need to instinctively recognize this ECG pattern in a patient with new chest pain! == KEY POINTS regarding D e W inter T Waves : In 2008 — Robert J.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Psychiatric 52

Dr. Smith's ECG Blog

AUGUST 26, 2009

Methods : We searched the catheterization laboratory database for all cases coded as acute Inferior STEMI from January 2002 through March 2008. Objectives : To find the incidence of any rSTD or T-wave inversion (TWI) in angiographically proven inferior STEMI.

EKG/ECG 52

EKG/ECG Documentation/Coding Research Academics 52

Advanced Emergency Nursing from AENJ

AUGUST 2, 2016

All efforts to identify the decedent by hospital staff, law enforcement agencies or social service agencies should be well documented in the medical records. Visible Proofs: Forensic Views of the Body exhibition at the National Library of Medicine closed on February 25, 2008. California Government Code Section 27491 - 27504.1.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

When Pendell and I are coding ECGs for the Queen's training, this is one category: "Definite ischemia, difficult to differentiate between posterior OMI and subendocardial ischemia." ECG changes in many of the cases I've seen are not “static” until reperfusion ( as had been initially reported in 2008 by deWinter et al. ). "

EKG/ECG 83

EKG/ECG Shock Documentation/Coding Academics 83

ACEP Now

DECEMBER 10, 2023

After resuscitation, the patient should be evaluated by a multi-disciplinary team in the hospital to re-affirm the patient’s code status and medical treatment goals. 2008 Sep;34(9):e4. In summary, EPs must resuscitate all patients presenting to the ED for SA, including those with terminal illness and advance directive forms for CMO.

Resuscitation 52

Resuscitation EKG/ECG Documentation/Coding Hospitals 52

ACEP Now

SEPTEMBER 5, 2024

A recent success by the ACEP was averting a decrease of our reimbursement for our 99284 E&M codes, saving an estimated $200 million for emergency physicians in 2023. If ACEP is already doing this, why be a member? ACEP has a voice for all, but its reach is limited by resources.

Leadership 98

Leadership PPE EMS Wellness 98

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present." Smith comment: But the tests (ECG and troponin) are extremely specific and so the post test probability is nearly 100%. Repeat cTnI drawn at around 8 AM was 3.910 ng/mL. This patient was not one of the lucky 6.4%

EKG/ECG 131

EKG/ECG Documentation/Coding Wellness Emergency Department 131

PulmCCM

OCTOBER 30, 2023

In 2008, the U.S. And maybe, noticing all the fuss, some clinicians might have started coding for VAP slightly less often in equivocal cases. incidence of VAP has remained stubbornly persistent : though it declined from 20 cases to 15 per 1000 ventilated patients 2008-2015, the rate then crept back up to 17 per 1000 in 2017.

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

Don't Forget the Bubbles

MARCH 11, 2024

Recommendations for sudden infant death syndrome prevention: a discussion document. References The ISPN Guide to Pediatric Neurosurgery (USA): Positional Plagiocephaly in Children Homepage. New York, USA: The International Society for Pediatric Neurosurgery, 2024 (Accessed January 9, 2024). Bialocerkowski, A. Vladusic, S. L., & Wei Ng, C.

Radiology 59

Radiology Radiology Pediatrics Documentation/Coding 59

Dr. Smith's ECG Blog

JULY 22, 2023

Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon. Drugs that have been associated with Brugada ECG patterns include tricyclic antidepressants, anesthetics, cocaine , methadone, antihistamines, electrolyte derangements, and even tramadol. [2].

EKG/ECG 92

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 92

Don't Forget the Bubbles

MARCH 19, 2024

Acknowledging the challenges associated with paediatric social admissions begins with documenting social issues and assessing their social history with the same level of detail as their medical history. Key messages Consider social determinants of health and document these in a child’s clinical notes. What can clinicians do?

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

Advanced Emergency Nursing from AENJ

JULY 9, 2015

Pull out the manikins (or use a volunteer; BVM only) and run some awkward codes! NREMT (2008). December 2008 JEMS Vol. How versatile are your airway skills? Oh, sure, you can handle any supine situations! Gather everyone. Most airway management is done with the patient supine and on a table. Resuscitation, 56(1), 83-89.

Airway Management 40

Airway Management Pediatrics Resuscitation Emergency Nursing 40

PulmCCM

OCTOBER 16, 2023

Numerous specific recommendations are available here: search the document for “dressings” or “Catheter Site Dressing Regimens” Other Methods to Prevent CLABSI Catheters impregnated with antibiotics (minocycline–rifampin) or chlorhexidine reduce catheter colonization and CVC-related bloodstream infections.

CDC 52

CDC Hospitals Ultrasounds Documentation/Coding 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon. Drugs that have been associated with Brugada ECG patterns include tricyclic antidepressants, anesthetics, cocaine , methadone, antihistamines, electrolyte derangements, and even tramadol. [2].

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 52

Don't Forget the Bubbles

JUNE 10, 2024

The history of necrotising enterocolitis The earliest documented cases resembling Necrotising enterocolitis (NEC) date back to the late 19th and early 20th centuries. Let’s delve into the significant challenges posed by small bellies: big battles – the not-so-simple case of necrotising enterocolitis. Clark, R., & Swanson, J.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

EB Medicine

MAY 3, 2019

Jeff: If those figures seem a bit high, another CDC study found that in a general population survey of a quarter million people between 2006-2008, 9% met the criteria for major depression. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Current depression among adults United States, 2006 and 2008.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

EB Medicine

JULY 8, 2019

From the 80’s to 2008, the worldwide prevalence of obesity nearly doubled! Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. From the 80’s to 2008, the worldwide prevalence of obesity nearly doubled!

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Dr. Smith's ECG Blog

OCTOBER 6, 2018

Diagnosis of acute myocardial infarction in angiographically documented occluded infarct vessel: limitations of ST-segment elevation in standard and extended ECG leads. JACC 51(3):307-14; January 22, 2008. This difficulty results in high lateral OMI being the most commonly missed OMIs by the misguided STEMI criteria.

EKG/ECG 40

EKG/ECG Seizures Documentation/Coding Outcomes 40

Don't Forget the Bubbles

JUNE 5, 2023

Babies born between March-May 2020 were compared with a historic baseline” cohort of babies (1 629 babies ) born between 2008-2011. This prospective cohort study tried to document the effectiveness of antibiotics prescribed for chest infections in children. vs 89.3%), could point (83.8% vs vs 92.8%) or wave bye-bye (87.7% vs

Outcomes 124

Outcomes Research Wellness Documentation/Coding 124

RebelEM

MAY 15, 2024

2008 Sep;1138:329-50. Coding for Mucositis. Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department. Ann Emerg Med. 2017 Jun;69(6):755-764. doi: 10.1016/j.annemergmed.2016.11.007. 2016.11.007. Epub 2016 Dec 29. Febrile Neutropenia. doi: 10.1196/annals.1414.035.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

Dr. Smith's ECG Blog

MAY 23, 2022

Code STEMI was called." This repeat ECG is not available in the chart, but sounds similar to the presenting ECG, and it was excellent care that the code "STEMI" was activated despite no evidence of STEMI criteria. The pain resolved again before cath, which found a 80% RCA occlusion.

EKG/ECG 52

EKG/ECG Documentation/Coding Hyperthermia / Hypothermia Research 52

The Skeptics' Guide to EM

MARCH 15, 2025

Not only does the liberal presence of such reference numbers impart an aura of scholarship, but their judicious placement after this or that assertion subtly suggests documented validity. 2008 Greenberg SA. But watch outthose little numbers may be no more than the trappings of credibility. Clin Sci (Lond). 2021 Mar Porrino JA Jr et al.

Academics 64

Academics Research Documentation/Coding EMS 64

EB Medicine

DECEMBER 1, 2018

Antigen drift refers to small point mutations to the viral genes that code for H and N. In 2007-2008, an oseltamivir-resistant H1N1 strain emerged globally. There are actually 16 different H subtypes and 9 different N subtypes, but only H1, H2, H3, and N1 and N2 have caused epidemic disease.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 40

Advanced Emergency Nursing from AENJ

MARCH 27, 2015

Confirming endotracheal placement: In addition to the usual required methods and documentation, remember that, most likely, your patient will still be breathing. McGraw-Hill Medical, 2008. If a beveled ETT, then rotate 90° to left to allow wedge shaped tip to center; if fails, rotate 90° again (total 180°) to move bevel fully left.

Resuscitation 40

Resuscitation Airway Management EMS CPR 40

Maria Yang, MD

DECEMBER 21, 2024

That article was published in 2008, when social media, though common, had yet to hit its peak. And, like weve already seen in this document, the approach seems to be all or nothing. This came from growing concerns of youth spending a lot of time online in China and South Korea. or the government?

Psychiatric 40

Psychiatric Research Documentation/Coding Wellness 40