Dr. Smith's ECG Blog

OCTOBER 8, 2024

She was worked as a full code, and ROSC was achieved. 2009;Available from: [link] 4. Repeat ECG did not demonstrate ST elevations in the anterior leads." OMI was Missed again!! About 45 minutes after the second EKG, the patient was found in cardiac arrest. Heart [Internet]. Dressler W, Roesler H. Am Heart J [Internet]. 1947;34:627–645.

EKG/ECG 111

EKG/ECG Documentation/Coding Resuscitation Shock 111

ACEP Now

MAY 6, 2023

The emergency physician’s documentation of these injuries may prove to be crucial in law enforcement’s reconstruction of the crash and may have significant implications for subsequent legal proceedings. Sudbury, Massachusetts: Jones and Bartlett; 2009. Discussion There were over 2.1 Mechanisms of injury in motor vehicle crashes.

Forensics 52

Forensics Documentation/Coding Head Injuries Fractures 52

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. 2009 Mar;123(3):858-64. Pediatrics.

Pediatrics 72

Pediatrics Emergency Department Research Burns 72

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

Taming the SRU

JUNE 3, 2024

CESAR Trial Published in 2009 Found that even those who didn’t get ECMO, but were transported to a tertiary care center had better outcomes No matter where you go, critical care transport will be part of your life as a sending physician, receiving physician, or both. This shows that we are sometimes limited by the data that we have.

Shock 91

Shock Seizures Airway Management Stroke 91

Pediatric EM Morsels

AUGUST 18, 2023

None of the patients were documented to have joint disease at follow up. From 2001 to 2009, in a pediatric hospital gram negative culture showed a drop in sensitivity to ciprofloxacin from 96% to 93%. There were 2523 children included. 451 pediatric patients were included. This was similarly seen with levofloxacin.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

EMDocs

MAY 26, 2023

2009 Nov;27(4):655-67, ix. 2009 Jun;21(3):196-202. Restraints should not be applied indefinitely, and multiple reevaluations should be done to determine when it is safe to remove restraints. Coburn VA, Mycyk MB. Physical and chemical restraints. Emerg Med Clin North Am. doi: 10.1016/j.emc.2009.07.003. 2009.07.003. PMID: 19932399.

Pediatrics 76

Pediatrics Emergency Department Psychiatric Documentation/Coding 76

Mind The Bleep

OCTOBER 29, 2024

Provide detailed documentation of the initial assessment, treatment provided, and the patient’s response to interventions. Cardiovasc Intervent Radiol 32 , 155–158 (2009). Preparation for Transfer Ensure the patient is hemodynamically stable before transfer. Sagoschen, I. Kirkpatrick JJ, Enion DS, Burd DA. Br J Hosp Med (Lond).

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

EMDocs

NOVEMBER 6, 2024

tetani infection is also indicated.

Poisoning 78

Poisoning Airway Management Dislocations Forensics 78

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

The Skeptics' Guide to EM

DECEMBER 5, 2020

As an alternative diagnostic method, the HINTS exam was first established in 2009 to better differentiate central from peripheral causes of AVS [4]. Over the past decade, some emergency physicians have adopted this examination into their own bedside clinical assessment and documentation. But what is the HINTS exam?

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

Mind The Bleep

FEBRUARY 29, 2024

It is worth looking through previous documentation to see whether the patient’s team or senior intensivists have set any individual cardiovascular targets. 2009) Oxford Handbook of Critical Care. C Assessment BP and MAP Invasive reading (via an arterial line) or non-invasive (via a BP cuff)? Resources and References Singer, M.

Documentation/Coding 52

Documentation/Coding Hospitals Wellness Best Practices 52

RebelEM

MARCH 27, 2023

There may have very well been a policy where only RTs can make changes to a ventilator after an order was placed to ensure accurate documentation. Unfortunately, its not clear whether the documentation came from RTs or ED providers. Females and patients with increased BMI are at increased risk of not being placed on LPV. Crit Care Med.

Emergency Department 52

Emergency Department Operations Academics 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. Fitzgibbons, S.C., Gordon, P.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

PulmCCM

FEBRUARY 19, 2024

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

Don't Forget the Bubbles

FEBRUARY 26, 2024

uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. Changes in the use of invasive and noninvasive mechanical ventilation in pediatric asthma: 2009–2019. Journal of Paediatrics and Child Health. 2018 Jun;54(6):633-7. Scotland HI. BTS/SIGN British guideline on the management of asthma. Accessed November 2023.

Pediatrics 70

Pediatrics Research Documentation/Coding Outcomes 70

PulmCCM

OCTOBER 30, 2023

Then, in 2009, the condition disappeared completely. And maybe, noticing all the fuss, some clinicians might have started coding for VAP slightly less often in equivocal cases. It used to be highly prevalent in U.S. ICUs, and a popular research focus for academics, generating a steady stream of papers. Just kidding! In 2008, the U.S.

Sepsis 52

Sepsis Shock Hospitals Outcomes 52

Pediatric Education

NOVEMBER 12, 2023

No specific documentation regarding the duration of the car seat testing could be identified in the medical records. 2009-0559 Davis NL. The pertinent physical exam showed the patient was now 3.34 kg (10-50% using premature infant growth chart), 47 cm length and 32 cm head circumference (10%) without any abnormal findings. Pediatrics.

Pediatrics 40

Pediatrics Poisoning Hospitals Documentation/Coding 40

EMDocs

JULY 11, 2023

2009 Nov;15(6):1281-90. PMID: 7382250 MASAC Document 257 – Guidelines for Emergency Department Management of Individuals with Hemophilia and Other Bleeding Disorders. Haemophilia. PMID: 19637999. Plummer ES, et al. Prominent forehead hematomas (“goose-eggs”) as an initial manifestation of hemophilia. PMID: 23968747.

Head Injuries 63

Head Injuries Pediatrics Dislocations CDC 63

Taming the SRU

NOVEMBER 14, 2023

A retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011 identified 8.6 Foreign body removal steps Assess hearing before and after the procedure and document any suspected damage/injury prior to removal attempts so that these will not later be attributed to the procedure (6).

Emergency Department 93

Emergency Department Pediatrics Wellness Documentation/Coding 93

PulmCCM

OCTOBER 16, 2023

per 1,000 central-line days between 2001 and 2009. As effective practices spread (and changes in reporting occurred), nationwide rates of CLABSI in the U.S. also decreased from 3.64 CLABSI rates then increased dramatically during the Covid-19 pandemic.

CDC 52

CDC Hospitals Ultrasounds Documentation/Coding 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. 2 The astute paramedic recognized this possibility and announced a CODE STEMI. NEJM 362(9):779; March 4, 2009. NEJM 362(9):779; March 4, 2009. Look at the aortic outflow tract.

EKG/ECG 52

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 52

Pediatric Emergency Playbook

JUNE 1, 2017

The best documented cormorbidity is sickle cell disease, although other pro-thrombotic conditions also put the child at risk. 2009; 8:67-69. 2009; 24:156-8. Myocardial infarction in an adult resulting from coronary aneurysms previously documented in childhood after an acute episode of Kawasaki’s disease. 2009; 27:942-947.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Dr. Smith's ECG Blog

APRIL 6, 2023

second that might document underlying SSS. That said — the term, “trifascicular block” is no longer recommended ( Surawicz et al, Circulation — AHA/ACCF/HRS Recs, 2009 ).

EKG/ECG 52

EKG/ECG Operations Documentation/Coding Wellness 52

Pediatric Emergency Playbook

APRIL 1, 2016

2009; (55) 12:2098–2112. for the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. ACCF 2012 Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations. Pediatr Emer Care. 2014;30: 493-495. Kelley WE, Januzzi JL, Christenson RH.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

EMS in America: The Foundation Documents. HISTORICAL BACKGROUND TO ACCIDENTAL DEATH AND DISABILITY: THE NEGLECTED DISEASE OF MODERN SOCIETY. Prehospital Emergency Care, 4(4), 285-289. Touchstone, Mike. Accessed 2/29/2016. Sakran, J. Werlin, E., & McCunn, M.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Dr. Smith's ECG Blog

JUNE 8, 2023

As they documented, “Paramedics noted patient’s 12 Lead appeared to have 1mm of elevation in III and borderline 1mm elevation in aVF, with mild depression in I and aVL. Cardiology documented “late presentation STEMI but likely aborted given resolution of ST changes from EMS to hospital.” Eur Heart J 2009 4 Lemkes et al.

EKG/ECG 65

EKG/ECG Documentation/Coding EMS Emergency Department 65

EB Medicine

DECEMBER 1, 2018

Antigen drift refers to small point mutations to the viral genes that code for H and N. Jeff: In fact, a meta-analysis on vaccine effectiveness from 2004-2015 found that the pooled effectiveness against influenza B was 54%, against the H1N1 pandemic in 2009 was 61%, and against the H3N2 virus was 33%.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 40

RebelEM

MAY 15, 2024

Coding for Mucositis. Neutropenic Fever: Fever (one reading of 38.3C Cohort Study of the Impact of Time to Antibiotic Administration on Mortality in Patients with Febrile Neutropenia. Antimicrob Agents Chemother. 2014 Jul; 58(7): 3799–3803. doi: 10.1128/AAC.02561-1 02561-1 Stiff, PJ. Loyola University Medical Center. September 30, 2005.

Infectious Diseases 105

Infectious Diseases Administration Sepsis Anaphylaxis 105

The Skeptics' Guide to EM

SEPTEMBER 15, 2018

. * Intervention: Malpractice claims involving trainees (residents) in an emergency department setting over a three-year period from 2009-2012. Outcomes: Coded information covering a number of domains. Comparison: Malpractice claims not involving trainees in the same time period.

Documentation/Coding 40

Documentation/Coding Teamwork Hospitals Emergency Department 40

RebelEM

NOVEMBER 11, 2024

Reliance on Electronic Health Records Data : As with many retrospective studies, reliance on EHR data for identifying eligible patients and outcomes is prone to inaccuracies, missing data, and variability in clinical documentation practices. 2009 Dec;37(12):3114-9. 2009 Mar 26;360(13):1283-97. Ann Transl Med. 2018 May;6(10):182.

Sepsis 84

Sepsis Outcomes Administration Shock 84

Dr. Smith's ECG Blog

APRIL 8, 2015

Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful. Yield of Diagnostic Tests in Evaluating Syncopal Episodes in Older Patients Arch Intern Med 2009 Jul 27; 169:1299-1305. Arch Intern Med 2009 Jul 27; 169:1262. Ann Emerg Med 2009 Dec; 54:769.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

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. Clinical Anesthesia, Lippincott and Williams & Wilkins, New York, 2009, pp. Some have succeeded with slow full rotation (360°). Always be gentle! Barash, B. Cullen, R.

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Resuscitation Airway Management EMS CPR 40