Dr. Smith's ECG Blog

OCTOBER 12, 2024

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. Vital signs were within normal limits on arrival to the Emergency Department. Am J Emerg Med. 2016 Nov;34(11):2182-2185. Epub 2016 Aug 27. or basilar ischemia.

EKG/ECG 115

EKG/ECG Documentation/Coding Emergency Department COPD 115

Dr. Smith's ECG Blog

MAY 27, 2024

Since the ECG now meets STEMI criteria, a code STEMI was activated. 2022 ACC expert consensus decision pathway on the evaluation and disposition of acute chest pain in the emergency department: a report of the American College of Cardiology solution set oversight committee. Am J Emerg Med 2016 5. Kontos et al.

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EKG/ECG Documentation/Coding Emergency Department 122

Don't Forget the Bubbles

JANUARY 22, 2024

The campaign started in the United States in 2012, in Canada two years later, and in the United Kingdom in 2016. Choosing Wisely UK was launched in 2016 by the Academy of Medical Royal Colleges to identify tests, treatments, and procedures of questionable value. 2016 ;50(13):826-8. 70% had liver function tests. Br J Sports Med.

Emergency Department 90

Emergency Department Best Practices Radiology Radiology 90

RebelEM

JUNE 8, 2023

If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergency department pharmacist. Clinical Bottom Line: Acute hypotension must be treated emergently in order to decrease morbidity and mortality. Am J Emerg Med. J Med Toxicol. Epub 2019 Jul 3.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

The Skeptics' Guide to EM

OCTOBER 1, 2022

Disparities in the emergency department management of pediatric migraine by race, ethnicity, and language preference. Guest Skeptic: Dr. Lauren Westafer is an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. AEM September 2022. AEM September 2022.

Pediatrics 52

Pediatrics Emergency Department Documentation/Coding Research 52

ACEP Now

NOVEMBER 7, 2023

1 In 2016, the 21st Century Cures Act (Cures Act) took additional steps to authorize the Secretary of Health and Human Services to identify and define information blocking and associated exceptions. Training opportunities for documentation best practices should be employed. Published December 16, 2016. HealthIT.gov website.

Documentation/Coding 52

Documentation/Coding Best Practices Ethical Issues Academics 52

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. While it was < 15% in 1990, by 2016 it reached 40%. Jeff: And we also have the AspireAssist siphon, which was approved in 2016.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

AUGUST 8, 2023

2016 validation study 0 points for low risk, 1-5 for intermediate risk and 6-7 for high risk. Document consideration of torsion in males with abdominal pain. Just the facts: assessment and management of testicular torsion in the emergency department. References: Rosenberg H, Long B, Keays M. 2021 Nov;23(6):740-743.

Ultrasounds 93

Ultrasounds Documentation/Coding Outcomes Emergency Department 93

Taming the SRU

FEBRUARY 5, 2024

1) However, it wasn’t until the 1890s that purposeful, successful, and safe attempts to access this fluid were documented (2). The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). WHO - Who Needs an LP in the ED? Glennie, L., Gaillemin, O.,

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

The Skeptics' Guide to EM

OCTOBER 28, 2017

Stevens and colleagues updated their review in 2016 and concluded “sucrose is effective for reducing procedural pain” and “no serious side effects or harms have been documented with this intervention”. There are certain patient populations who are at risk for in adequate pain management.

Pediatrics 52

Pediatrics Documentation/Coding Emergency Department Hospitals 52

The Skeptics' Guide to EM

JULY 30, 2022

Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Case: A 63-year-old woman presents to your emergency department (ED) with two-day history of nausea, vomiting and constipation. She is also the creator of all those wonderful Paper in a Pictures.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

ACEP Now

OCTOBER 26, 2023

The Case A two-year-old female, seen three days ago at different local emergency department (ED)—Children’s General—presents with fever, headache, and neck pain. 2 However, many emergency physicians are unaware of this interpretation, instead letting concern for violating HIPAA override patient-care needs. HHS website.

Infectious Diseases 52

Infectious Diseases Documentation/Coding Hospitals Emergency Department 52

RebelEM

MARCH 9, 2023

However, evaluating and managing patients with acute alcohol intoxication in the emergency department can be challenging. Barr 2016 , Trevejo-Nunez 2015) Patients are at high risk of bleeding from the GI tract due to clotting factor impairment or devastating hemorrhage from esophageal varices in the setting of portal hypertension.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

EMDocs

JUNE 16, 2023

And now we’re here at our destination, the place we know and love, the emergency room to talk about what we should be doing for the growing volume of children with mental health problems boarding in the emergency department. McEnany, Olutosin Ojugbele, Julie R. Doherty, Jennifer L. McLaren, JoAnna K. 10.1542/peds.2020-1174

Psychiatric 52

Psychiatric Pediatrics Emergency Department Best Practices 52

PHEM Cast

APRIL 21, 2021

Guidance documents College of Paramedics Statement on Intubation, available here. Emergency tracheal intubation: complications associated with repeated laryngoscope attempts. Association Between Repeated Intubation Attempts and Adverse Events in Emergency Departments: An Analysis of a Multicenter Prospective Observational Study.

Airway Management 40

Airway Management Resuscitation EMS Hospitals 40

Pediatric Emergency Playbook

APRIL 1, 2016

used BNP in the emergency department to differentiate heart failure from respiratory causes in infants and children with heart failure and those with no past medical history. 2016; 417: 54–56. for the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Cohen et al. Am J Cardiol.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

EMDocs

NOVEMBER 16, 2024

Posterior – Shortened, adducted, internally rotated 5,6 Anterior – Shortened, abducted, externally rotated 5,6 As with all dislocations, perform and document distal neurovascular exam before and after management. 8 Perform and document distal neurovascular exam. 2016 Mar 21;8(1):6253. Emerg Med J. 2003.011809.

EMS 97

EMS Dislocations Fractures Operations 97

Don't Forget the Bubbles

JULY 3, 2023

This time we have our first group of colleagues from Birmingham Children’s Hospital Emergency Department. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Am J Hematol.

Emergency Department 105

Emergency Department Hospitals Domestic Violence Pediatrics 105

Don't Forget the Bubbles

MAY 10, 2023

You’re in the paediatric emergency department, typing some notes for the child you’ve just discharged. Then you hear the words coming out of the speaker, “ Paediatric code black. Paediatric code black ”. You’ve heard the phrase code black before – it’s a traumatic cardiac arrest. Scand J Trauma Resusc Emerg Med.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

ACEP Now

APRIL 9, 2025

.” 1 A study by van Zwieten in 2004 found that 49 percent of deaths attributed to droperidol required dosages 50 mg, magnitudes greater than typical dosages used in the emergency department (ED). It did so with varenicline on December 16, 2016 15 and canagliflozin on August 26, 2020. West J Emerg Med.

Emergency Department 52

Emergency Department Administration EKG/ECG Resuscitation 52

Don't Forget the Bubbles

AUGUST 23, 2023

In most Emergency Departments, staff are allotted little of that scarce resource, time, to begin processing what has just occurred. The Pause Jonathon Bartels worked as an Emergency Nurse in America in 2009. After the death of a young person in the Emergency Department, he initiated ‘ The Pause.’ & Liska, H.

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

RebelEM

MAY 15, 2024

Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents. Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department.

Infectious Diseases 98

Infectious Diseases Administration Sepsis Anaphylaxis 98

Emergency Medicine Journal

JANUARY 22, 2024

This is an Institutional Review Board-exempt retrospective review of de-identified ED data available for the state of Maryland through the Healthcare Cost and Utilization Project (HCUP) database from 2016 to 2018.

Outcomes 40

Outcomes Emergency Department Poisoning Documentation/Coding 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.” Int J Cardiol 2016 3. Kontos et al.

EKG/ECG 86

EKG/ECG Documentation/Coding EMS Emergency Department 86

Don't Forget the Bubbles

DECEMBER 16, 2024

Despite the clear benefits, pertussis vaccination coverage during pregnancy has declined from 75% in 2016 to just 58.6% Clear history taking In the Emergency Department, healthcare professionals should prioritise thorough history-taking when assessing potential suspected cases. in 20232024. Measles facts [Internet].

Infectious Diseases 59

Infectious Diseases Documentation/Coding Pediatrics CDC 59

Advanced Emergency Nursing from AENJ

AUGUST 2, 2016

Act V, scene I [Text from Folger Shakespeare Library] [Audio recording of Dramatic Reading; Chapter Vox] [Video recording of Act V, scene1] Most deaths that are brought to, or occur in, an emergency department will require, at least, discussion with the local Coroner or Medical Examiner. Accessed 07/30/2016. Accessed 07/30/2016.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. McGraw Hill; 2016. Emerg Med Pract.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Don't Forget the Bubbles

JULY 26, 2023

Prioritise listening to the first 30 minutes which given a good overview of aetiology and treatment (53 mins) Basics of cardiac rhythm problems in the ED Palpitations are a common reason for children to present to the emergency department, the majority of these will be benign from a cardiac perspective and instead related to stress or anxiety.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

The Skeptics' Guide to EM

DECEMBER 2, 2017

Case: You are working a regular shift in the emergency department when you hear a code blue called. The American Heart Association ( AHA ) reports that were 209,000 IHCA arrests in 2016. DISCLAIMER: The views and opinions of this podcast do not represent the United States Government or the US Air Force.

Hospitals 40

Hospitals CPR Resuscitation Documentation/Coding 40

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). Int J Emerg Med. The role of venous blood gas in the emergency department: a systematic review and meta-analysis.

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

EB Medicine

JUNE 6, 2019

Jeff: Abdominal pain is the one of most frequent complaint in US emergency departments, representing 8% of all adult ED visits, with admission rates for all patients with abdominal pain ranging between 18-42% and reaching as high as 60% for the elderly. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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. Finally, much of this correlates well with The new Canadian Syncope Arrhythmia Risk Score , just published in 2016, results of which are given below in the Annotated Bibliography.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. 2016 Aug;25(1):29-39.

Seizures 98

Seizures Stroke Outcomes EMS 98

The Skeptics' Guide to EM

DECEMBER 26, 2020

Mortality among patients with frequent emergency department use for alcohol-related reasons in Ontario: a population-based cohort study. CMAJ 2020 Guest Skeptic: Dr. Hasan Sheikh is an emergency and addictions physician in Toronto and a lecturer at the University of Toronto. Date: December 18th, 2020 Reference: Hulme et al.

Emergency Department 52

Emergency Department Administration Documentation/Coding EMS 52

Downeast Emergency Medicine

OCTOBER 21, 2021

Background Suicide is disturbingly prevalent among patients we care for in the Emergency Department. Applications were coded as “consistent” with Federation of State Medical Boards (FSBM) if they inquired only about current impairment from a mental health condition or did not ask about mental health conditions.

Documentation/Coding 52

Documentation/Coding Emergency Department Shock Research 52

RebelEM

DECEMBER 23, 2024

Reliance on ICD-10 and billing codes: Because this study was performed retrospectively using a national database, data on eligibility, types and quantity of fluid received, and patient outcomes were all assessed using ICD-10 and billing codes.

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Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 128

EMDocs

JANUARY 6, 2025

4,5 Of particular concern is the Sudanese conflict, which began in April 2023, and which has caused the largest internal displacement of a population in documented history. International Monetary Fund; 2016. Burden of injury during the complex political emergency in northern Uganda. Ann Emerg Med. Can J Surg J Can Chir.

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Infectious Diseases CDC PPE Rapid Diagnostic Testing 75