Total Medical ComplianceHIPAA

NOVEMBER 7, 2022

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Documentation/Coding 93

Documentation/Coding Wellness 93

Dr. Smith's ECG Blog

OCTOBER 23, 2023

Macroscopic T-Wave Alternans: A Red Flag for Code Blue. 2017 Oct 1;177(10):1520-1522. This 1910 description by Lewis serves well to this day to remind us of the 2 principal clinical situations in which electrical alternans is most often encountered: i ) Supraventricular reentry tachycardias; and , ii ) Pericaradial tamponade.

EKG/ECG 120

EKG/ECG Documentation/Coding Psychiatric EMS 120

PEMBlog

MAY 11, 2023

Injectable lidocaine, when done well, is reliable – but it can take years to master the ideal technique that doesn’t create a giant mound of subcutaneous lidocaine that can impact needle entry and landmarks. These were used by two independent reviewers to determine Neonatal Facial Coding System with pain scores.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Outcomes 52

Ken Grauer, MD

JULY 29, 2023

The "good news" — is that we clearly see sinus P waves in ECG #1 , that document conversion to sinus rhythm ( ie, upright P waves in lead II that precede each QRS complex with a constant and normal PR interval ). This young woman did well for a year — but unfortunately suffered another cardiac arrest, from which she could not be resuscitated.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

Sensible Medicine

AUGUST 7, 2024

There is evidence that, for children and adults, elevated cortisol levels and chronic stress can lead to behavioral, mental-health, and mood issues, as well as changes in inflammation and immunity. In the resulting document , the working group changed the ages at which children can be expected to reach developmental milestones.

CDC 106

CDC Documentation/Coding Research Pediatrics 106

Don't Forget the Bubbles

MAY 10, 2023

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. You know a paediatric code black means paediatric traumatic cardiac arrest. 2017; 55(5); 449-453. You actually run down the corridor.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

The Skeptics' Guide to EM

OCTOBER 28, 2017

[display_podcast] Date: October 24th, 2017 Reference: Harrison et al. Pediatrics 2017 Guest Skeptic: Dr. Anthony Crocco is a Pediatric Emergency Physician and is the Medical Director & Division Head of the Division of Pediatric Emergency at McMaster’s Children’s Hospital. Anthony is also the creator of SketchyEBM.

Pediatrics 52

Pediatrics Documentation/Coding Emergency Department Hospitals 52

Don't Forget the Bubbles

MARCH 19, 2024

Despite being deemed medically fit for discharge in August 2017, Jack lived in limbo between two hospitals for two and a half years due to delays in disability services and social services arranging a specialist placement for him. Key messages Consider social determinants of health and document these in a child’s clinical notes.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

Northwestern EM Blog

SEPTEMBER 26, 2022

It is well-documented that ED physicians have historically high rates of burnout compared to other specialties as well as a high incidence of post-traumatic stress disorder (PTSD) compared to the general population. PTSD is 2 times more prevalent in physicians (14.8%), with EM resident physicians falling in the range from 11.9%-21.5%.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

Advanced Emergency Nursing from AENJ

MAY 2, 2017

Consider the traumas and medical emergencies that have a seasonal prominence in your locality, then prepare topical presentations in formats that work well with your group. As with a well-run ‘mega-code’, these are rehearsals for future events that may present suddenly.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Documentation/Coding Emergency Nursing Pediatrics 40

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. Upside-down position for the out of hospital management of children with SVT, Bronzetti et al, International Journal of Cardiology 2017 this showed that a modified position (upside down) improved cardioversion rates from 33% to 67%.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

The Injectable Orange

JUNE 20, 2017

While well evaluated, you see the residents go back to the shop floor and struggle to apply any of the lessons that the group agreed had been take homes from the previous sim session. Hicks (2017). How do they do it so well?” Simulcast Journal Club Podcast March 2017 [link] Breakout Group 3 – Debriefing. Stimulus by Prof.

Head Injuries 52

Head Injuries Documentation/Coding Wellness Resuscitation 52

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

mEq/L for Mg++ ) — given that ECF levels of these cations comprise only ~1-2% of total body stores ( Jahnen-Dechent and Ketteler — Clin Kidney J 5(Suppl 1):i3-i14, 2012 — and — Udensi and Tchounwou — Int J Clin Exp Physiol 4(3): 111-122, 2017 ). mEq/L for K+ and 1.76 Smith's ECG Blog.

Seizures 104

Seizures EKG/ECG EMS Stroke 104

Emergency Medicine Ireland

JULY 3, 2023

There are of course much more complex neurohumoral, inflammatory type cytokiney thingies going on but as you can tell they are well over my head so I’ve skipped them for now. But if we’ve been paying attention so far we’ll realise that congestion itself may be causing the kidney injury and decongestion may well fix things.

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

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 70

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 70

EMDocs

JUNE 2, 2023

You should always follow your local practice guidelines and recommendations as well as adhere to approved medications in your facility. Document what you gave and why, as well as the impact. 2017 Sep;40(3):397-410. If a patient has a PRN on their med list do that! Summary All right, so that’s it for this episode.

Psychiatric 66

Psychiatric Pediatrics Emergency Department Administration 66

Don't Forget the Bubbles

JUNE 10, 2024

Baby A, a preterm infant, appears to be faring well for the moment—requiring minimal respiratory support, on full feeds, without IV access, and generally in an okay condition. The history of necrotising enterocolitis The earliest documented cases resembling Necrotising enterocolitis (NEC) date back to the late 19th and early 20th centuries.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

ACEP Now

MARCH 14, 2024

These can be delayed, up to weeks later, so it’s important to educate patients on the importance of follow-up with burn care well-versed with electrical injuries or neurology if they have or develop these symptoms. Documentation with coronary arteriography within 12 1/2 hours of the onset of symptoms in two cases (three episodes).

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Dr. Smith's ECG Blog

JULY 21, 2024

In both tracings — an exceedingly fast PMVT is documented. In this study — Procainamide was superior to Amiodarone for terminating monomorphic VT, as well as having fewer adverse effects than Amiodarone ( Ortiz et al — Eur Heart J 1;38 (17): 1329-1335, 2017 ). The arrhythmia starts with a PVC having a short coupling interval.

EKG/ECG 113

EKG/ECG Shock Hospitals Sepsis 113

Advanced Emergency Nursing from AENJ

JANUARY 9, 2017

Medical emergency personnel prepare well for their work: preplanning, checking equipment, reserve supplies, drills to varied scenarios. One of the most important steps to take is redundant documentation: identity; money, credit, finances, ownership, documents. Was the car actually packed for evacuation?

Documentation/Coding 40

Documentation/Coding Emergency Nursing Wellness Pediatrics 40

Dr. Smith's ECG Blog

JULY 27, 2023

PEARL #3: The pathophysiologic mechanism for producing amphetamine-induced acute MI is unclear ( Bazmi et al — SQUMJ 17(10); e31-37, 2017 — and — Sinha et al — Case Rep Cardiol, 2016 ). BOTTOM Line in Today’s CASE: I was surprised by the elevated troponins in today’s case. An OMI is always a possibility with acute amphetamine use.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

PulmCCM

OCTOBER 30, 2023

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 Outcomes 52

RebelEM

SEPTEMBER 26, 2022

A meta-analysis of fifteen RCTs comparing blood product transfusion rates of cardiothoracic and surgery patients found significantly lower transfusion rates of FFP in TEG/ROTEM guided group compared to traditional tests, with no difference in survival rates (Fahrendorff 2017). Published 2017 Apr 13. Article: Kumar M et al.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 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

RebelEM

DECEMBER 28, 2022

However, the optimal treatment duration for UTI in men is not well studied, and current practice guidelines are based on historical dogma. Patients were enrolled after the initiation of treatment through a search for diagnosis codes and antibiotic prescriptions.

Outcomes 52

Outcomes Documentation/Coding Hospitals EMS 52

Downeast Emergency Medicine

APRIL 26, 2021

Trauma patients between the ages of 18-90 years had to have either had one documented episode of hypotension (defined as a systolic BP <90 mmHg) or tachycardia (>100 beats/minute) to be included in the study. Inclusion was based on suspected rather than confirmed TBI given treatment was in the field.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

This patient was reported to have distant heart sounds but was not hypotensive and did not have JVD according to documentation. 2017 Nov;35(4):525-537. There appears to be some ST elevation in leads II and aVF, as well as to a lesser extent in the lateral chest leads. J Am Soc Echocardiogr. 2013 Sep;26(9):965-1012.e15.

EKG/ECG 52

EKG/ECG Ultrasounds Documentation/Coding COPD 52

Dr. Smith's ECG Blog

DECEMBER 27, 2018

This ECG comes from Pierre Taboulet ( [link] /)( [link] ) an ECG whiz who codes a lot of ECGs for Cardiologs' Artificial Intelligence Deep Neural Network algorithm ( [link] ). JACC 69(23):1694-1703; April 4, 2017. I do believe that the 4-variable formula will work very well in LVH. But we need to test it.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Wellness 52

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Recent studies have shown that low-dose ketamine can reduce pain in acute painful crises of sickle cell patients as well as being an opioid-sparing drug.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

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

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Nachi: Taken all together, the rising rates of obesity and the rising success and availability of bariatric procedures has led to an increased number of bariatric procedures, with 228,000 performed in the US in 2017. In 2017, these were performed 60%, 18%, and 3% of the time.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EB Medicine

AUGUST 6, 2019

Nachi: Well, I’m sure more of those studies are still coming. Nachi: Next we have Betrixaban, the latest Factor Xa inhibitor to be approved, back in 2017. Nachi: Well that was a ton of information and background on the DOACs. Show More v Jeff: Fair enough, we’ll take what we can get. Jeff: Agree.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EB Medicine

DECEMBER 1, 2018

Nachi: And just last year we saw the 2017-2018 influenza epidemic with record-breaking ED visits. 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: The reason for this is multifactorial.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 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). 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

RebelEM

MAY 15, 2024

The loss of these cells leads to immunosuppression as well as decreased responsiveness of the immune system as a whole Patients with neutropenia will not only get very sick very quickly, but also will have blunted immune response and may not localize signs of infection well Fever or malaise may be their only presenting symptoms.

Infectious Diseases 105

Infectious Diseases Administration Sepsis Anaphylaxis 105

Sensible Medicine

NOVEMBER 21, 2024

Ryan during the monkeypox outbreak, our empirical research found that he was the single most accurate source of information on Twitter/X… Read more a month ago · 267 likes · 62 comments · Benjamin Ryan This is a controversial topic, and it is not usually well covered in medical journals or the lay media.

Pediatrics 86

Pediatrics Domestic Violence Research Psychiatric 86

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. Jeff: a 2017 ACEP clinical policy also recommends against routine lab testing in those with acute psychiatric complaints. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40