Dr. Smith's ECG Blog

MARCH 10, 2025

Weve also published the largest study on this question: Emergency Department Code STEMI patients with initial electrocardiogram labeled normal by computer interpretation: a 7-year retrospective review. This underestimates computer false normal ECGs because we only included code STEMIs, not Non-STEMIs with OMI.

EKG/ECG 89

EKG/ECG Outcomes Documentation/Coding Emergency Department 89

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. Epub 2018 Nov 22. Epub 2018 May 23.

Pediatrics 70

Pediatrics Emergency Department Research Burns 70

RebelEM

AUGUST 22, 2024

1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. Patients whose last known well (LKW) time was within 24 hours of presentation. Documented at the following time points: Before treatment. 2020;51(7):2018-2025. Administration of intravenous tissue plasminogen activator (IV tPA) within 4.5

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

The Skeptics' Guide to EM

MAY 11, 2019

JAMA Surgery 2018 Guest Skeptic: Dr. Robert Leeper is an assistant professor of surgery at Western University and the London Health Sciences Centre. J AMA Surgery 2018 Guest Skeptic: Dr. Robert Leeper is an assistant professor of surgery at Western University and the London Health Sciences Centre.

Documentation/Coding 40

Documentation/Coding Operations Academics Ultrasounds 40

Sensible Medicine

MAY 25, 2023

“The Centers for Medicare and Medicaid Services should make establishing payment codes for products involving women’s heart disease a priority to prompt private insurers to cover new service lines.” One of them, the coronary artery calcium score (CAC) was reviewed in 2018 by the U.S.

Documentation/Coding 76

Documentation/Coding Academics Wellness 76

Sensible Medicine

MARCH 27, 2024

Peter Attia - From Surgeon to Longevity Guru I first encountered Peter Attia online while researching ketosis , the Atkins diet and low carb diets in 2012 and found his writing to be incredibly well-researched and helpful. The 2018 American guidelines recommend an LDL-C level <100 mg/dl for primary prevention.

Research 113

Research Documentation/Coding Wellness 113

ACEP Now

NOVEMBER 13, 2023

1,2 In a 2018 study by ACEP, nearly half of emergency physicians polled reported a physical assault while at work. For the safety of staff as well as patients, interventions that interrupt escalations before they blossom into violence deserve further study. References Workplace Violence in Healthcare, 2018. Published 2018.

Emergency Department 52

Emergency Department Documentation/Coding Psychiatric Best Practices 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. In some specific congenital heart diseases, the prevalence of arrhythmias is now being seen as a late surgical complication as children now survive into adulthood.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 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. Elsevier; 2018. Updated 2018 Dec 16]. Courtesy of wiki commons under CC Attribution 3.0 Stat Pearls.

Emergency Department 94

Emergency Department Pediatrics Wellness Fractures 94

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 132

EKG/ECG Documentation/Coding Wellness Emergency Department 132

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. Neth Heart J.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

Dr. Smith's ECG Blog

JULY 26, 2023

But the well-formed Q-wave and the presence of a normal T-wave in inferior leads led me to believe this was Old Inferior MI with persistent ST Elevation, otherwise known as inferior LV aneurysm. To facilitate comparison in Figure-1 — I put this 2018 prior tracing ( = ECG #3 ) — together with ECG #1.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

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). (And A., & Koehler, P. The first lumbar puncture.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

American Medical Compliance

OCTOBER 17, 2023

Thousands of these infections result in death, as well. To ensure that any hazards requiring preventive control will be greatly mitigated or averted and to help ensure that the food is not tainted, preventive controls that must be documented must be put into action.

Documentation/Coding 52

Documentation/Coding Wellness 52

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

A b rief chart review revealed his most recent echo in 2018, with LV EF 67%, “very small” inferior wall motion abnormality. As I discussed and documented in Lesson 1 of My Comment at the bottom of the page in the April 2, 2022 post of Dr. Smith's ECG Blog — certain patients may remain in sustained VT not only for hours — but even for days!

EKG/ECG 140

EKG/ECG Shock Academics Documentation/Coding 140

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 92

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Administration 92

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 Academics 52

Emergency Medicine Ireland

DECEMBER 17, 2020

There is a substantial ANZICS document on tracheostomy that forms the structure for this tasty morsel. And this seems to work exceptionally well. I suppose this is somewhat similar to ultrasound for CVCs as plenty of people seem to cope perfectly well without it * no good data to guide a solid recommendation as yet. 2018.03.01.

Ultrasounds 40

Ultrasounds Documentation/Coding Wellness 40

Don't Forget the Bubbles

MARCH 19, 2024

Just 20% of a person’s health and general well-being is related to access to care and the quality of services. 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. Dublin: Author.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

Thankfully this patient’s second ECG met STEMI criteria, so paramedics brought them as a code STEMI. Eur Heart J 2018 4. QUERY: Given the modest size of the QRS in lead aVL — Isn't the ST segment in lead aVL disproportionately elevated as well as abnormally shaped? ). Int J Cardiol Heart Vasc 2020 3. Lemkes et al.

EKG/ECG 52

EKG/ECG Documentation/Coding EMS Wellness 52

Dr. Smith's ECG Blog

JULY 24, 2018

They stated that the patient was coded for 20 minutes, including multiple doses of epinephrine, and they also gave glucose, calcium, and bicarb. Sinus tachycardia with unequivocal evidence of hyperkalemia, including widened QRS with "pulled apart" morphology (widened QRS) compared to baseline, as well as clearly peaked T-waves.

EKG/ECG 52

EKG/ECG Dehydration Resuscitation Documentation/Coding 52

ACEP Now

MARCH 13, 2024

Consequences of this are well documented and include delayed treatment, exposure to error, increased length of stay, and increased mortality. 2018):e0203316. Emergency departments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. PloS one 13.8

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

Dr. Smith's ECG Blog

JUNE 20, 2018

A 40 something woman with a history of hyperlipidemia and additional risk factors including a smoking history presented with substernal chest pain radiating to "both axilla" as well as the upper back. The medicine note documents that the patient had worsening pain with lying flat and relief with leaning forward. That may be the case.

EKG/ECG 52

EKG/ECG Documentation/Coding Ultrasounds Wellness 52

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. 2018 Jun;54(6):633-7. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

Dr. Smith's ECG Blog

DECEMBER 14, 2018

Pseudonormalization of Wellens' Waves Pseudonormalization of T-waves Anterior pseudonormalization = Comment by K EN G RAUER, MD ( 12/14/2018 ): = Interesting case that brings up a number of important concepts regarding Wellens’ Syndrome. For clarity — I’ve reproduced the first 2 ECGs in this case in Figure-1.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Wellness 52

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. 2018 Nov;20(11):1-20. 8,9 Disposition Disposition depends on the patient’s clinical status and voltage exposure.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

To explain my opinion — I’ve added E CG # 2 to Figure-1 , which is taken from the March 12, 2018 post on Dr. Smith’s ECG blog — in which this woman in her 40s with progressively worsening dyspnea was found to have massive acute PE. Finally — Note that the S1Q3T3 pattern is missing in ECG #2 , despite documentation of a massive PE.

EKG/ECG 52

EKG/ECG COPD Documentation/Coding Shock 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

Dr. Smith's ECG Blog

MARCH 31, 2023

has performed so well clinically: It has been programmed using ECG criteria put forth by Drs. Meyers, Weingart and Smith in their 2018 OMI Manifesto. Smith's ECG Blog have already seen numerous clinical cases that we have presented in which the PM Cardio AI Bot app. NOTE: There is a reason the PM Cardio AI Bot app.

EKG/ECG 52

EKG/ECG Academics Wellness Documentation/Coding 52

Dr. Smith's ECG Blog

MAY 8, 2023

Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. There is concordant ST elevation in I, aVL with reciprocal concordant STD in inferior leads, as well as excessively discordant TE in V2-V4. This is a huge anterolateral OMI. I cannot be anything else.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 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. The investigators in this trial attempt to address the lengthy duration of antibiotics recommended and routinely prescribed among stable males with UTIs (Kang, 2018). Article: Drekonja DM et al.

Outcomes 52

Outcomes Documentation/Coding Hospitals EMS 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] ). I do believe that the 4-variable formula will work very well in LVH. I do research on Cardiologs' algorithm: Smith SW et al. But we need to test it.

EKG/ECG 40

EKG/ECG Documentation/Coding Emergency Department Wellness 40

RebelEM

SEPTEMBER 26, 2022

What They Did Single-center randomized controlled study design performed by the Department of Hepatology & Liver transplantation in New Delhi Study participants, investigator clinicians, data collectors, and data analysts were blinded Investigators recruited participants from February 27, 2016 – March 3, 2018.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

Sensible Medicine

FEBRUARY 28, 2024

He is a thoughtful well-read cardiologist. For the 25% who now find themselves with documented advanced subclinical atherosclerosis there is much greater motivation to make lifestyle changes: to lose weight, to exercise, to improve their diet and to stop smoking. We agree on many things. I have argued it is has no value.

Stroke 45

Stroke Documentation/Coding Outcomes Wellness 45

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.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Dr. Smith's ECG Blog

APRIL 15, 2019

Here was his initial ED ECG: There is sinus tachycardia at a rate of about 140 There is profound ST Elevation across all precordial leads, as well as I and aVL. CLICK HERE — for the ESC/ACC/AHA/WHF 2018 Consensus Document on the 4th Universal Definition of MI, in which these concepts are discussed and illustrated.

EKG/ECG 40

EKG/ECG Sepsis Documentation/Coding Shock 40

EB Medicine

AUGUST 6, 2019

Nachi: Well, I’m sure more of those studies are still coming. Nachi: Well that was a ton of information and background on the DOACs. Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. Show More v Jeff: Fair enough, we’ll take what we can get.

Emergency Department 40

Emergency Department Stroke Wellness Administration 40