Dr. Smith's ECG Blog

OCTOBER 12, 2024

The providers documented concern for ST elevation in the precordial and lateral leads as well as a concern for hyperkalemic T waves in the setting of succinylcholine administration. Preliminary findings documented in the cath lab were “Anterior STEMI and no significant coronary artery disease.” (!!!) Potassium resulted as 4.9,

EKG/ECG 118

EKG/ECG Documentation/Coding Emergency Department COPD 118

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 134

EKG/ECG Shock Hospitals Sepsis 134

SheMD

MAY 11, 2023

Transcripts were coded to sort data into “leadership occurrences” or “unrelated to leadership” as well as critical treatment decisions. CPR-related performance items were coded by the second as present or absent. 2019; 47(1): e8- e13. Differences between genders were quantified by averages with confidence intervals.

Leadership 52

Leadership Documentation/Coding Teamwork CPR 52

RebelEM

JUNE 8, 2023

Epub 2019 Jul 3. Am J Emerg Med. 2022 2022 Sep 5. PMID: 36108346 Cole JB, et al. Human Errors and Adverse Hemodynamic Events Related to “Push Dose Pressors” in the Emergency Department. J Med Toxicol. PMID: 31270748 Maheshwari K, et al. Intensive Care Med. 2018;44(6):857–67. Am J Emerg Med.

Administration 97

Administration Emergency Department Outcomes Documentation/Coding 97

The Skeptics' Guide to EM

MAY 11, 2019

Date: May 6th, 2019 Reference: Sceats et al. Date: May 6th, 2019 Reference: Sceats et al. Background: The first documented appendectomy was done by Claudius Amyand in 1735. 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

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. FACP, FNLA, a world-renowned expert in lipidology. To support his Medicine 3.0 To support his Medicine 3.0

Research 107

Research Documentation/Coding Wellness 107

Maria Yang, MD

DECEMBER 14, 2024

Internet platforms profit from obtaining information from children without parents knowledge or consentand social medias effect on the well-being of American children is well-documented. Around 2012, American teens experienced a dramatic decline in wellness.

Documentation/Coding 40

Documentation/Coding Wellness 40

Dr. Smith's ECG Blog

JULY 7, 2024

But because Code STEMI was cancelled on arrival and the patient had delayed angiography, the discharge diagnosis was 'non-STEMI' despite having the exact same pathology. The patient also had a 100% proximal LAD occlusion, with a peak troponin of 100,000 ng/L.

EKG/ECG 69

EKG/ECG Documentation/Coding EMS Wellness 69

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. Oxford Medical Case Reports, Volume 2019, Issue 9, September 2019, omz091. Accessed November 7, 2023.

Emergency Department 93

Emergency Department Pediatrics Wellness Documentation/Coding 93

Total Medical ComplianceHIPAA

OCTOBER 15, 2022

The HHS Office for Civil Rights (OCR) recently settled three more investigations in the Right of Access Initiative it started in 2019. If a patient emails a request for their records, it is considered sufficient documentation for the practice to provide those records once the practice confirms the email address belongs to the patient.

Documentation/Coding 52

Documentation/Coding Administration Wellness 52

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

Taming the SRU

APRIL 22, 2023

If untreated, atrial fibrillation can increase clot formation and lead to an increased risk for heart attack and stroke as well as development of congestive heart failure. For treatment, the American Heart Association’s 2019 guidelines recommend limiting use of non-dihydropyridiine CCB due to potential for negative inotropic effects.

Outcomes 52

Outcomes Stroke Documentation/Coding Fractures 52

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. Epub 2019 Nov 29.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 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. Information on complications following Fontan has been brought together by: Management of the Child and Adult with Fontan Circulation, Rychik et al, Ciculation 2019.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Don't Forget the Bubbles

OCTOBER 14, 2024

The government recognizes they cannot return to their country of origin owing to a well-founded fear of being persecuted for the reasons provided for in the United Nations Refugee Convention or European Convention on Human Rights (such as persecution due to race, sexuality, political opinions, or religion).

Documentation/Coding 59

Documentation/Coding Hospitals Wellness Operations 59

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. ” Indeed, cause of death is coded differently over time and across counties, states, and countries.

CDC 96

CDC Sepsis Research Pediatrics 96

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

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. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. Scotland HI.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

Don't Forget the Bubbles

MARCH 19, 2024

In 2019, 14% of all child and adolescent mental health patients were treated in approved adult hospitals. Just 20% of a person’s health and general well-being is related to access to care and the quality of services. Key messages Consider social determinants of health and document these in a child’s clinical notes.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

RebelEM

AUGUST 12, 2024

Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability.

Outcomes 81

Outcomes Hospitals Operations Shock 81

SheMD

OCTOBER 5, 2023

As we start the 2019-2020 interview season, I have had time to reflect on my experiences as both an interviewee and interviewer. If staying in a hotel- don’t forget to use discount codes the residency program may offer. I have heard stories of interviewees being rude to the Residency Coordinator- this did NOT end well for the student.

Research 52

Research Leadership Documentation/Coding Academics 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 2019 = Comment by K EN G RAUER, MD ( 2/13 /2023 ): = I love cases like this one! [1] So even for true positive STEMIs, identifying OMI can help expedite reperfusion. Eur Heart J 2018 4. Bergmark et al.

EKG/ECG 52

EKG/ECG Documentation/Coding EMS Wellness 52

RebelEM

MARCH 27, 2023

2019 Aug; PMID: 30954692 Clinical Question: What is the impact of system factors in the implementation of standard-of-care LPV in critically ill ED patients admitted to the ICU? 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.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

EMDocs

JUNE 16, 2023

It’s stressful for the ED clinical staff as well. Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document. 2019 Jul 22;20(5):690-695. This has a downstream effect. Challenges while Boarding The length of stay for pediatric mental health visits has increased. 10.1542/peds.2022-057383

Psychiatric 52

Psychiatric Pediatrics Emergency Department Best Practices 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. 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. Meyers, Weingart and Smith in their 2018 OMI Manifesto. What About the Initial ECG?

EKG/ECG 52

EKG/ECG Academics Wellness Documentation/Coding 52

Pediatric EM Morsels

OCTOBER 27, 2023

Taking care of a critically ill child can be nerve-racking to say the least, and downright petrifying for those who don’t do it frequently, even if they are well-trained and brilliant clinicians. Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Broselow does not.

Pediatrics 269

Pediatrics Resuscitation Documentation/Coding Wellness 269

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. Conducted at 2 US Veterans Affairs medical centers from 2012–2019. 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

Lancet 2019; Vol 394, Iss 10210, P 1713-1723[ Full Text ]. 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. Bossers SM, Loer SA, Bloemers FW, et al.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

RebelEM

SEPTEMBER 26, 2022

Patients from both groups are well balanced regarding results from a wide range of coagulation studies. Hayes-Larson 2019). Significant coagulopathy: INR > 1.8 Randomized study design Blind adjudication of transfusion reaction outcomes Follow-up was complete. Investigators performed an Intention-to-treat analysis.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

Pediatric Education

NOVEMBER 12, 2023

weeks was seen for well-care. No specific documentation regarding the duration of the car seat testing could be identified in the medical records. 2019-1703 Author Donna M. Patient Presentation A former 35 week, appropriate for gestational age male, now 37.5 The pertinent physical exam showed the patient was now 3.34 Pediatrics.

Pediatrics 40

Pediatrics Poisoning Hospitals Documentation/Coding 40

Northwestern EM Blog

MAY 16, 2022

The above study was well summarized and bears repeating that, in this multicenter randomized study assessing CT vs POCUS vs radiology performed US in patients with suspected renal colic in the ED setting, initial US reduced radiation exposure without adversely affecting patient-centered outcomes. J Urol 2019. Thanks again toDr.’s

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Dr. Smith's ECG Blog

JUNE 23, 2023

The amiodarone was discontinued and the patient did well. == MY Comment , by K EN G RAUER, MD ( 6/23 /2023 ): == From an academic standpoint — I love WCT ( W ide- C omplex T achycardia ) rhythms. This likelihood of VT increases to at least 90% if the patient has documented underlying heart disease.

EKG/ECG 52

EKG/ECG Academics Documentation/Coding Wellness 52

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

Dr. Smith's ECG Blog

AUGUST 8, 2020

MY THOUGHTS on ECG #2 ( compared to ECG #1 ): The first thing to note in comparing ECG #1 with ECG #2 — is that the frontal plane axis, as well as R wave progression and QRS morphology in each of the 12 leads is fairly similar in the 2 tracings. Figure-2: Comparison of the prior ECG with the initial ECG done in the ED ( See text ).

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

Pediatric EM Morsels

OCTOBER 6, 2023

(Forster, 2021) Transmission is by Fecal-Oral route (Chiodini 2018) Incubation period 6-30 days after exposure (Chiodini 2018) Salmonella typhi produces an endotoxin although its clinical significance is not yet well understood (Gibani 2019) Two typhoid vaccines are available for those > 6 m/o and are 50-80% effective.

Pediatrics 161

Pediatrics CDC Seizures Documentation/Coding 161

Pediatric EM Morsels

AUGUST 18, 2023

None of the patients were documented to have joint disease at follow up. Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications. There were 2523 children included. 451 pediatric patients were included. Clin Pediatr. 55(2):107-10.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

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