Dr. Smith's ECG Blog

OCTOBER 18, 2023

4,5] We have now formally studied this question: Emergency department Code STEMI patients with initial electrocardiogram labeled ‘normal’ by computer interpretation: a 7-year retrospective review.[6] 2019 ; 54 : 79 - 81. have published a number of warnings about the previous reassuring studies.[4,5] J Electrocardiol. Am J Emerg Med.

EKG/ECG 118

EKG/ECG Documentation/Coding Emergency Department Outcomes 118

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. 2016) “Implementation of a Post-Code Pause: Extending Post-Event Debriefing to Include Silence”. 2012) “Implementation of a Rapid Post-Code Debrief Quality Improvement Project in a Community Emergency Department Setting”. & Liska, H.

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

ACEP Now

NOVEMBER 13, 2023

For the safety of staff as well as patients, interventions that interrupt escalations before they blossom into violence deserve further study. 5 Hospitals commonly activate a “code” in response to agitated patients, alerting security personnel to the location of that patient. 2019;(6):297-302. J Nurs Admin. J Emerg Nurs.

Emergency Department 52

Emergency Department Documentation/Coding Psychiatric Best Practices 52

EMDocs

JUNE 8, 2023

and 9 hours of symptom onset; stroke symptoms that started during sleep were assumed to have started halfway between the actual last known well and the time of wake-up. Subsequently reduced enrollment to 310 patients because no patients had been lost to follow-up or had insufficient data documented. 2019; 380:1795-1803.

Stroke 77

Stroke Administration Outcomes Documentation/Coding 77

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 52

Documentation/Coding Operations Academics Ultrasounds 52

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

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 98

EKG/ECG Documentation/Coding Emergency Department COPD 98

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

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

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 66

EKG/ECG Documentation/Coding EMS Wellness 66

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

Don't Forget the Bubbles

MAY 31, 2023

The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. Which patients were involved? How good was this paper? Do you believe the results?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

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

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 98

Administration Emergency Department Outcomes Documentation/Coding 98

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. You’re just about aware of the tannoy in the background. Emerg Med J.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

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

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. 2019 May-Jun;19(4):378-385.

Pediatrics 71

Pediatrics Emergency Department Research Burns 71

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. 2019 Mar;20(2):409-418. Epub 2019 Feb 19. 2019 May;20(3):537. 2019 Jul;20(4):688-689. West J Emerg Med.

Psychiatric 66

Psychiatric Pediatrics Emergency Department Administration 66

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

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

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 94

Research Documentation/Coding Wellness 94

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

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 92

Emergency Department Pediatrics Wellness Documentation/Coding 92

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

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

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

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

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

SEPTEMBER 2, 2024

Regarding my Systematic assessment of ECG #1: There is significant baseline artifact , as well as baseline wander. I therefore feel it relevant to document ( in your dictation/on the medical chart ) when significant artifact potentially impairs the accuracy of your interpretation. Smith's ECG Blog.

Seizures 104

Seizures EKG/ECG EMS Stroke 104

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 76

CDC Sepsis Research Pediatrics 76

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

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 Documentation/Coding Academics 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

EM Updates

JUNE 15, 2021

After admission to the EDAT, documentation was performed on the inpatient electronic health record (EHR), which at MMC is a different platform than the ED EHR. Hot” and “cold” zones were set up, as well as detached screening/testing locations, and many ambulatory patients were assessed and released without ever entering the ED.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 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

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

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He was admitted on oxygen and was doing fairly well with saturations of 100% on 2 L nasal cannula. A Rising Troponin That afternoon, he complained of increased shortness of breath and was noted to have oxygen saturations in the 70s, prompting a mini code to be called. By the next day, the hs-cTnI was up to 1827 ng/L. Median age was 66.4

Shock 52

Shock EKG/ECG Outcomes Hospitals 52