Dr. Smith's ECG Blog

OCTOBER 23, 2023

Macroscopic T-Wave Alternans: A Red Flag for Code Blue. 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. J Am Coll Cardiol. doi: 10.1016/j.jacc.2005.08.066.

EKG/ECG 128

EKG/ECG Documentation/Coding Psychiatric EMS 128

EMDocs

AUGUST 22, 2024

13 Interventions may include: Ascertaining a patient’s preferred language early in the clinical encounter (during registration, for instance), and clearly documenting this preference in a place that is visible to all providers. Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors.

Documentation/Coding 82

Documentation/Coding Emergency Department Best Practices Federal Emergency Management Agency 82

EMDocs

DECEMBER 4, 2023

The Wells’ Criteria for DVT can help risk stratify [2,3]. If the patient’s Wells score is ≤ 0, DVT is nearly clinically excluded and no further immediate lab or ultrasound is necessary. In patients with a Wells’ score of 1-2 (moderate risk), DVT can be ruled out with a negative d-dimer rather than an US. mg/kg for 24 hours.

Ultrasounds 71

Ultrasounds Documentation/Coding Wellness EMS 71

Downeast Emergency Medicine

DECEMBER 1, 2021

ROSENBERG ET AL Northern New England and, in particular, Maine have been especially hard-hit by the opioid epidemic, with Maine experiencing its’ highest number of opioid deaths ever in 2020. All transcripts were then coded using a final code book and resultant codes were organized into themes and subthemes with supportive quotes.

Emergency Department 52

Emergency Department Documentation/Coding Leadership Hospitals 52

Sensible Medicine

SEPTEMBER 26, 2023

adults say they have a great deal of confidence in medical scientists to act in the best interests of the public, down from 40% who said this in November 2020.” ” As well, such a rule “would also increase accountability for journals. Overall, 29% of U.S. ” It's time to adopt the Pottery Barn rule.

Research 128

Research Hospitals Documentation/Coding Outcomes 128

ACEP Now

OCTOBER 30, 2023

This makes documentation and communication of the utmost importance for these patients for their health and safety. If they are part of the Deaf community, ensure that they have an American Sign Language interpreter present, as well as an in-person interpreter to best communicate the emotion behind their speech. Am J Public Health.

Sexual Assault 98

Sexual Assault Teamwork Outcomes Dehydration 98

Dr. Smith's ECG Blog

JUNE 11, 2024

Queen of Hearts is available and performs well. Emergency department Code STEMI patients with initial electrocardiogram labeled ‘normal’ by computer interpretation: a 7-year retrospective review. Learning Points: You cannot trust conventional algorithms even to find STEMI(+) OMI, even when they say "normal ECG."

EKG/ECG 116

EKG/ECG Documentation/Coding Emergency Department Wellness 116

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 111

Seizures EKG/ECG EMS Stroke 111

Dr. Smith's ECG Blog

MARCH 22, 2024

I sent this to Dr. Smith with no context and he said "Could very well be a septal OMI." This is documented as a STEMI in the clinical notes and in the cath report, but certainly does not meet STEMI criteria and is therefore an NSTEMI by definition. Here is the Queen's verdict and her explanation: She sees OMI but with low confidence.

EKG/ECG 117

EKG/ECG Wellness Documentation/Coding 117

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 122

EKG/ECG Shock Hospitals Sepsis 122

ACEP Now

DECEMBER 6, 2024

This case report documents the first known instance of using NTG during an emergency department resuscitation to treat a patient in cardiac arrest due to severe coronary artery vasospasm. Cardiac arrest secondary to myocardial ischemia from coronary vasospasm is well documented. N Engl J Med. 1992;326(22):1451-1455. Circulation.

Resuscitation 52

Resuscitation EKG/ECG Documentation/Coding COPD 52

The Skeptics' Guide to EM

OCTOBER 21, 2020

Date: October 21st, 2020 This is an SGEM Xtra episode. Date: October 21st, 2020 This is an SGEM Xtra episode. The rivalry between Newton and Hooke is well documented. I had the honour of presenting at the Department of Family Medicine’s Grand Rounds at the Schulich School of Medicine and Dentistry.

Documentation/Coding 52

Documentation/Coding Wellness 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

EM Updates

JUNE 15, 2021

In the last week of March and first week of April 2020, hospitals across New York City were overwhelmed with critically ill COVID-19 patients, many of whom had unprecedented oxygen requirements. From April 6 to May 3, 2020, 90 patients were admitted to the EDAT. The study was approved by the MMC institutional review board.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

Don't Forget the Bubbles

JANUARY 1, 2024

While adenotonsillectomy may not directly impact cognitive functions, it can benefit other aspects of health and well-being in children with mild sleep-disordered breathing. During the COVID-19 pandemic (2020-2021), the incidence of IPD reached its lowest level in 20 years. Pediatrics. Shikha A, et al. Eur J Pediatr. 2023 Dec 27.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 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. 2020;(5):898-907. J Am Coll Emerg Physicians Open.

Emergency Department 52

Emergency Department Documentation/Coding Psychiatric Best Practices 52

The Skeptics' Guide to EM

JANUARY 23, 2021

A joint statement on the issue was published in 2020 by AAEM/RSA, ACEP, ACOEP/RSO, CORD, EMRA, and SAEM/RAMS. The American College of Emergency Physicians ( ACEP ) also has a number of documents discussing APPs in the ED. The American College of Emergency Physicians ( ACEP ) also has a number of documents discussing APPs in the ED.

Research 52

Research Poisoning Documentation/Coding Outcomes 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

The Skeptics' Guide to EM

OCTOBER 1, 2022

It is not well documented, whether gaps in pain assessment and treatment exist in conditions in which opioids are not indicated, such as migraine headaches. Some groups of patients who are at greater risk than others ( elderly , women , mentally ill , certain ethnic groups, and insurance status ).

Pediatrics 52

Pediatrics Emergency Department Documentation/Coding Research 52

SheMD

JULY 27, 2023

Unequal distribution of domestic responsibility has been documented as a factor in the underrepresentation in female physicians in leadership roles in academic medicine as well as contributing to career satisfaction. 2020 Jun 3;20(1):178. How does this apply to us? BMC Med Educ. doi: 10.1186/s12909-020-02072-x.

Academics 52

Academics Leadership Documentation/Coding Research 52

ACEP Now

MAY 6, 2023

million ED visits for injuries from motor vehicle accidents (MVAs) in 2020. The emergency physician’s documentation of these injuries may prove to be crucial in law enforcement’s reconstruction of the crash and may have significant implications for subsequent legal proceedings. Discussion There were over 2.1

Forensics 52

Forensics Documentation/Coding Head Injuries Fractures 52

SheMD

OCTOBER 8, 2023

Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. Actually, I wanted to ask what supports the program has in place for parents (male and female) as well as people increasing their families, be it biologically or through adoption?” Their well-being should be considered.

Leadership 105

Leadership Best Practices Documentation/Coding Academics 105

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. Courtesy of wiki commons under CC Attribution 3.0 germany File:Hematoma ear.jpg - Wikimedia Commons.

Emergency Department 93

Emergency Department Pediatrics Wellness Documentation/Coding 93

Don't Forget the Bubbles

MARCH 19, 2024

The Ombudsman for Children’s Office suggested that in 2020, 18 children were admitted to paediatric hospitals in Ireland, and 10 children in 2021 for reasons beyond their medical needs. Just 20% of a person’s health and general well-being is related to access to care and the quality of services. What can clinicians do?

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

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 125

EKG/ECG Documentation/Coding Wellness Emergency Department 125

SheMD

OCTOBER 5, 2023

Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. 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.

Research 52

Research Leadership Documentation/Coding Academics 52

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. The CDC reports that in the US in 2020 there were 93 Sudden Unexpected Infant Deaths per 100,000 live births (Fig. Subscribe now How Many Infants Die of SIDS?

CDC 76

CDC Sepsis Research Pediatrics 76

Northwestern EM Blog

SEPTEMBER 12, 2022

It is well known that most hospitals in large population centers already operate at or near full capacity [4]. Other things listed on tags can be a patient’s name, bar code, MRN or other tracking criteria. 2020, epmonthly.com/article/not-heroes-wear-capes-one-las-vegas-ed-saved-hundreds-lives-worst-mass-shooting-u-s-history/.

Mass Casualty Incidents 52

Mass Casualty Incidents EMS Hospitals Operations 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. JAMA Cardiol [Internet] 2020;Available from: [link] 4.

Shock 52

Shock EKG/ECG Outcomes Hospitals 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. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients.

Outcomes 81

Outcomes Hospitals Operations Shock 81

EMDocs

JUNE 16, 2023

It’s stressful for the ED clinical staff as well. Pediatrics October 2020; 146 (4): e20201174. 2020-1174 AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health Jennifer A. Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document.

Psychiatric 52

Psychiatric Pediatrics Emergency Department Best Practices 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]. Acute Crit Care.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 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. Int J Cardiol Heart Vasc 2020 3. 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 2021 2. Aslanger et al.

EKG/ECG 52

EKG/ECG Documentation/Coding EMS Wellness 52

Dr. Smith's ECG Blog

JANUARY 31, 2020

Although diagnostic of MI, it is highly suspicious for " Old inferior MI with persistent ST Elevation" or "inferior aneurysm morphology" because of the well-formed Q-waves and the flat T-waves. There are well-formed Q-waves 3. We need to do some more investigation. Here are other cases of inferior LV aneurysm. The T-waves are flat.

EKG/ECG 52

EKG/ECG Wellness Documentation/Coding Hospitals 52

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

It radiated to both shoulders and both upper extremities, and there was shortness of breath and diaphoresis as well. Ongoing pain noted throughout all documentation, but after nitro drip and prn morphine, "pain improved to 2/10." Academic Emergency Medicine 27(S1): S220; May 2020. CT aorta negative for dissection. Abstract 556.

EKG/ECG 83

EKG/ECG Outcomes Academics Documentation/Coding 83

Mind The Bleep

SEPTEMBER 17, 2024

Document clearly: The location of all wounds Medical photography or drawn labelled diagrams can aid in explaining the exact location. Always consider an ATLS approach to the assessment. Feel for any swelling/collection/abscess. Move: Assess the range of motion of the surrounding joints to help determine the involvement of adjacent structures.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

ACEP Now

JULY 7, 2023

Mental health evaluation teams can rely on documentation and interviews to understand a patient’s initial agitation level. The article also will not address severe agitation, which is already well covered elsewhere and is the topic of an ACEP clinical policy currently in development. 2020 Jul 3;1(5):898-907.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52