Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk. Am J Emerg Med.

Infectious Diseases 161

Infectious Diseases Pediatrics Sepsis Documentation/Coding 161

EMDocs

SEPTEMBER 19, 2023

Reference: emDOCs – NCSE Journal of Emergency Medicine – Review Case 4: 52-year-0ld male brought in by EMS with “code STEMI” ECG demonstrates ST depressions with rocket like T waves in V2-V4. This document covers high sensitivity troponin, risk disposition pathways, and STEMI equivalents. J Am Coll Cardiol.

Seizures 72

Seizures Documentation/Coding EKG/ECG Emergency Department 72

ALiEM

MARCH 11, 2024

In July 2022, a 32-year-old male with a past medical history of HIV (on antiretroviral therapy, CD4 390, viral load undetectable) presented to the emergency department with constitutional symptoms and a rash for 4-5 days. There is limited literature documenting eye involvement and pictographic examples of its presentation. Eye (Lond).

Documentation/Coding 56

Documentation/Coding Academics Emergency Department Hospitals 56

American Medical Compliance

FEBRUARY 2, 2024

COVID-19 Prevention Requirements The Occupational Safety and Health Standards Board decided to approve COVID-19 preventative standards that are not emergency measures on December 15, 2022. Employees who are working from home. Workers covered by the legislation on Aerosol Transmissible Diseases (Cal. 8, § 5199) (section 5199).

Infectious Diseases 52

Infectious Diseases Documentation/Coding PPE Wellness 52

Don't Forget the Bubbles

MAY 31, 2023

2023 May 17:archdischild-2022-325280. doi: 10.1136/archdischild-2022-325280. in the Lancet Diabetes and Endocrinology 2022 , stated that an ‘ additional pronounced increase during the COVID-19 pandemic were general phenomena observed in most registries from different countries and continents.’ 2022 Nov 1;10(11):786-94.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

PulmCCM

MARCH 11, 2024

Societies push back on CMS’s cuts to critical care billing In 2022, the U.S. About 544,000 99292 codes were billed to CMS in 2021, according to ACCP , reportedly stable at about 10% of the total bills. Read their letter to CMS here , asking that critical care billing return to pre-2022 historical norms.

Hospice 52

Hospice Documentation/Coding Administration Hospitals 52

The Skeptics' Guide to EM

AUGUST 10, 2024

A code stroke is activated, and a CT head shows a left basal ganglia hemorrhage with no vascular lesions on CT angiography. The 2022 AHA/ASA guidelines give several recommendations on blood pressure lowering and coagulopathy reversal along with an algorithm. Blood Pressure Lowering:

Stroke 71

Stroke Airway Management Outcomes Documentation/Coding 71

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. 2022 — and — Kontos et al; 2022 ACC Expert Consensus — JACC 80(20):1925-1960, 2022 ).

EKG/ECG 69

EKG/ECG Documentation/Coding EMS Wellness 69

Sensible Medicine

DECEMBER 18, 2023

Now let’s compare the two documents. Conclusion In October 2022, while the AAP continued to recommend masking children as young as 2, the group met indoors and did not mask themselves (see pic). From their document. The USPSTF has issued draft guidance that emphasizes diet and exercise. This is Orwellian.

Pediatrics 142

Pediatrics Documentation/Coding Burns Academics 142

ACEP Now

DECEMBER 11, 2023

A recent article documents 56 additional U.S. Published November 3, 2022. Published October 26, 2022. Published August 22, 2022. Published November 11, 2022. The wave of increasing hospital closures and service line cutbacks continues to sweep the U.S. Accessed December 8, 2023. The Atlantic website. Payerchin R.

Hospitals 98

Hospitals Administration Documentation/Coding Research 98

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. 2022 Aug;22(6):1049-1056. 2021.12.028.

Pediatrics 71

Pediatrics Emergency Department Research Burns 71

Dr. Smith's ECG Blog

APRIL 18, 2024

Emergent cath lab activation is also named after this test (code STEMI), so patients whose ECGs don’t meet STEMI criteria don’t get emergent angiograms, despite guidelines. And because there was no Code STEMI, the discharge diagnosis was “non-STEMI”, so this case will not be flagged as an opportunity for improvement. But only 6.4%

EKG/ECG 118

EKG/ECG Documentation/Coding Fractures Emergency Department 118

Dr. Smith's ECG Blog

MAY 27, 2024

Inferior hyperacute T waves, which have been added to the 2022 ACC consensus on chest pain as a “STEMI equivalent”[3] 3. Since the ECG now meets STEMI criteria, a code STEMI was activated. J Am Coll Cardiol 2022 4. But STEMI criteria is only 43% sensitive for OMI.[1] Conduction disorders in the setting of acute STEMI.

EKG/ECG 119

EKG/ECG Documentation/Coding Emergency Department 119

Total Medical ComplianceHIPAA

MAY 25, 2022

But there’s a twist, the malware inside the PDF is still Word document. The Word document is named “has been verified”. The pop-up message that asks the user to open the Word document says, “The file ‘has been verified’.” May 24, 2022. The user receives an email named “Remittance Invoice” with the infected PDF attached.

Documentation/Coding 52

Documentation/Coding 52

Stop and Think

NOVEMBER 19, 2023

In fact, the authors reported a decline in sudden cardiac death during the years 2021-2022. This was a 20-year survey in which the authors used 4 independent databases to document the incidence and causes of sudden cardiac death in NCAA athletes. They found 143 cases of sudden cardiac death over the 20 years.

Documentation/Coding 130

Documentation/Coding Wellness Resuscitation 130

ACEP Now

OCTOBER 9, 2023

3 A new 2022 proposed change to Section 1557 hopes to expand its scope to other HHS activities (including Medicare Part B) and telehealth services, require staff training on availability of services, and further define the roles of qualified versus nonqualified interpreters. Published August 4, 2022. emergencies, patient’s request).

Emergency Department 64

Emergency Department Documentation/Coding EMS Wellness 64

Dr. Smith's ECG Blog

OCTOBER 23, 2023

2022 Jul;27(4):e12939. Epub 2022 Feb 11. Macroscopic T-Wave Alternans: A Red Flag for Code Blue. I last reviewed the phenomenon of electrical alternans in My Comment at the bottom of the page in the November 28, 2022 post of Dr. Smith's ECG Blog. Ann Noninvasive Electrocardiol. doi: 10.1111/anec.12939. J Am Coll Cardiol.

EKG/ECG 120

EKG/ECG Documentation/Coding Psychiatric EMS 120

Emergency Medicine Journal

NOVEMBER 28, 2023

Methods A thematic analysis of WMTY over a 12 month period from 1st January to 31st December 2022 was performed. Age, Gender, Clinical Frailty Score (CFS) and documentation of ‘WMTY’ was analysed. 468 (79%) patients had documentation of WMTY. Results 592 patient responses were analysed. Mean (SD) age was 83 (6.9)

Emergency Department 40

Emergency Department Documentation/Coding Administration Hospitals 40

EB Medicine

SEPTEMBER 1, 2022

In this episode, Sam Ashoo, MD interviews Lela Bachrach, MD, MS, Larissa Truschel, MD, MPH, and Makini Chisolm-Straker, MD, MPH - the authors of the July 2022 PEMP article on Human Trafficking of Children and Adolescents: Recognition and Response in the Emergency Department. Do you find this dissuades patients form reporting?

Emergency Department 52

Emergency Department Documentation/Coding EMS Best Practices 52

Dr. Smith's ECG Blog

MARCH 4, 2024

link] Or use the QR code: 10 Cases: Case 1 Do you want to be interrupted to view what the computer calls normal or nonspecific ECGs? (THE PM CARDIO OMI AI APP) If you want this bot to help you make the early diagnosis of OMI and save your patient and his/her myocardium, you can sign up to get an early beta version of the bot here.

EKG/ECG 109

EKG/ECG Documentation/Coding Wellness Resuscitation 109

Emergency Medicine Journal

JUNE 20, 2024

We evaluated feasibility of identification, provided preliminary effect size estimates and documented participant acceptability. We enrolled ED patients, 45–75 years old, in the Greater Rochester, NY region into a randomised controlled pilot from January to May 2022.

Emergency Department 40

Emergency Department Documentation/Coding Outcomes 40

Pediatric EM Morsels

JULY 28, 2023

A critical MORSEL is that every child you treat for DKA needs to have an initial thorough neuro exam including cranial nerves and then frequent neuro reassessments … and document it ( so your colleagues who take over care for the kid can know if there has been a change )! 2022; 23( 7): 835- 856. Pediatr Diabetes. doi: 10.1111/pedi.13406

Fluid Resuscitation 245

Fluid Resuscitation Pediatrics Resuscitation Research 245

The Skeptics' Guide to EM

JANUARY 28, 2023

Date: January 22, 2022 Reference: Samuels-Kalow M et al. Date: January 22, 2022 Reference: Samuels-Kalow M et al. The ruling of the US Supreme Court on June 24, 2022 in Dobbs v Jackson Women’s Health Organization overturned Roe v Wade and allowed individual US states to determine their own restrictions on abortion.

Research 52

Research Documentation/Coding Academics Wellness 52

ACEP Now

JANUARY 11, 2024

A recent article documents 56 additional U.S. Published November 3, 2022. Published October 26, 2022. Published August 22, 2022. Published November 11, 2022. The wave of increasing hospital closures and service line cutbacks continues to sweep the United States. Becker’s Hospital CFO report website. Payerchin R.

Hospitals 52

Hospitals Administration Documentation/Coding Research 52

The Skeptics' Guide to EM

JULY 30, 2022

Date: July 28th, 2022 Reference: Brower et al. AEM July 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Date: July 28th, 2022 Reference: Brower et al.

Ultrasounds 52

Ultrasounds Operations Outcomes Documentation/Coding 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Results and Conclusion Since go–live (August 2022) electronic resources have become the standard first offer for families 44 core electronic ED resources cover safety net advice for common conditions, health promotion and signposting links to support health inequalities Sharing options: scanned via QR code (see figure 1 ), sent via text/SMS or (..)

Emergency Department 40

Emergency Department Head Injuries Documentation/Coding 40

American Medical Compliance

DECEMBER 26, 2023

On December 27, 2020, the United States Congress adopted the No Surprises Act (NSA) as part of the Consolidated Appropriations Act of 2021, which has various provisions to assist in protecting customers against unexpected costs beginning January 1, 2022. The following course highlights the NSA and how it impacts healthcare.

Ambulance Services 52

Ambulance Services Documentation/Coding 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. 2022 Apr 20;17(4):e0267288. 2022 Oct;16(5):2049-2055. How does this apply to us? doi: 10.1371/journal.pone.0267288.

Academics 52

Academics Leadership Documentation/Coding Research 52

ACEP Now

OCTOBER 3, 2023

This document is an update of guidelines first published in 2000, and then updated in 2007. Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented. Accessed 2022, [link]. J Safety Res.

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation EMS 98

JournalFeed

MARCH 26, 2022

The JournalFeed podcast for the week of March 21-25, 2022. For continued access to all the JournalFeed has to offer will require you to be a member as of April 4th, 2022. Check out journalfeed.org for details.

Documentation/Coding 40

Documentation/Coding Stroke Emergency Department Resuscitation 40

Sensible Medicine

JUNE 11, 2024

In November 2022, OpenAI launched ChatGPT-3.5. This interface shortens the time required for human-to-computer interaction by transforming an input given through natural language into almost any form, from text to images to computer code.

Wellness 75

Wellness Documentation/Coding Outcomes Research 75

Total Medical ComplianceHIPAA

OCTOBER 15, 2022

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. For example, if the patient’s email is not on file, call to confirm the request and email address and document the call in the patient’s file.

Documentation/Coding 52

Documentation/Coding Administration Wellness 52

Don't Forget the Bubbles

MAY 10, 2023

In May 2022, Holly and Joe, two students on the joint QMUL and DFTB PEM MSc , created video presentations on human factors. 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. Let’s rewind.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

The Skeptics' Guide to EM

FEBRUARY 3, 2023

September 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: You are working an overnight shift at a small rural hospital. You are tidying your things in anticipation of the arrival of the dayshift when a code blue is called. Circulation.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Outcomes Documentation/Coding 52

Pediatric EM Morsels

AUGUST 18, 2023

None of the patients were documented to have joint disease at follow up. Morley 2022) This myth is: BUSTED. There were 2523 children included. Number of adverse effects was similar between the groups, however in the Levofloxacin group 85% of MSK complaints were arthralgias. 451 pediatric patients were included. Pediatr Infect Dis J.

Pediatrics 130

Pediatrics Infectious Diseases Hospitals Seizures 130

Dr. Smith's ECG Blog

JUNE 8, 2023

As they documented, “Paramedics noted patient’s 12 Lead appeared to have 1mm of elevation in III and borderline 1mm elevation in aVF, with mild depression in I and aVL. Cardiology documented “late presentation STEMI but likely aborted given resolution of ST changes from EMS to hospital.” Kontos et al. Welsh et al.

EKG/ECG 61

EKG/ECG Documentation/Coding EMS Emergency Department 61

ACEP Now

DECEMBER 10, 2023

After resuscitation, the patient should be evaluated by a multi-disciplinary team in the hospital to re-affirm the patient’s code status and medical treatment goals. 2022 Jun;34(3):473-474. Suicide by advance directive? J Med Ethics. 2008 Sep;34(9):e4. Bode MJF, Huber J, Roberts DM. Emerg Med Australas.

Resuscitation 52

Resuscitation Hospitals EKG/ECG Documentation/Coding 52