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

RebelEM

MAY 15, 2023

Frantically look through the assisted care documents for do-not-resuscitate paperwork Place a chest tube on the left side Place a chest tube on the right side Start noninvasive or mechanical ventilation FOR THE RIGHT ANSWER CLICK ON THE ROSH REVIEW LOGO BELOW References: Dixon A. Accessed October 19, 2022. Accessed October 19, 2022.

EMS 98

EMS Documentation/Coding Resuscitation 98

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] 2022 ; 51 : 384 - 387 3. 2022 ; 55 : 180 - 182 6. have published a number of warnings about the previous reassuring studies.[4,5]

EKG/ECG 119

EKG/ECG Documentation/Coding Emergency Department Outcomes 119

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 100

Seizures Documentation/Coding EKG/ECG Emergency Department 100

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 The USPSTF has issued draft guidance that emphasizes diet and exercise.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 145

Pediatrics Documentation/Coding Burns Academics 145

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 131

EKG/ECG Documentation/Coding Psychiatric EMS 131

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. Utilizing certified interpreters and documenting their use. Educating patients on their rights.

Documentation/Coding 105

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 105

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 121

EKG/ECG Documentation/Coding Fractures Emergency Department 121

EMDocs

SEPTEMBER 26, 2024

An unknown EP reviews the report, determines that there is no reason to notify the patient, and documents nothing. It wasn’t, so you weren’t called, nor did the doc need to document anything. This patient’s history was either poorly taken or poorly documented. 3 : September 2022. Tyler W et al. Volume 80, no.

Radiology 98

Radiology Radiology EKG/ECG Documentation/Coding 98

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 ). As a result of a familial gene mutation — there is fatty infiltration of the RV free wall ( Shah et al — Stat Pearls-NCBI-2022 ).

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

Northwestern EM Blog

MARCH 1, 2025

This maneuver improves oxygenation and gas exchange via three main mechanisms (Malhotra, 2022): 1. It is the distending force of the lungs, opposing the innate inward elastic recoil of the lung parenchyma (Neupane and Jamil, 2022). Document thorough skin assessment every nursing shift, and inspect weight-bearing ventral surfaces.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 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 128

EKG/ECG Documentation/Coding Wellness Resuscitation 128

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 123

EKG/ECG Documentation/Coding Emergency Department 123

Sensible Medicine

AUGUST 7, 2024

In 2022 the CDC paid the AAP to form an expert working group to revise its developmental surveillance checklists. In the resulting document , the working group changed the ages at which children can be expected to reach developmental milestones. Let’s look at 1967 vs. 2022 for the DDST and the CDC: Table 2.

CDC 114

CDC Documentation/Coding Research Pediatrics 114

Total Medical ComplianceHIPAA

DECEMBER 8, 2022

If you need assistance in determining the number of exit routes necessary for your workplace, consult current guidance under the NFPA, Life Safety Code, or International Fire Code. HIPAA: True or False: There is no way to check whether a link to a website in an email goes where it says it will go. Answer: False.

Documentation/Coding 40

Documentation/Coding 40

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

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 90

Stroke Airway Management Documentation/Coding Outcomes 90

Mind The Bleep

OCTOBER 29, 2024

Provide detailed documentation of the initial assessment, treatment provided, and the patient’s response to interventions. 2022 Mar 2;83(3):1-12. Epub 2022 Mar 4. Preparation for Transfer Ensure the patient is hemodynamically stable before transfer. Kirkpatrick JJ, Enion DS, Burd DA. Hydrofluoric acid burns: a review.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 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. 2022 Aug;22(6):1049-1056. 2021.12.028.

Pediatrics 75

Pediatrics Emergency Department Research Burns 75

Medical Law

OCTOBER 19, 2024

This documentation can be indispensable in proving fault or supporting your claims in disputes with insurance companies. At the accident site, CHP officers may provide you with a card containing a QR code that allows you to access the online crash portal and get a free copy of the accident report.

Documentation/Coding 52

Documentation/Coding 52

EB Medicine

JANUARY 3, 2023

2) 2023 E/M coding guidelines are in effect. 2) 2023 E/M coding guidelines are in effect. Announcements: 1) The interactive Clinical Pathways have launched and they are available for free!

Shock 52

Shock Pediatrics Airway Management Sepsis 52

EMDocs

FEBRUARY 12, 2025

Published 2022 Sep 27. J Appl Clin Med Phys. 2022;23(3):e13526. doi:10.1002/acm2.13526 Writing Committee Members, Hirshfeld JW Jr, Ferrari VA, et al. Clin J Oncol Nurs. 2020;24(6):681-684. doi:10.1188/20.CJON.681-684 681-684 Radiation Emergency Medical Management. Cutaneous Radiation Syndrome. 2022;29(10):7021-7050. WoundReference.

Best Practices 57

Best Practices Documentation/Coding Radiology Radiology 57

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. 2022 ; 51 : 384 - 387.

EKG/ECG 89

EKG/ECG Outcomes Documentation/Coding Emergency Department 89

Don't Forget the Bubbles

DECEMBER 16, 2024

A review of child deaths in England and Wales from 2019 to 2022 revealed that delayed or missed vaccinations were a contributing factor in 3% of cases. Since 2022, measles cases have risen steadily worldwide, with significant outbreaks reported in several South Asian and African countries. 2010;375(9716):2134-45. Epidemiol Infect.

Infectious Diseases 59

Infectious Diseases Documentation/Coding Pediatrics CDC 59

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

We documented that the majority of stenotic lesions had compensatory enlargement and thus exhibited remodeling. Strictly speaking — this case does not at this time qualify as MINOCA — because the negative cath and 2 normal hs-troponins done 6 hours apart failed to document infarction. (

EKG/ECG 122

EKG/ECG Ultrasounds Documentation/Coding Wellness 122

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.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

RebelEM

JUNE 8, 2023

2022 Sep 5. 2022 2022 Sep 5. Prior literature primarily focused on safety and medication errors, and while this study did the same, they also assessed variables associated with PDP response. Paper: Singer S, et al. The safety and efficacy of push dose vasopressors in critically ill adults. Am J Emerg Med. Am J Emerg Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

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 Seizures Hospitals 130

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

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

Dr. Smith's ECG Blog

OCTOBER 8, 2024

She was worked as a full code, and ROSC was achieved. For more on Precordial Swirl — See the October 15, 2022 post in Dr. Smith's ECG Blog ). Repeat ECG did not demonstrate ST elevations in the anterior leads." OMI was Missed again!! About 45 minutes after the second EKG, the patient was found in cardiac arrest.

EKG/ECG 123

EKG/ECG Documentation/Coding Resuscitation Shock 123

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 66

EKG/ECG Documentation/Coding EMS Wellness 66

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

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).

Academics 56

Academics Documentation/Coding Emergency Department Hospitals 56

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.

Documentation/Coding 88

Documentation/Coding Wellness Outcomes Research 88

PEMBlog

JUNE 14, 2023

2022-057383 Nordstrom K, Berlin JS, Nash SS, Shah SB, Schmelzer NA, Worley LLM. Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document. Zima; Follow-up After Pediatric Mental Health Emergency Visits. Pediatrics March 2023; 151 (3): e2022057383. 10.1542/peds.2022-057383

Psychiatric 98

Psychiatric Emergency Department Pediatrics Best Practices 98

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