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. INTERACT-2 demonstrated that in patients with ICH, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability (SGEM#73).

Stroke 90

Stroke Airway Management Documentation/Coding Outcomes 90

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 104

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 104

EMDocs

SEPTEMBER 26, 2024

This story, while unlikely to reflect the standards of most readers, has a somewhat surprising outcome. 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. 3 : September 2022.

Radiology 97

Radiology Radiology EKG/ECG Documentation/Coding 97

Sensible Medicine

AUGUST 7, 2024

And while PP is mostly aesthetic, severe cases are usually prescribed physical therapy and sometimes orthosis (helmets), although Collett et al shows that the outcome is the same with or without physical therapy, and with or without orthotic treatment. Let’s look at 1967 vs. 2022 for the DDST and the CDC: Table 2.

CDC 114

CDC Documentation/Coding Research Pediatrics 114

Mind The Bleep

OCTOBER 29, 2024

Provide detailed documentation of the initial assessment, treatment provided, and the patient’s response to interventions. Proper stabilization and detailed communication with the burns centre are essential for optimal patient outcomes. 2022 Mar 2;83(3):1-12. Epub 2022 Mar 4. Kirkpatrick JJ, Enion DS, Burd DA.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

RebelEM

JUNE 8, 2023

2022 Sep 5. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose. Prior literature primarily focused on safety and medication errors, and while this study did the same, they also assessed variables associated with PDP response.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

ACEP Now

OCTOBER 3, 2023

This document is an update of guidelines first published in 2000, and then updated in 2007. These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

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. Other companies are also racing to provide AI-based technology in healthcare.

Documentation/Coding 85

Documentation/Coding Wellness Outcomes Research 85

RebelEM

AUGUST 12, 2024

Epub 2022 Aug 28. Intravenous amino acid therapy for kidney protection in cardiac surgery a protocol for a multi-centre randomized blinded placebo controlled clinical trial. The PROTECTION trial. Contemp Clin Trials.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Dr. Smith's ECG Blog

JUNE 15, 2023

I sent this ECG to the Queen of Hearts (PMcardio OMI), and here is the verdict: You can subscribe for news and early access (via participating in our studies) to the Queen of Hearts here: [link] queen-form Then I learned that a Code STEMI was activated for concern of anterior "STEMI" in V1-V2. High sensitivity troponin I was 23 ng/L.

EKG/ECG 98

EKG/ECG Documentation/Coding Outcomes Hospitals 98

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. Charles Brower is a second-year resident training in Emergency Medicine at the University of Cincinnati.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

ACEP Now

OCTOBER 30, 2023

One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. This makes documentation and communication of the utmost importance for these patients for their health and safety. 2022; 14: 441–456.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

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

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

EMDocs

AUGUST 8, 2023

Bimodal age of distribution: at birth and 12-18 years 14% of cases occur in adults; older patients have worse outcomes Bell clapper deformity – bilateral in 80% of patients Prior episode of torsion Family history Trauma (can be minor) Clinical Presentation: Sudden/severe testicular pain Often unilateral, may radiate.

Ultrasounds 94

Ultrasounds Documentation/Coding Outcomes Emergency Department 94

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 Documentation/Coding CPR 52

PulmCCM

SEPTEMBER 28, 2024

Mmmm… Nectar-Thickened Data Makhnevich et al performed a retrospective matched cohort study of 8,916 patients with Alzheimer-type dementia admitted at 11 hospitals in New York (2017-2022) who had documented clinical suspicion of dysphagia. The primary outcome was death in the hospital. to 1.14).

Outcomes 52

Outcomes Documentation/Coding Hospitals 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." Comparative early and late outcomes after primary percutaneous coronary intervention in st-segment elevation and Non–St-segment elevation acute myocardial infarction (from the Cadillac trial). Stuckey, T.,

EKG/ECG 131

EKG/ECG Documentation/Coding Wellness Emergency Department 131

Greater Sydney Area HEMS

AUGUST 1, 2023

When I found it, I felt the documentation (if done at all) largely tended to be the bare minimum, and certainly not reflective of the beautiful learning conversations happening in the room. And so, for this project we made the decision to look solely at process measures that reflected our interventions, as opposed to broader outcome measures.

Documentation/Coding 52

Documentation/Coding Outcomes Hospitals Administration 52

RebelEM

OCTOBER 5, 2023

Secondary Outcome By day 90, mortality was 9.3% Strengths: The investigators framed a research question centered on patient outcomes, ensuring the study’s relevance and practicality. Control: Normal Saline via continuous infusion according to the same regimen used in the hydrocortisone group. in the placebo group (p = 0.006).

Research 94

Research Outcomes Administration Shock 94

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.

Stroke 40

Stroke Documentation/Coding Emergency Department Resuscitation 40

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Triage documented a complaint of left shoulder pain. We have shown that morphine is associated with worse outcomes (see learning points below) and have published many blog posts about it , such as this one: Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mass delusion (and Opiate pain relief). Milasinovic, D.,

EKG/ECG 123

EKG/ECG Outcomes Academics Documentation/Coding 123

SheMD

JULY 27, 2023

What were their outcomes: Physician mothers report having more domestic responsibilities than their partners. 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.

Academics 52

Academics Leadership Documentation/Coding Research 52

PulmCCM

JANUARY 16, 2024

You can read the document for all the caveats. Their effects on meaningful patient outcomes are unclear, though, and their appropriate use continues to be debated. Neither document commented on treating ARDS patients with statins, which seemed very likely to have benefited some patients with hyperinflammatory ARDS in past trials.

Research 87

Research Documentation/Coding Outcomes Fractures 87

Don't Forget the Bubbles

JULY 3, 2023

This data relies heavily on the coding, which we know is not standardized across healthcare sites- and, therefore may not be truly reflective. Epub 2022 Nov 30. This retrospective cohort study compared pre- and post-guideline outcomes. Epub 2022 Nov 23. Why does it matter? Pediatr Emerg Care. 2023 May 1;39(5):318-323.

Emergency Department 105

Emergency Department Hospitals Domestic Violence Pediatrics 105

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. The primary outcome was patient CRC screening or scheduling.

Emergency Department 40

Emergency Department Documentation/Coding Outcomes 40

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. This is a critical error that leads to poorer outcomes for patients in need of critical care. Unfortunately, its not clear whether the documentation came from RTs or ED providers. N Engl J Med.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

When Pendell and I are coding ECGs for the Queen's training, this is one category: "Definite ischemia, difficult to differentiate between posterior OMI and subendocardial ischemia." Yet this is rarely followed, and patient outcomes like this are the result once in a while. Published 2022 Feb 20. 2022;Available from: [link] 7.

EKG/ECG 83

EKG/ECG Shock Documentation/Coding Academics 83

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. 2022, Sept 12). Wleklinski, N. Debriefing in the ED. Expert Commentary by Bailitz, J].

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

RebelEM

SEPTEMBER 11, 2023

Published 2022 Sep 2. Outcomes: Primary: Percent change in management decisions after introducing the Radiology Department RUQ US. Moreover, surgeons may seek “official” documentation in a patient’s chart before surgery. Article: Hilsden R, Mitrou N, Hawel J, Leeper R, Thompson D, Myslik F. 2022;7(1):e000944.

Ultrasounds 68

Ultrasounds Radiology Radiology Emergency Department 68

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. Would you be satisfied with only US and no follow-up CT?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

PulmCCM

OCTOBER 30, 2023

IDSA cites multiple large observational studies showing no improvement in sepsis outcomes at many centers after SEP-1 implementation. And maybe, noticing all the fuss, some clinicians might have started coding for VAP slightly less often in equivocal cases. Do nebulized antibiotics result in lower use of systemic antibiotics?

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

Mind The Bleep

FEBRUARY 27, 2024

The children who received no bolus had significantly better outcomes and reduced mortality compared to the two bolus group. [2] Maintenance Fluids In 1957, Malcolm Holliday and William Segar published an article in the Journal of Paediatrics, which claimed to be a simple scheme that could be easily remembered to calculate fluid requirements.

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

Dr. Smith's ECG Blog

APRIL 17, 2023

Full case details and outcomes are below. His HEAR score (before troponin resulted) was documented at 3, with documentation stating "low suspicion for ACS." Chest pain is documented as ongoing. Case 1: Case 2: Case 1: What do you think? This was sent to Dr. Smith by SamGhali (@EM_RESUS) with zero other info.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Psychiatric 52

Dr. Smith's ECG Blog

MAY 8, 2023

Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. This was several months after the 2022 ACC Guidelines adding modified Sgarbossa criteria as a STEMI equivalent in ventricular paced rhythm). Triage ECG: What do you think? This is diagnostic of proximal LAD occlusion.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52

Dr. Smith's ECG Blog

JUNE 30, 2023

Outcome: Patient ruled out for MI by troponins. Smith and Meyers containing thousands of tracings with documentation of cardiac catheterization results. Wang and Smith as suggestive of BTWI ( These criteria were cited by Dr. Meyers in the March 22, 2022 post of Dr. Smith's ECG Blog ). It is still normal. Here are multiple cases.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Wellness 52

Cook County EM Blog

MARCH 20, 2023

Further document handedness, occupation, site of injury, and thorough review of systems to evaluate for potential complications ○ Complications as distant as pneumomediastinum following air injection of the hand have been reported5,6. ➢ Latex paint-gun injuries of the hand: are the outcomes better? PMID: 18923762; PMCID: PMC2532970.

Fractures 52

Fractures Documentation/Coding Operations Research 52