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 70

EKG/ECG Documentation/Coding EMS Wellness 70

ACEP Now

OCTOBER 9, 2023

This demographic is higher risk of adverse events during hospital encounters, often due to communication issues, leading to tragic outcomes and malpractice suits including cases of missed intracerebral hemorrhages, unnecessary or incorrect surgeries, misused medical devices, and fatal medication dosing. Census Bureau, 60.6

Emergency Department 64

Emergency Department Documentation/Coding EMS Wellness 64

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.

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation 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.

Wellness 77

Wellness Documentation/Coding Outcomes Research 77

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

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

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

Don't Forget the Bubbles

JANUARY 1, 2024

Data from the Nurse-Family Partnership program involving 60,171 families were analysed across four cohorts, including pre-pandemic and three pandemic cohorts (from July 2022 to October 2023). Outcomes From a Randomized Clinical Trial. Two-Year Autism Risk Screening and 3-Year Developmental Outcomes in Very Preterm Infants.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

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 Outcomes Dehydration 98

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). 2022 Nov;10(11):1086-1098. Epub 2022 Aug 29. Notably, in the initial analysis of blunt chest trauma (i.e.

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

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 92

EKG/ECG Documentation/Coding Outcomes Hospitals 92

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

Sensible Medicine

SEPTEMBER 26, 2023

According to a 2022 Pew surve y, “Trust in scientists and medical scientists, once seemingly buoyed by their central role in addressing the coronavirus outbreak, is now below pre-pandemic levels. Researchers would know that whatever they publish is eventually going to be linked to a list of replication attempts and their outcomes.”

Research 128

Research Hospitals Documentation/Coding Outcomes 128

RCEM Learning

JANUARY 23, 2024

This can include randomisation procedures, recruitment and follow-up response rates, what outcome measures patients will prefer, whether patients agree to complete the intervention (in this case the exercise programme) and so on. According to our timelines submitted to the funders, recruitment was due to start in January 2022.

Research 72

Research Wellness Outcomes Documentation/Coding 72

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

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

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 125

EKG/ECG Outcomes Documentation/Coding Academics 125

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

EMDocs

JULY 3, 2023

Introduction SAH has the potential for rapid progression and devastating outcomes. This neurological evaluation should include assessment and documentation of the GCS, the presence of any neurologic deficits, and an NIHSS. 2022 Jan;39(1-2):35-48. Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage.

Seizures 85

Seizures Stroke Outcomes EMS 85

Sensible Medicine

SEPTEMBER 26, 2023

According to a 2022 Pew surve y, “Trust in scientists and medical scientists, once seemingly buoyed by their central role in addressing the coronavirus outbreak, is now below pre-pandemic levels. Researchers would know that whatever they publish is eventually going to be linked to a list of replication attempts and their outcomes.”

Research 52

Research Hospitals Documentation/Coding Outcomes 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 87

EKG/ECG Shock Documentation/Coding Academics 87

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

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.

Documentation/Coding 52

Documentation/Coding Fractures Operations Research 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 Hospitals Dehydration Research 96

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 110

CDC Documentation/Coding Research Pediatrics 110

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

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 74

Outcomes Hospitals Operations Shock 74

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

Sensible Medicine

JANUARY 23, 2024

A Critical Appraisal Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales was published in The Lancet on 1/15/2024. Outcomes were as follows: A severe COVID-19 outcome was defined as COVID-19 hospitalisation or death. Below are the main results.

Outcomes 100

Outcomes Documentation/Coding Hospitals Wellness 100

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 93

Research Outcomes Administration Shock 93

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 119

EKG/ECG Documentation/Coding Wellness Emergency Department 119

ACEP Now

DECEMBER 11, 2023

The outcomes measured in these studies usually entailed subjective nasal symptoms, but also “change in nasal airway resistance,” following single or repeated administration of oral phenylephrine. 2 With a primary outcome of “daily reflective nasal congestion score,” there was no difference in the primary outcome. References U.S.

Administration 64

Administration Outcomes Research Documentation/Coding 64

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 68

Ultrasounds Outcomes Documentation/Coding 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

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

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 Documentation/Coding Academics 52

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