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 121

EKG/ECG Documentation/Coding Emergency Department Outcomes 121

Dr. Smith's ECG Blog

MARCH 4, 2024

I have often written about how an ECG interpreted as "normal" by a conventional algorithm may well be manifesting OMI, or even long QT or hyperkalemia. 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? 2 cases at once! You can use it an unlimited amount.

EKG/ECG 112

EKG/ECG Documentation/Coding Wellness Resuscitation 112

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

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 123

EKG/ECG Documentation/Coding Psychiatric EMS 123

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. Healthcare workers and patients must champion a human-centered approach to AI innovation.

Wellness 77

Wellness Documentation/Coding Outcomes Research 77

ACEP Now

OCTOBER 9, 2023

percent) do not speak English as a primary language, and 25 million of those speak English less than well (known as “limited English proficiency” or LEP); many indicators show this number will only continue to grow. Physicians should document the interpreter’s name and identification number if available in the patient’s chart.

Emergency Department 64

Emergency Department Documentation/Coding EMS Wellness 64

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

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

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

The cut points for what constitute OMI and not OMI as well as confidence levels are calibrated to maximize sensitivity and specificity according to the receiver operating characteristic. The diagonal branches are overlapping one another and not well visualized in this view. The QOH output is a number between 0 and 1.

EKG/ECG 70

EKG/ECG Operations Wellness Ultrasounds 70

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). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

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: 10.1017/dmp.2021.49.

Academics 52

Academics Leadership Documentation/Coding Research 52

Medical Law

JULY 19, 2024

However, the influx of cyclists also highlights the pressing need for well-maintained infrastructure to ensure safety. Successfully navigating these legal hurdles often requires an attorney who is well-versed in government liability cases. Our firm received an AV Preeminent Rating from Martindale-Hubbell, and we have a perfect 10.0

Documentation/Coding 52

Documentation/Coding Shock Wellness 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. (Jackson 2016) It can also be used in UTIs , but is typically reserved for special cases where the infectious bacteria is found to be multidrug resistant or in complicated UTIs. There were 2523 children included.

Pediatrics 130

Pediatrics Infectious Diseases Hospitals Seizures 130

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].

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation EMS 98

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

Total Medical ComplianceHIPAA

JANUARY 12, 2023

Department of Health and Human Services (HHS) Office for Civil Rights (OCR) had its busiest year with the announcement of its 22 nd enforcement settlement on December 15, 2022. TMC clients have access to ready to use forms, as well as expert support, white-glove service, and first-class training! Last year, the U.S.

Operations 104

Operations Best Practices Documentation/Coding Administration 104

RCEM Learning

JANUARY 23, 2024

But the principles and processes are very similar, considering the ethics approvals needed, the staff I needed to employ, the mountains of documents I needed to prepare, and the lack of sleep that is involved in those early months. According to our timelines submitted to the funders, recruitment was due to start in January 2022.

Research 72

Research Wellness Outcomes Documentation/Coding 72

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

JUNE 8, 2023

There were trends toward larger infarct size with delayed angiography, both by cMR and integral high-sensitivity troponin concentration, as well as toward higher rate of major adverse cardiovascular events (MACE) (8.5 Cardiology documented “late presentation STEMI but likely aborted given resolution of ST changes from EMS to hospital.”

EKG/ECG 62

EKG/ECG Documentation/Coding EMS Emergency Department 62

Cook County EM Blog

MAY 15, 2023

His EKG suggested a posterior MI as well as other signs of ischemia. A code STEMI was activated, and the patient was given sublingual nitroglycerin and morphine for his pain. Repeat EKGs continued to show ST depression in V2, as well as a new q wave in lead II, and deeper, wider q waves in lead III and aVF. Alsagaff, M.Y.,

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

Dr. Smith's ECG Blog

JUNE 27, 2024

With ongoing transcutaneous pacing, Cardiology emergently took the patient to the cath lab for temporary pacing wire placement via right IJ which she tolerated well. To EMPHASIZE: What follows are advanced concepts that extend well beyond what is needed for appropriate emergency management of today's patient.

EKG/ECG 121

EKG/ECG Documentation/Coding Emergency Department Wellness 121

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. ” As well, such a rule “would also increase accountability for journals. Overall, 29% of U.S.

Research 128

Research Hospitals Documentation/Coding Outcomes 128

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

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. 2022; 14: 441–456.

Sexual Assault 98

Sexual Assault Teamwork Outcomes Dehydration 98

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). 2023 Nov 23:archdischild-2022-325119. Pediatr Infect Dis J. 2023 Dec 1. Selzer A, et al. Arch Dis Child. Metz TD, et al. Pediatrics. 2023 Dec 27.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

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 113

EKG/ECG Wellness Documentation/Coding 113

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

Don't Forget the Bubbles

MARCH 19, 2024

Just 20% of a person’s health and general well-being is related to access to care and the quality of services. Acknowledging the challenges associated with paediatric social admissions begins with documenting social issues and assessing their social history with the same level of detail as their medical history. Dublin: Author.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

SheMD

OCTOBER 5, 2023

Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. If staying in a hotel- don’t forget to use discount codes the residency program may offer. The benefits include getting a true feel for living in the city- but this can be a little riskier in cities you don’t know very well.

Research 52

Research Leadership Documentation/Coding Academics 52

EMDocs

JUNE 6, 2023

Literature suggests we should avoid evaluating ocular pressure, though there are no case reports or peer reviewed data documenting extrusion of ocular contents from ocular pressure evaluation in the ED setting. Epub 2022 Dec 5. No need for Seidel test if there’s obvious globe rupture. References: Pelletier J, Koyfman A, Long B.

Fractures 75

Fractures Documentation/Coding Ultrasounds Wellness 75

Dr. Smith's ECG Blog

APRIL 17, 2023

4) There is well formed J-point notching. He also stated he "just didn't feel well" starting about 14 hours prior to presentation, but the chest pain was only noticed about 2 hours prior to presentation. His HEAR score (before troponin resulted) was documented at 3, with documentation stating "low suspicion for ACS."

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Psychiatric 52

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 116

EKG/ECG Shock Hospitals Sepsis 116

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. ” As well, such a rule “would also increase accountability for journals. Overall, 29% of U.S.

Research 52

Research Hospitals Documentation/Coding Outcomes 52

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

As I discussed and documented in Lesson 1 of My Comment at the bottom of the page in the April 2, 2022 post of Dr. Smith's ECG Blog — certain patients may remain in sustained VT not only for hours — but even for days! IV Diltiazem was Contraindicated!

EKG/ECG 138

EKG/ECG Shock Documentation/Coding Academics 138

Pediatric Education

NOVEMBER 19, 2023

They felt he was breastfeeding well and had only mild jaundice. His examination was normal and the diagnosis of a well newborn infant was made. mg/dL which was well below treatment threshold. Some infants may need car seat tolerance screening as well. The laboratory evaluation of a transcutaneous bilirubin was 8.4

Infectious Diseases 40

Infectious Diseases Administration Pediatrics Wellness 40

ACEP Now

JULY 6, 2023

5 Patients with acute ischemic strokes, STEMIs, and trauma, as well as many other diagnoses, have their workup largely completed, and even sometimes definitive therapy executed, before they leave the emergency department, rather than requiring inpatient units. “A Updated September 21, 2022. February 22, 2022. Mayo Clinic Staff.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 52

ACEP Now

MARCH 14, 2024

These can be delayed, up to weeks later, so it’s important to educate patients on the importance of follow-up with burn care well-versed with electrical injuries or neurology if they have or develop these symptoms. Documentation with coronary arteriography within 12 1/2 hours of the onset of symptoms in two cases (three episodes).

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52