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

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. Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors.

Documentation/Coding 104

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

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. 2022 Mar 2;83(3):1-12.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Sensible Medicine

AUGUST 7, 2024

There is evidence that, for children and adults, elevated cortisol levels and chronic stress can lead to behavioral, mental-health, and mood issues, as well as changes in inflammation and immunity. In 2022 the CDC paid the AAP to form an expert working group to revise its developmental surveillance checklists.

CDC 114

CDC Documentation/Coding Research Pediatrics 114

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.

Documentation/Coding 85

Documentation/Coding Wellness Outcomes Research 85

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 Seizures Hospitals 130

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 74

Pediatrics Emergency Department Research Burns 74

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

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

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

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

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].

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

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

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 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

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 120

EKG/ECG Documentation/Coding Emergency Department Wellness 120

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. Click the button below to learn more about these practices, as well as other COVID-19 associated practices necessary in your dental facility.

Infectious Diseases 52

Infectious Diseases Documentation/Coding PPE Wellness 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." African Flag Sign provided by Dr. McLaren — with additional detailed discussion of this entity in My Comment at the bottom of the page in the May 11, 2022 post in Dr. Smith's ECG Blog ). link] Lupu, L.,

EKG/ECG 131

EKG/ECG Documentation/Coding Wellness Emergency Department 131

The Skeptics' Guide to EM

OCTOBER 1, 2022

Date: September 28th, 2022 Reference: Hartford et al. AEM September 2022. Date: September 28th, 2022 Reference: Hartford et al. AEM September 2022. It is not well documented, whether gaps in pain assessment and treatment exist in conditions in which opioids are not indicated, such as migraine headaches.

Pediatrics 52

Pediatrics Emergency Department Documentation/Coding Research 52

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 Dehydration Outcomes 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 114

EKG/ECG Wellness Documentation/Coding 114

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 139

EKG/ECG Shock Academics Documentation/Coding 139

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

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

EMDocs

JUNE 2, 2023

You should always follow your local practice guidelines and recommendations as well as adhere to approved medications in your facility. Document what you gave and why, as well as the impact. 2022 May 11;12(5):e059876. If a patient has a PRN on their med list do that! Summary All right, so that’s it for this episode.

Psychiatric 93

Psychiatric Pediatrics Emergency Department Administration 93

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 131

EKG/ECG Shock Hospitals Sepsis 131

Don't Forget the Bubbles

JANUARY 22, 2024

A QIP performed in a paediatric intensive care unit aimed to reduce unnecessary LFT requests by implementing a blood test request form and a table of common investigations to facilitate and document discussion between the nursing and medical teams. Don’t Forget the Bubbles, 2022 Levinson W, Kallewaard M, Bhatia RS, et al. BMJ Qual Saf.

Emergency Department 90

Emergency Department Best Practices Radiology Radiology 90

RebelEM

AUGUST 12, 2024

Epub 2022 Aug 28. Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability. Epub 2022 Aug 28. The PROTECTION trial. Contemp Clin Trials. The PROTECTION trial.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Greater Sydney Area HEMS

AUGUST 1, 2023

Why does it work so well? 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. – The re-design of C+C documentation process was launched. It also dovetails with our governance process.

Documentation/Coding 52

Documentation/Coding Outcomes Hospitals Administration 52

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Regarding my Systematic assessment of ECG #1: There is significant baseline artifact , as well as baseline wander. I therefore feel it relevant to document ( in your dictation/on the medical chart ) when significant artifact potentially impairs the accuracy of your interpretation. Smith's ECG Blog.

Seizures 113

Seizures EKG/ECG EMS Stroke 113

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 66

EKG/ECG Operations Wellness Ultrasounds 66

SheMD

OCTOBER 8, 2023

Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. Actually, I wanted to ask what supports the program has in place for parents (male and female) as well as people increasing their families, be it biologically or through adoption?” Their well-being should be considered.

Leadership 105

Leadership Best Practices Academics Documentation/Coding 105

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

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

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

JULY 22, 2023

The patient did well and was ultimately discharged home. Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon. As for our patient, on discharge, her EKG had completed returned to her baseline morphology and she has been doing well in follow-up.

EKG/ECG 92

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 92