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] have published a number of warnings about the previous reassuring studies.[4,5] Am J Emerg Med. 2022 ; 55 : 180 - 182 6.

EKG/ECG 122

EKG/ECG Documentation/Coding Emergency Department Outcomes 122

ACEP Now

AUGUST 1, 2023

2023 CPT Documentation Guidelines FAQ Updated, Expanded ACEP has updated its 2023 CPT Documentation Guidelines, expanding from 39 to 70 questions. The letter followed ACEP’s participation in a June 29 roundtable hosted by the Committee. Read more at acep.org/NSA-HELP-letter.

Documentation/Coding 52

Documentation/Coding Emergency Department Emergency Nursing Research 52

RebelEM

NOVEMBER 6, 2024

2023 Aug 4. 2023 Nov 5. Multiple Concomitant Injuries in One Upper Extremity: A Case Report. Am J Case Rep. 2016 Jan 6;17:6-11. doi: 10.12659/ajcr.894984. PMID: 26732673 Akhondi H, Varacallo M. Anterior Interosseous Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. J Am Acad Orthop Surg.

Dislocations 103

Dislocations Fractures Soft Tissue Injuries Outcomes 103

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 94

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 94

ACEP Now

DECEMBER 11, 2023

A recent article documents 56 additional U.S. Published September 15, 2023. Accessed December 8, 2023. Accessed December 8, 2023. Accessed December 8, 2023. Accessed December 8, 2023. Published July 21, 2023. Accessed December 8, 2023. Published April 19, 2023. Accessed December 8, 2023.

Hospitals 98

Hospitals Administration Documentation/Coding Research 98

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 124

EKG/ECG Documentation/Coding Fractures Emergency Department 124

Dr. Smith's ECG Blog

MAY 26, 2023

Severely ill patients from any etiology can have very abnormal ECGs = My Comment by K EN G RAUER, MD ( 5/26 /2023 ): = There are more questions than answers in today's case. A NSWER : In Figure-3 — I have color-coded P waves in the long lead II rhythm strip of ECG #2. How Are the P Waves Color-Coded?

Shock 98

Shock EKG/ECG Documentation/Coding Resuscitation 98

Total Medical ComplianceHIPAA

FEBRUARY 15, 2023

Among many other documents offered to our clients, TMC also provides access to Federal and State posters in the client portal. Each employer shall take steps to insure that such notices are not altered, defaced, or covered by other material.” The posters must be at least 8½ inches by 14 inches, with a font size of at least 10.

Documentation/Coding 52

Documentation/Coding 52

Sensible Medicine

JULY 25, 2024

The take-home message is that wearing a surgical mask for 2 weeks during the winter season of 2023 reduced the spread of self-reported viral illness. The study does not find a benefit on documented covid-19 infections, though it lacked power for this. According to some, the study proves masks work.

Documentation/Coding 145

Documentation/Coding Academics Research 145

RebelEM

JUNE 22, 2023

Lancet Infect Dis 2023 PMID: 37302406 Clinical Question: Does outpatient treatment with ivermectin, fluvoxamine or metformin soon after SARS-CoV-2 infection reduce the risk of developing long-COVID in overweight patients? Lancet Infect Dis 2023 PMID: 37302406 Faust J. Lancet Infect Dis 2023.

Outcomes 135

Outcomes Research Documentation/Coding Wellness 135

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 Dec 22. 2023 Dec 21. 2023 Dec 19. 2023 Dec 12 Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes. Pediatrics.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

Pediatric EM Morsels

JULY 28, 2023

A critical MORSEL is that every child you treat for DKA needs to have an initial thorough neuro exam including cranial nerves and then frequent neuro reassessments … and document it ( so your colleagues who take over care for the kid can know if there has been a change )!

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

Total Medical ComplianceHIPAA

OCTOBER 7, 2023

According to the HHS Office for Civil Rights data breach portal , healthcare data breaches impacted over 39 million people in the United States so far in 2023. Here are a few key concepts: Data Encryption: Converting your data into a code to prevent unauthorized access.

Documentation/Coding 99

Documentation/Coding 99

PulmCCM

JUNE 5, 2023

Read in AJRCCM In The News The Hospitalist and the Resuscitationist 2023 Conference will take place September 27-30 in Montreal. Check out the preliminary program , and use code PULMCCM15 to get 15% off the attendance fees. Patients with secondary pneumothoraces (e.g., iatrogenic or hospital-acquired) were excluded.

Advances Cardiac Life Support (ACLS) 96

Advances Cardiac Life Support (ACLS) Documentation/Coding CPR Shock 96

ACEP Now

JUNE 7, 2023

The example provided illustrates both the potential and current limitations of the technology, presently requiring careful review to ensure spurious extrapolations have not been inserted into the medical documentation. Published March 20, 2023. Last revised April 12, 2023. Accessed May 15, 2023. Published March 29, 2023.

Documentation/Coding 78

Documentation/Coding Wellness Administration Research 78

EMDocs

SEPTEMBER 30, 2024

2023 May;64(5):555-563. Among patients with a primary provider documented in the chart, 30-day outpatient follow-up rate was 21.3% (n = 313). Guidelines – Global Initiative for Asthma (GINA) 2023 The 2019 Global Initiative for Asthma (GINA) guidelines recommend that all patients with asthma be prescribed ICS. J Emerg Med.

Outcomes 95

Outcomes Documentation/Coding Academics Administration 95

PulmCCM

FEBRUARY 8, 2024

ATS and ESICM each separately issued its own updated ARDS guideline in 2023, and SCCM did not lend its name to either. You can read the document for all the caveats. 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 52

Research Documentation/Coding Fractures Outcomes 52

PulmCCM

JANUARY 29, 2024

AHA Updates its Cardiac Arrest Guidelines In December 2023, the American Heart Association published a “focused update” to its landmark guidelines for the management of cardiac arrest. Read the document for all the details (it’s not long). PulmCCM is not affiliated with the American Heart Association.

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

EM Literature of Note

OCTOBER 9, 2024

Before even considering the results, there are multiple fundamental considerations taking this published exploration into the realm of curiosity rather than insightfulness: This communication was submitted in Oct 2023 – meaning the LLMs used, while modern at the time, are debatably becoming obsolete.

Radiology 86

Radiology Radiology Emergency Department Documentation/Coding 86

Board Bombs

MARCH 5, 2023

Let’s quickly review what’s you need to know for the boards, but also emphasize what’s more important when running a code. March 5th, 2023. Let’s quickly review what’s you need to know for the boards, but also emphasize what’s more important when running a code. March 5th, 2023. Cite this podcast as: Briggs, Blake.

Documentation/Coding 52

Documentation/Coding 52

Dr. Smith's ECG Blog

OCTOBER 23, 2023

Macroscopic T-Wave Alternans: A Red Flag for Code Blue. PMID: 11723026. == MY Comment , by K EN G RAUER, MD ( 10/23 /2023 ): == The various forms of electrical alternans are frequently misunderstood, if not completely unnoticed. J Am Coll Cardiol. 2006 Jan 17;47(2):269-81. doi: 10.1016/j.jacc.2005.08.066. 2005.08.066. Epub 2006 Jan 4.

EKG/ECG 134

EKG/ECG Documentation/Coding Psychiatric EMS 134

ACEP Now

OCTOBER 3, 2023

In April 2023, the third edition of the Brain Trauma Foundation’s evidence-based guidelines for the prehospital management of traumatic brain injury (TBI) was published in Prehospital Emergency Care. This document is an update of guidelines first published in 2000, and then updated in 2007. References Lulla A, et al.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

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

PulmCCM

JUNE 12, 2023

Read in Nature Don’t forget to register for the Hospitalist and Resuscitationist 2023 conference Sepetmber 27-30 in Montreal. Use code PULMCCM15 and get 15% off when you register online. Over 40% reported being bullied at work, and almost two thirds reported witnessing others being abused or harrassed by a superior.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 105

ALiEM

JANUARY 26, 2024

Ciprofloxacin has been documented as a cause of IgA vasculitis. Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. Case Question: What are common triggers for this diagnosis?

Documentation/Coding 73

Documentation/Coding Academics EMS Hospitals 73

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 125

EKG/ECG Ultrasounds Documentation/Coding Wellness 125

PulmCCM

JANUARY 15, 2025

According to a 2023 analysis of applications for FDA approval , as late as 2020 manufacturers were complying with a minimum of effort—e.g., Draft Guidance Document Wong et al. JAMA Network Open 2023. In 2013, FDA issued a suggestion that manufacturers test devices on patients “with a range of skin pigmentations.”

Documentation/Coding 81

Documentation/Coding Academics Administration Research 81

Dr. Smith's ECG Blog

JANUARY 5, 2024

The documentation does not describe any additional details of the history. They also documented "Reproducible chest tenderness." Written by Willy Frick A 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of "chest burning." The following ECG was obtained. ECG 1 What do you think?

EKG/ECG 123

EKG/ECG Burns Urgent Care Documentation/Coding 123

EMDocs

JUNE 9, 2023

We’re defining “protocol” here as a written document that provides oversight from the medical director about how to assess and treat patients. Reassessment and Documentation After any type of restraint is instituted, careful assessment, re-assessment, and documentation is required. Was the documentation complete?

EMS 89

EMS Documentation/Coding Pediatrics Psychiatric 89

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. The registrars would later sign up for C+C as a non-clinical portfolio item when this was formally established in 02/2023.

Documentation/Coding 52

Documentation/Coding Outcomes Hospitals Administration 52

Sensible Medicine

MAY 25, 2023

On April 26, 2023, Bobby Jindal and Chirag Parghi declared, on the opinion pages of the WSJ, that “ Mammograms Can Promote Heart Health.” ” I’m a doctor who has referred hundreds of women for mammograms. Why didn’t I know this? Have I been neglecting the medical literature?

Documentation/Coding 79

Documentation/Coding Academics Wellness 79

RebelEM

AUGUST 22, 2024

Documented at the following time points: Before treatment. Time from Presentation to Treatment: The duration from when the patient arrived at the ED and the stroke code was called to the administration of tPA. Paper: Lema GMC, De Leacy R, Fara MG, et al. A Remote Consult Retinal Artery Occlusion Diagnostic Protocol. Ophthalmology.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

Mind The Bleep

DECEMBER 19, 2023

1) Ophthalmology is a competitive specialty, with 971 applications for 98 posts in 2023 (competition ratio 9.9). (2) 2) As of 2023, applications are made through the ‘Oriel’ recruitment system. points 2023 Max. cited 2023 Dec 4]. cited 2023 Nov 11]. 2023 Competition ratios | Health Education England.

Documentation/Coding 52

Documentation/Coding Research 52

ACEP Now

NOVEMBER 7, 2023

3 These regulations have led to widespread practices of EHI, such as test results and clinical documentation, being shared with patients in real time. Training opportunities for documentation best practices should be employed. Accessed: October 11, 2023. Accessed October 11, 2023. Code of federal regulations eCFR website.

Documentation/Coding 52

Documentation/Coding Best Practices Ethical Issues Academics 52

ALiEM

JANUARY 22, 2024

Fever was documented to be 102°F and was not associated with any chills or rigors. Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. Epub 2011 Sep 12. PMID: 21911554; PMCID: PMC3193135.

Documentation/Coding 64

Documentation/Coding Academics Emergency Department Hospitals 64

ALiEM

JANUARY 10, 2025

Other documented pharmacological causes of anisocoria include nebulized ipratropium bromide and scopolamine (14-19). Treasure Island (FL): StatPearls Publishing Copyright 2023, StatPearls Publishing LLC.; Anisocoria. Int Ophthalmol Clin. 2019;59(3):125-39. Payne WN, Blair K, Barrett MJ. Anisocoria. StatPearls. 2022;26(1):42-3.

Pediatrics 64

Pediatrics Documentation/Coding Academics Administration 64

ACEP Now

JUNE 7, 2023

ED leaders worked to develop new physician documentation and coding guidelines that needed to be implemented at the beginning of 2023. Volumes collapsed in 2020, but in 2023 EDs are now nearly back to 2019 volumes. Executive Summary of ED Operations in 2022 Volume was up from 2021. percent.

Emergency Department 52

Emergency Department Documentation/Coding Operations EMS 52