Dr. Smith's ECG Blog

OCTOBER 18, 2023

1-3] But these studies were very short duration and used cardiology interpretation of ECGs or emergent angiography rather than patient outcomes. 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]

EKG/ECG 122

EKG/ECG Documentation/Coding Emergency Department Outcomes 122

RebelEM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

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

EMDocs

SEPTEMBER 30, 2024

2023 May;64(5):555-563. Primary outcome: Prescription of ICS on ED discharge from the index visit Secondary outcomes: ICS prescription rates in high-risk subgroups Rates of outpatient follow-up within 30 days of an ED visit for asthma Variation in ICS prescription rates among attending ED physicians. J Emerg Med.

Outcomes 95

Outcomes Documentation/Coding Academics Administration 95

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

PulmCCM

JUNE 12, 2023

TTM2 found no improvement in survival or neurologic outcome among patients randomized to cooling to a target of 33 °C, as compared to controls receiving fever prevention (e.g. Read in Nature Don’t forget to register for the Hospitalist and Resuscitationist 2023 conference Sepetmber 27-30 in Montreal.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 105

RebelEM

JANUARY 29, 2024

Clin Exp Emerg Med 2023. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE? Click here for Direct Download of the Podcast Paper: Aykan AC et al. Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7%

Stroke 130

Stroke Outcomes Hospitals Administration 130

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.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

RebelEM

AUGUST 22, 2024

hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. Outcomes: Primary Outcome: Visual Acuity (VA) Improvement Measured using logarithm of the minimum angle of resolution (logMAR). Paper: Lema GMC, De Leacy R, Fara MG, et al.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

PulmCCM

JUNE 5, 2023

There was no significant difference in survival with a favorable neurologic outcome at 30 days (20% vs 16% nominally favoring the ECMO group, P=0.52) or at 6 months. Read in AJRCCM In The News The Hospitalist and the Resuscitationist 2023 Conference will take place September 27-30 in Montreal. In the U.S.,

Advances Cardiac Life Support (ACLS) 96

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

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

RebelEM

JULY 3, 2023

Pregnant or incarcerated patients Documentation for systolic BP is incomplete Intervention: Administration of IV calcium within 60 min prior to or 30 min after IV diltiazem administration in patients with AF/AFL with RVR. Limitations: The primary and secondary outcomes were nearly all disease oriented and not patient oriented.

Administration 88

Administration Outcomes Documentation/Coding Emergency Department 88

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. Their effects on meaningful patient outcomes are unclear, though, and their appropriate use continues to be debated. ” What About Statins for ARDS?

Research 52

Research Documentation/Coding Fractures Outcomes 52

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. Clinical Outcomes Associated With Overestimation of Oxygen Saturation by Pulse Oximetry in Patients Hospitalized With COVID-19. Nature (news).

Documentation/Coding 81

Documentation/Coding Academics Administration Research 81

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) 2024 Feb 28:fetalneonatal-2023-326501. doi: 10.1136/archdischild-2023-326501. Of the 74.9%

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

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

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. Accessed October 10, 2023.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

Don't Forget the Bubbles

OCTOBER 10, 2024

Reviewed by: Isabella Davenport Article 2: Does it improve outcomes if you replace the nail in nail bed repair? 2023 Mar 30;110(4):432-438. Children with nail bed injuries were randomly assigned to nail replacement or discarding , with the primary outcomes being secondary infection in 7 days and cosmetic outcome in four months.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

Emergency Medicine Journal

DECEMBER 30, 2024

Background Calls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response (‘pre-alerts’) have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke).

Emergency Department 52

Emergency Department Stroke Documentation/Coding Outcomes 52

PulmCCM

JANUARY 16, 2024

ATS and ESICU 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. Their effects on meaningful patient outcomes are unclear, though, and their appropriate use continues to be debated. ” What About Statins for ARDS?

Research 87

Research Documentation/Coding Outcomes Fractures 87

The Skeptics' Guide to EM

FEBRUARY 3, 2023

Date: February 1, 2023 Reference: Wolfrum et al. Date: February 1, 2023 Reference: Wolfrum et al. You are tidying your things in anticipation of the arrival of the dayshift when a code blue is called. Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial. Circulation. Circulation.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Documentation/Coding Outcomes 52

Dr. Smith's ECG Blog

JANUARY 27, 2024

Fortunately they spontaneously reperfused, or else they could have had a worse outcome, but deferring all ‘normal’ ECGs will perpetuate delayed diagnosis and reperfusion for STEMI(-)OMI. This 4% is underestimation because it only included patients admitted as STEMI not those admitted as NSTEMI like the case above.

EKG/ECG 120

EKG/ECG Emergency Department Outcomes Documentation/Coding 120

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. The patient also had a 100% proximal LAD occlusion, with a peak troponin of 100,000 ng/L.

EKG/ECG 69

EKG/ECG Documentation/Coding EMS Wellness 69

The Skeptics' Guide to EM

MARCH 31, 2023

Date: March 28, 2023 Reference: Fowler et al. AEM March 2023 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: You arrive at 7am to relieve your colleague after a night shift. Date: March 28, 2023 Reference: Fowler et al.

Academics 52

Academics Documentation/Coding Emergency Department Outcomes 52

Taming the SRU

NOVEMBER 14, 2023

Complications of auricular hematoma drainage include pain, paresthesia, bleeding, infection, poor cosmetic outcome, scar formation, and re-accumulation of hematoma after the procedure. Accessed November 9, 2023. Updated 2023 Jan 2]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Accessed November 7, 2023.

Emergency Department 93

Emergency Department Pediatrics Wellness Fractures 93

Taming the SRU

JUNE 3, 2024

CESAR Trial Published in 2009 Found that even those who didn’t get ECMO, but were transported to a tertiary care center had better outcomes No matter where you go, critical care transport will be part of your life as a sending physician, receiving physician, or both.

Shock 91

Shock Seizures Airway Management Stroke 91

PulmCCM

JANUARY 6, 2025

A follow-up study in 2023 showed the Epic model performed badly in complex patients. A cluster randomized trial using all-cause mortality as an outcome was always needed to determine whether EMR alerts improve outcomes for suspected severe infection. But for whom, and to what end? Epic disputed the findings.)

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

Taming the SRU

APRIL 22, 2023

Currently, there is limited data investigating outcome differences between beta blockers and calcium channel blockers for atrial fibrillation with rapid ventricular response in a patient diagnosed with heart failure. There were similar lengths of say overall and no significant difference in safety outcomes. TamingtheSRU.

Outcomes 52

Outcomes Stroke Fractures Documentation/Coding 52

Emergency Medicine Journal

NOVEMBER 28, 2023

It can be challenging and time consuming to access the information required to reflect upon their clinical practice by reviewing the outcomes of their individual patients, referred to as patient follow-up. Patient outcomes are commonly documented in electronic health records (EHR). It was implemented in December 2020.

EMS 40

EMS Documentation/Coding Outcomes Hospitals 40

Don't Forget the Bubbles

FEBRUARY 26, 2024

2023 Apr 28;11:1167506. Outcomes of paediatric critical care asthma patients. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. Accessed November 2023. 2023 Feb;20(2):245-53. Frontiers in Pediatrics.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Ongoing pain noted throughout all documentation, but after nitro drip and prn morphine, "pain improved to 2/10." Long term outcome unknown but obviously bleak. Association of intravenous morphine use and outcomes in acute coronary syndromes: Results from the CRUSADE Quality Improvement Initiative. Repeat trop 150 ng/L.

EKG/ECG 81

EKG/ECG Outcomes Academics Documentation/Coding 81

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. Updated 2023 Jul 17]. Updated 2023 Jul 17]. Chemical Burns. In: StatPearls [Internet].

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 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. Smith : I think it looks more like posterior OMI.

EKG/ECG 86

EKG/ECG Shock Documentation/Coding Academics 86

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

Dr. Smith's ECG Blog

APRIL 4, 2023

As he documented, “This patient is experiencing chest pain consistent with an acute coronary syndrome. As cardiology documented, “possible STEMI. Given ECG changes, echocardiographic findings, and typical history, code STEMI called.” Fortunately, Dr. Cho was not looking for STEMI ECG criteria but for an acute coronary occlusion.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Wellness 52

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. For review — I've copied below my summary of this entity from My Comment in the February 10, 2023 post of Dr. Smith's ECG Blog.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Psychiatric 52

EMDocs

JANUARY 11, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association (AHA) and Neurocritical Care Society (NCS) released their 2023 Scientific Statement on the critical care management of post ROSC patients. 2023 Dec 1. Neurocrit Care. doi: 10.1007/s12028-023-01871-6. Epub ahead of print.

Seizures 87

Seizures Shock Infectious Diseases CPR 87