American Medical Compliance

FEBRUARY 2, 2024

These regulations went into effect on February 3, 2023. Use of the ATD Standard Cal/OSHA requires employers covered by the Aerosol Transmissible Disease (ATD) Standard (California Code of Regulations, Title 8, Section 5199) to protect employees from airborne infectious disease such as COVID-19 and pathogens transmitted by aerosols.

Infectious Diseases 52

Infectious Diseases Documentation/Coding PPE Wellness 52

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 121

EKG/ECG Documentation/Coding Emergency Department Outcomes 121

ACEP Now

OCTOBER 26, 2023

One of the HCFA letters, written by then Medicaid Director Tim Westmoreland (the Westmoreland Letter) specifically cited that the CPT 9928X codes should be reimbursed under federal PLP unless the Medicaid plan believed there were program integrity issues with the claim. ACEP, state chapters, and EDPMA respond with litigation.

Documentation/Coding 124

Documentation/Coding Hospitals Administration Emergency Department 124

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

ACEP Now

AUGUST 1, 2023

A rural ED staffed by a well-trained EP is an essential resource in small communities that may be otherwise lacking in readily available healthcare resources. emergency department deserves access to an emergency physician no matter their zip code. Three take home points for what I believe. Every patient in a U.S.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 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 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

ALiEM

JANUARY 22, 2024

Fever was documented to be 102°F and was not associated with any chills or rigors. The patient also complained of shortness of breath for one week associated with a dry cough, as well as an altered sensorium for one day. The patient during his hospital stay developed ARDS and was on mechanical ventilation for 20 days. Epub 2011 Sep 12.

Documentation/Coding 64

Documentation/Coding Academics Emergency Department Hospitals 64

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? Blinding procedures were well constructed as to mask group allocation. Lancet Infect Dis 2023.

Outcomes 144

Outcomes Research Documentation/Coding Wellness 144

ACEP Now

NOVEMBER 13, 2023

For the safety of staff as well as patients, interventions that interrupt escalations before they blossom into violence deserve further study. 5 Hospitals commonly activate a “code” in response to agitated patients, alerting security personnel to the location of that patient. Accessed October 10, 2023. 2023;(3):415-424.

Emergency Department 52

Emergency Department Documentation/Coding Psychiatric Best Practices 52

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 70

EKG/ECG Documentation/Coding EMS Wellness 70

Medical Law

JUNE 20, 2023

California Vehicle Code 21212 provides that all riders and passengers under the age of 18 are legally required to wear a helmet when using a bicycle, a non-motorized scooter, in-line roller skates, or a skateboard to travel along streets or bikeways, or on any other public bicycle path or trail.

Documentation/Coding 52

Documentation/Coding CDC Research Wellness 52

Don't Forget the Bubbles

MAY 31, 2023

2023 May 17:archdischild-2022-325280. The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. Arch Dis Child. Which patients were involved?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

EMDocs

DECEMBER 4, 2023

The Wells’ Criteria for DVT can help risk stratify [2,3]. If the patient’s Wells score is ≤ 0, DVT is nearly clinically excluded and no further immediate lab or ultrasound is necessary. In patients with a Wells’ score of 1-2 (moderate risk), DVT can be ruled out with a negative d-dimer rather than an US. mg/kg for 24 hours.

Ultrasounds 71

Ultrasounds Documentation/Coding Wellness EMS 71

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.

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation EMS 98

Sensible Medicine

SEPTEMBER 13, 2024

She presents with a folder of records and codes for outside EMRs. Accept that the patient knows more about his symptoms, and may very well know more about his disease, than you do. 1 This never works out well. For the last 12-18 months she has been suffering from fatigue, headache, joint pain, and rashes.

Psychiatric 54

Psychiatric Documentation/Coding Radiology Radiology 54

Mind The Bleep

JULY 26, 2023

Good Medical Practice is the GMC’s core guidance document (a new version is out this year) and there are supporting documents covering important areas like consent , confidentiality , prescribing and treating children. Take care to document these discussions in the records. Most employers will have a chaperones policy too.

Documentation/Coding 52

Documentation/Coding Patient Safety Wellness Hospitals 52

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." The proximal LAD has mild disease, but the distal LAD and diagonal branches are not well evaluated in this view. The distal LCx is seen, and the OM is not well visualized here.

EKG/ECG 109

EKG/ECG Burns Urgent Care Documentation/Coding 109

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

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. 2023 Jan-Feb;23(1):93-101. Pediatrics.

Pediatrics 71

Pediatrics Emergency Department Research Burns 71

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 123

EKG/ECG Documentation/Coding Psychiatric EMS 123

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 64

Documentation/Coding Academics Wellness 64

Taming the SRU

NOVEMBER 14, 2023

B) on right: hand drawn images of layers of ear demonstrating auricular hematoma The epidemiology and incidence of ED presentation for auricular hematomas has not been well-studied because it is a relatively uncommon condition. Accessed November 9, 2023. Courtesy of wiki commons under CC Attribution 3.0 Facial Plast Surg. 25(1):23-39.

Emergency Department 91

Emergency Department Pediatrics Wellness Documentation/Coding 91

Pediatric Education

MARCH 10, 2024

She was doing well and but was having problems with her math and some reading. “She’s doing well socially and developing pretty normally, so that is good. They learn or do some things exceptionally well, but they also are exceptional in that they have problems learning too. Accessed December 11, 2023.

Wellness 40

Wellness Leadership Pediatrics Documentation/Coding 40

Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

And you can see why: the artery may sponstaneously reperfuse, as it did here well before angiography, and documented with resolution of pain and evolution of the ECG to typical full reperfusion pattern Peak troponin I was 8544 ng/L. This is typical for a brief LAD OMI. I focus my comment on this initial ECG in today's case.

EKG/ECG 126

EKG/ECG Wellness Documentation/Coding 126

Taming the SRU

APRIL 22, 2023

If untreated, atrial fibrillation can increase clot formation and lead to an increased risk for heart attack and stroke as well as development of congestive heart failure. Additionally, a higher HR reduction at 30 and 60 minutes, as well as ED discharge/transfer. TamingtheSRU.

Outcomes 52

Outcomes Documentation/Coding Stroke Fractures 52

Pediatric EM Morsels

OCTOBER 6, 2023

(Forster, 2021) Transmission is by Fecal-Oral route (Chiodini 2018) Incubation period 6-30 days after exposure (Chiodini 2018) Salmonella typhi produces an endotoxin although its clinical significance is not yet well understood (Gibani 2019) Two typhoid vaccines are available for those > 6 m/o and are 50-80% effective.

Pediatrics 161

Pediatrics CDC Seizures Infectious Diseases 161

ACEP Now

SEPTEMBER 5, 2024

Creation of an accurate database of emergency physicians living and working within a state, as well as a network of each states’ EM groups and ED medical directors would help chapter leaders disseminate relevant information, strengthen advocacy efforts, and plan regional solutions summits to focus on unique challenges.

Leadership 52

Leadership PPE EMS Wellness 52

Pediatric EM Morsels

AUGUST 18, 2023

None of the patients were documented to have joint disease at follow up. (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. 451 pediatric patients were included.

Pediatrics 130

Pediatrics Infectious Diseases Hospitals Seizures 130

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. Am J Public Health.

Sexual Assault 98

Sexual Assault Teamwork Outcomes Dehydration 98

Don't Forget the Bubbles

MAY 6, 2024

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. Data collected were the worst values documented within the same calendar day as the blood cultures were obtained. Of the 74.9% showed clinical improvement without antibiotics.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

ACEP Now

FEBRUARY 11, 2024

4 It is believed that substantial gastrointestinal loss causes chloride and potassium depletion, as well as hypovolemia, acute kidney injury, and renal potassium loss. There have been documented cases of overdose, and of note, there is no known antidote. Published December 18, 2023. Published January 2023.Updated

Seizures 52

Seizures Fluid Resuscitation Poisoning EKG/ECG 52

RebelEM

JULY 3, 2023

Currently, the infusion of IV calcium before diltiazem is not well understood, and more studies have focused on administering IV calcium prior to verapamil than diltiazem. The study was dependent on EMR documentation which is prone to error. Article: Rossi N et al. Am J Emerg Med.

Administration 97

Administration Outcomes Documentation/Coding Emergency Department 97

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. 2023 Jul 17. Treasure Island (FL): StatPearls Publishing; 2023 Jan– PMID: 28846317. Accessed October 21, 2023.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Dr. Smith's ECG Blog

JUNE 17, 2024

There are well preserved R-waves in Wellens waves. I cannot tell you how many times such "written" documentation was off, due to the tendency to inscribe a normal number instead of counting for 30 seconds because "the patient looked like they were breathing normally".

EKG/ECG 139

EKG/ECG Emergency Department Shock Ultrasounds 139

Mind The Bleep

MAY 16, 2023

When prescribing drugs off licence, ensure you explain this to the patient/career and gain and document verbal consent. [8] SM, “Paediatric Constipation Differential Diagnoses,” 5 March 2023. Kahana DD, “Constipation,” 5 March 2023. Management of Constipation in CED,” 5 March 2023.

Dehydration 52

Dehydration Best Practices Documentation/Coding Emergency Department 52

Don't Forget the Bubbles

FEBRUARY 26, 2024

Increasing PEEP is thought to cause bronchodilation by providing direct mechanical stimulus as well as secondary stimulation through pulmonary stretch receptors coupled with activation of the non-cholinergic parasympathetic pathway. 2023 Apr 28;11:1167506. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

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. 2023 Feb;64:113-120. No need for Seidel test if there’s obvious globe rupture. Am J Emerg Med. doi: 10.1016/j.ajem.2022.11.036.

Fractures 75

Fractures Documentation/Coding Ultrasounds Wellness 75