Dr. Smith's ECG Blog

MAY 26, 2023

Thus, since high dose insulin's (HDI) primary beneficial effect on calcium channel overdose is to as a positive inotrope, it does not work well for dihydropyridine overdose. 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? Learning Points: 1.

Shock 98

Shock EKG/ECG Documentation/Coding Resuscitation 98

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

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

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 123

EKG/ECG Burns Urgent Care Documentation/Coding 123

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 134

EKG/ECG Wellness Documentation/Coding 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

RebelEM

AUGUST 22, 2024

1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. Patients whose last known well (LKW) time was within 24 hours of presentation. Documented at the following time points: Before treatment. Administration of intravenous tissue plasminogen activator (IV tPA) within 4.5 Ophthalmology. Am J Ophthalmol.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

Dr. Smith's ECG Blog

JANUARY 2, 2025

In the middle of the night, a "code" was called, and multiple rhythms like this were recorded. Clinically, it is well to remember that this variation in QTc estimation is greater at faster heart rates ( with faster heart rates being common in "sicker" patients, for whom we are most likely to need to assess the QTc ).

EKG/ECG 119

EKG/ECG Sepsis Wellness Documentation/Coding 119

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

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 81

Documentation/Coding Academics Wellness 81

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

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 93

Emergency Department Pediatrics Wellness Fractures 93

ACEP Now

JUNE 14, 2024

Related to clinical policy development, the Board considered a referred 2023 Council amended resolution, regarding the creation of a clinical policy on emergency physicians’ role in the medication and procedural management of early pregnancy loss. There were some ACEP business decisions at the April Board meeting, as well.

Sexual Assault 52

Sexual Assault Seizures Documentation/Coding EMS 52

ALiEM

JANUARY 10, 2025

Constitutional : No distress, well appearing. Other documented pharmacological causes of anisocoria include nebulized ipratropium bromide and scopolamine (14-19). Treasure Island (FL): StatPearls Publishing Copyright 2023, StatPearls Publishing LLC.; Physical Exam Vitals : BP 85/66; HR 143; RR 42; SpO2 100%; T 98.3F Anisocoria.

Pediatrics 64

Pediatrics Documentation/Coding Academics Administration 64

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 PPE Documentation/Coding Wellness 52

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. Baseline Data Timeline of interventions/actions: 11/2023 – A project awareness campaign was initiated.

Documentation/Coding 52

Documentation/Coding Outcomes Hospitals Administration 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 69

EKG/ECG Documentation/Coding EMS Wellness 69

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 98

Leadership PPE EMS Wellness 98

Don't Forget the Bubbles

OCTOBER 14, 2024

The government recognizes they cannot return to their country of origin owing to a well-founded fear of being persecuted for the reasons provided for in the United Nations Refugee Convention or European Convention on Human Rights (such as persecution due to race, sexuality, political opinions, or religion).

Documentation/Coding 59

Documentation/Coding Hospitals Wellness Operations 59

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 Dehydration Outcomes 98

Dr. Smith's ECG Blog

JANUARY 27, 2024

Smith : Old inferior MI with persistent ST Elevation ("inferior aneurysm") has well-formed Q-waves. The patient had a history of ‘NSTEMI’ a decade prior, with an RCA stent. Does this change your interpretation? In inferior aneurysm, we usually see QR-waves, whereas for anterior aneurysm, we see QS-waves (no R- or r-wave at all!).

EKG/ECG 120

EKG/ECG Emergency Department Outcomes Documentation/Coding 120

The Skeptics' Guide to EM

JANUARY 25, 2025

BMC Med 2023 Guest Skeptic: Dr. Jestin Carlson is the Program Director for the AHN-Saint Vincent EM Residency in Erie Pennsylvania. ROC curves help clinicians determine how well a test or model can differentiate between patients with and without a condition. Date: January 9, 2025 Reference: White et al. p-value significance threshold.

Research 47

Research EMS Documentation/Coding Operations 47

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

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 68

Psychiatric Documentation/Coding Radiology Radiology 68

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 87

Fractures Documentation/Coding Ultrasounds Wellness 87

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 88

Administration Outcomes Documentation/Coding Emergency Department 88

ACEP Now

MAY 6, 2023

The emergency physician’s documentation of these injuries may prove to be crucial in law enforcement’s reconstruction of the crash and may have significant implications for subsequent legal proceedings. Updated January 20, 2023. Accessed April 3, 2023. Discussion There were over 2.1 Accessed 4/3/23. 1988;28:498–501.

Forensics 52

Forensics Documentation/Coding Fractures Head Injuries 52

Don't Forget the Bubbles

OCTOBER 10, 2024

2023 Mar 30;110(4):432-438. Adopting this approach would reduce time in surgery for the child as well as the financial cost of nail bed repair. 2024 Jul 10:archdischild-2023-326727. doi: 10.1136/archdischild-2023-326727. doi: 10.1136/archdischild-2023-326247. doi: 10.1093/bjs/znad031 What’s it about?

Emergency Department 75

Emergency Department Outcomes Research Operations 75

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

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 Stroke Fractures Documentation/Coding 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

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]. Updated 2023 Jul 17].

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

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.

Leadership 40

Leadership Wellness Pediatrics Documentation/Coding 40

Dr. Smith's ECG Blog

JANUARY 13, 2025

This criterion is perplexing and not well explained. Unexplained cardiac arrest or documented VF/polymorphic VT: +3 3. ST is followed by a symmetrically negative T-wave 7. The duration of QRS is longer than in RBBB," and "there is a mismatch between V1 and V6." The downsloping should be such that the Corrado index is greater than 1.0

Hyperthermia / Hypothermia 74

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 74

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

PEMBlog

DECEMBER 4, 2024

Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2023–24 School Year. Um, with the first documented epidemic occurring in Paris in 1578. If you’re unvaccinated and not up to date, well then what are you doing in healthcare? Well, tough Schenectes.

Pediatrics 52

Pediatrics PPE Wellness 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