Dr. Smith's ECG Blog

JUNE 13, 2024

Her first set of vitals were documented: BP 116/57 Pulse 94bpm Respiratory rate 24/min O2 sat 90% on room air Temp 97F She had been cleaning a Jeep in the sun, and was sunburned. The physician documented “normal sinus rhythm”. The physician documented that she was “improved” and the patient was discharged. They were dismissed.

EKG/ECG 93

EKG/ECG Documentation/Coding EMS Burns 93

Sensible Medicine

FEBRUARY 6, 2024

First, their qualifications are spectacular: academic accolades, research, publications, clinical medicine experiences prior to residency, even real-life professional experiences. If applicants are more impressive on paper, but no more impressive in the clinics and hospitals, aren’t we doing something wrong?

Military 128

Military Free Clinics Documentation/Coding Academics 128

EMDocs

JUNE 9, 2023

How do we manage the agitated child in the pre-hospital environment? After listening to this episode you will be able to: Identify unique aspects of the pre-hospital environment that impact assessment and treatment of agitated children Describe the role of EMS personnel and EMS director in the care of agitated children. mg/kg IN; 0.1-0.15

EMS 95

EMS Documentation/Coding Pediatrics Psychiatric 95

EMDocs

SEPTEMBER 30, 2024

5 urban academic EDs, attending charts. Among patients with a primary provider documented in the chart, 30-day outpatient follow-up rate was 21.3% (n = 313). The primary outcome was hospital admission rates. Clinical question: In adult patients with asthma discharged from the ED, what are prescription rates for ICS?

Outcomes 101

Outcomes Academics Documentation/Coding Emergency Department 101

PulmCCM

APRIL 29, 2024

ICUs, and a popular research focus for academics, generating a steady stream of papers. government proposed adding VAP to its “hospital-acquired conditions” list—the ones that it won’t pay for. Hospital administrators put VAP on the kill list. It used to be highly prevalent in U.S. Just kidding!

Documentation/Coding 52

Documentation/Coding Academics Administration Research 52

RCEM Learning

MAY 20, 2022

Author: Rick Body / Editor: Govind Oliver / Code: / Published: 06/02/2020 In 2017 the National Institute for Health Research (NIHR) published its Training Review. It further encompasses an understanding of the development of pre-hospital and in-hospital medical systems and the skills necessary for this development.”

Academics 52

Academics Documentation/Coding Research Hospitals 52

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?

Academics 73

Academics Documentation/Coding EMS Hospitals 73

ACEP Now

JULY 7, 2024

My current practice is a hybrid of academic and community sites, and I have worked in myriad community hospitals from busy ones to single coverage critical access hospitals. If you have a difficult outcome, it is helpful to know what risk management support you have at your hospital.

Resuscitation 98

Resuscitation Risk Management Hospitals Critical Access 98

The Skeptics' Guide to EM

MAY 11, 2019

His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation. His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation.

Documentation/Coding 40

Documentation/Coding Operations Academics Ultrasounds 40

Sensible Medicine

AUGUST 21, 2023

On yesterday’s podcast , I talked with Bobby Yeh, an academic cardiologist who made a compelling case for enhancing credibility of observational research. Please do listen. Bobby is one of the smartest people in cardiology today. ” For example, mortality is a patient outcome—provided it can be reliably ascertained.

Administration 97

Administration Outcomes Research COPD 97

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. Software attacks crippled operations in large hospital chains, and physical assaults on ED staff continued unabated. Patient volume losses in 2020 reversed in 2021.

Emergency Department 52

Emergency Department Documentation/Coding Operations EMS 52

RebelEM

JUNE 8, 2023

The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study. PMID: 31270748 Maheshwari K, et al. Intensive Care Med. 2018;44(6):857–67. PMID: 29872882 Jones AE, et al. 2006;130(4):941–6.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

The Injectable Orange

APRIL 4, 2017

For many Australian hospitals, April is ‘No Falls Month’ This month we have a full-scale education attack against one of the most prevalent forms of in hospital patient harm – the fall. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine , 21 (10), 1069–1082.

Emergency Department 52

Emergency Department Evidence-Based Practice Academics Documentation/Coding 52

ALiEM

JANUARY 22, 2024

Fever was documented to be 102°F and was not associated with any chills or rigors. The patient during his hospital stay developed ARDS and was on mechanical ventilation for 20 days. A 40-year-old male, tailor by occupation, was brought to the Emergency Department with complaints of high-grade fever for the past 11 days.

Academics 64

Academics Documentation/Coding Emergency Department Hospitals 64

Taming the SRU

AUGUST 4, 2024

Know your audience, and tailor your presentation to them in terms of humor, pop culture references, and dress code Err on the side of making your presentation slightly shorter than the alloted time to allow room for questions. It is better to finish early than rushing through your presentation

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

Dr. Smith's ECG Blog

JULY 21, 2024

The patient was extubated on Day-3 of the hospital stay. The patient improved, and on Day-11 of the hospital stay — he was off inotropes and on a small dose of a ß-blocker. In both tracings — an exceedingly fast PMVT is documented. Distinction of PMVT vs VFib is an academic one in this case ).

EKG/ECG 132

EKG/ECG Shock Hospitals Sepsis 132

The Skeptics' Guide to EM

NOVEMBER 21, 2020

He is also the CME editor for Academic Emergency Medicine. He is also the CME editor for Academic Emergency Medicine. Your hospital has asked you to consider adding some advanced practice providers (APPs) instead of physician hours. Reference: Pines et al. AEM November 2020. Reference: Pines et al. AEM November 2020.

Emergency Department 52

Emergency Department Telemedicine Academics Outcomes 52

ALiEM

MARCH 11, 2024

The patient’s eye lesion and symptoms resolved and he was discharged on hospital day eight. There is limited literature documenting eye involvement and pictographic examples of its presentation. During the current outbreak, ocular involvement has been used as a criteria for hospital admission. ” N Engl J Med.

Academics 56

Academics Documentation/Coding Emergency Department Hospitals 56

Northwestern EM Blog

MARCH 1, 2025

Document thorough skin assessment every nursing shift, and inspect weight-bearing ventral surfaces. Academic Emergency Medicine. Maren Leibowitz, MD Critical Care Fellow Mount Sinai Hospital How To Cite This Post: [Peer-Reviewed, Web Publication] Goins, E. Reattach EKG leads to back. Tilt patient into reverse Trendelenburg.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 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. Dr. Bissmeyer is a senior resident at Orange Park Hospital in Jacksonville, Fla. 1033, section 4004.

Documentation/Coding 52

Documentation/Coding Ethical Issues Best Practices Academics 52

Don't Forget the Bubbles

MAY 6, 2024

of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) The study included academic NICUs, which may reduce the generalisability of the results. 807 patients between the ages of 7 days to 17 years, from the ED, ward and PICU, were included across ten hospitals in Switzerland. Of the 74.9%

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

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. STOP5: a hot debrief model for resuscitation cases in the emergency department. Wleklinski, N. 2022, Sept 12).

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

RebelEM

MARCH 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. Consecutive enrollment avoided sampling bias Limitations: Retrospective observational study at a single academic center limits external validity (ie. J Crit Care.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

ACEP Now

MARCH 13, 2024

Consequences of this are well documented and include delayed treatment, exposure to error, increased length of stay, and increased mortality. 1 Hospital boarding is the main driver of ED crowding, with patients nearly always awaiting transfer to inpatient beds and now more commonly, to other hospitals.

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

SheMD

OCTOBER 8, 2023

Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. My life outside of the hospital has always served to make me more balanced and I hope to continue to foster that in residency.” “You Disclaimer: This post was written before the COVID-19 pandemic.

Leadership 105

Leadership Best Practices Academics Documentation/Coding 105

PulmCCM

OCTOBER 30, 2023

If clinicians don’t consistently comply, hospitals get “dinged” with public reporting of their supposedly low quality of sepsis care. CMS has added SEP-1 to its “value-based purchasing” program for 2024, meaning hospitals will face financial penalties for noncompliance. The stakes are going up.

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

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." In the first year since discharge, he has been hospitalized 3 times with CHF. Academic Emergency Medicine 27(S1): S220; May 2020. Setting – large, academic, suburban ED. CT aorta negative for dissection.

EKG/ECG 79

EKG/ECG Outcomes Academics Documentation/Coding 79

EMDocs

JUNE 16, 2023

Episode 4 covered management of the agitated child in the pre-hospital environment. Over the past 50 years, mental health has shifted away from hospital-based to community-based care models. Episode 2 covered non-pharmacologic management and episode 3 covered pharmacologic management of agitation. Why are we boarding?

Psychiatric 52

Psychiatric Pediatrics Emergency Department Best Practices 52

SheMD

OCTOBER 5, 2023

Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. If staying in a hotel- don’t forget to use discount codes the residency program may offer. Practically, this means arriving 30 minutes early to the hospital and approximately 15 minutes early to the interview. Be on Time!

Research 52

Research Leadership Documentation/Coding Academics 52

EM Updates

JUNE 15, 2021

Maimonides Medical Center (MMC) is Brooklyn’s largest hospital, an academic quaternary care center with, in normal times, 711 total beds, 66 intensive care beds, and an Emergency Department that treats approximately 120,000 patients per year. Treatment protocols changed rapidly and were devised by departmental and hospital consensus.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

Advanced Emergency Nursing from AENJ

MARCH 14, 2016

But the admitted patient 'without a bed" could not go upstairs to a lower ratio unit (Tele or ICUs) until a bed there was available, so the patient remained at 1:4, unless tying up the Code Room at 1:1. It's common to endow academic chairs or departments.

Emergency Nursing 40

Emergency Nursing Documentation/Coding Academics Pediatrics 40

ACEP Now

JULY 6, 2023

Warfarin pills are inexpensive, but the associated hospital care is not. Brian Zink captured a wonderful initial vision statement for our specialty with the title of his book, “Anyone, Anything, Anytime,” which documented the history of our specialty. Warfarin is a drug highly prone to drug-drug and drug-food interactions.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 52

Dr. Smith's ECG Blog

MARCH 31, 2023

I first became interested in computerized ECG interpretation in the beginning of my academic days in the early 1980s ( References to some of my work appear below — as I believe I may have been the first family physician to publish in this area ). RED arrows in leads V3,V4 highlight T- QRS-D in ECG #2. ( Louis, 1998, pp 374-379.

EKG/ECG 52

EKG/ECG Academics Wellness Documentation/Coding 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

Code STEMI was activated. in-hospital mortality was 18.8% From an academic standpoint — I found several subtle ECG findings from the 2 tracings in this case to be especially interesting. This one of the highest risk OMI patterns possible to see on an ECG. The patient arrived to the ED in cardiogenic shock but awake. Eur Heart J.

EKG/ECG 52

EKG/ECG Shock EMS Documentation/Coding 52

ACEP Now

AUGUST 1, 2023

Our Indiana ACEP colleagues have helped us all as emergency physicians in championing the passage of state legislation mandating a physician leading a hospital’s emergency department to be physically present in that hospital.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 98

ACEP Now

MAY 10, 2024

This may impact the external validity of the results to attending physicians in a non-academic, community, or rural settings. Dr. Milne is chief of emergency medicine and chief of staff at South Huron Hospital, Ontario, Canada. Prevalence: The prevalence of 3.5 percent was high compared to previously published data. However, 3.5

Ultrasounds 52

Ultrasounds Outcomes Academics Documentation/Coding 52

Dr. Smith's ECG Blog

APRIL 8, 2015

Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful. Academic Emergency Medicine., Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to general hospital: the EGSYS score. Thiruganasambandamoorthy, V.,

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52