Dr. Smith's ECG Blog

JANUARY 5, 2024

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 documentation does not describe any additional details of the history. He described the symptom as chest burning with occasional radiation into his throat and jaw.

EKG/ECG 122

EKG/ECG Burns Urgent Care Documentation/Coding 122

Dr. Smith's ECG Blog

JUNE 13, 2024

Click here to sign up for Queen of Hearts Access Case A 58-year-old woman presented to the ED with burning chest pain that started 2-3 hours earlier while sitting on a porch swing. The physician documented “normal sinus rhythm”. The physician documented that she was “improved” and the patient was discharged. CK MB was 1.9

EKG/ECG 93

EKG/ECG Documentation/Coding EMS Burns 93

Sensible Medicine

SEPTEMBER 19, 2024

Our leaders have done a terrible thing to doctors—they’ve told doctors to put their heads down and focus on billing and coding in short visits with patients, as they measure their performance by a doctor’s throughput. We have not given doctors the time or resources to study the root causes of disease.

Research 145

Research Military Poisoning Burns 145

ACEP Now

MARCH 14, 2024

Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm. FIGURE 1: Electrical burns of the patient’s bilateral feet. FIGURE 2: Traumatic amputation and electrical burn of the patient’s left arm. He was intubated by EMS due to the extent of his injuries.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Taming the SRU

SEPTEMBER 15, 2023

ETT onto a fiberoptic scope. ETT onto a fiberoptic scope.

CPR 90

CPR Burns Airway Management Wellness 90

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

EMDocs

DECEMBER 4, 2023

Document a risk and benefit discussion with the patient regarding empiric anticoagulation, perhaps even including the HAS-BLED score in the documentation [10]. Give the first dose of enoxaparin in the ED: 1 mg/kg subcutaneously for 12 hours or 1.5 mg/kg for 24 hours.

Ultrasounds 90

Ultrasounds Documentation/Coding Wellness EMS 90

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. Acad Pediatr. 2022 Mar;22(2):190-192.

Pediatrics 70

Pediatrics Emergency Department Research Burns 70

Taming the SRU

MAY 11, 2024

Usually presents consistent with failure of that organ.

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

Emergency Medicine Journal

NOVEMBER 28, 2023

BURN 478 0 35 7.3 TOOTHACHE) 574 0 107 18.6 0[0 , 0.66] INJURY OF LOWER BACK 573 1 76 13.3 0.031 , 0.98] POSTOPERATIVE/MEDICAL DEVICE WITH COMPLICATION 571 4 221 38.7 VAGINAL BLEEDING (ABNORMAL) 559 1 178 31.8 0.032 , 1] BLOOD IN STOOLS 521 7 247 47.4 0.65 , 2.7] EYE INJURY 498 0 81 16.3 0[0 , 0.77] LIMB WEAKNESS 481 32 325 67.6 5.2 , 9.9]

Documentation/Coding 40

Documentation/Coding Sexual Assault Hyperthermia / Hypothermia Head Injuries 40

Don't Forget the Bubbles

OCTOBER 16, 2024

Don’t be afraid to ask the simple questions: Where do I document? Are there distinctive sub-specialty referral pathways for your area e.g. liver, burns, surgery, neurosurgery etc. Top tip: verbally communicating your plan followed by clear documentation can help avoid confusion! Where do I prescribe? Where is the staff room?

Documentation/Coding 52

Documentation/Coding Teamwork Leadership Burns 52

ACEP Now

APRIL 4, 2024

However, the patient had known dextrocardia based on documented medical history and was confirmed with a recent chest x-ray. Burns E, Buttner R. 5 The patient’s initial left-sided EKG did not demonstrate concerning ST segment changes. Coronary Artery Disease. 2019;30(5):390-392. Right Ventricular Infarction. Life in the Fast Lane.

EKG/ECG 40

EKG/ECG Burns Documentation/Coding Emergency Department 40

SheMD

SEPTEMBER 11, 2023

Who’s running codes? Vacation and time away from work is needed to prevent burn-out! If you’re at a hospital with multiple programs, who’s up first to doing them? Surgery, Internal Medicine, Anesthesia, Emergency Medicine? Is there a simulation lab on-site for practicing procedures? Social Life. How do holidays work?

Hospitals 52

Hospitals Burns Documentation/Coding 52

Northwestern EM Blog

SEPTEMBER 12, 2022

This post will discuss a brief overview of hospital planning and operational setup with key elements of a disaster response from events that cause high numbers of blunt trauma, penetrating trauma, burns or crush injuries that may be seen following explosive events, mass shootings, or large scale motor vehicle collisions, to name a few.

Mass Casualty Incidents 52

Mass Casualty Incidents EMS Hospitals Hazardous Materials 52

PulmCCM

FEBRUARY 19, 2024

At Shands (the level 1 trauma center admitting adults), the panel relates the impressive results that mortality fell by 58%, and unplanned codes by 47% “after the widespread implementation of patient/ family activated RRT/MET.” More health care professionals are burned out or disengaged. Societal trust has declined.

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

Dr. Smith's ECG Blog

NOVEMBER 13, 2022

ST elevation in both anterior and inferior leads does not necessarily indicate an LAD "wraparound" lesion ( Bozbeyoğlu reference documenting this cited by Dr. Aslanger below — with Dr. Aslanger as one of the co-authors ). Smith's Blog show this same phenomenon ).

EKG/ECG 52

EKG/ECG Burns Documentation/Coding Hospitals 52

Dr. Smith's ECG Blog

JULY 19, 2019

Written by Pendell Meyers, with edits by Steve Smith A man in his early 40s with history of MI s/p PCI presented with bilateral anterior chest pain described as burning and belching with no radiation since last night starting around 11pm (roughly 11 hours ago). He also described a syncopal episode just prior to onset of symptoms.

EKG/ECG 52

EKG/ECG Burns Documentation/Coding Hospitals 52

EB Medicine

DECEMBER 4, 2019

Fun fact: planes also take off heavy - with tons of fuel that will be burned prior to landing. Alternatively, you may have to fly in circles for some time to burn fuel off in planes that cannot dump. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Say you were to take off from London, bound for the US.

Dehydration 40

Dehydration EMS Wellness Burns 40

Taming the SRU

JUNE 6, 2023

mg/kg of IBW Seek to match a patient's minute ventilation with TV and RR after intubation Intentionally match patient's intrinsic RR noted prior to intubation Note that healthy lungs can handle 8 mL/kg, based on IBW, if that is useful for compensation Secure your ETT Thomas Tube Holder is a new ETT holder on Air Care for ETT down to size 6.5

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Mind The Bleep

NOVEMBER 21, 2023

It is important to be accurate when assessing and documenting wounds as it can have medico-legal implications, should your assessment later come up in a court case. Wounds are a very common presentation to A&E and minor injuries departments. Wound management is very clinician dependent and there is a lot of variation in practice.

Fractures 40

Fractures Burns Documentation/Coding Hospitals 40

American Medical Compliance

JANUARY 8, 2025

Recognizing the Signs of Abuse Healthcare providers must remain vigilant for signs of abuse, which can include: Physical Signs : Unexplained bruises, burns, or fractures, along with frequent hospitalizations for preventable issues. Documentation : Detailed documentation is crucial.

Incident Reporting 105

Incident Reporting Documentation/Coding Dehydration Burns 105

American Medical Compliance

MARCH 3, 2025

Common Cal/Osha Violations No formal workplace violence prevention plan Lack of staff training on de-escalation techniques Failure to report and document violent incidents Inadequate security measures in high-risk areas How to Avoid This Violation Develop a Workplace Violence Prevention Plan as required by Cal/OSHA.

PPE 103

PPE Legal Issues Head Injuries Burns 103

Sensible Medicine

MARCH 4, 2025

There is a well-documented misunderstanding among American doctors about nicotine and cigarette substitutes. Swedish snus is vastly safer than cigarettes and the FDA recently authorized the sale of heat-not-burn tobacco (HNB), e-cigarettes/vapor, and nicotine pouches as “appropriate for the protection of the public health.”

CDC 128

CDC Research Documentation/Coding Leadership 128

Sensible Medicine

NOVEMBER 6, 2024

For example, veterans with abnormal spirometry results would also need documented or presumed exposure to toxic inhalants during their service, such as burn pits or agent orange. To qualify for disability payments, veterans need a service-connected diagnosis beyond meeting abnormal spirometry criteria alone.

COPD 78

COPD Burns Documentation/Coding 78

EMDocs

JANUARY 6, 2025

4,5 Of particular concern is the Sudanese conflict, which began in April 2023, and which has caused the largest internal displacement of a population in documented history. Physical injuries and burns among refugees in Lebanon: implications for programs and policies. In: CDC Yellow Book 2024. Centers for Disease Control; 2023.

Infectious Diseases 72

Infectious Diseases CDC PPE Rapid Diagnostic Testing 72