Dr. Smith's ECG Blog

MARCH 19, 2024

This case was sent by Amandeep (Deep) Singh at Highland Hospital, part of Alameda Health System. The patient presented to an outside hospital An 80yo female per triage “patient presents with chest pain, also hurts to breathe” PMH: CAD, s/p stent placement, CHF, atrial fibrillation, pacemaker (placed 1 month earlier), LBBB.

EKG/ECG 110

EKG/ECG Hospitals Documentation/Coding Outcomes 110

Ken Grauer, MD

FEBRUARY 28, 2023

Although acute Myocarditis is often suspected as the cause of troponin elevation in Covid-positive patients — documented viral myocarditis caused by Covid appears to be much less common than initially thought ( Up-to-Date — Caforio et al — Jan, 2023 ). Microvascular dysfunction — cardiac vasculitis — intravascular thrombosis.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

RebelEM

JUNE 8, 2023

Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

ACEP Now

DECEMBER 6, 2024

1 Relatively little literature on the clinical characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) patients complicated by coronary vasospasm exists beyond anecdotal reports, however. Cardiac arrest secondary to myocardial ischemia from coronary vasospasm is well documented. Angina pectoris. 1959;27:375-388.

Resuscitation 98

Resuscitation EKG/ECG Documentation/Coding COPD 98

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. The past is the past.

Resuscitation 98

Resuscitation Risk Management Hospitals Critical Access 98

Don't Forget the Bubbles

JUNE 19, 2024

This may limit the generalisability of the results in regional/community hospital settings. A proportion of the patients who were initially missed using the CDR were found to actually have risk factors documented in EMS reports or the medical record. Were the predictor variables and the outcome evaluated in a blinded fashion?

CPR 124

CPR Research Documentation/Coding Outcomes 124

American Medical Compliance

AUGUST 7, 2024

For example, CMS requires accurate and timely documentation of patient care to ensure proper billing and reimbursement. Adhering to CMS quality measures, such as reducing hospital readmission rates and improving patient safety protocols, helps maintain high standards of care.

Hazardous Materials 105

Hazardous Materials Documentation/Coding Legal Issues Patient Safety 105

Mind The Bleep

OCTOBER 29, 2024

First aid done pre-hospital. 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. The AMPLE framework offers a structured approach [2].

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

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. Finally, most hospitals lack the necessary protocols and processes to coordinate the complex interdisciplinary care patients with RAO may require. Paper: Lema GMC, De Leacy R, Fara MG, et al.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

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) The primary outcome was the successful intubation on the second attempt. Of the 74.9% Why does it matter?

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

PulmCCM

FEBRUARY 5, 2024

You can read the document here. Depends On the Patient, and Who You Ask The Centers for Disease Control and Prevention defines a fever (for general hospitalized patients) as >38°C. Also, many patients with infection won’t have fevers, and those that don’t may be at the highest risk for poor outcomes.

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

Sensible Medicine

APRIL 12, 2024

There have been observational studies and a handful of actual RCTs looking at how duty hours have affected medical education, patient outcomes, the prevalence of medical errors, housestaff satisfaction, sleep duration… I am definitely not one to question whether restricting housestaff duty hours was necessary.

Radiology 83

Radiology Radiology Hospitals Documentation/Coding 83

Sensible Medicine

MAY 22, 2023

A true crisis in humanity goes unnoticed in nearly every US hospital. See screenshot: The endpoint was the proportion of patients whose chart had a documented goals of care care discussion. The setting of the trial was 3 hospitals in one healthcare system. Think about possible outcomes—both good and bad.

Documentation/Coding 63

Documentation/Coding Hospitals Shock Outcomes 63

Sensible Medicine

AUGUST 7, 2024

This is an astounding difference in the quality of sleep, and to this day, premature infants in the hospital are slept on their stomachs. There are few studies about crawling, but all of them show positive outcomes from achieving the skill: shoulder stability, abdominal and hip strength, hand-eye coordination, and joint stability.

CDC 113

CDC Documentation/Coding Research Pediatrics 113

Don't Forget the Bubbles

OCTOBER 10, 2024

This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis. 2023 Mar 30;110(4):432-438.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

The Injectable Orange

FEBRUARY 21, 2017

This post captures some of the resources discussed in the ED Nurses Vent and Haemodynamic Monitoring workshop at Redcliffe Hospital. These resources are high quality FOAM and can help with expanding upon the learning and piqued curiosity from the workshop. Happy self-directed learning.

Airway Management 52

Airway Management Documentation/Coding Outcomes Evidence-Based Practice 52

Taming the SRU

JUNE 3, 2024

Myth: Some patients are “too sick to transport” Myth Part B: The receiving hospital gets to decide if a patient is too sick to transport. What drives the concern? Relative to inactions, actions receive more attention, elicit stronger emotional reactions, trigger higher regret, and are often perceived as more consequential.

Shock 91

Shock Seizures Airway Management Stroke 91

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. As part of our education this month, I would encourage the enthusiastic ED nurse to read the following article.

Emergency Department 52

Emergency Department Evidence-Based Practice Academics Documentation/Coding 52

The Skeptics' Guide to EM

MARCH 22, 2019

She is a clinical researcher at Cabrini Hospital and an Adjunct Clinical Associate Professor at Monash University. She is a clinical researcher at Cabrini Hospital and an Adjunct Clinical Associate Professor at Monash University. Date: March 20th, 2019 Guest Skeptic: Dr.Katie Walker is an emergency physician in Melbourne, Australia.

Emergency Department 52

Emergency Department Dislocations Documentation/Coding Research 52

The Skeptics' Guide to EM

NOVEMBER 21, 2020

Your hospital has asked you to consider adding some advanced practice providers (APPs) instead of physician hours. The American College of Emergency Physicians ( ACEP ) has a number of documents discussing APPs in the ED. Case: You are the medical director of a medium sized urban emergency department (ED).

Emergency Department 52

Emergency Department Telemedicine Academics Outcomes 52

JournalFeed

MARCH 26, 2022

Epi vs. NorEpi Spoon feed: Continuous epinephrine infusion for post-resuscitation shock in out of hospital cardiac arrest (OHCA) was associated with both higher all-cause and cardiovascular specific mortality when compared to norepinephrine. Check out journalfeed.org for details.

Stroke 40

Stroke Documentation/Coding Emergency Department Resuscitation 40

Greater Sydney Area HEMS

AUGUST 1, 2023

In contrast to hospital life, we work in relative isolation in HEMS. Again, stark contrast to the hospital environment, where we are so often blitzed with service provision to the point where it’s a challenge to schedule emptying your bladder! Why is C+C important? Why do I personally love it so much?

Documentation/Coding 52

Documentation/Coding Outcomes Hospitals Administration 52

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. 2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. J Crit Care.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

The Skeptics' Guide to EM

APRIL 24, 2021

Date: April 19th, 2021 Guest Skeptic: Dr. Kirsty Challen (@KirstyChallen) is a Consultant in Emergency Medicine and Emergency Medicine Research Lead at Lancashire Teaching Hospitals Trust (North West England). Exclusions: Prisoners or those in police custody, pregnant or breast-feeding, or with documented allergy to any study medications.

Emergency Department 40

Emergency Department Research Outcomes Documentation/Coding 40

Mind The Bleep

FEBRUARY 27, 2024

This is hospital dependent and you should be told about which fluid to prescribe at your induction (or I’m sure the nurses will tell you!) The children who received no bolus had significantly better outcomes and reduced mortality compared to the two bolus group. [2] saline + 5% dextrose or plasma-lyte 148 + 5% dextrose.

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

RebelEM

SEPTEMBER 11, 2023

Outcomes: Primary: Percent change in management decisions after introducing the Radiology Department RUQ US. Moreover, surgeons may seek “official” documentation in a patient’s chart before surgery. However, many facilities lack this advanced infrastructure, making it difficult to adopt similar practices.

Ultrasounds 68

Ultrasounds Radiology Radiology Emergency Department 68

Cook County EM Blog

MARCH 10, 2022

Delays in care, as seen in our patient, can lead to poor neurological outcomes (1,2). Chronic compressive or mechanical stress on the spinal cord has been well documented to increase the risk of syrinx and secondary spinal cord changes. Braun P, Kazmi K, Nogués-Meléndez P, Mas-Estellés F, Aparici-Robles F. Eur J Radiol. 2007;64(1):119.

Emergency Department 52

Emergency Department Hospitals Wellness Documentation/Coding 52

The Skeptics' Guide to EM

MARCH 4, 2018

Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant (PA) working primarily in rural Missouri in community hospitals. Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant (PA) working primarily in rural Missouri in community hospitals. JAMA May 2017. JAMA May 2017.

Infectious Diseases 40

Infectious Diseases Documentation/Coding Ultrasounds Outcomes 40

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. Long term outcome unknown but obviously bleak. Repeat ECG: New developing Q waves in V2 and V3, further confirming evolving OMI.

EKG/ECG 78

EKG/ECG Outcomes Academics Documentation/Coding 78

PHEM Cast

APRIL 21, 2021

Guidance documents College of Paramedics Statement on Intubation, available here. The Effect of Paramedic Rapid Sequence Intubation on Outcome in Patients with Severe Traumatic Brain Injury. The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis.

Airway Management 40

Airway Management Resuscitation EMS Hospitals 40

Dr. Smith's ECG Blog

JUNE 14, 2017

This case was sent by Dr Avinash Krishnamurthy, a fine emergency medicine resident from Australia Cairns base hospital Case : An adolescent male had a mechanical fall and injured his left shoulder and arm. There was apparently no syncope and he had no bony injuries, but he did complain of left sided chest pain. His chest was tender.

EKG/ECG 52

EKG/ECG Documentation/Coding Ultrasounds Wellness 52

The Skeptics' Guide to EM

DECEMBER 5, 2020

John’s Riverside Hospital Emergency Medicine Residency in Yonkers, New York. John’s Riverside Hospital Emergency Medicine Residency in Yonkers, New York. Over the past decade, some emergency physicians have adopted this examination into their own bedside clinical assessment and documentation.

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

Pediatric Emergency Playbook

APRIL 1, 2016

We could use it to track treatment , and see if we can clear the lactate; decreased lactate levels are associated with a better outcome in adults. Myopericarditis in Children: Elevated Troponin I Level Does Not Predict Outcome. for the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

EMDocs

JANUARY 11, 2024

Methods This scientific statement was led by the AHA and NCS and focused on the acute and critical care management of adult cardiac arrest survivors of in-hospital and out-of-hospital cardiac arrest. Centers managing patients after CA should collect data and evaluate outcomes of care (95.7%, 22/23).

Seizures 97

Seizures Shock Infectious Diseases CPR 97

Don't Forget the Bubbles

FEBRUARY 26, 2024

Evidence (although limited) suggests using HFNC can delay the initiation of NIV and result in longer intensive care and hospital stays. Outcomes of paediatric critical care asthma patients. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. How does bi-level positive pressure ventilation work?

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

Advanced Emergency Nursing from AENJ

NOVEMBER 27, 2017

The following quotes from the ILCOR and AHA documents, under fair-use doctrine, will help summarize for you the changes. AHA statements are labeled with" [AHA]" We can now expect more frequent and closer cycling and knowledge translation from the laboratory workbench or studies of cases and outcomes to our own practice.

CPR 40

CPR Basic Life Support Resuscitation Pediatrics 40

Mind The Bleep

FEBRUARY 2, 2025

Unless you’re documenting something hilarious, please keep it brief and to the point. History of Presenting Complaint In this section use SOCRATES to document the pain. Drugs/Allergies When documenting drugs – try to get the dose and frequency (this can be found on Summary Care Records from the GP if you have access).

Documentation/Coding 95

Documentation/Coding COPD EKG/ECG Wellness 95