ACEP Now

APRIL 2, 2024

Posterior circulation strokes make up 20 percent of all strokes but account for 40 percent of stroke misdiagnoses. Dizziness is especially tricky, with up to 40 percent of strokes presenting with dizziness being missed. His neurological exam on arrival is documented as normal. His blood pressure is 190 over 115.

Stroke 40

Stroke Documentation/Coding Poisoning Emergency Department 40

RebelEM

AUGUST 22, 2024

What They Did: Retrospective review of consecutive RAO cases managed as part of a remote ophthalmology consult protocol activated on May 1, 2021, at three stroke centers across a health system. The protocol involved collaboration between the ophthalmology service, ED, and stroke service, including neurology and neuroendovascular teams.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

Taming the SRU

JULY 25, 2024

Femoral nerve block case review - morbidity & mortality - community practice - r2 Clinical pathologic case - visual diagnosis - when time matters - operational aspects of stroke care Femoral nerve Block Case Review WITH dr. stolz Why do we care about regional anesthesia, specifically femoral nerve blocks?

Stroke 98

Stroke Fractures Operations Outcomes 98

Sensible Medicine

APRIL 29, 2024

Say blueberries and rates of stroke. In this section, they documented the variations in analytic method (for instance, the choice of model and co-variates). This time in nutritional epidemiology. Take a moment and think about the methods section of a standard association study. In other words: one way.

Stroke 142

Stroke Documentation/Coding Shock Research 142

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 136

Stroke Outcomes Hospitals Administration 136

ACEP Now

OCTOBER 3, 2023

This document is an update of guidelines first published in 2000, and then updated in 2007. Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented. 2019;154(7):e191152.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

Dr. Smith's ECG Blog

OCTOBER 12, 2024

CTA head and neck were obtained and showed no evidence of intracranial hemorrhage, large vessel occlusion stroke (what a helpful and apt name for an acute arterial occlusion paradigm, by the way.), Preliminary findings documented in the cath lab were “Anterior STEMI and no significant coronary artery disease.” (!!!) ng/mL and 0.10

EKG/ECG 115

EKG/ECG Documentation/Coding Emergency Department COPD 115

ACEP Now

JUNE 6, 2023

Notoriously elusive, with a high misdiagnosis rate, thoracic aortic dissection (AD) can mimic many conditions, including acute coronary syndrome (ACS, the most common), gastroesophageal reflux disease (GERD), stroke, and spinal-cord compression. 1 Opioids or anxiolytics are often given to patients whose diagnosis of AD is missed or delayed.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

EMDocs

SEPTEMBER 19, 2023

Also think about NCSE in patients with prior cerebral pathology (ie, ischemic stroke); a patient who was seizing, was treated, and is not coming out of their post ictal state; and in patients with unexplained altered mental status with no other cause. Official diagnosis requires EEG, which is not something we can typically obtain in the ED.

Seizures 98

Seizures Documentation/Coding EKG/ECG Emergency Department 98

Mind The Bleep

NOVEMBER 21, 2023

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 52

Documentation/Coding COPD EKG/ECG Wellness 52

RebelEM

JUNE 8, 2023

They can be associated with side effects such as reflex bradycardia, decreased stroke volume in phenylephrine, tachycardia and hypertension associated with epinephrine. However, peripherally dosed push dose pressors, (PDPs), are beginning to be administered more frequently for management of acute hypotension.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

The Skeptics' Guide to EM

DECEMBER 5, 2020

You’re about to call in your MRI tech from home, but then you remember reading that the HINTS exam is more sensitive than early MRI for diagnosis of posterior stroke. You wonder, “Why can’t I just rule out stroke with the HINTS exam? Posterior circulation strokes account for approximately up to 25% of all ischemic strokes [1].

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

Taming the SRU

JUNE 3, 2024

Susan Wilcox Increasing regionalization due to: Growth of specialty centers Increasing development of healthcare systems Hub-and-spoke models Development of ECMO, trauma, transplant, and stroke centers The higher the acuity of the centers, the higher the acuity of the patient that needs to get there.

Shock 91

Shock Seizures Airway Management Stroke 91

PulmCCM

JANUARY 6, 2025

This led the authors to speculate that qSOFA parameters were being documented more diligently on the wards randomized to screening. there is no validated method to diagnose sepsis; i.e., that unlike in diabetes, strokes, and bypass surgery, there is no way to reliably quantify the denominator in the SEP-1 quality metric).

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

Dr. Smith's ECG Blog

JANUARY 9, 2024

Slow VT below the detection rate of the ICD lead to worsening heart failure and low stroke volume. Lowering the back up rate (LRL) of the ICD/pacer allowed for an intrinsic rhythm with physiologic AV conduction and normal AV synchrony with resultant increase in stroke volume and cardiac outpt.

EKG/ECG 119

EKG/ECG Stroke Hospitals Documentation/Coding 119

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

I therefore feel it relevant to document ( in your dictation/on the medical chart ) when significant artifact potentially impairs the accuracy of your interpretation. Regarding my Systematic assessment of ECG #1: There is significant baseline artifact , as well as baseline wander.

Seizures 113

Seizures EKG/ECG EMS Stroke 113

JournalFeed

MARCH 26, 2022

High-dose IN Fentanyl Spoon Feed: Higher doses of intranasal (IN) fentanyl for pain ranging from 2-5 μg/kg (with a maximum of 200 μg) were given in a pediatric emergency department, with no documented episodes of apnea, hypotension, or respiratory failure.

Stroke 40

Stroke Documentation/Coding Emergency Department Resuscitation 40

Sensible Medicine

JUNE 30, 2023

There was fatigue, weight loss, nausea, declining kidney function, and a few strokes. ” I documented those words in my progress note that day. SV was a patient who kept me up at night for the better part of 18 months. She was in her late 70’s and she was dying. Then, everything changed.

Hospitals 98

Hospitals Hospice Resuscitation COPD 98

Taming the SRU

FEBRUARY 5, 2024

1) However, it wasn’t until the 1890s that purposeful, successful, and safe attempts to access this fluid were documented (2). Metropolitan Museum of Art, CC0, via Wikimedia Commons The ancient Egyptian physician Imhotep is often credited with the discovery of cerebral spinal fluid (CSF) —over 5,000 years ago! (1)

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

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. A subset of these patients develop an accelerated rate either primarily or due to other factors known as rapid ventricular response.

Outcomes 52

Outcomes Stroke Fractures Documentation/Coding 52

Downeast Emergency Medicine

APRIL 26, 2021

Trauma patients between the ages of 18-90 years had to have either had one documented episode of hypotension (defined as a systolic BP <90 mmHg) or tachycardia (>100 beats/minute) to be included in the study. MI or stroke). TXA does not increase the incidence of thromboembolic events such as DVT/PE, stroke, or MI.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Taming the SRU

AUGUST 4, 2024

Differential Diagnosis: For medical students or interns: discuss mnemonics to remember differentials; for R2s/R3s, ask them to consider 5 likely differential diagnosis and how this patient would decompensate based on those differentials Patient Care: For medical students, encourage them to find at least 3 abnormal physical exam findings throughout (..)

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

Sensible Medicine

FEBRUARY 28, 2024

JMM Although the skeptical cardiologist questions the value of many procedures and diagnostic tests in cardiology, he remains an enthusiastic advocate of the use of coronary artery calcium (CAC) testing to better personalize each individual's risk of heart attack and stroke. For many individuals, this is life-transforming.

Stroke 45

Stroke Documentation/Coding Outcomes Wellness 45

Dr. Smith's ECG Blog

FEBRUARY 16, 2019

Written by Pendell Meyers, few edits by Smith A man in his 60s with history of stroke and hypertension but no known heart disease presented with chest pain that started on the morning of presentation at around 8am. Here is his triage ECG when he presented at 1657: What do you think?

EKG/ECG 52

EKG/ECG Documentation/Coding Stroke 52

EB Medicine

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Dr. Smith's ECG Blog

JULY 3, 2018

After admission he undergoes another ECG, though it is unclear from documentation whether there was a change in his chest pain. Documentation strongly suggests that this finding was what ultimately convinced the cardiologists that this was not pericarditis. After this result he was given therapeutic enoxaparin. Teaching points: 1.

EKG/ECG 52

EKG/ECG Documentation/Coding Administration Outcomes 52

Pediatric Emergency Playbook

APRIL 1, 2016

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. for the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. ACCF 2012 Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

ACEP Now

JULY 6, 2023

5 Patients with acute ischemic strokes, STEMIs, and trauma, as well as many other diagnoses, have their workup largely completed, and even sometimes definitive therapy executed, before they leave the emergency department, rather than requiring inpatient units. “A In 2023 we must move beyond that title.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 52

Dr. Smith's ECG Blog

MAY 16, 2023

Like they would for any other acute arterial occlusion syndrome (such as suspicion of acute large vessel stroke), they take the patient across the hall and perform an immediate CT (coronary) angiogram, showing patent coronaries. Imagine: the providers in the case above are not sufficiently sure that the patient above doesn't have OMI.

EKG/ECG 52

EKG/ECG Stroke Documentation/Coding Outcomes 52

Northwestern EM Blog

MAY 16, 2022

Please ensure that you document and discuss with the patient accordingly. He endorses nausea without vomiting and denies fever. Finally, a burden on us as EM clinicians is training in and awareness of clinical practice guidelines and recommendations from specialties outside of EM.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Pediatric Emergency Playbook

JUNE 1, 2017

The best documented cormorbidity is sickle cell disease, although other pro-thrombotic conditions also put the child at risk. The previously well child now decompensated: undiagnosed thrombophilia Asymptomatic patent foramen ovale (PFO) is the cause of some cases of cryptogenic vascular disease, such as stroke and MI. Pongratz G et al.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Dr. Smith's ECG Blog

JANUARY 5, 2020

See below how this has been documented. speci fi city of the General Electric (GE) algorithm for AF, but they excluded cases with ventricular paced rhythm (VPR), in which the underlying atrial rhythm was frequently AF;we did not exclude VPR, as accurate identi fi cation of AF in VPR is important for determination of stroke risk [ 22 ].

EKG/ECG 52

EKG/ECG COPD Wellness Sepsis 52

EB Medicine

AUGUST 1, 2018

In fact, cannabis use has been documented for medical use dating as far back as 600 BC in West and Central Asia. First up is the link between cannabis use and stroke or TIA. times higher risk of stroke or TIA. times higher risk of stroke or TIA. Cannabis users who smoked at least once weekly had a 3.3

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EB Medicine

MAY 3, 2019

Next, schedule a follow up appointment, ideally within a week of discharge, and lastly, document the patient’s preferred follow up resources and steps taken to get them there. After that, ask the patient to identify the most viable resources and address any barriers the patient may have in getting there.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

EMDocs

JULY 3, 2023

National Institutes of Health Stroke Scale (NIHSS) is 13; vital signs include pulse 86 beats/minute (bpm), blood pressure 164/94 mmHg, and saturation of 98% on room air. This neurological evaluation should include assessment and documentation of the GCS, the presence of any neurologic deficits, and an NIHSS. J Stroke Cerebrovasc Dis.

Seizures 98

Seizures Stroke Outcomes EMS 98

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. to 1.45) for fatal or nonfatal stroke. g/dL —Hypotension (obviously!) to 1.51) for death from any cause, 1.27 (95 percent confidence interval, 0.99 to 3.80).

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95