Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Bedside cardiac ultrasound with no obvious wall motion abnormalities. We documented that the majority of stenotic lesions had compensatory enlargement and thus exhibited remodeling. He had a previous ECG on file: Proving the findings are new The cath lab was activated. He was given aspirin and sublingual nitro and the pain resolved.

EKG/ECG 122

EKG/ECG Ultrasounds Documentation/Coding Wellness 122

EM Ottawa

OCTOBER 3, 2024

Point-of-care ultrasound (POCUS) is often taught to answer binary questions, like, “Is there free fluid in the abdomen?” ” However, when we combine POCUS images with clinical documentation, we are telling a story — and every good story has a beginning, middle, and end.

Ultrasounds 54

Ultrasounds Documentation/Coding Radiology Radiology 54

EMDocs

AUGUST 8, 2023

Keys: Order the ultrasound in a patient with testicular pain, especially with any TWIST score >0. Minimal if any harm to patients by obtaining ultrasound. Even with a normal ultrasound, if the history/exam are concerning – call urology. Repeat ultrasound after manual detorsion to look for normal blood flow.

Ultrasounds 94

Ultrasounds Documentation/Coding Outcomes Emergency Department 94

EMDocs

FEBRUARY 12, 2025

Imaging: In severe cases, imaging with ultrasound, CT or MRI may be useful in assessing the extent of tissue injury and in further evaluating other etiologies including infection and worsening malignancy. Research indicates that timely intervention can significantly reduce morbidity associated with radiation skin injuries. 2022;23(3):e13526.

Best Practices 56

Best Practices Documentation/Coding Radiology Radiology 56

RebelEM

SEPTEMBER 11, 2023

Background: Point of care ultrasound (POCUS) has a demonstrated sensitivity of 89.8% Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. and specificity of 88.0% Article: Hilsden R, Mitrou N, Hawel J, Leeper R, Thompson D, Myslik F. Trauma Surg Acute Care Open.

Ultrasounds 68

Ultrasounds Radiology Radiology Emergency Department 68

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). It is most helpful to do the ultrasound immediately before needle insertion, as movement of the patient may shift cutaneous landmarks from underlying bony structures. WHY - Why Not? REFERENCES 1.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

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." On intravascular ultrasound (IVUS), the mid RCA plaque was described as "cratered, inflamed, and bulky," and the OM plaque was described as "bulky with evidence of inflammation and probably ulceration."

EKG/ECG 121

EKG/ECG Burns Urgent Care Documentation/Coding 121

Don't Forget the Bubbles

NOVEMBER 20, 2023

Document the size, consistency and location in the notes to compare if they represent. These may require surgical drainage following confirmation on ultrasound scan. They may grow again with subsequent upper respiratory tract infections. Difficulty swallowing, stridor or altered voice should prompt urgent ENT assessment.

Pediatrics 124

Pediatrics Documentation/Coding Emergency Department Ultrasounds 124

Dr. Smith's ECG Blog

JUNE 17, 2024

Cardiac Ultrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism. Now another, with ultrasound. Submitted by a Med Student, with Great Commentary on Bias! Chest pain, SOB, Precordial T-wave inversions, and positive troponin. What is the Diagnosis? This is a quiz. The ECG is nearly pathognomonic.

EKG/ECG 139

EKG/ECG Emergency Department Shock Ultrasounds 139

RebelEM

JANUARY 29, 2024

Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. A prospective, Single-Arm Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. CHEST 2010.

Stroke 136

Stroke Outcomes Hospitals Administration 136

Dr. Smith's ECG Blog

MAY 13, 2024

The Queen of Hearts read this ECG as OMI – Low Confidence Click here to sign up for QoH Access The providers taking care of this patient were concerned regarding his clinical history and initial ECG, so they next performed a bedside cardiac ultrasound. Speckle Tracking Echocardiography may provide another useful adjunct.

EKG/ECG 120

EKG/ECG Emergency Department Ultrasounds Documentation/Coding 120

Sensible Medicine

JULY 24, 2023

But there had been two placebo-controlled drug trials that documented a 45-55 second increase in exercise time. Using an echocardiogram (ultrasound), they found that muscle downstream from the stented vessel looked a lot better in the treatment arm vs placebo. You might wonder how they came up with 200 patients?

Academics 98

Academics Documentation/Coding Ultrasounds Wellness 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

Northwestern EM Blog

MAY 16, 2022

What is your initial imaging test of choice, ultrasound (US) or non-contrast CT, and why? Would you be confident in a point-of-care-ultrasound evaluation or a formal ultrasound? Many patients in the ultrasound groups did get additional imaging, but this was not the majority. How do you proceed? In this study, 40.7%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Taming the SRU

JUNE 3, 2024

glenn, haffner, and jackson In Flight Emergencies: As a responding physician to an in-flight emergency, you may recommend diverting the plane, however, the captain (lead pilot) will make the final decision.

Shock 91

Shock Seizures Airway Management Stroke 91

Taming the SRU

AUGUST 4, 2024

In select patient populations (such as those with poor outpatient follow-up), screening with a BMP to evaluate their serum creatinine may be beneficial Patients with asymptomatic hypertension should be referred to their PCP for outpatient follow-up.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

ACEP Now

JUNE 6, 2023

A medical student reports a murmur, not documented by either the emergency physician or the cardiologist. POCUS: Point-of-care ultrasound for AD is highly specific, but operator-dependent, and lacking in sensitivity—although late–model units can have sensitivity as high as 80-85 percent. Then what? He denies back pain.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

Emergency Medicine Ireland

DECEMBER 17, 2020

There is a substantial ANZICS document on tracheostomy that forms the structure for this tasty morsel. I suppose this is somewhat similar to ultrasound for CVCs as plenty of people seem to cope perfectly well without it * no good data to guide a solid recommendation as yet.

Ultrasounds 40

Ultrasounds Documentation/Coding Wellness 40

Dr. Smith's ECG Blog

OCTOBER 18, 2023

A majority (62.5%) of those presenting with ‘normal’ ECGs had the cath lab activated without any ECG being labeled ‘STEMI’ by automated interpretation – based on signs of Occlusion MI including ECG changes, regional wall motion abnormality on bedside ultrasound, or refractory ischemia.

EKG/ECG 119

EKG/ECG Documentation/Coding Emergency Department Outcomes 119

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Pads were placed with ultrasound guidance, so they were in the correct position. As I discussed and documented in Lesson 1 of My Comment at the bottom of the page in the April 2, 2022 post of Dr. Smith's ECG Blog — certain patients may remain in sustained VT not only for hours — but even for days! However, this is not SVT.

EKG/ECG 139

EKG/ECG Shock Academics Documentation/Coding 139

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. first appeared on The Skeptics Guide to Emergency Medicine.

Documentation/Coding 40

Documentation/Coding Operations Academics Ultrasounds 40

Dr. Smith's ECG Blog

JULY 21, 2024

In both tracings — an exceedingly fast PMVT is documented. Another approach is sympathetic chain (stellate ganglion) blockade if you have the skills to do it: it requires some expertise and ultrasound guidance. That said — there is no evidence on ECG of re-occlusion of the infarct artery.

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

Dr. Smith's ECG Blog

AUGUST 9, 2024

He had no previously documented medical problems except polysubstance use. However the patient continued to have chest pain and bedside ultrasound showed hypokinesis of the septum with significantly reduced LVEF. He reported a history of “Wolf-Parkinson-White” and “heart attack” but said neither had been treated.

EKG/ECG 107

EKG/ECG EMS Emergency Department Wellness 107

Taming the SRU

MAY 30, 2023

Generally accepted (and some airlines spell it out) that they are assuming the liability even for you helping Documentation: To protect yourself (and the airline), will/should make documentation of what happened. hours earlier and went to OR 3.5 hours earlier and went to OR 3.5 Each airline generally has their own protocol.

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52

Dr. Smith's ECG Blog

JUNE 14, 2017

A bedside cardiac ultrasound was normal. I’ve attached an article and an abstract (that article is in Japanese unfortunately … ) that do document that you CAN however on occasion find AIVR in otherwise healthy children — and I suppose that IS what we have here. His chest was tender. He wrote: "ECG 1 - shows wide ???IVCD

EKG/ECG 52

EKG/ECG Documentation/Coding Ultrasounds Wellness 52

Dr. Smith's ECG Blog

OCTOBER 2, 2021

After rethinking the case, he remained concerned about ACS and subsequently performed a point-of-care ultrasound in order to evaluate for regional wall motion abnormality. We assume that at some point the patient's pain returned, but it is not documented, so exactly when this happened is uncertain.

EKG/ECG 52

EKG/ECG Ultrasounds EMS Documentation/Coding 52

Resus Review

FEBRUARY 12, 2015

Use ultrasound to identify an large vessels in the area. Dont forget to document your perc trach procedure well. Skin Incision The neck should be carefully palpated and the anatomy should identified (thyroid cartilage, cricoid cartilage, and 2-3 tracheal rings). Consider labelling the landmarks with a permanent marker.

Operations 52

Operations Documentation/Coding Ultrasounds Wellness 52

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

Fortunately, this operator used intravascular ultrasound (IVUS). The operator documented thoughtful consideration of risks and benefits of stent placement. An angiogram is a " lumenogram " and does not "see" the extraluminal plaque. Most plaque is outside the lumen!! And so other modalities may be necessary.

EKG/ECG 66

EKG/ECG Operations Wellness Ultrasounds 66

The Skeptics' Guide to EM

MARCH 4, 2018

With point of care ultrasound, you diagnose cellulitis without the presence of an abscess affecting a 6cm diameter area. Exclusions: There were 26 exclusions in their supplemental documentation.

Infectious Diseases 40

Infectious Diseases Documentation/Coding Ultrasounds Outcomes 40

EMDocs

JANUARY 11, 2024

These conversations should occur frequently and be clearly documented for other health care professionals who are not present during the conversations (96%, 22/23). In ICUs where noninvasive monitoring of cerebral autoregulation is in routine use, maintain MAP at or near the predicted MAPOPT (88.2%, 15/17).

Seizures 97

Seizures Shock Infectious Diseases CPR 97

PulmCCM

OCTOBER 16, 2023

Most central lines in the ICU are placed under ultrasound guidance in the internal jugular vein, representing a perceived middle ground of risk for pneumothorax and infection prevention. Peripherally-inserted central catheters (PICCs) are inserted through the skin into an arm vein, and advanced under ultrasound into large central veins.

CDC 52

CDC Hospitals Ultrasounds Documentation/Coding 52

Mind The Bleep

FEBRUARY 29, 2024

It is worth looking through previous documentation to see whether the patient’s team or senior intensivists have set any individual cardiovascular targets. Assessing a patient’s cardiovascular status and whether we need to manipulate any aspects of it is disease process-specific and patient-specific.

Documentation/Coding 52

Documentation/Coding Hospitals Wellness Best Practices 52

Dr. Smith's ECG Blog

JUNE 27, 2021

A bedside ultrasound was done, with dozens of clips, and was even done with Speckle Tracking. There was no cough or fever, the CXR looks like pulmonary edema, the ultrasound showed classic pulmonary edema B lines. Differential favors aspiration/developing pneumonia and follow to resolution recommended." Here are a few clips.

EKG/ECG 40

EKG/ECG Radiology Radiology Ultrasounds 40

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: Diagnosis of appendicitis, in a pregnant patient, ultrasound vs. mri. Jeff: Next we have everybody’s favorite, the ultrasound. Jeff: Indeed. Sounds familiar.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

On arrival, the patient was in shock, was intubated, and had an immediate cardiac ultrasound. What does a heart look like on ultrasound when the EKG looks like that? Here you go: It's not the world's greatest cardiac ultrasound video, but it does appear to show poor function and low volume. They transported to the ED.

Shock 40

Shock EKG/ECG Resuscitation Ultrasounds 40

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Advances in Medical Imaging (CT, MRI, and Ultrasound) facilitating rapid, accurate, diagnosis affording new potential to save additional lives. EM makes a strong push into bedside use of ultrasound sonography. Emergency Ultrasound is one of the greatest advances in emergency care. EMS in America: The Foundation Documents.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole. This patient was reported to have distant heart sounds but was not hypotensive and did not have JVD according to documentation.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40