Dr. Smith's ECG Blog

OCTOBER 12, 2024

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. Vital signs were within normal limits on arrival to the Emergency Department. Written by Bobby Nicholson What do you think of this “STEMI”? Blood glucose was not low at 162 mg/dL.

EKG/ECG 98

EKG/ECG Documentation/Coding Emergency Department COPD 98

Taming the SRU

AUGUST 4, 2024

to teach you and your learner something new on shift skin adhesives WITH dr. hill Dermabond is a polymer (octyl cyanoacrylate) that can be used to repair lacerations in the Emergency Department faster than sutures, allowing the ED physician to be more efficient. It is better to finish early than rushing through your presentation

Emergency Department 84

Emergency Department Dislocations Documentation/Coding Burns 84

RebelEM

MARCH 13, 2024

This was not a Code 3 respiratory distress, fentanyl overdose with minimal response to Narcan or even an unconscious stroke patient with the blood pressure of a giraffe. The patient came in working hard to breath, had minimal improvement after meds and treatments and was clearly tiring.

Documentation/Coding 59

Documentation/Coding Outcomes EMS Stroke 59

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

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. If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergency department pharmacist.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

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

The Skeptics' Guide to EM

DECEMBER 5, 2020

Case: A 50-year-old female presents to your community emergency department in the middle of the night with new-onset constant but mild vertigo and nausea. 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.

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

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

EB Medicine

DECEMBER 1, 2018

Antigen drift refers to small point mutations to the viral genes that code for H and N. When cells are infected by 2 or more strains, a new strain can emerge after genetic reassortment. In the emergency department, standard isolation and droplet precautions should be maintained for suspected or confirmed infections.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 40

Don't Forget the Bubbles

JULY 5, 2023

The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke. A 6-year-old girl from Saudi Arabia was referred by her General Practitioner to the local emergency department. How is sickle cell disease diagnosed?

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EB Medicine

MAY 3, 2019

This month, we’re moving into uncharted territories for the podcast… we’re talking psychiatry Nachi: Specifically, we’ll be discussing Depressed and Suicidal Patients in the emergency department. Routine serum testing and urine toxicology testing are not recommended for psychiatric patients presenting to the emergency department.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

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 94

Sepsis Documentation/Coding Administration Fractures 94

ACEP Now

JULY 6, 2023

Emergency physicians have earned the right to “re-brand” ourselves as indispensable, money-saving change agents in the health care enterprise. Of course, the bill for any episode of emergency department (ED) care can be substantial, exceeding the billed charges for equivalent care provided in some primary care offices.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 52

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). The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). WHO - Who Needs an LP in the ED?

Infectious Diseases 96

Infectious Diseases Seizures Ultrasounds Sepsis 96

All Ohio EM

FEBRUARY 11, 2019

It’s still going to take a while for this product to make its way to all emergency departments. Dr. Mike Pallaci covered endovascular therapy for stroke with a quick review of some very relevant studies that put endovascular therapy on the map. Even once it arrives, it will cost upwards of $25k per dose! Image from R.E.B.E.L

EMS 52

EMS Stroke Leadership Documentation/Coding 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

She presented to the emergency department after a couple of days of chest discomfort. Slow VT below the detection rate of the ICD lead to worsening heart failure and low stroke volume. She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. The ECG below was recorded.

EKG/ECG 99

EKG/ECG Stroke Hospitals Documentation/Coding 99

Northwestern EM Blog

MAY 16, 2022

1 Low-dose non-contrast abdominal CT has become the gold standard for diagnosis as it has become readily available in emergency departments nationwide, with some studies touting sensitivity and specificity of 97% and 95%, respectively.2 Please ensure that you document and discuss with the patient accordingly. References Fwu, C.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Pediatric Emergency Playbook

APRIL 1, 2016

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. used BNP in the emergency department to differentiate heart failure from respiratory causes in infants and children with heart failure and those with no past medical history. Cohen et al. Later, Maher et al. Am J Cardiol.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Taming the SRU

JUNE 6, 2023

million presentation to ED’s throughout the US Usually occur due to falls Also commonly occur due to sports, MVC’s, etc.

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. J Stroke Cerebrovasc Dis.

Seizures 85

Seizures Stroke Outcomes EMS 85

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. The ROSE (Risk Stratification of syncope in the emergency department) Study. g/dL —Hypotension (obviously!) J Am Coll Cardiol, 2010; 55:713-721, doi:10.1016/j.jacc.2009.09.049

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52