University of Maryland Department of Emergency Med

NOVEMBER 2, 2023

BACKGROUND: Prehospital (EMS) clinicians are positioned on the front lines of health care. With respect to stroke identification and treatment, ea. Click to view the rest

Stroke 64

Stroke Documentation/Coding EMS 64

Emergency Medicine Cases

JULY 31, 2018

In anticipation of EM Cases Episode 113 Diagnosis an Workup of Pulmonary Embolism with Dr. Kerstin DeWit and Dr. Eddy Lang, we have Dr. Peter Reardon telling us his Best Case Ever (Coding in the Scanner) of a young woman who presents with a seizure followed by hemodynamic instability, who codes while in the CT scanner.

Documentation/Coding 52

Documentation/Coding Seizures EMS Resuscitation 52

RebelEM

JUNE 29, 2023

Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? REBEL EM Blog, June 1, 2023. Back on June 1st, 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? Below you will find some of the points we discussed.

CPR 144

CPR EMS Documentation/Coding Outcomes 144

Emergency Medicine Cases

JUNE 7, 2022

In this part 2 of our 2-part podcast series on Cardiac Arrest - The When, Why & How, we discuss some of the finer art of cardiac arrest care and answer questions such as: how should we best communicate to EMS, the ED team and the family of the patient to keep the team focused, garner the most important info and keep the flow of the code going?

Documentation/Coding 52

Documentation/Coding CPR Resuscitation EMS 52

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Written by Pendell Meyers A man in his 40s called EMS for acute chest pain that awoke him from sleep, along with nausea and shortness of breath. For clarity in Figure-1 — I've labeled the 2 EMS ECGs and the baseline ECG recorded ~1 month earlier. Vitals were within normal limits except for tachypnea.

EKG/ECG 122

EKG/ECG EMS Documentation/Coding Shock 122

Emergency Medicine Cases

AUGUST 28, 2017

In anticipation of EM Cases Main Episode 100 on Disaster Medicine with Laurie Mazurik, David Kollek and Joshua Bezanson, Dr. Mazurik tells of her experience as a disaster medicine leader with keeping health care workers safe during the SARS era.

Documentation/Coding 52

Documentation/Coding EMS 52

EMDocs

JUNE 13, 2024

We just don’t document it. If we don’t use printed instructions, document our verbal instructions regarding the most common side effects of the drug(s) being prescribed. Documenting our warnings should be standard care. State regulations and codes may place that responsibility on our shoulders. EM, April 2011.

Documentation/Coding 95

Documentation/Coding Patient Safety Emergency Department Hospitals 95

Dr. Smith's ECG Blog

JUNE 7, 2024

Now let’s look at the actual sequence, with the addition of clinical context, and see how the patient was managed: The patient received aspirin from EMS and arrived at triage painfree (ECG #1). The discharge diagnosis was STEMI based on the STEMI positive ECG and code STEMI activation, with culprit lesion on angiography.

EKG/ECG 113

EKG/ECG Documentation/Coding EMS Outcomes 113

PDC Healthcare

MAY 1, 2023

But in mass-casualty incidents and large-scale hazards, chaotic scenes […] The post PDC Partners with Pulsara to Streamline Communication Between EMS, Hospital Personnel, and Emergency Management appeared first on connectID - PDC Healthcare Blog.

Mass Casualty Incidents 98

Mass Casualty Incidents EMS Hospitals Documentation/Coding 98

EMDocs

OCTOBER 3, 2023

This is also where keeping up with documentation starts to slip. You’ll need to put the following tasks in a rank order list: new patient evaluations, dispositions, managing critical or potentially critical patients, results review, team huddle, running the board, calling consults, doing procedures, and documentation. It’s up to you.

Documentation/Coding 117

Documentation/Coding EMS Operations Emergency Department 117

The Skeptics' Guide to EM

APRIL 13, 2024

Case: A 70-year-old woman was brought into the emergency department by EMS after her family reported she was having trouble talking. A code stroke is activated, and the initial CT head shows no signs of hemorrhage or early ischemic changes. A CT angiogram shows a proximal middle cerebral artery occlusion.

Stroke 134

Stroke Documentation/Coding Emergency Department EMS 134

RebelEM

NOVEMBER 6, 2024

PMID: 31082090 Post Peer Reviewed By: Anand Swaminathan MD, MPH (Insta @EMSwami) The post Elbow Dislocations appeared first on REBEL EM - Emergency Medicine Blog. Treasure Island (FL): StatPearls Publishing; 2024 Jan–.

Dislocations 107

Dislocations Fractures Soft Tissue Injuries Outcomes 107

EMDocs

JUNE 9, 2023

After listening to this episode you will be able to: Identify unique aspects of the pre-hospital environment that impact assessment and treatment of agitated children Describe the role of EMS personnel and EMS director in the care of agitated children. That includes the patient, EMS personnel, and general public.

EMS 95

EMS Documentation/Coding Pediatrics Psychiatric 95

EMDocs

MAY 9, 2024

Exam documents that he is alert and oriented but “tired appearing” and “not appearing post-ictal.” Defense : The EP did address the seizure when he documented “not post-ictal.” There is no negligence, as the documentation supports reasonable judgment. EM is a “team sport.” VS are normal with a temp of 97.3.

Seizures 101

Seizures Dehydration Documentation/Coding Infectious Diseases 101

EMDocs

JUNE 28, 2023

And listen to your EMS providers and nurses. EMS is called, and he is brought to the ED for a reported “slip and fall” with associated facial abrasions. EMS is called, and he is brought to the ED for a reported “slip and fall” with associated facial abrasions. Nursing documentation includes the presence of a facial droop.

Documentation/Coding 87

Documentation/Coding EMS Stroke Patient Safety 87

Emergency Medicine Cases

MARCH 26, 2020

We touch on PPE conservation strategies as we struggle with supplies, give you the bottom line on donning/doffing sequencing, and discuss the core principles of the protected code blue. The post Ep 139 COVID-19 Part 3 – PPE: What We Know, Conservation Strategies and Protected Code Blue appeared first on Emergency Medicine Cases.

PPE 52

PPE Documentation/Coding Resuscitation Wellness 52

Dr. Smith's ECG Blog

JUNE 13, 2024

Her first set of vitals were documented: BP 116/57 Pulse 94bpm Respiratory rate 24/min O2 sat 90% on room air Temp 97F She had been cleaning a Jeep in the sun, and was sunburned. 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

Dr. Smith's ECG Blog

JANUARY 2, 2025

Dodd KW, Elm KD, Dodd EM, Smith SW. In the middle of the night, a "code" was called, and multiple rhythms like this were recorded. New formula for evaluation of the QT interval in patients with left bundle branch block. Heart Rhythm [Internet]. 2014;11:22732277. Available from: [link] 2. 2017;236:14. LBBB, ventricular pacing, etc.)."

EKG/ECG 117

EKG/ECG Sepsis Wellness Documentation/Coding 117

EM Ottawa

DECEMBER 28, 2023

There is a well-documented correlation amongst EMS and adult ED physicians who provide less pediatric care to […] The post Pediatric Traumatic Cardiac Arrest appeared first on EMOttawa Blog. Pediatric trauma is a high acuity but low frequency event (2).

Pediatrics 83

Pediatrics Documentation/Coding EMS Wellness 83

The Skeptics' Guide to EM

JANUARY 25, 2025

Jestin Carlson is the Program Director for the AHN-Saint Vincent EM Residency in Erie Pennsylvania. Dr. Richard Bukata We have had the pleasure of both working for the Legend of EM, Dr. Richard Bukata.He P-hacking is not exclusive to AUC but is a well-documented problem in broader research, particularly surrounding the 0.05

Research 48

Research EMS Documentation/Coding Operations 48

Pediatric EM Morsels

JULY 28, 2023

A critical MORSEL is that every child you treat for DKA needs to have an initial thorough neuro exam including cranial nerves and then frequent neuro reassessments … and document it ( so your colleagues who take over care for the kid can know if there has been a change )! Pediatr Diabetes. 2022; 23( 7): 835- 856. doi: 10.1111/pedi.13406

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

EMDocs

SEPTEMBER 19, 2023

Episode 86: Tricky Cases Part 2 Case 3: 56-year-old female with history of seizures, actively seizing, EMS called. Patient seized for approximately 20 minutes prior to EMS arrival. This document covers high sensitivity troponin, risk disposition pathways, and STEMI equivalents. They administer two doses of 10 mg midazolam IM.

Seizures 90

Seizures Documentation/Coding EKG/ECG Emergency Department 90

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.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation Pediatrics 98

EMDocs

SEPTEMBER 26, 2024

An unknown EP reviews the report, determines that there is no reason to notify the patient, and documents nothing. An attorney is consulted and a lawsuit filed against the hospital, the first ED physician, the EM group, and the PCP. It wasn’t, so you weren’t called, nor did the doc need to document anything.

Radiology 93

Radiology Radiology EKG/ECG Documentation/Coding 93

American Medical Compliance

FEBRUARY 15, 2023

The EMS Fraud Waste and Abuse Training course is designed to combat fraud, waste, and abuse in the workplace. The EMS Fraud Waste and Abuse Training is designed to educate EMS workers on how to prevent, detect, and report fraud, waste, and abuse in the healthcare setting. Documentation of this distribution is required.

EMS 52

EMS Administration Documentation/Coding Operations 52

ACEP Now

JANUARY 4, 2025

The specialty, he said, spoke to his interest in surgery and EMS in a way that family medicine did not. A closer look, though, also shows the technology of the daya bulky, two-way radio for communicating with EMS, metal gurneys, glass saline bottles, and portable ECG monitors the size of a small shopping cart.

Forensics 52

Forensics Urgent Care Hospitals Emergency Department 52

EMDocs

OCTOBER 11, 2023

.” The tech cleans the wound and documents it as 2cm long and “ dirty.” The ED physician documents suturing a 3 cm laceration in a single layer, omitting any reference to any wound exploration, cleansing or debridement. I thought they were incidental “ bone islands” so I didn ’ t document them. Negligence was present.

Documentation/Coding 84

Documentation/Coding Radiology Radiology Patient Safety 84

EM Ottawa

SEPTEMBER 28, 2023

You are treating a 43-year-old male with two days of left lower quadrant abdominal pain, a documented fever of 38.4 and malaise. He has no urinary or bowel symptoms. His past medical history is unremarkable. He looks well by ED standards. After a focused history and physical examination, you narrow the differential to diverticulitis.

Documentation/Coding 115

Documentation/Coding Wellness Infectious Diseases EMS 115

EMDocs

AUGUST 22, 2024

13 Interventions may include: Ascertaining a patient’s preferred language early in the clinical encounter (during registration, for instance), and clearly documenting this preference in a place that is visible to all providers. Utilizing certified interpreters and documenting their use. Educating patients on their rights.

Documentation/Coding 100

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 100

Dr. Smith's ECG Blog

APRIL 18, 2024

Emergent cath lab activation is also named after this test (code STEMI), so patients whose ECGs don’t meet STEMI criteria don’t get emergent angiograms, despite guidelines. And because there was no Code STEMI, the discharge diagnosis was “non-STEMI”, so this case will not be flagged as an opportunity for improvement. But only 6.4%

EKG/ECG 122

EKG/ECG Documentation/Coding Fractures Emergency Department 122

Dr. Smith's ECG Blog

OCTOBER 23, 2023

Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return of spontaneous circulation. Macroscopic T-Wave Alternans: A Red Flag for Code Blue. J Am Coll Cardiol. 2006 Jan 17;47(2):269-81.

EKG/ECG 132

EKG/ECG Documentation/Coding Psychiatric EMS 132

The Skeptics' Guide to EM

AUGUST 10, 2024

Case: A 65-year-old man is brought into the emergency department (ED) by emergency medical services (EMS) after his family saw him slump over at the dinner table. A code stroke is activated, and a CT head shows a left basal ganglia hemorrhage with no vascular lesions on CT angiography.

Stroke 86

Stroke Airway Management Documentation/Coding Outcomes 86

EMDocs

APRIL 18, 2024

The admitting nurse documents an “OTJ injury” with a chief complaint of “My boss made me come.” Reference : EM@3AM: High-Pressure Injection Injury High-Pressure Injection Injuries. The employee is surprised when his boss tells him “Get to the E.R! Right now!” He arrives in the ED of his small community hospital about 30 minutes later.

Patient Safety 104

Patient Safety Hospitals Documentation/Coding EMS 104

Emergency Medicine Cases

MAY 23, 2017

This is the first ever video podcast on EM Cases with Jordan Chenkin from EMU Conference 2017 discussing how to optimize three aspects of cardiac arrest care: persistent ventricular fibrillation, optimizing pulse checks and PEA arrest, with code team videos contrasting the ACLS approach to an optimized approach.

Documentation/Coding 52

Documentation/Coding EMS Ultrasounds Resuscitation 52

Emergency Medicine Journal

MARCH 21, 2024

Background In 2019, the emergency medical services (EMS) covering the western Norway Regional Health Authority area implemented its version of the prehospital clinical criteria G-FAST (Gaze deviation, Facial palsy, Arm weakness, Visual loss, Speech disturbance) to detect acute ischaemic stroke (AIS) with large vessel occlusion (LVO).

Stroke 52

Stroke Documentation/Coding EMS Hospitals 52

EMergucate

MAY 25, 2016

Information Systems (Computerised Vs Manual) Manual systems Pros Cheap Easy Convenient Cons Failed documentation – notes, timing, summaries, legibility Difficult … Continue reading →

Emergency Department 40

Emergency Department EMS Documentation/Coding 40

Dr. Smith's ECG Blog

OCTOBER 12, 2024

With EMS, patient had a GCS of 3 and was saturating 60% on room air. He improved to 100% with the addition of non-rebreather, however remained altered and was intubated by EMS with ketamine and succinylcholine. Preliminary findings documented in the cath lab were “Anterior STEMI and no significant coronary artery disease.” (!!!)

EKG/ECG 117

EKG/ECG Documentation/Coding Emergency Department COPD 117