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 92

EKG/ECG Documentation/Coding EMS Burns 92

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. Reversal of Warfarin: Freeman et al.

Stroke 89

Stroke Airway Management Documentation/Coding Outcomes 89

ACEP Now

OCTOBER 3, 2023

This document is an update of guidelines first published in 2000, and then updated in 2007. These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

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 102

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 102

EMDocs

SEPTEMBER 26, 2024

This story, while unlikely to reflect the standards of most readers, has a somewhat surprising outcome. 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.

Radiology 95

Radiology Radiology EKG/ECG Documentation/Coding 95

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 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 133

Stroke Outcomes Hospitals Administration 133

RebelEM

NOVEMBER 30, 2023

Outcomes: Primary Outcome: In-hospital mortality. Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. There was no specified time-frame for the primary outcome, potentially affecting the precision of the findings. Mayo Clin Proc Innov Qual Outcomes. 2.89, p = 0.01.

Sepsis 118

Sepsis Fluid Resuscitation Resuscitation Administration 118

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. Outcomes: Primary Outcome: Visual Acuity (VA) Improvement Measured using logarithm of the minimum angle of resolution (logMAR). Within 24 hours after treatment. 1 week after treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

RebelEM

JULY 3, 2023

Pregnant or incarcerated patients Documentation for systolic BP is incomplete Intervention: Administration of IV calcium within 60 min prior to or 30 min after IV diltiazem administration in patients with AF/AFL with RVR. Limitations: The primary and secondary outcomes were nearly all disease oriented and not patient oriented.

Administration 91

Administration Outcomes Documentation/Coding Emergency Department 91

Taming the SRU

MAY 11, 2024

r1 clinical knowledge - r4 capstone - research grand rounds - the art of em - Community corner - PEM Lecture r1 Clinical knowledge: transplant complications WITH dr. gabor Time-sensitive peri-transplant emergencies: Bleeding fistula- stop the bleed. Flood syndrome- start fluids, give antibiotics, consult surgery.

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

Don't Forget the Bubbles

JUNE 19, 2024

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? Were the predictor variables and the outcome evaluated in the initial sample?

CPR 124

CPR Research Outcomes Documentation/Coding 124

Taming the SRU

DECEMBER 8, 2023

EMS had reported she had coded en route. ED providers should be familiar with several extraction techniques for foreign bodies in the external auditory canal including the use of manual extractors, irrigation, and other methods such as adhesives and acetone. She regained pulses with warming on arrival.

Hyperthermia / Hypothermia 88

Hyperthermia / Hypothermia Head Injuries Resuscitation Documentation/Coding 88

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

The Skeptics' Guide to EM

MAY 8, 2021

He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR […] The post SGEM#329: Will Corticosteroids Help if…I Will Survive a Cardiac Arrest? He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR Safety Team. first appeared on The Skeptics Guide to Emergency Medicine.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

Dr. Smith's ECG Blog

AUGUST 9, 2024

He had no previously documented medical problems except polysubstance use. About 2 hours later the patient arrived at a PCI-capable center and repeat ECG was obtained: The transferring EMS crew noted “runs of VT” during transport. FINAL Point: During transport to the PCI center — the EMS crew noted, "runs of VT". Washam, J.

EKG/ECG 107

EKG/ECG EMS Emergency Department Outcomes 107

ACEP Now

OCTOBER 30, 2023

One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. This makes documentation and communication of the utmost importance for these patients for their health and safety. EM Resident. J Emerg Med.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

RebelEM

AUGUST 12, 2024

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

Outcomes 81

Outcomes Hospitals Operations Shock 81

The Skeptics' Guide to EM

MAY 2, 2020

A Contemporary Analysis Using National EMS Information System (NEMSIS) Data. A Contemporary Analysis Using National EMS Information System (NEMSIS) Data. The EMS crew arrives and performs a 3 lead EKG that does not show an ST elevated myocardial infarction. Date: April 24th, 2020 Reference: Watanabe et al.

Documentation/Coding 40

Documentation/Coding EMS EKG/ECG Outcomes 40

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. How does “resulting” or the tendency to equate a decision’s quality with its outcome affect learning in and after residency? How would the hemodynamics respond to RSI?

Documentation/Coding 58

Documentation/Coding Outcomes EMS Stroke 58

The Skeptics' Guide to EM

JULY 30, 2022

Somewhat surprisingly, we’ve never covered SBO on the SGEM, although Ped EM Superhero, Dr Anthony Crocco shared his views on the (lack of) utility of abdominal X-rays in paediatric constipation back in 2016 ( SGEM Xtra: RANThony#4 ). Charles Brower is a second-year resident training in Emergency Medicine at the University of Cincinnati.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

PHEM Cast

DECEMBER 12, 2016

Emergency Department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. Joint Position Statement of Nat Assoc EMS Physicians and ACS Committee on Trauma. Emergency thoracotomy in thoracic trauma: a review. Injury; 2006 (37): 1-19. Clay et al. World Journal of Emergency Surgery; 2006: 1:4. Rhee et al.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

Emergency Medicine Journal

NOVEMBER 28, 2023

It can be challenging and time consuming to access the information required to reflect upon their clinical practice by reviewing the outcomes of their individual patients, referred to as patient follow-up. Patient outcomes are commonly documented in electronic health records (EHR). It was implemented in December 2020.

EMS 40

EMS Documentation/Coding Outcomes Hospitals 40

RebelEM

OCTOBER 5, 2023

Secondary Outcome By day 90, mortality was 9.3% Strengths: The investigators framed a research question centered on patient outcomes, ensuring the study’s relevance and practicality. Control: Normal Saline via continuous infusion according to the same regimen used in the hydrocortisone group. in the placebo group (p = 0.006).

Research 94

Research Outcomes Administration Shock 94

Dr. Smith's ECG Blog

JULY 7, 2024

Written by Jesse McLaren A previously healthy 60 year old developed exertional chest pain with diaphoresis, and called EMS. Here’s the EMS ECG, digitized with PM cardio. What do you think? There’s sinus arrhythmia with normal conduction, normal axis and normal voltages. There’s loss of R waves in V2-3 with hyperacute waves V1-5.

EKG/ECG 67

EKG/ECG Documentation/Coding EMS Wellness 67

RebelEM

MARCH 2, 2023

Essentially there was no difference, meaning we wouldn’t expect to find a difference in outcomes Although not patient oriented, why is there no breakdown of how many patients had cardiogenic shock, congestive heart failure, echocardiographic findings, or even troponin levels. appeared first on REBEL EM - Emergency Medicine Blog.

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 52

The Skeptics' Guide to EM

NOVEMBER 16, 2019

NEJM Oct 2019 Guest Skeptic: Dr. Laura Melville (@lmelville535) is an emergency physician in Brooklyn, New York, is a part of the New York ACEP Research Committee, ALL NYC EM, and is the NYP-Brooklyn Methodist Resident Research Director. Case: A 59-year-old woman comes is brought into your emergency department (ED) by EMS in cardiac arrest.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia EMS Research Documentation/Coding 40

The Skeptics' Guide to EM

FEBRUARY 23, 2019

The study by Alam et al took adult patients with a diagnosis of suspected infection and randomized them to ceftriaxone 2g IV started pre-hospital or usual care with a primary outcome of all-cause mortality at 28 days. The Surviving Sepsis Campaign makes a number of recommendations in their 2016 guideline.

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

EMDocs

JUNE 22, 2023

I have been a part of many traumatic codes and resuscitations during my training, but I knew this one would probably be my most difficult one. Early contact with Medcom ensured that they would be able to activate one of the most effective and competent air EMS teams in the state – AirCare. Should be here in 5 minutes.” She was calm.

Resuscitation 98

Resuscitation Ultrasounds Critical Access Radiology 98

Taming the SRU

OCTOBER 30, 2024

Despite adherence to strict ACLS protocols, neurologic outcomes remain poor.​ The VA-ECMO set-up is specifically used for eCPR​ Meta-analyses for eCPR have shown aggregate survival rates with good neurologic outcomes up to 21.3% Debrief codes and odd encounters for yourself, your team, and your hospital system. R2 CPC: WITH drs.

Hospitals 52

Hospitals Emergency Department EKG/ECG Documentation/Coding 52

All Ohio EM

FEBRUARY 11, 2019

The MR CLEAN trial showed improved functional outcome if endovascular therapy was initiated within 6 hrs. Finally, we are reminded of a Rebel EM post that gives an awesome break down of the literature surrounding endovascular therapy. Shout out to University of Cincinnati EM, who took home 1 st place in the sim competition.

EMS 52

EMS Stroke Leadership Documentation/Coding 52

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. This is a critical error that leads to poorer outcomes for patients in need of critical care. Unfortunately, its not clear whether the documentation came from RTs or ED providers.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

The Skeptics' Guide to EM

DECEMBER 2, 2017

Case: You are working a regular shift in the emergency department when you hear a code blue called. SGEM#64 : Classic EM Papers (OPALS Study) * SGEM#136 : CPR – Man or Machine? From a patient oriented outcome perspective, more than 80% of adults with IHCA who do survive end up having a favorable neurologic outcome at discharge.

Hospitals 40

Hospitals CPR Resuscitation Documentation/Coding 40

The Skeptics' Guide to EM

APRIL 24, 2021

On investigating you find a collection of nursing, EMS and hospital security personnel surrounding an obviously agitated patient with blood on his head who is attempting to punch them. 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

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. Would you be satisfied with only US and no follow-up CT?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

The Skeptics' Guide to EM

MARCH 4, 2018

He also hosts a great #FOAMed blog and podcast called TOTAL EM. Exclusions: There were 26 exclusions in their supplemental documentation. Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant (PA) working primarily in rural Missouri in community hospitals.

Infectious Diseases 40

Infectious Diseases Documentation/Coding Outcomes Ultrasounds 40

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. Difficult prehospital endotracheal intubation – predisposing factors in a physician based EMS. Tracheal intubation. 20(12);681-686.

Airway Management 40

Airway Management Resuscitation EMS Hospitals 40

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

It is well documented with continuous 12-lead monitoring that acute re-occlusion is frequently asymptomatic. It shows that on a 7 day angiogram, only 58% of re-occlusions were symptomatic: Ohman EM, Califf RM, Topol EJ et al. Silent ischemia as a marker for early unfavorable outcomes in patients with unstable angina.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Wellness 52