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 86

Stroke Airway Management Documentation/Coding Outcomes 86

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

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 EMS 98

RebelEM

JANUARY 29, 2024

appeared first on REBEL EM - Emergency Medicine Blog. 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

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

ACEP Now

JANUARY 30, 2024

Be Prepared for All Pediatric Challenges Whether you want to brush up on your pediatric EM skills or take your dual-boarded training to the next level, the Advanced Pediatric EM Assembly helps you be prepared for any pediatric patient you may treat. Learn more at acep.org/accelerate. Discover more at acep.org/MOC.

Pediatrics 52

Pediatrics EMS Documentation/Coding Stroke 52

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. EMS is called and finds his blood pressure 175/100. Then what? He denies back pain.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

Taming the SRU

AUGUST 4, 2024

Know your audience, and tailor your presentation to them in terms of humor, pop culture references, and dress code Err on the side of making your presentation slightly shorter than the alloted time to allow room for questions. It is better to finish early than rushing through your presentation

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Her husband called EMS when the patient experienced new onset seizures accompanied by micturition. The ECG below was recorded by EMS. I therefore feel it relevant to document ( in your dictation/on the medical chart ) when significant artifact potentially impairs the accuracy of your interpretation. What is your assessment?

Seizures 114

Seizures EKG/ECG EMS Stroke 114

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. Also, don’t forget to like and subscribe!

Documentation/Coding 58

Documentation/Coding Outcomes EMS Stroke 58

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. Rezaie, MD (Twitter: @srrezaie ) The post The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults appeared first on REBEL EM - Emergency Medicine Blog.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

The Skeptics' Guide to EM

DECEMBER 5, 2020

She is the New York ACEP liaison for the Research and Education Committee and is a past ALL NYC EM Resident Education Fellow. 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. How hard can it be?”

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

All Ohio EM

FEBRUARY 11, 2019

Dr. Mike Pallaci covered endovascular therapy for stroke with a quick review of some very relevant studies that put endovascular therapy on the map. Based on data from MR CLEAN, merely 1/110 screened strokes would meet inclusion criteria. 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

Taming the SRU

JULY 31, 2024

However, believers in this superstition will perceive crazier shifts if the word is uttered so you probably shouldn’t say it, or use cautiously Full moons have no impact on ED, EMS, or HEMS volumes or acuity. Nice people are not more likely to get cancer. Black clouds don’t exist (but I still sort of think they do).

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

ACEP Now

JULY 6, 2023

Emergency medicine (EM) has evolved over time and has long passed a crossroads where previously unachievable capabilities should be celebrated and shared. Brian Zink captured a wonderful initial vision statement for our specialty with the title of his book, “Anyone, Anything, Anytime,” which documented the history of our specialty.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 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

Northwestern EM Blog

MAY 16, 2022

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

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

EMDocs

JULY 3, 2023

Authors: Mikalah Ward, MD (EM Resident Physician, University of Kentucky); Susan Owens, MD (EM Attending Physician, University of Kentucky) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. Stroke 2020;51:1326-1332 Connolly ES Jr., Rabinstein AA, Carhuapoma JR,  2012;43:1711––1737.

Seizures 98

Seizures Stroke Outcomes EMS 98

EB Medicine

AUGUST 1, 2018

Nachi: Sometimes… Jeff: This month’s issue was authored by Mollie Williams, who is the EM residency program director at the Brooklyn Hospital Center. 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.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

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. Syncope and cause of death were identified by codes from the International Classification of Disease, Ninth Revision. to 1.45) for fatal or nonfatal stroke. to 3.80).

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EM Literature of Note

JANUARY 9, 2025

This is yet another one of those “Get With The Guidelines” stroke analyses, a retrospective dredge with massive imbalances between groups followed by statistical adjustments capable of turning out whichever result suits an author list with a full, dense printed page of pharma and stroke technology conflicts of interest.

Stroke 86

Stroke Documentation/Coding EMS Administration 86

Taming the SRU

JUNE 6, 2023

mg/kg of IBW Seek to match a patient's minute ventilation with TV and RR after intubation Intentionally match patient's intrinsic RR noted prior to intubation Note that healthy lungs can handle 8 mL/kg, based on IBW, if that is useful for compensation Secure your ETT Thomas Tube Holder is a new ETT holder on Air Care for ETT down to size 6.5

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

EMDocs

JANUARY 29, 2025

An attorney is consulted and the records referred to an EM expert for review. My MDM shows that I considered the possibility of an aneurysm, meningitis, hemorrhage, stroke, and temporal arteritis. Takeaways: Documentation of rational MDM prevents lawsuits. Good doctors document good MDM. No lawsuit was filed.

Documentation/Coding 74

Documentation/Coding Patient Safety Stroke EMS 74

EMDocs

FEBRUARY 18, 2025

Authors: Lloyd Tannenbaum, MD (EM Attending Physician, Geisinger Wyoming Valley, PA) // Reviewer: Brit Long, MD (@long_brit) Hello and welcome back to ECG Pointers, a series designed to make you more confident in your ECG interpretations. Did you guys forget theres a patient coding? Please check it out. Hey, wait a sec!

EKG/ECG 63

EKG/ECG Documentation/Coding Wellness CPR 63

EB Medicine

DECEMBER 1, 2018

Antigen drift refers to small point mutations to the viral genes that code for H and N. Jeff: Of note, EMS providers should use face masks themselves and place them on patients as well. There are actually 16 different H subtypes and 9 different N subtypes, but only H1, H2, H3, and N1 and N2 have caused epidemic disease.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 40

EMDocs

JANUARY 6, 2025

4,5 Of particular concern is the Sudanese conflict, which began in April 2023, and which has caused the largest internal displacement of a population in documented history. About three-quarters of the countries in sub-Saharan Africa serve as origin or destination points for refugees.

Infectious Diseases 72

Infectious Diseases CDC PPE Rapid Diagnostic Testing 72