EMDocs

JUNE 28, 2023

EMS report includes concern for CVA, with variable documentation of face and extremity weakness. Nursing documentation includes the presence of a facial droop. He is transported to a different hospital as possible trauma. A lawsuit is filed against the first hospital and ED physician. a stroke or cardiac event).

Documentation/Coding 90

Documentation/Coding EMS Stroke Patient Safety 90

RebelEM

AUGUST 22, 2024

Finally, most hospitals lack the necessary protocols and processes to coordinate the complex interdisciplinary care patients with RAO may require. 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.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

PulmCCM

JANUARY 6, 2025

With financial penalties coming for noncompliance with the new rule, hospital administrators rapidly deployed the alerts to fire on all eligible inpatients. The SCREEN Trial SCREEN was a stepped-wedge cluster randomized trial of an EMR alert for organ failure, conducted at 45 wards of 5 hospitals in Saudi Arabia from 2019 to 2021.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

ACEP Now

APRIL 2, 2024

Posterior circulation strokes make up 20 percent of all strokes but account for 40 percent of stroke misdiagnoses. Dizziness is especially tricky, with up to 40 percent of strokes presenting with dizziness being missed. His neurological exam on arrival is documented as normal. His blood pressure is 190 over 115.

Stroke 40

Stroke Documentation/Coding Poisoning Emergency Department 40

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

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

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. The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. PMID: 31270748 Maheshwari K, et al. Intensive Care Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Sensible Medicine

JUNE 30, 2023

Patients present with troublesome symptoms that they “just want checked out before the weekend” and I’m left either worrying about them all weekend or admitting them to the hospital where I know little will happen for the next two days. She did not require hospitalization. It was not exertional.

Hospitals 97

Hospitals Hospice Resuscitation COPD 97

Taming the SRU

JUNE 3, 2024

Susan Wilcox Increasing regionalization due to: Growth of specialty centers Increasing development of healthcare systems Hub-and-spoke models Development of ECMO, trauma, transplant, and stroke centers The higher the acuity of the centers, the higher the acuity of the patient that needs to get there. What drives the concern?

Shock 91

Shock Seizures Airway Management Stroke 91

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

Dr. Smith's ECG Blog

JANUARY 9, 2024

Slow VT below the detection rate of the ICD lead to worsening heart failure and low stroke volume. Lowering the back up rate (LRL) of the ICD/pacer allowed for an intrinsic rhythm with physiologic AV conduction and normal AV synchrony with resultant increase in stroke volume and cardiac outpt.

EKG/ECG 119

EKG/ECG Stroke Hospitals Documentation/Coding 119

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 58

Documentation/Coding Outcomes EMS Stroke 58

The Skeptics' Guide to EM

DECEMBER 5, 2020

John’s Riverside Hospital Emergency Medicine Residency in Yonkers, New York. John’s Riverside Hospital Emergency Medicine Residency in Yonkers, New York. 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

JANUARY 30, 2024

This focus on insurer consolidation broadens ACEP’s recent advocacy efforts with the Federal Trade Commission on hospital and physician consolidation, non-competes, and corporatization of medicine. Learn more at acep.org/accelerate. Look for “Qual-ED” in your preferred podcast platform.

Pediatrics 52

Pediatrics EMS Documentation/Coding Stroke 52

JournalFeed

MARCH 26, 2022

Epi vs. NorEpi Spoon feed: Continuous epinephrine infusion for post-resuscitation shock in out of hospital cardiac arrest (OHCA) was associated with both higher all-cause and cardiovascular specific mortality when compared to norepinephrine. Check out journalfeed.org for details.

Stroke 40

Stroke Documentation/Coding Emergency Department Resuscitation 40

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

Mind The Bleep

JUNE 18, 2023

It is a very common presentation or comorbidity to see in community services and general hospital. ICD-10 codes: F00-03 are the ICD codes for dementia and its subtypes F02. ICD-10 codes: F00-03 are the ICD codes for dementia and its subtypes F02.

Psychiatric 52

Psychiatric Documentation/Coding Stroke Fractures 52

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

En route to the hospital the patient experienced multiple short-lasting episodes, with cramping and loss of consciousness. I therefore feel it relevant to document ( in your dictation/on the medical chart ) when significant artifact potentially impairs the accuracy of your interpretation. One episode was of longer duration.

Seizures 113

Seizures EKG/ECG EMS Stroke 113

Downeast Emergency Medicine

APRIL 26, 2021

Four level-1 US trauma centers participated in the study where the inclusion criteria were trauma patients who were within 2 hours of their injury and were transported to the trauma center from either the field or another hospital. MI or stroke). The primary outcome was head injury-related death in-hospital within 28 days of injury.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 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). 2018) Epidemiology of lumbar punctures in hospitalized patients in the United States. Journal of the history of the neurosciences, 6(2), 147–153. Vickers A, Donnelly JP, Moore JX, Barnum SR, Schein TN, et al.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

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. 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

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

were hospitalizations during f/u period; 26.4% were hospitalizations during f/u period; 26.4% There also were no significant differences in pain scores, hospitalizations, ED readmissions among the groups. Please ensure that you document and discuss with the patient accordingly. vs. US 31.2%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

ACEP Now

JULY 6, 2023

Warfarin pills are inexpensive, but the associated hospital care is not. 5 Patients with acute ischemic strokes, STEMIs, and trauma, as well as many other diagnoses, have their workup largely completed, and even sometimes definitive therapy executed, before they leave the emergency department, rather than requiring inpatient units. “A

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 52

Pediatric Emergency Playbook

APRIL 1, 2016

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. for the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. ACCF 2012 Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

EB Medicine

MAY 3, 2019

It’s also important to elicit any psychiatric history, including prior hospitalizations. Next, schedule a follow up appointment, ideally within a week of discharge, and lastly, document the patient’s preferred follow up resources and steps taken to get them there. These patients typically do not require inpatient hospitalization.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

EMDocs

JULY 3, 2023

National Institutes of Health Stroke Scale (NIHSS) is 13; vital signs include pulse 86 beats/minute (bpm), blood pressure 164/94 mmHg, and saturation of 98% on room air. This neurological evaluation should include assessment and documentation of the GCS, the presence of any neurologic deficits, and an NIHSS. J Stroke Cerebrovasc Dis.

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

Taming the SRU

SEPTEMBER 1, 2023

Lane & Mcdonough Definition of an immediate whole body CT (iWBCT) scan Shortly after patient arrival. 2015) reported a sensitivity of 98.9%

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

Sensible Medicine

DECEMBER 1, 2023

This is the doctor who explains why, at age 80, it would be crazy to be “full code.” 2 Worse than the person who does not benefit -- the person on a statin who has an MI or the person who got the Covid vaccine and still ended up in the hospital with COVID -- are people harmed by an indicated and accepted intervention.

Wellness 94

Wellness Documentation/Coding Outcomes Stroke 94

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. Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to general hospital: the EGSYS score. g/dL —Hypotension (obviously!) Del Rosso A, et al.

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

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. GPs and local hospitals should provide easy access to medication and vaccinations to ensure good compliance. How is sickle cell disease diagnosed?

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

ACEP Now

DECEMBER 11, 2023

These included oral and nasal spray formulations of these two decongestants, but a third, phenylpropanolamine, was excluded due to safety concerns relating to hemorrhagic strokes. Radecki (@emlitofnote) i s an emergency physician and informatician with Christchurch Hospital in Christchurch, New Zealand. References U.S.

Administration 64

Administration Outcomes Research Stroke 64

Taming the SRU

JUNE 6, 2023

Allows for the patient to be held for a psychiatric evaluation Varies greatly based on state laws In OH, this means patient can be held for 24h prior to being evaluation by a psychiatrist & may be held for additional 72h after that initial evaluation is performed In OH, can be signed by physician, psychologist, mental health NP, mental health clinical (..)

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

ACEP Now

FEBRUARY 11, 2025

1 Regional anesthesia services are typically provided by anesthesiologists; however, there are various reasons why not all hospital models can support a dedicated service line run by anesthesiologists including physician shortage. Regional anesthesia has been shown to decrease hospital LOS for hip fractures up to 0.9

Emergency Department 80

Emergency Department Fractures Ultrasounds Hospitals 80