Ken Grauer, MD

FEBRUARY 28, 2023

Figure-2: I've color-coded P waves from Figure-1 according to P wave morphology ( See text ). NOTE: For clarity — I've color-coded P waves in the long lead II rhythm strip according to morphology. Remember — 12 leads are better than one! Microvascular dysfunction — cardiac vasculitis — intravascular thrombosis.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

The Trauma Pro

JULY 5, 2024

But under-prescribing can create problems as well. Uncontrolled pain is a huge patient dissatisfier, and can lead to unwelcome complications as well (think pneumonia after rib fractures). Be sure to fill out a consent as soon as practical, and document any attempts that were made to obtain it.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

PEMBlog

MARCH 4, 2025

Well cover its clinical presentation, epidemiology, diagnostic approach, and management, including why standard beta-lactam antibiotics wont work. Plus, well discuss whether M. Studies supporting antibiotic treatment of documented mycoplasma pneumoniae in children are limited. Pediatr Emerg Care. 2025 Feb 17. doi: 10.1097/PEC.0000000000003338.

Pediatrics 94

Pediatrics Military CDC Hospitals 94

ACEP Now

OCTOBER 29, 2024

Our nurse did not study Paul Ekman’s Facial Action Coding System for Action Units to code “fear” in the patient’s face. 4 However, emergency physicians rely on gestalt to predict outcomes well. Dr. Koo is faculty and an emergency physician at MedStar Washington Hospital Center in Washington, D.C., 1999;21(10):974.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

Ken Grauer, MD

JULY 29, 2023

The ECG in Figure-1 was obtained from an 18-year old woman — who moments before been resuscitated from out-of-hospital cardiac arrest. An ICD ( I mplantable C ardiac D efibrillator ) was inserted — and the patient was discharged from the hospital. Epsilon waves are best seen in leads V1 , V2 — and a bit less well seen in V3,V4.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

EMDocs

JULY 25, 2024

The brother’s wife calls the airport police who are able to locate him and send him to a nearby hospital. The nurse completes the Columbia-Suicide Severity Rating Scale (C-SSRS) and documents that the patient’s recent thoughts of killing himself and his detailed plan makes him “High Risk” for suicide.

Documentation/Coding 105

Documentation/Coding Hospitals Patient Safety Emergency Department 105

EMDocs

AUGUST 22, 2024

3,4 Notably, institutions receiving federal funding (such as hospitals receiving Medicare reimbursement) must abide by Title VI of the 1964 Civil Rights Act, which entitles persons with NELP to language assistance. Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors.

Documentation/Coding 105

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 105

ACEP Now

OCTOBER 26, 2023

One of the HCFA letters, written by then Medicaid Director Tim Westmoreland (the Westmoreland Letter) specifically cited that the CPT 9928X codes should be reimbursed under federal PLP unless the Medicaid plan believed there were program integrity issues with the claim. The provision similarly downcoded hospital facility fees.

Documentation/Coding 124

Documentation/Coding Hospitals Emergency Department Administration 124

Stop and Think

JANUARY 1, 2024

My friend Dr. Andrew Foy had this idea: during rounds in the hospital with learners, Foy noticed that many things get done (drugs prescribed, tests ordered) as a matter of culture or history. Well, that can be a problem. Sometimes things we do are well grounded in evidence. They sit in a Google document.

Documentation/Coding 98

Documentation/Coding Wellness EKG/ECG Hospitals 98

Dr. Smith's ECG Blog

MARCH 14, 2024

The most recent study found a NPV of 100% of triage ECGs labeled ‘normal’ or ‘otherwise normal’ for final hospital diagnosis of ACS, and concluded that avoiding physician interruption would “alleviate interruptions in workflow and improve patient safety.” It is well known that NOMI usually has a normal ECG or nonspecific ECG.

EKG/ECG 119

EKG/ECG Documentation/Coding Patient Safety Outcomes 119

The Trauma Pro

OCTOBER 31, 2023

If you believe that harm will occur, here are your options, from least to most damaging to your professional status at the hospital: Contact another consultant in the same or overlapping specialty (if there is one). Contact the trauma medical director, service chief, or hospital administrator and see if they can intervene.

Risk Management 113

Risk Management Fractures Documentation/Coding Hospitals 113

The Trauma Pro

DECEMBER 26, 2023

Everyone knows that venous thromboembolism (VTE) is a potential problem in hospitalized patients, and especially so in trauma patients. Screening looks at patient factors such as age, obesity, and previous VTE, as well as injury risk factors like spine and pelvic fractures and decreased mobility. And we probably won’t, ever.

Fractures 124

Fractures Documentation/Coding Hospitals Research 124

AED Leader

NOVEMBER 25, 2024

Effective January 1, 2017, the state’s Health and Safety Code 19300 mandates that certain high-occupancy buildings must install Automated External Defibrillators (AEDs). Specifically, the law targets high-occupancy structures such as theaters, schools, hospitals, shopping malls, and office spaces. Training is another crucial component.

CPR 52

CPR Documentation/Coding Shock Hospitals 52

ACEP Now

DECEMBER 6, 2024

1 Relatively little literature on the clinical characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) patients complicated by coronary vasospasm exists beyond anecdotal reports, however. Cardiac arrest secondary to myocardial ischemia from coronary vasospasm is well documented. Angina pectoris. 1959;27:375-388.

Resuscitation 98

Resuscitation EKG/ECG Documentation/Coding COPD 98

EMDocs

DECEMBER 4, 2023

The facility does not have ultrasound (US) availability at the time of the patient’s presentation, as the sonographer comes to the hospital only 2 days a week. The Wells’ Criteria for DVT can help risk stratify [2,3]. In those with a high-risk Wells’ score (>2), a negative D-dimer has less clinical utility.

Ultrasounds 97

Ultrasounds Documentation/Coding Wellness EMS 97

Sensible Medicine

MAY 15, 2024

At the same time, I struggle to see how such a person could run codes and work in trauma surgery. In this week’s Sensible Medicine podcast, I asked why students have an entire lecture with prolonged discussion of whether a patient coming to the hospital from prison should be called a prisoner. What happens when you walk and talk?

Administration 120

Administration Documentation/Coding Hospitals Wellness 120

ACEP Now

OCTOBER 10, 2024

He completed residency in emergency medicine through Emory while training at Grady Hospital in Atlanta. Most recently, Dr. McCormick served as an emergency physician at Northside Hospital. In the Atlanta region, we had AMC, one of the largest hospitals in the region closed. Overburden the other hospital systems.

Telemedicine 105

Telemedicine Critical Access Hospitals Emergency Department 105

EMDocs

JUNE 8, 2023

and 9 hours of symptom onset; stroke symptoms that started during sleep were assumed to have started halfway between the actual last known well and the time of wake-up. Subsequently reduced enrollment to 310 patients because no patients had been lost to follow-up or had insufficient data documented.

Stroke 98

Stroke Administration Documentation/Coding Outcomes 98

ACEP Now

JULY 7, 2024

My current practice is a hybrid of academic and community sites, and I have worked in myriad community hospitals from busy ones to single coverage critical access hospitals. You are well prepared for this. Lead your room well. If the resuscitation does not go as well as you wanted, learn from it and move on.

Resuscitation 98

Resuscitation Risk Management Hospitals Critical Access 98

Don't Forget the Bubbles

MARCH 19, 2024

This has coincided with a widespread shortage of specialist placements for children facing behavioural, psychiatric, and child protection challenges, leading to an over-reliance on the placement of these children in hospitals. A paediatric social admission is one where a child is admitted to the hospital but not for a medical reason.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

Sensible Medicine

APRIL 12, 2024

For probably the twelfth time on Sensible Medicine, I’ll reference Lisa Rosenbaum’s essay, Being Well while Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training which brought some of the current inter-generational angst to the fore. That 95-hour work week was not all work.

Radiology 83

Radiology Radiology Hospitals Documentation/Coding 83

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

American Medical Compliance

AUGUST 7, 2024

It protects the health and well-being of staff. For example, CMS requires accurate and timely documentation of patient care to ensure proper billing and reimbursement. Adhering to CMS quality measures, such as reducing hospital readmission rates and improving patient safety protocols, helps maintain high standards of care.

Hazardous Materials 105

Hazardous Materials Documentation/Coding Legal Issues Patient Safety 105

EMDocs

FEBRUARY 13, 2024

If tomorrow, CMS came out with a new pay-for-performance metric that tied hospital reimbursement with clinician work satisfaction, what do you think would happen? The hospital would move heaven and earth to improve your satisfaction scores. Maybe your group or hospital has something to this effect and, if so, embrace it.

Emergency Department 98

Emergency Department Hospitals Documentation/Coding Wellness 98

Clinical Correlations

NOVEMBER 1, 2024

By Chloe Fong Peer Reviewed The correlation between vitamin deficiency and alcohol use disorder (AUD) has been well documented in the literature, with a study from 1963 finding that 70% of patients admitted to the hospital.

Documentation/Coding 52

Documentation/Coding Hospitals Wellness 52

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. First aid done pre-hospital. Provide detailed documentation of the initial assessment, treatment provided, and the patient’s response to interventions.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Pediatric EM Morsels

AUGUST 18, 2023

None of the patients were documented to have joint disease at follow up. Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications. There were 2523 children included. 451 pediatric patients were included. J Pediatric Infect Dis Soc.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

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 98

Hospitals Hospice Resuscitation COPD 98

Don't Forget the Bubbles

MAY 10, 2023

Then you hear the words coming out of the speaker, “ Paediatric code black. Paediatric code black ”. You’ve heard the phrase code black before – it’s a traumatic cardiac arrest. You know a paediatric code black means paediatric traumatic cardiac arrest. As you arrive in resus, so too do half the children’s hospital.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

RebelEM

AUGUST 22, 2024

1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. Finally, most hospitals lack the necessary protocols and processes to coordinate the complex interdisciplinary care patients with RAO may require. Patients whose last known well (LKW) time was within 24 hours of presentation. 1 week after treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

ACEP Now

SEPTEMBER 5, 2024

With elimination of CME funding in many of our hospitals and groups, it is crucial to continue to add value and communicate that value to residents before graduation. While some issues are handled locally, many issues cannot be solved in our emergency department or hospital. If ACEP is already doing this, why be a member?

Leadership 98

Leadership PPE EMS Wellness 98

Don't Forget the Bubbles

JUNE 19, 2024

Well-designed multicentre large studies in children were warranted; cue Leonard et al. This may limit the generalisability of the results in regional/community hospital settings. 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.

CPR 124

CPR Research Documentation/Coding Outcomes 124

Sensible Medicine

AUGUST 21, 2023

Administrative data sets are often collected for the purpose of billing, or costing, or administrative organization, and thus are extremely vulnerable to up coding or intentional or accidental omissions. Next week I am going to show you what a well-done medical study looks like. It is our goal. Thanks for your support.

Administration 97

Administration Outcomes Research COPD 97

Downeast Emergency Medicine

DECEMBER 1, 2021

329 participants were enrolled at an urban teaching hospital over a period of four years. Rosenberg and colleagues took a qualitative approach when investigating barriers and facilitators to successful implementation of ED-initiated buprenorphine programs in critical access hospital EDs across Maine.

Emergency Department 52

Emergency Department Documentation/Coding Leadership Administration 52

PulmCCM

FEBRUARY 5, 2024

You can read the document here. Depends On the Patient, and Who You Ask The Centers for Disease Control and Prevention defines a fever (for general hospitalized patients) as >38°C. Read the original document here. Ultrasound is well-suited for identifying most serious biliary system abnormalities.

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

ACEP Now

JUNE 7, 2023

Whereas previous versions of GPT were unable to pass the medical examinations, GPT-4 demonstrated scores of approximately 85 percent correct on each Step of USMLE, well above the passing threshold. Future versions are likely to have greater accuracy and error-checking abilities, as well as improved domain-specific generative abilities.

Documentation/Coding 78

Documentation/Coding Wellness Administration Research 78

Dr. Smith's ECG Blog

MAY 26, 2023

Thus, since high dose insulin's (HDI) primary beneficial effect on calcium channel overdose is to as a positive inotrope, it does not work well for dihydropyridine overdose. A NSWER : In Figure-3 — I have color-coded P waves in the long lead II rhythm strip of ECG #2. How Are the P Waves Color-Coded? Learning Points: 1.

Shock 98

Shock EKG/ECG Documentation/Coding Resuscitation 98