Mind The Bleep

FEBRUARY 2, 2025

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 95

Documentation/Coding COPD EKG/ECG Wellness 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 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47

Stroke 130

Stroke Outcomes Hospitals Administration 130

The Skeptics' Guide to EM

AUGUST 10, 2024

A code stroke is activated, and a CT head shows a left basal ganglia hemorrhage with no vascular lesions on CT angiography. INTERACT-2 demonstrated that in patients with ICH, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability (SGEM#73).

Stroke 72

Stroke Airway Management Documentation/Coding Outcomes 72

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

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. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 97

Administration Emergency Department Outcomes Documentation/Coding 97

Emergency Medicine Journal

DECEMBER 30, 2024

Background Calls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response (‘pre-alerts’) have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke).

Emergency Department 52

Emergency Department Stroke Documentation/Coding Outcomes 52

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9% 2015) reported a sensitivity of 98.9%

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

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?

Documentation/Coding 58

Documentation/Coding Outcomes EMS Stroke 58

Sensible Medicine

DECEMBER 1, 2023

This is the doctor who explains why, at age 80, it would be crazy to be “full code.” I wonder how the patient doctor relationship, issues of equity, race or gender concordance affect the outcomes of these conversations. When the doctor and patient stray into each other’s lane, conflict often follows.

Wellness 98

Wellness Documentation/Coding Outcomes Stroke 98

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. Benefits of transport are evidenced based.

Shock 91

Shock Seizures Airway Management Stroke 91

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

Taming the SRU

APRIL 22, 2023

If untreated, atrial fibrillation can increase clot formation and lead to an increased risk for heart attack and stroke as well as development of congestive heart failure. There were similar lengths of say overall and no significant difference in safety outcomes. There was no difference in safety outcomes.

Outcomes 52

Outcomes Stroke Fractures Documentation/Coding 52

JournalFeed

MARCH 26, 2022

High-dose IN Fentanyl Spoon Feed: Higher doses of intranasal (IN) fentanyl for pain ranging from 2-5 μg/kg (with a maximum of 200 μg) were given in a pediatric emergency department, with no documented episodes of apnea, hypotension, or respiratory failure.

Stroke 40

Stroke Documentation/Coding Emergency Department Resuscitation 40

The Skeptics' Guide to EM

DECEMBER 5, 2020

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. You wonder, “Why can’t I just rule out stroke with the HINTS exam? Posterior circulation strokes account for approximately up to 25% of all ischemic strokes [1].

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. MI or stroke).

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

PulmCCM

JANUARY 6, 2025

A cluster randomized trial using all-cause mortality as an outcome was always needed to determine whether EMR alerts improve outcomes for suspected severe infection. This led the authors to speculate that qSOFA parameters were being documented more diligently on the wards randomized to screening.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

Sensible Medicine

JUNE 30, 2023

1] Would the outcomes be different? There was fatigue, weight loss, nausea, declining kidney function, and a few strokes. ” I documented those words in my progress note that day. From a professional standpoint, there is no question that my answer to the final question would be, “the past.”

Hospitals 98

Hospitals Hospice Resuscitation COPD 98

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. The MR CLEAN trial showed improved functional outcome if endovascular therapy was initiated within 6 hrs. Check out the link for the original NEJM article on andexanet-alfa. NNT 7, NNH 19.

EMS 52

EMS Stroke Leadership Documentation/Coding 52

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. He endorses nausea without vomiting and denies fever.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Pediatric Emergency Playbook

APRIL 1, 2016

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. We could use it to track treatment , and see if we can clear the lactate; decreased lactate levels are associated with a better outcome in adults. Myopericarditis in Children: Elevated Troponin I Level Does Not Predict Outcome.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Sensible Medicine

FEBRUARY 28, 2024

JMM Although the skeptical cardiologist questions the value of many procedures and diagnostic tests in cardiology, he remains an enthusiastic advocate of the use of coronary artery calcium (CAC) testing to better personalize each individual's risk of heart attack and stroke. For many individuals, this is life-transforming.

Stroke 43

Stroke Documentation/Coding Outcomes Wellness 43

Dr. Smith's ECG Blog

MAY 16, 2023

Other outcome information is not available. Like they would for any other acute arterial occlusion syndrome (such as suspicion of acute large vessel stroke), they take the patient across the hall and perform an immediate CT (coronary) angiogram, showing patent coronaries. Formal echo showed normal function, no WMA, and no effusion.

EKG/ECG 52

EKG/ECG Stroke Documentation/Coding Outcomes 52

Don't Forget the Bubbles

JULY 5, 2023

Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Taming the SRU

JULY 25, 2024

Femoral nerve block case review - morbidity & mortality - community practice - r2 Clinical pathologic case - visual diagnosis - when time matters - operational aspects of stroke care Femoral nerve Block Case Review WITH dr. stolz Why do we care about regional anesthesia, specifically femoral nerve blocks?

Stroke 97

Stroke Fractures Operations Outcomes 97

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. Actively, I ask them on their patients that we both had the opportunity to see: What abscesses would they prefer to pack?

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

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

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. Introduction SAH has the potential for rapid progression and devastating outcomes. Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage.

Seizures 93

Seizures Stroke Outcomes EMS 93

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

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. 2 With a primary outcome of “daily reflective nasal congestion score,” there was no difference in the primary outcome. References U.S.

Administration 64

Administration Outcomes Research Stroke 64

EB Medicine

MAY 3, 2019

Jeff: And finally, how many of you wish there was a clearly outlined evidence-based approach to managing such patients to improve care and outcomes? 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.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

EB Medicine

AUGUST 1, 2018

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. times higher risk of stroke or TIA. times higher risk of stroke or TIA. Cannabis users who smoked at least once weekly had a 3.3

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Stop and Think

NOVEMBER 19, 2024

The OPTION trial compared two strategies to reduce stroke and bleeding after catheter ablation of atrial fibrillation. CMS has already issued a special billing code for extra payment of the device. The core treatment goal after AF ablation is stroke prevention. The current strategy is to continue an anticoagulant medication.

Stroke 128

Stroke Documentation/Coding Outcomes Wellness 128

Dr. Smith's ECG Blog

APRIL 8, 2015

Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. 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. These premonitory symptoms were negative predictors of adverse outcomes in EGSYS.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

JANUARY 29, 2025

My MDM shows that I considered the possibility of an aneurysm, meningitis, hemorrhage, stroke, and temporal arteritis. Takeaways: Documentation of rational MDM prevents lawsuits. A wrong judgement leading to an unfortunate outcome is not negligence. Good doctors document good MDM. No lawsuit was filed.

Documentation/Coding 66

Documentation/Coding Patient Safety Stroke EMS 66

ACEP Now

FEBRUARY 11, 2025

Proving Cost Savings Our ED is a community Level II Trauma Center, Stroke Center, and STEMI [ST-elevation myocardial infarction] Receiving Center with 4,500 trauma activations, 569 hip fractures, and 450 rib fractures per year. Regional nerve blocks improve pain and functional outcomes in hip fracture: a randomized controlled trial.

Emergency Department 52

Emergency Department Fractures Ultrasounds Hospitals 52