Dr. Smith's ECG Blog

JANUARY 2, 2025

She was managed for sepsis with antibiotics including azithromycin, had hypotension with arterial and central lines placed and pressors. I do not see OMI here and all trops were only minimally elevated, consistent with either chronic injury from cardiomyopathy or with acute injury from sepsis. She was intubated.

EKG/ECG 117

EKG/ECG Sepsis Wellness Documentation/Coding 117

Mind The Bleep

FEBRUARY 2, 2025

could it be driven by a much more pressing sepsis ). If the aim is for someone to take over care then an explanation of why they can provide better care often works better than why you can’t look after them Outline the purpose of your referral early. We don’t know if the patient is unwell with this AF or otherwise (?could

Radiology 96

Radiology Radiology Sepsis Documentation/Coding 96

EMDocs

APRIL 2, 2024

Check the pulse RSI= Resuscitation Sequence Intubation Hypoxia, Hypotension, and Acidosis are the reason patients code during/post intubation These patients are super high risk for all 4 Optimize first pass success – Induction agent + paralytic Unconscious patients will still have muscle tone Induction Ketamine or Etomidate at half doses (i.e.,

Documentation/Coding 111

Documentation/Coding CPR EKG/ECG Sepsis 111

The Trauma Pro

JULY 13, 2023

Sepsis score. Lack of accurate team arrival documentation. Anyone who has actually generated one of these can tell you that it’s a disaster! Reams of paper, typically 20-30 pages. Hundreds of “chronological” entries. Inclusion of extraneous information from later in the hospital stay. Ebola screens.

Sepsis 100

Sepsis Documentation/Coding Hospitals 100

EMDocs

OCTOBER 10, 2024

Exam is normal except for tenderness as documented in the diagram. Sepsis is diagnosed and antibiotics started for the first time. High level amputation is considered, but she dies of sepsis and multiorgan failure on hospital day 7. She never had a documented abdominal exam. I just failed to document it.

Documentation/Coding 93

Documentation/Coding Hospitals Sepsis Infectious Diseases 93

EB Medicine

JANUARY 3, 2023

2) 2023 E/M coding guidelines are in effect. 2) 2023 E/M coding guidelines are in effect. Announcements: 1) The interactive Clinical Pathways have launched and they are available for free!

Shock 52

Shock Pediatrics Airway Management Sepsis 52

Don't Forget the Bubbles

MAY 6, 2024

of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) Reviewed by: Tasnim Ransome and Spyridon Karageorgos Article 3: Which Sepsis Scoring Tools Perform Best? Organ Dysfunction in Children With Blood Culture-Proven Sepsis: Comparative Performance of Four Scores in a National Cohort Study. Of the 74.9% Hagenbuch, N.,

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

PulmCCM

FEBRUARY 5, 2024

You can read the document here. Read the original document here. In 18 severe sepsis patients in 3 years at one center who underwent PET scanning (apparently done ad hoc), 14 of the 18 had positive tests, and 11 were true positives, leading to surgery in 2 and pacemaker removal in 2 (and longer / new antibiotics in 2).

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

EM Literature of Note

OCTOBER 9, 2024

while also relying upon finished human documentation for its “decision-support” The prompts – “should”/”does” – replicate the intent of the decision-support concept of the exploration, but not the retrospective nature of the content. The “sepsis measure fallout gestapo” might disagree, however.

Radiology 86

Radiology Radiology Emergency Department Documentation/Coding 86

The Skeptics' Guide to EM

FEBRUARY 23, 2019

Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. Date: February 22nd, 2019 Reference: Lane et al. Reference: Lane et al.

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

Don't Forget the Bubbles

MAY 31, 2023

We have a ringside view in the Children’s Emergency Department – the unique opportunity to see different types of acute presentations, whether DKA, sepsis or asthma, amongst a host of febrile children.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. We have a special episode for you this month… We’ve brought Dr. Jeremy Rose, one of the peer reviewers, and a sepsis expert, on with us to talk through the content this month. Jeff : Sepsis chair. Sepsis-3!!

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

EM Guide Wire

SEPTEMBER 9, 2020

0.5 – 1 mg q5min, max dose 3 mg peds = 0.02 Epinephrine bolus 20-40 mcg IV (EMCRIT recommended dose using push dose epi) peds 0.01 Dosing formula on MedCalc using serum level & amount ingested (mg ingested x 0.8

Documentation/Coding 52

Documentation/Coding Hyperthermia / Hypothermia Sepsis Shock 52

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

Taming the SRU

JULY 31, 2024

morbidity and mortality - faculty case follow-up - R4 Capstone - high-risk, low prevalence diseases in pediatrics morbidity and mortality WITH dr. moulds Syncope Complete heart block is a rare but important cause of syncope P waves outnumbering QRS complexes should clue to you to high grade heart block Triage EKGs are often obtained to screen for cardiac (..)

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

ACEP Now

OCTOBER 30, 2023

This makes documentation and communication of the utmost importance for these patients for their health and safety. Oftentimes, it can be an indication of pain, infection, distress, anxiety, dehydration, or the first sign of sepsis. This leads into the next part of the model—Assessment. One commonly used example is tachycardia.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

Emergency Medicine Ireland

JULY 3, 2023

Type 5 is the big bucket where they put all the left over disease that cause both kidney and heart failure eg things like amyloid, or sepsis or cirrhosis. This segues relatively nicely into a section of the document on palliative care. Type 4 is again renocardiac with the kidneys causing the heart failure but on a chronic basis.

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

Northwestern EM Blog

MARCH 1, 2025

There are several etiologies including viral pneumonia, bacterial pneumonia, sepsis, trauma, and pancreatitis. Document thorough skin assessment every nursing shift, and inspect weight-bearing ventral surfaces. Reattach EKG leads to back. Tilt patient into reverse Trendelenburg.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

Pediatric Emergency Playbook

APRIL 1, 2016

Lactate A sick child with sepsis syndrome? In the adult literature, we know that a lactate level above 4 mmol/L in patients with severe sepsis was associated with the need for critical care. The acute recognition and treatment of sepsis is first and foremost, clinical. The short answer – yes.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

RebelEM

JANUARY 29, 2024

What They Did: Single-center, pilot prospective observational cohort trial in Turkey Thrombolysis 25mg of alteplase without a bolus was administered over 6 hours by peripheral IV infusion If hemodynamic instability persisted despite first dose of thrombolysis, a second 6hr infusion of 25mg alteplase without bolus was administered (No patients in the (..)

Stroke 133

Stroke Outcomes Hospitals Administration 133

Mind The Bleep

SEPTEMBER 14, 2024

Management Immediate management: Consider ABCDE approach and Sepsis 6 pathway including early empirical IV antibiotics. References British Society for Surgery of the Hand – Flexor Sheath Infection Document Pang H-N, Teoh L-C, Yam AK, et al. Blood tests: FBC (leukocytosis), CRP, serum urate if suspecting gout as differential.

Operations 52

Operations Sepsis Documentation/Coding 52

Dr. Smith's ECG Blog

JULY 21, 2024

The stay in the cardiac intensive care unit (CICU) was further complicated by sepsis, delirium, GI bleeding, and anuric renal failure with need for renal replacement therapy. In both tracings — an exceedingly fast PMVT is documented. That said — there is no evidence on ECG of re-occlusion of the infarct artery.

EKG/ECG 132

EKG/ECG Shock Hospitals Sepsis 132

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). The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. C., & Solomon, T. van de Beek, D., Cabellos, C.,

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

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

RebelEM

MARCH 9, 2023

Pain / Additional Complaints : Alcohol can weaken the immune system with only moderate use, predisposing individuals to pneumonia, soft tissue infections, and sepsis. Document at each reassessment and always have a low threshold to add on a CTH or labs if the patient is not progressing appropriately.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

RebelEM

MARCH 27, 2023

4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. There may have very well been a policy where only RTs can make changes to a ventilator after an order was placed to ensure accurate documentation.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

RebelEM

OCTOBER 5, 2023

Background: Community-acquired pneumonia (CAP) can lead to pulmonary and systemic inflammation, resulting in impaired gas exchange, sepsis, organ failure, and an increased risk of death. Corticosteroids have excellent anti-inflammatory and immunomodulatory effects that could mitigate some of the inflammation caused by pneumonia.

Research 94

Research Outcomes Administration Shock 94

Dr. Smith's ECG Blog

APRIL 15, 2019

A previous ECG from 4 years prior was normal: This looks like an anterior STEMI, but it is complicated by tachycardia (which can greatly elevate ST segments) and by the presentation which is of fever and sepsis. Although the quality is suboptimal, it appears to me to show a hyperdynamic heart and possibly and apical wall motion abnormality.

EKG/ECG 40

EKG/ECG Sepsis Documentation/Coding Shock 40

ACEP Now

JULY 7, 2023

Patients with sepsis get antibiotics. Mental health evaluation teams can rely on documentation and interviews to understand a patient’s initial agitation level. This month, we are discussing the medical management of patients with mild to moderate agitation. Emergency departments (EDs) focus on rapid initiation of medical treatment.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

Northwestern EM Blog

MAY 16, 2022

Please ensure that you document and discuss with the patient accordingly. were hospitalizations during f/u period; 26.4% Finally, a burden on us as EM clinicians is training in and awareness of clinical practice guidelines and recommendations from specialties outside of EM.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Emergency Medicine Ireland

AUGUST 1, 2022

The next job is to document clearance from the blood. There are some nuances once you get into the weeds (and beyond the scope of an ICU exam) about addition of aminoglycosides (not routinely recommended) or addition of rifampicin (generally only in the context of prosthetic joints or hardware). once on the bug juice repeat the cultures.

Sepsis 40

Sepsis Shock Documentation/Coding 40

PulmCCM

FEBRUARY 19, 2024

At Shands (the level 1 trauma center admitting adults), the panel relates the impressive results that mortality fell by 58%, and unplanned codes by 47% “after the widespread implementation of patient/ family activated RRT/MET.” Family-Activated METs in Adults Halves Mortality?

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

EB Medicine

JULY 8, 2019

Leakage from the staple line typically presents within the first week, but can present up to 35 days, usually with fevers, tachycardia, abdominal pain, nausea, vomiting sepsis, or peritonitis. Some may present with isolated tachycardia while others may present with profound sepsis – tachycardia, hypotension, and fever. At 6 to 8 mL/kg.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Northwestern EM Blog

APRIL 25, 2022

Violation of the joint capsule exposes the sterile intra-articular space to the environment which can result in a deep infection and sepsis. Ideally your exploration should be in a bloodless, painless field and documented as such. The knee joint is the most common joint to be affected, followed by the ankle.

Soft Tissue Injuries 52

Soft Tissue Injuries Fractures Sepsis Documentation/Coding 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. 2 The astute paramedic recognized this possibility and announced a CODE STEMI. For instance: sepsis, bleeding, dehydration, hypoxia, and mild ACS. Look at the aortic outflow tract.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Don't Forget the Bubbles

JUNE 10, 2024

The history of necrotising enterocolitis The earliest documented cases resembling Necrotising enterocolitis (NEC) date back to the late 19th and early 20th centuries. Systemic Infections : Sepsis and other systemic infections can predispose infants to NEC by compromising the gut barrier and promoting inflammation.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

EM Updates

JUNE 15, 2021

After admission to the EDAT, documentation was performed on the inpatient electronic health record (EHR), which at MMC is a different platform than the ED EHR. Providers carried out their tasks using foreign ordering and documentation pathways within an EHR that had to be learned immediately and without training. N Engl J Med.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52