Mind The Bleep

OCTOBER 29, 2024

Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. Provide detailed documentation of the initial assessment, treatment provided, and the patient’s response to interventions. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% Check temperature and blood glucose levels.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

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

Dr. Smith's ECG Blog

OCTOBER 8, 2024

She was worked as a full code, and ROSC was achieved. A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. About 45 minutes after the second EKG, the patient was found in cardiac arrest. She was taken to the cath lab, where she was found to have 100% in-stent restenosis of the proximal LAD.

EKG/ECG 122

EKG/ECG Documentation/Coding Resuscitation Shock 122

RebelEM

JUNE 8, 2023

Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study. 2006;130(4):941–6. PMID: 17035422 Holler JG, et al. 2015;10(3):e0119331.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

She was in shock with thready pulses. The rate is not fast enough to be causing shock, so if it is VT, the priority is still to treat hyperK and secondarily to cardiovert. They thought it was VT, but did not shock. On arrival, the patient was in shock, was intubated, and had an immediate cardiac ultrasound.

Shock 40

Shock EKG/ECG Resuscitation Ultrasounds 40

Sensible Medicine

MAY 22, 2023

See screenshot: The endpoint was the proportion of patients whose chart had a documented goals of care care discussion. In a university hospital system known for its strength in palliative care, only a third of seriously ill patients in the intervention arm have a documented goals of care discussion. The absolute risk difference of 4.1%

Documentation/Coding 65

Documentation/Coding Hospitals Shock Outcomes 65

AED Leader

JUNE 11, 2024

Quick Shock Delivery and Fast Charging In a life-threatening situation, quick response time is vital. Philips defibrillators are designed to deliver a shock quickly, minimizing the time between chest compressions and defibrillation. This rapid shock delivery feature can significantly improve the chances of a successful resuscitation.

CPR 52

CPR Shock Resuscitation Operations 52

AED Leader

APRIL 24, 2024

Their AEDs are designed to be user-friendly, reliable, and effective in delivering life-saving shocks to restore a normal heart rhythm. Escalating Energy : This feature allows the AED to automatically increase the energy level of subsequent shocks if the initial shock is unsuccessful, increasing the chances of restoring a normal heart rhythm.

CPR 52

CPR Shock Pediatrics Documentation/Coding 52

EMDocs

JANUARY 11, 2024

Individualize the choice of using inotropes, vasopressors, or fluids to treat post-CA hypotension and to target the likely cause(s) contributing to the shock and hemodynamic state (100%, 23/23). In patients with enteral intolerance or shock, start with trophic EN (rates of 10–20 mL/h) and adjust according to tolerance (91%, 19/21).

Seizures 98

Seizures Shock Infectious Diseases CPR 98

Don't Forget the Bubbles

MAY 6, 2024

of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) Data collected were the worst values documented within the same calendar day as the blood cultures were obtained. Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days.

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

ACEP Now

JUNE 14, 2024

The inaugural ACEP Accelerate conference – which combined the ED Director’s Academy, the Advanced Pediatrics EM Assembly, Reimbursement & Coding, and Teaching Fellowship—took place in Arlington, TX in March 2023. Open applications will be coming soon, but you can find out more and get on the interest list today at acep.org/EDap.

Sexual Assault 52

Sexual Assault Seizures Documentation/Coding EMS 52

Emergency Medicine Ireland

JULY 3, 2023

Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. This segues relatively nicely into a section of the document on palliative care. Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. To start with there are apparently 5 types of cardiorenal syndrome.

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

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. Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. What do you see?

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Pediatric Emergency Playbook

APRIL 1, 2016

There are two main reasons for an elevated lactate: the stress state and the shock state. The shock state is due to tissue hypoxia, seen in septic shock. We should use lactate to detect occult shock. Children compensate so well for shock, that subtle tissue hypoxia may not be detected until later. Am J Cardiol.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

When Pendell and I are coding ECGs for the Queen's training, this is one category: "Definite ischemia, difficult to differentiate between posterior OMI and subendocardial ischemia." The notes now refer to the patient being in cardiogenic shock, on pressors. In my opinion, I think it looks more like subendocardial ischemia.

EKG/ECG 81

EKG/ECG Shock Documentation/Coding Academics 81

Taming the SRU

SEPTEMBER 15, 2023

ETT onto a fiberoptic scope.

CPR 90

CPR Burns Airway Management Wellness 90

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

The Skeptics' Guide to EM

FEBRUARY 3, 2023

You are tidying your things in anticipation of the arrival of the dayshift when a code blue is called. The patient is in ventricular fibrillation, and you achieve return of spontaneous circulation (ROSC) on the second shock. The nurses started CPR immediately and place pads before you even arrived. The patient is still unconscious.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Documentation/Coding CPR 52

Medical Law

JULY 19, 2024

Unlike vehicles, bicycles have less stability and shock absorption, making them more susceptible to road imperfections. This documentation is vital for any subsequent legal proceedings and helps establish a clear record of the event. Moreover, these issues often go unrepaired for extended periods, exacerbating the risk.

Documentation/Coding 52

Documentation/Coding Shock Wellness 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

EMDocs

FEBRUARY 9, 2024

A 200J shock is reasonable – though a higher dose may be needed for larger patients. The literature base for the use of lidocaine for torsade storm is documented primarily by case studies in drug-induced TdP. Assess your patient and if there is any sign of instability, use electricity.

EKG/ECG 97

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 97

AED Leader

JUNE 25, 2024

Keep Track of Maintenance and Servicing Proper documentation of maintenance and servicing activities is crucial for record-keeping and compliance purposes. Expired pads or batteries may not deliver the shocks or power required in a life-saving situation.

Operations 52

Operations Best Practices Documentation/Coding Shock 52

Dr. Smith's ECG Blog

JUNE 11, 2021

The patient was brought to the ED as a possible Code STEMI and was seen directly by cardiology. But by this time the patient went into cardiogenic shock and passed away. The paramedics found the patient with ROSC and a GCS 7, and an ECG showing LBBB with possible lateral ST elevation. Vitals were HR 58 BP 167/70 R20 sat 96%.

EKG/ECG 52

EKG/ECG Documentation/Coding CPR Shock 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

This does not mean that all patients need to be immediately shocked — but it does mean that since 90+% of such rhythms will turn out to be VT, that we need to assume VT until proven otherwise. Because of this 1st bullet — We need to always assume VT for such rhythms until we prove otherwise, and treat accordingly.

EKG/ECG 118

EKG/ECG Stroke Hospitals Documentation/Coding 118

Mind The Bleep

FEBRUARY 27, 2024

saline vs balanced crystalloid solutions for initial fluid management in the treatment of septic shock which may give us more insight into this topic. [5] They concluded that some evidence in the literature shows a shorter length of hospital stay associated with prescribing balanced isotonic fluids (Plasma-lyte) over non-balanced (0.9%

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

Dr. Smith's ECG Blog

JUNE 17, 2018

I have always said that tachycardia should argue against acute MI unless there is cardiogenic shock or 2 simultaneous pathologies. All ECGs were coded by an expert clinician as having ST-elevation, ST-depression, T-wave inversion [ST/T abnormalities, (ST/T-A)], or none of the above. PR depression, which suggests pericarditis 4.

EKG/ECG 52

EKG/ECG Documentation/Coding Shock Ultrasounds 52

Don't Forget the Bubbles

OCTOBER 16, 2024

Don’t forget the essentials: Eat Hydrate +/- caffeinate Exercise Unwind Sleep It’s not rocket science, but it’s shocking how many of us forget! Don’t be afraid to ask the simple questions: Where do I document? Top tip: verbally communicating your plan followed by clear documentation can help avoid confusion!

Documentation/Coding 52

Documentation/Coding Teamwork Leadership Burns 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

Don't Forget the Bubbles

OCTOBER 10, 2024

The others, such as respiratory rate, heart rate, and decompensated shock, were excluded due to the presumed difficulty for non-healthcare professionals to assess them accurately. Inclusion criteria required documented acute streptococcal pharyngitis, as per positive throat swab culture or rapid antigen testing, in patients 1-18 years of age.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

PulmCCM

OCTOBER 16, 2023

Numerous specific recommendations are available here: search the document for “dressings” or “Catheter Site Dressing Regimens” Other Methods to Prevent CLABSI Catheters impregnated with antibiotics (minocycline–rifampin) or chlorhexidine reduce catheter colonization and CVC-related bloodstream infections.

CDC 52

CDC Hospitals Ultrasounds Documentation/Coding 52

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

Tachycardia is unusual in ACS unless there is cardiogenic shock or a second simultaneous pathology. Finally — Note that the S1Q3T3 pattern is missing in ECG #2 , despite documentation of a massive PE. Remember that is the odds ratio comparing all patients without PE to those with PE.

EKG/ECG 52

EKG/ECG COPD Documentation/Coding Shock 52

Dr. Smith's ECG Blog

APRIL 15, 2019

CLICK HERE — for the ESC/ACC/AHA/WHF 2018 Consensus Document on the 4th Universal Definition of MI, in which these concepts are discussed and illustrated.

EKG/ECG 40

EKG/ECG Sepsis Documentation/Coding Shock 40

Dr. Smith's ECG Blog

JANUARY 5, 2020

See below how this has been documented. MAT almost always occurs in one of 2 common clinical scenarios : i ) Severe pulmonary disease ( ie, COPD, long-term asthma; pulmonary hypertension ) ; or , ii ) Acutely ill patients with multisystem disease ( ie, patients with sepsis; shock; electrolyte and/or acid-base disorders ).

EKG/ECG 52

EKG/ECG COPD Wellness Sepsis 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation. This patient was reported to have distant heart sounds but was not hypotensive and did not have JVD according to documentation.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

EB Medicine

JULY 8, 2019

Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Finally, there is the roux-en-y gastric bypass.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EB Medicine

AUGUST 6, 2019

Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. Jeff: That is simply shocking! PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. This can help with destination selection when relevant. Let’s also talk lab studies.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Shocked x 2 without effect. Warning: if this is VT, a calcium channel blocker can result in shock and death. Today's case is insightful in many ways — especially since despite prompt electrical cardioversion, we are told that this patient "was shocked X 2 without effect". However, this is not SVT. What to do now? K returned 3.6

EKG/ECG 138

EKG/ECG Shock Academics Documentation/Coding 138