Mind The Bleep

NOVEMBER 21, 2023

” Yes, I have seen clerking look like this and I can confirm, it does not go down well. 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.

Documentation/Coding 52

Documentation/Coding COPD EKG/ECG Wellness 52

ACEP Now

JANUARY 30, 2024

Live and in person for the first time in three years, the PEM Assembly is part of this year’s ACEP Accelerate, where you can fuel your future with four different, professional, enhancing tracks, including the ED Director’s Academy and the Reimbursement and Coding Conferences. Learn more at acep.org/accelerate. Discover more at acep.org/MOC.

Pediatrics 52

Pediatrics EMS Documentation/Coding Stroke 52

Dr. Smith's ECG Blog

OCTOBER 12, 2024

CTA head and neck were obtained and showed no evidence of intracranial hemorrhage, large vessel occlusion stroke (what a helpful and apt name for an acute arterial occlusion paradigm, by the way.), Preliminary findings documented in the cath lab were “Anterior STEMI and no significant coronary artery disease.” (!!!) ng/mL and 0.10

EKG/ECG 98

EKG/ECG Documentation/Coding Emergency Department COPD 98

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. Would they ever be well enough to be extubated? If we tried to wait it out, could he pull through on BiPAP alone? How would the hemodynamics respond to RSI?

Documentation/Coding 59

Documentation/Coding Outcomes EMS Stroke 59

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

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Recent studies have shown that low-dose ketamine can reduce pain in acute painful crises of sickle cell patients as well as being an opioid-sparing drug.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

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. Additionally, a higher HR reduction at 30 and 60 minutes, as well as ED discharge/transfer.

Outcomes 52

Outcomes Stroke Documentation/Coding Fractures 52

Sensible Medicine

DECEMBER 1, 2023

PP has a long history of hypertension and type II diabetes, both well controlled. When I first learned about shared decision making, I was taught that when patient and doctor stay in their lanes – doctors say what is or is not indicated and patients express their preferences – things tend to go well. What do you think?

Wellness 82

Wellness Documentation/Coding Outcomes Stroke 82

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%

Sepsis 94

Sepsis Documentation/Coding Administration Fractures 94

Mind The Bleep

JUNE 18, 2023

ICD-10 codes: F00-03 are the ICD codes for dementia and its subtypes F02. – One stroke is prevented for every 37 patients with dementia who avoid 2-3 months of antipsychotic symptoms for their BPSD. In a general hospital there are the dementia and delirium team, as well as Liaison Psychiatry who you can refer to.

Psychiatric 52

Psychiatric Documentation/Coding Stroke Fractures 52

Taming the SRU

AUGUST 4, 2024

We discussed some practices to push learners outside of their comfort zone and promote learning, based on their level as well as their goals for the shift. It is better to finish early than rushing through your presentation

Emergency Department 84

Emergency Department Dislocations Documentation/Coding Burns 84

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. However, peripherally dosed push dose pressors, (PDPs), are beginning to be administered more frequently for management of acute hypotension.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Sensible Medicine

JUNE 30, 2023

On the other hand, KW was a middle-aged American man with chest pain and significant risk factors for coronary artery disease – hypertension and diabetes – neither of which had ever been terribly well-controlled. She was well hydrated and her vital signs were normal. PH is a woman I have written about in the past.

Hospitals 92

Hospitals Hospice Resuscitation COPD 92

Sensible Medicine

FEBRUARY 28, 2024

He is a thoughtful well-read cardiologist. 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.

Stroke 44

Stroke Documentation/Coding Outcomes Wellness 44

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 LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). (And

Infectious Diseases 96

Infectious Diseases Seizures Ultrasounds Sepsis 96

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Regarding my Systematic assessment of ECG #1: There is significant baseline artifact , as well as baseline wander. I therefore feel it relevant to document ( in your dictation/on the medical chart ) when significant artifact potentially impairs the accuracy of your interpretation. Smith's ECG Blog.

Seizures 104

Seizures EKG/ECG EMS Stroke 104

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. This medication has specific indications and contraindications that we should know well.

EMS 52

EMS Stroke Leadership Documentation/Coding 52

Downeast Emergency Medicine

APRIL 26, 2021

Trauma patients between the ages of 18-90 years had to have either had one documented episode of hypotension (defined as a systolic BP <90 mmHg) or tachycardia (>100 beats/minute) to be included in the study. MI or stroke). TXA does not increase the incidence of thromboembolic events such as DVT/PE, stroke, or MI.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 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. Nachi: Well, I’m sure more of those studies are still coming. Show More v Jeff: Fair enough, we’ll take what we can get. Jeff: Agree.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

ACEP Now

JULY 6, 2023

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 In 2023 we must move beyond that title.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 52

Northwestern EM Blog

MAY 16, 2022

The above study was well summarized and bears repeating that, in this multicenter randomized study assessing CT vs POCUS vs radiology performed US in patients with suspected renal colic in the ED setting, initial US reduced radiation exposure without adversely affecting patient-centered outcomes.

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. Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. Don't go looking, if you won't do anything with the test. Am J Cardiol. 2012;110:284 –289.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Dr. Smith's ECG Blog

JANUARY 5, 2020

See below how this has been documented. speci fi city of the General Electric (GE) algorithm for AF, but they excluded cases with ventricular paced rhythm (VPR), in which the underlying atrial rhythm was frequently AF;we did not exclude VPR, as accurate identi fi cation of AF in VPR is important for determination of stroke risk [ 22 ].

EKG/ECG 52

EKG/ECG COPD Wellness Sepsis 52

Mind The Bleep

NOVEMBER 2, 2024

Babies in the neonatal unit will typically wait until they are well enough for the examination e.g. NIPE is not performed for baby’s who are ventilated, on CPAP or have lots of different lines inserted. Other important questions to ask: Have they been feeding well? Was the baby head down presentation from 36 weeks onwards?

Documentation/Coding 52

Documentation/Coding Dislocations Ultrasounds Wellness 52

Taming the SRU

JUNE 6, 2023

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

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Sensible Medicine

APRIL 29, 2024

You can assess how well (or poorly) a practicing cardiologist did analyzing a paper in the Journal of Clinical Epidemiology. Say blueberries and rates of stroke. In this section, they documented the variations in analytic method (for instance, the choice of model and co-variates). It’s the Methods !

Stroke 137

Stroke Documentation/Coding Shock Research 137

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.  2012;43:1711––1737.

Seizures 85

Seizures Stroke Outcomes EMS 85

EB Medicine

MAY 3, 2019

The PSS-3 assesses for depression/hopelessness and suicidal ideations in the past 2 weeks as well as lifetime history of suicide attempt. 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

DECEMBER 1, 2018

Antigen drift refers to small point mutations to the viral genes that code for H and N. Jeff: Of note, EMS providers should use face masks themselves and place them on patients as well. Jeff: Viral culture and RT-PCR remain the gold standard, but both require more time and money, as well as a specialized lab. Nachi: Amazing.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 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. Jeff: And the etiology of CHS is not well understood. Cannabis users who smoked at least once weekly had a 3.3

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Dr. Smith's ECG Blog

APRIL 8, 2015

True Syncope: If, on the other hand, the patient is well, had no other serious symptoms , has a normal sinus rhythm, and normal physical exam , then you need to be certain the syncope was not due to a dangerous brady- or tachydysrhythmia that could recur. Vasovagal syncope is generally benign. g/dL —Hypotension (obviously!)

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52