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

ACEP Now

FEBRUARY 11, 2024

The ultrasound-guided clavipectoral plane block (CPB) is a newly described technique in the emergency medicine literature. Ultrasound Survey Scan FIGURE 1A: Ultrasound probe should be placed at the clavicle with the probe marker facing cephalad (toward the head). FIGURE 1B: Ultrasound image with labeled relevant anatomy.

Ultrasounds 52

Ultrasounds Fractures Emergency Department Hospitals 52

Dr. Smith's ECG Blog

OCTOBER 18, 2023

4,5] We have now formally studied this question: Emergency department Code STEMI patients with initial electrocardiogram labeled ‘normal’ by computer interpretation: a 7-year retrospective review.[6] have published a number of warnings about the previous reassuring studies.[4,5] Am J Emerg Med. 2022 ; 55 : 180 - 182 6.

EKG/ECG 122

EKG/ECG Documentation/Coding Emergency Department Outcomes 122

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Bedside cardiac ultrasound with no obvious wall motion abnormalities. We documented that the majority of stenotic lesions had compensatory enlargement and thus exhibited remodeling. He had a previous ECG on file: Proving the findings are new The cath lab was activated. He was given aspirin and sublingual nitro and the pain resolved.

EKG/ECG 125

EKG/ECG Ultrasounds Documentation/Coding Wellness 125

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. First, examine the patient and risk-stratify them for the diagnosis of DVT before deciding on the clinical utility of an ultrasound. Ultrasound. mg/kg for 24 hours.

Ultrasounds 90

Ultrasounds Documentation/Coding Wellness EMS 90

EM Ottawa

OCTOBER 3, 2024

Point-of-care ultrasound (POCUS) is often taught to answer binary questions, like, “Is there free fluid in the abdomen?” ” However, when we combine POCUS images with clinical documentation, we are telling a story — and every good story has a beginning, middle, and end.

Ultrasounds 54

Ultrasounds Documentation/Coding Radiology Radiology 54

EB Medicine

NOVEMBER 1, 2021

Also, this month use code ACEP21! It is in Beta and your feedback is welcome. ,* Also, this month use code ACEP21! It is in Beta and your feedback is welcome. and get 20% of all orders at [link] Emergency Department Management of Rib Fractures Author: Patrick Maher, MD Episode Outline: Why rib fractures? Coming to Google Play soon.

Fractures 52

Fractures Documentation/Coding Operations Emergency Department 52

EMDocs

AUGUST 8, 2023

Keys: Order the ultrasound in a patient with testicular pain, especially with any TWIST score >0. Minimal if any harm to patients by obtaining ultrasound. Even with a normal ultrasound, if the history/exam are concerning – call urology. Repeat ultrasound after manual detorsion to look for normal blood flow.

Ultrasounds 87

Ultrasounds Documentation/Coding Outcomes Emergency Department 87

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). It is most helpful to do the ultrasound immediately before needle insertion, as movement of the patient may shift cutaneous landmarks from underlying bony structures. WHY - Why Not? REFERENCES 1.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

Dr. Smith's ECG Blog

JANUARY 5, 2024

The documentation does not describe any additional details of the history. They also documented "Reproducible chest tenderness." On intravascular ultrasound (IVUS), the mid RCA plaque was described as "cratered, inflamed, and bulky," and the OM plaque was described as "bulky with evidence of inflammation and probably ulceration."

EKG/ECG 123

EKG/ECG Burns Urgent Care Documentation/Coding 123

The Skeptics' Guide to EM

MAY 11, 2019

His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation. His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation. first appeared on The Skeptics Guide to Emergency Medicine.

Documentation/Coding 40

Documentation/Coding Operations Academics Ultrasounds 40

Taming the SRU

AUGUST 4, 2024

Know your audience, and tailor your presentation to them in terms of humor, pop culture references, and dress code Err on the side of making your presentation slightly shorter than the alloted time to allow room for questions. It is better to finish early than rushing through your presentation

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

Dr. Smith's ECG Blog

JUNE 17, 2024

Cardiac Ultrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism. Now another, with ultrasound. Submitted by a Med Student, with Great Commentary on Bias! Chest pain, SOB, Precordial T-wave inversions, and positive troponin. What is the Diagnosis? This is a quiz. The ECG is nearly pathognomonic.

EKG/ECG 141

EKG/ECG Emergency Department Shock Ultrasounds 141

Don't Forget the Bubbles

NOVEMBER 20, 2023

Document the size, consistency and location in the notes to compare if they represent. These may require surgical drainage following confirmation on ultrasound scan. They may grow again with subsequent upper respiratory tract infections. Difficulty swallowing, stridor or altered voice should prompt urgent ENT assessment.

Pediatrics 124

Pediatrics Documentation/Coding Emergency Department Ultrasounds 124

Dr. Smith's ECG Blog

MAY 13, 2024

The Queen of Hearts read this ECG as OMI – Low Confidence Click here to sign up for QoH Access The providers taking care of this patient were concerned regarding his clinical history and initial ECG, so they next performed a bedside cardiac ultrasound. Speckle Tracking Echocardiography may provide another useful adjunct.

EKG/ECG 123

EKG/ECG Emergency Department Ultrasounds Documentation/Coding 123

RebelEM

JANUARY 29, 2024

Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. A prospective, Single-Arm Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. CHEST 2010.

Stroke 133

Stroke Outcomes Hospitals Administration 133

EMDocs

JUNE 22, 2023

I have been a part of many traumatic codes and resuscitations during my training, but I knew this one would probably be my most difficult one. Have you done an ultrasound yet?” This guy is an ultrasound guru. Should be here in 5 minutes.” reported one of the seasoned nurses. She was calm. My response: “Call everyone.

Resuscitation 98

Resuscitation Ultrasounds Critical Access Radiology 98

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. Passively, I watch another clinician’s cursory examination of a critically ill patient to determine how they deem a patient “toxic-appearing” or their bedside neurological assessment to activate a code stroke.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

Sensible Medicine

JULY 24, 2023

But there had been two placebo-controlled drug trials that documented a 45-55 second increase in exercise time. Using an echocardiogram (ultrasound), they found that muscle downstream from the stented vessel looked a lot better in the treatment arm vs placebo. You might wonder how they came up with 200 patients?

Academics 98

Academics Documentation/Coding Ultrasounds Wellness 98

Taming the SRU

SEPTEMBER 15, 2023

ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED? ETT onto a fiberoptic scope.

CPR 90

CPR Burns Airway Management Wellness 90

Dr. Smith's ECG Blog

JANUARY 2, 2025

Bedside cardiac ultrasound showed moderately decreased LV function. In the middle of the night, a "code" was called, and multiple rhythms like this were recorded. She was intubated. CT of the chest showed no pulmonary embolism but bibasilar infiltrates. LBBB, ventricular pacing, etc.)." CASE CONTINUED She was admitted to the ICU.

EKG/ECG 119

EKG/ECG Sepsis Wellness Documentation/Coding 119

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

Northwestern EM Blog

MAY 16, 2022

What is your initial imaging test of choice, ultrasound (US) or non-contrast CT, and why? Would you be confident in a point-of-care-ultrasound evaluation or a formal ultrasound? Many patients in the ultrasound groups did get additional imaging, but this was not the majority. How do you proceed? In this study, 40.7%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Emergency Medicine Cases

MAY 23, 2017

This is the first ever video podcast on EM Cases with Jordan Chenkin from EMU Conference 2017 discussing how to optimize three aspects of cardiac arrest care: persistent ventricular fibrillation, optimizing pulse checks and PEA arrest, with code team videos contrasting the ACLS approach to an optimized approach.

Documentation/Coding 52

Documentation/Coding EMS Ultrasounds Resuscitation 52

Taming the SRU

JUNE 3, 2024

glenn, haffner, and jackson In Flight Emergencies: As a responding physician to an in-flight emergency, you may recommend diverting the plane, however, the captain (lead pilot) will make the final decision.

Shock 91

Shock Seizures Airway Management Stroke 91

ACEP Now

JUNE 6, 2023

A medical student reports a murmur, not documented by either the emergency physician or the cardiologist. POCUS: Point-of-care ultrasound for AD is highly specific, but operator-dependent, and lacking in sensitivity—although late–model units can have sensitivity as high as 80-85 percent. Then what? He denies back pain.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

ACEP Now

JANUARY 4, 2025

A typical shift when he was starting out would include patients falling into what was coded as 1350 major medical/trauma, 1060 minor medical/trauma, or 1050 medical walk-in. Now, we have ultrasound or CT scans to confirm. Today, physicians can utilize MRIs, CT, and ultrasound, with the latter often available at the point of care.

Forensics 52

Forensics Urgent Care Hospitals Emergency Department 52

Emergency Medicine Ireland

DECEMBER 17, 2020

There is a substantial ANZICS document on tracheostomy that forms the structure for this tasty morsel. I suppose this is somewhat similar to ultrasound for CVCs as plenty of people seem to cope perfectly well without it * no good data to guide a solid recommendation as yet.

Ultrasounds 40

Ultrasounds Documentation/Coding Wellness 40

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Pads were placed with ultrasound guidance, so they were in the correct position. As I discussed and documented in Lesson 1 of My Comment at the bottom of the page in the April 2, 2022 post of Dr. Smith's ECG Blog — certain patients may remain in sustained VT not only for hours — but even for days! However, this is not SVT.

EKG/ECG 141

EKG/ECG Shock Academics Documentation/Coding 141

Dr. Smith's ECG Blog

JULY 21, 2024

In both tracings — an exceedingly fast PMVT is documented. Another approach is sympathetic chain (stellate ganglion) blockade if you have the skills to do it: it requires some expertise and ultrasound guidance. That said — there is no evidence on ECG of re-occlusion of the infarct artery.

EKG/ECG 134

EKG/ECG Shock Hospitals Sepsis 134

Dr. Smith's ECG Blog

AUGUST 9, 2024

He had no previously documented medical problems except polysubstance use. However the patient continued to have chest pain and bedside ultrasound showed hypokinesis of the septum with significantly reduced LVEF. He reported a history of “Wolf-Parkinson-White” and “heart attack” but said neither had been treated.

EKG/ECG 110

EKG/ECG EMS Emergency Department Wellness 110

Taming the SRU

MAY 30, 2023

Generally accepted (and some airlines spell it out) that they are assuming the liability even for you helping Documentation: To protect yourself (and the airline), will/should make documentation of what happened. hours earlier and went to OR 3.5 hours earlier and went to OR 3.5 Each airline generally has their own protocol.

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52

EMDocs

FEBRUARY 12, 2025

Imaging: In severe cases, imaging with ultrasound, CT or MRI may be useful in assessing the extent of tissue injury and in further evaluating other etiologies including infection and worsening malignancy. Research indicates that timely intervention can significantly reduce morbidity associated with radiation skin injuries. 2022;23(3):e13526.

Best Practices 54

Best Practices Documentation/Coding Radiology Radiology 54

Dr. Smith's ECG Blog

OCTOBER 2, 2021

After rethinking the case, he remained concerned about ACS and subsequently performed a point-of-care ultrasound in order to evaluate for regional wall motion abnormality. We assume that at some point the patient's pain returned, but it is not documented, so exactly when this happened is uncertain.

EKG/ECG 52

EKG/ECG Ultrasounds EMS Documentation/Coding 52

Dr. Smith's ECG Blog

JUNE 14, 2017

A bedside cardiac ultrasound was normal. I’ve attached an article and an abstract (that article is in Japanese unfortunately … ) that do document that you CAN however on occasion find AIVR in otherwise healthy children — and I suppose that IS what we have here. His chest was tender. He wrote: "ECG 1 - shows wide ???IVCD

EKG/ECG 52

EKG/ECG Documentation/Coding Ultrasounds Wellness 52

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

Fortunately, this operator used intravascular ultrasound (IVUS). The operator documented thoughtful consideration of risks and benefits of stent placement. An angiogram is a " lumenogram " and does not "see" the extraluminal plaque. Most plaque is outside the lumen!! And so other modalities may be necessary.

EKG/ECG 69

EKG/ECG Operations Wellness Ultrasounds 69

Resus Review

FEBRUARY 12, 2015

Use ultrasound to identify an large vessels in the area. Dont forget to document your perc trach procedure well. Skin Incision The neck should be carefully palpated and the anatomy should identified (thyroid cartilage, cricoid cartilage, and 2-3 tracheal rings). Consider labelling the landmarks with a permanent marker.

Operations 52

Operations Documentation/Coding Ultrasounds Wellness 52