Cook County EM Blog

MARCH 28, 2023

On point-of-care ocular ultrasound of the affected eye using the linear probe a round, mobile structure was noted in the posterior chamber with an absence of the lens in its typical position, consistent with posterior lens dislocation. What is the utility of point-of-care ultrasound in identifying lens dislocation?

Dislocations 52

Dislocations Ultrasounds Fractures Radiology 52

The Skeptics' Guide to EM

JULY 30, 2022

Point-of-Care Ultrasound-First for the Evaluation of Small Bowel Obstruction: National Cost Savings, Length of Stay Reduction, and Preventable Radiation Exposure. Point-of-Care Ultrasound-First for the Evaluation of Small Bowel Obstruction: National Cost Savings, Length of Stay Reduction, and Preventable Radiation Exposure.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

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 115

EKG/ECG Sepsis Wellness Documentation/Coding 115

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 118

EKG/ECG Documentation/Coding Emergency Department Outcomes 118

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 95

Ultrasounds Documentation/Coding Wellness EMS 95

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 Emergency Department Hospitals 52

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 121

EKG/ECG Ultrasounds Documentation/Coding Wellness 121

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 55

Ultrasounds Documentation/Coding Radiology Radiology 55

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 93

Ultrasounds Documentation/Coding Outcomes Emergency Department 93

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

RebelEM

SEPTEMBER 11, 2023

Background: Point of care ultrasound (POCUS) has a demonstrated sensitivity of 89.8% Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. and specificity of 88.0% Article: Hilsden R, Mitrou N, Hawel J, Leeper R, Thompson D, Myslik F. Trauma Surg Acute Care Open.

Ultrasounds 68

Ultrasounds Radiology Radiology Emergency Department 68

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 98

Infectious Diseases Seizures Ultrasounds Sepsis 98

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 119

EKG/ECG Burns Urgent Care Documentation/Coding 119

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 86

Dislocations Emergency Department Documentation/Coding Burns 86

Thinking Critical Care

AUGUST 3, 2024

This exclusive event, produced in collaboration with Flosonics Medical, will take place on September 28th, 2024 , in Toronto , Ontario, Canada This masterclass is designed for those who seek a deep dive into the cutting-edge techniques of venous congestion, Doppler ultrasound, and fluid resuscitation.

Fluid Resuscitation 52

Fluid Resuscitation Documentation/Coding Resuscitation Ultrasounds 52

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

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

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 91

CPR Burns Airway Management Wellness 91

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 92

Shock Seizures Airway Management Stroke 92

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

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

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

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

The Skeptics' Guide to EM

MARCH 4, 2018

With point of care ultrasound, you diagnose cellulitis without the presence of an abscess affecting a 6cm diameter area. Exclusions: There were 26 exclusions in their supplemental documentation.

Infectious Diseases 40

Infectious Diseases Documentation/Coding Ultrasounds Outcomes 40

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 65

EKG/ECG Operations Wellness Ultrasounds 65

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. Thirty minutes later the first Troponin I came back elevated at 650 ng/L (normal <26), and bedside ultrasound found anteroseptal akinesia. On arrival, GCS was 13 and the patient complained of ongoing chest pain.

EKG/ECG 52

EKG/ECG Documentation/Coding CPR Shock 52

Dr. Smith's ECG Blog

JUNE 17, 2018

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. All cases with at least one elevated cTnI were adjudicated into specific MI type (or no MI) by two clinicians who reviewed all medical records.

EKG/ECG 52

EKG/ECG Documentation/Coding Shock Ultrasounds 52

PulmCCM

OCTOBER 16, 2023

Most central lines in the ICU are placed under ultrasound guidance in the internal jugular vein, representing a perceived middle ground of risk for pneumothorax and infection prevention. Peripherally-inserted central catheters (PICCs) are inserted through the skin into an arm vein, and advanced under ultrasound into large central veins.

CDC 52

CDC Hospitals Ultrasounds Documentation/Coding 52

Mind The Bleep

FEBRUARY 29, 2024

It is worth looking through previous documentation to see whether the patient’s team or senior intensivists have set any individual cardiovascular targets. Assessing a patient’s cardiovascular status and whether we need to manipulate any aspects of it is disease process-specific and patient-specific.

Documentation/Coding 52

Documentation/Coding Hospitals Wellness Best Practices 52

EMDocs

JANUARY 11, 2024

These conversations should occur frequently and be clearly documented for other health care professionals who are not present during the conversations (96%, 22/23). In ICUs where noninvasive monitoring of cerebral autoregulation is in routine use, maintain MAP at or near the predicted MAPOPT (88.2%, 15/17).

Seizures 97

Seizures Shock Infectious Diseases CPR 97

Dr. Smith's ECG Blog

JUNE 27, 2021

A bedside ultrasound was done, with dozens of clips, and was even done with Speckle Tracking. There was no cough or fever, the CXR looks like pulmonary edema, the ultrasound showed classic pulmonary edema B lines. Differential favors aspiration/developing pneumonia and follow to resolution recommended." Here are a few clips.

EKG/ECG 40

EKG/ECG Radiology Radiology Ultrasounds 40

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

On arrival, the patient was in shock, was intubated, and had an immediate cardiac ultrasound. What does a heart look like on ultrasound when the EKG looks like that? Here you go: It's not the world's greatest cardiac ultrasound video, but it does appear to show poor function and low volume. They transported to the ED.

Shock 40

Shock EKG/ECG Resuscitation Ultrasounds 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole. 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. Nachi: If possible, obtain a view of the IVC also while doing your ultrasound to assess for volume status.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Dr. Smith's ECG Blog

JUNE 20, 2018

The medicine note documents that the patient had worsening pain with lying flat and relief with leaning forward. However, in almost every case, one should confirm absence of OMI (Occlusion MI) at least by contrast ultrasound. I n the intervening 3 hours, new Q-waves have developed in leads V3 and V4, and deepened in V5 and V6.

EKG/ECG 52

EKG/ECG Documentation/Coding Ultrasounds Wellness 52