EMDocs

MAY 4, 2024

. #1: Emergent Cath Lab Activations with “Normal” Computer ECG Interpretations Spoon Feed A significant minority of code STEMI patients have an initial normal computer ECG interpretation. Source Endovascular Thrombectomy for Large Ischemic Stroke Across Ischemic Injury and Penumbra Profiles.

Documentation/Coding 77

Documentation/Coding Stroke Emergency Department Pediatrics 77

PulmCCM

SEPTEMBER 17, 2023

Fully implemented, CDC’s toolkit would promote sepsis into the major leagues of “code strokes” and “code STEMIs” — highly prioritized system-wide operational programs enjoying executive sponsorship and significant financial and human resources. ” What is that, a sepsis Stasi?

CDC 98

CDC Sepsis Hospitals Documentation/Coding 98

Emergency Medicine Cases

JULY 4, 2017

In this two part EM Cases Journal Jam podcast Justin Morgenstern, Rory Spiegel and Anton Helman do a deep dive into the world's literature on systemic thrombolysis for ischemic stroke followed by an analysis of endovascular therapy for stroke.

Stroke 52

Stroke Documentation/Coding EMS 52

EMDocs

JUNE 28, 2023

EMS report includes concern for CVA, with variable documentation of face and extremity weakness. Nursing documentation includes the presence of a facial droop. There, his initial neuro exam is documented as normal, but a head CT reveals evidence of a possible acute CVA in the right hemisphere. a stroke or cardiac event).

Documentation/Coding 67

Documentation/Coding EMS Stroke Patient Safety 67

Board Bombs

AUGUST 16, 2020

Check out our interactive question bank podcast- the FIRST of its kind here: emrapidfire.supercast.tech Code Stroke? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidfire.supercast.tech Code Stroke? JK its just Bells Palsy. JK its just Bells Palsy. or is it?

Documentation/Coding 52

Documentation/Coding Stroke 52

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 Wellness EKG/ECG 52

EMDocs

SEPTEMBER 19, 2023

Also think about NCSE in patients with prior cerebral pathology (ie, ischemic stroke); a patient who was seizing, was treated, and is not coming out of their post ictal state; and in patients with unexplained altered mental status with no other cause. Official diagnosis requires EEG, which is not something we can typically obtain in the ED.

Seizures 72

Seizures Documentation/Coding EKG/ECG Emergency Department 72

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.

Pediatrics 52

Pediatrics EMS Documentation/Coding Stroke 52

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. The patient came in working hard to breath, had minimal improvement after meds and treatments and was clearly tiring.

Documentation/Coding 57

Documentation/Coding Outcomes EMS Stroke 57

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. 2019;154(7):e191152.

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation Pediatrics 98

The Skeptics' Guide to EM

DECEMBER 5, 2020

You’re about to call in your MRI tech from home, but then you remember reading that the HINTS exam is more sensitive than early MRI for diagnosis of posterior stroke. You wonder, “Why can’t I just rule out stroke with the HINTS exam? Posterior circulation strokes account for approximately up to 25% of all ischemic strokes [1].

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

JournalFeed

MARCH 26, 2022

High-dose IN Fentanyl Spoon Feed: Higher doses of intranasal (IN) fentanyl for pain ranging from 2-5 μg/kg (with a maximum of 200 μg) were given in a pediatric emergency department, with no documented episodes of apnea, hypotension, or respiratory failure.

Documentation/Coding 40

Documentation/Coding Stroke Emergency Department Shock 40

ACEP Now

APRIL 2, 2024

Posterior circulation strokes make up 20 percent of all strokes but account for 40 percent of stroke misdiagnoses. Dizziness is especially tricky, with up to 40 percent of strokes presenting with dizziness being missed. His neurological exam on arrival is documented as normal. His blood pressure is 190 over 115.

Stroke 40

Stroke Documentation/Coding Poisoning Emergency Department 40

ACEP Now

JUNE 6, 2023

Notoriously elusive, with a high misdiagnosis rate, thoracic aortic dissection (AD) can mimic many conditions, including acute coronary syndrome (ACS, the most common), gastroesophageal reflux disease (GERD), stroke, and spinal-cord compression. 1 Opioids or anxiolytics are often given to patients whose diagnosis of AD is missed or delayed.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

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 84

Sepsis Administration Documentation/Coding Fractures 84

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. J Stroke Cerebrovasc Dis.

Seizures 84

Seizures Stroke Outcomes EMS 84

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. A subset of these patients develop an accelerated rate either primarily or due to other factors known as rapid ventricular response.

Outcomes 52

Outcomes Documentation/Coding Stroke Wellness 52

Sensible Medicine

DECEMBER 1, 2023

This is the doctor who explains why, at age 80, it would be crazy to be “full code.” 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.

Wellness 81

Wellness Documentation/Coding Outcomes Stroke 81

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). Metropolitan Museum of Art, CC0, via Wikimedia Commons The ancient Egyptian physician Imhotep is often credited with the discovery of cerebral spinal fluid (CSF) —over 5,000 years ago! (1)

Infectious Diseases 86

Infectious Diseases Seizures Ultrasounds Sepsis 86

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

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. Even once it arrives, it will cost upwards of $25k per dose! Image from R.E.B.E.L

EMS 52

EMS Stroke Leadership Documentation/Coding 52

Sensible Medicine

JUNE 30, 2023

There was fatigue, weight loss, nausea, declining kidney function, and a few strokes. ” I documented those words in my progress note that day. SV was a patient who kept me up at night for the better part of 18 months. She was in her late 70’s and she was dying. Then, everything changed.

Hospitals 91

Hospitals Hospice Resuscitation COPD 91

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

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. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Sensible Medicine

APRIL 29, 2024

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). This time in nutritional epidemiology. Take a moment and think about the methods section of a standard association study. In other words: one way.

Documentation/Coding 136

Documentation/Coding Stroke Shock Research 136

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below).

Outcomes 119

Outcomes Stroke Hospitals Administration 119

Taming the SRU

JUNE 6, 2023

mg/kg of IBW Seek to match a patient's minute ventilation with TV and RR after intubation Intentionally match patient's intrinsic RR noted prior to intubation Note that healthy lungs can handle 8 mL/kg, based on IBW, if that is useful for compensation Secure your ETT Thomas Tube Holder is a new ETT holder on Air Care for ETT down to size 6.5

Documentation/Coding 59

Documentation/Coding Seizures Wellness Psychiatric 59

Sensible Medicine

FEBRUARY 28, 2024

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. For many individuals, this is life-transforming.

Stroke 44

Stroke Documentation/Coding Outcomes Wellness 44

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. This article outlines the main factors related to the presentation, aetiology, and treatment of BPSD.

Psychiatric 52

Psychiatric Documentation/Coding Stroke Fractures 52

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. times higher risk of stroke or TIA. Cannabis users who smoked at least once weekly had a 3.3

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

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 90

Administration Emergency Department Outcomes Documentation/Coding 90

Dr. Smith's ECG Blog

JANUARY 9, 2024

Slow VT below the detection rate of the ICD lead to worsening heart failure and low stroke volume. Lowering the back up rate (LRL) of the ICD/pacer allowed for an intrinsic rhythm with physiologic AV conduction and normal AV synchrony with resultant increase in stroke volume and cardiac outpt.

EKG/ECG 88

EKG/ECG Stroke Hospitals Documentation/Coding 88

ACEP Now

DECEMBER 11, 2023

These included oral and nasal spray formulations of these two decongestants, but a third, phenylpropanolamine, was excluded due to safety concerns relating to hemorrhagic strokes. NDAC briefing document: oral phenylephrine in the CCABA monograph. He is the Annals of Emergency Medicine podcast co-host and Journal Club editor.

Administration 64

Administration Outcomes Research Documentation/Coding 64

Don't Forget the Bubbles

JULY 5, 2023

The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke. What is the role of transcranial dopplers in primary prevention of strokes? What strategies are useful for secondary stroke prevention?

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Dr. Smith's ECG Blog

MAY 16, 2023

Like they would for any other acute arterial occlusion syndrome (such as suspicion of acute large vessel stroke), they take the patient across the hall and perform an immediate CT (coronary) angiogram, showing patent coronaries. Imagine: the providers in the case above are not sufficiently sure that the patient above doesn't have OMI.

EKG/ECG 52

EKG/ECG Documentation/Coding Stroke Outcomes 52

Northwestern EM Blog

MAY 16, 2022

Please ensure that you document and discuss with the patient accordingly. He endorses nausea without vomiting and denies fever. 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

Pediatric Emergency Playbook

APRIL 1, 2016

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. for the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. ACCF 2012 Expert Consensus Document on Practical Clinical Considerations in the Interpretation of Troponin Elevations.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52