Dr. Smith's ECG Blog

DECEMBER 27, 2023

Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present." Smith comment: But the tests (ECG and troponin) are extremely specific and so the post test probability is nearly 100%. Repeat cTnI drawn at around 8 AM was 3.910 ng/mL. This patient was not one of the lucky 6.4%

E-9-1-1 131

E-9-1-1 OR Coronary ACS 131

The Skeptics' Guide to EM

JULY 27, 2024

That document tells us “Before widespread implementation, CDRs should be compared to clinical judgement.” [3] A randomized control trial (RCT) done in the prehospital setting enrolled 2,698 patients. However, getting the right diagnosis is clearly important for our patients, and as good as we are, no clinician is perfect.

ICU 248

ICU ALS Ambulance OR 248

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 116

E-9-1-1 ACS OR Emergency Department 116

ESO

JANUARY 27, 2025

The ability to import data from the monitor to ESO EHR reduces documentation time while improving the accuracy of your data, allowing you to better focus on the delivery of care. You can use it to directly document and upload FLACC Pain Scores and final score data for non-verbal patients into ESO Insights for easier reporting.

MIH 98

MIH Community Paramedicine Paramedicine Paramedicine 98

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

We documented that the majority of stenotic lesions had compensatory enlargement and thus exhibited remodeling. Strictly speaking — this case does not at this time qualify as MINOCA — because the negative cath and 2 normal hs-troponins done 6 hours apart failed to document infarction. (

Coronary 122

Coronary ACS OR EMR 122

Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

And you can see why: the artery may sponstaneously reperfuse, as it did here well before angiography, and documented with resolution of pain and evolution of the ECG to typical full reperfusion pattern Peak troponin I was 8544 ng/L. This is diagnostic of full reperfusion.] 90% of normals have some STE in V2 and V3. Which 1 or 2 leads are KEY?

OR 131

OR STEMI Coronary 131

ACEP Now

NOVEMBER 7, 2024

Poorly healing wounds are primarily the result of chronic venous insufficiency, peripheral (arterial) vascular disease, prolonged pressure-point skin injury, or neuropathy secondary to vascular disease or diabetes. Once identified, they must protect the skin from further injury. Examples include Adaptic, Xeroform, Telfa, and Dermagen.

ED 97

ED OR Emergency Department Ambulance 97

ESO

JANUARY 30, 2025

While the list is not exhaustive an d critical incidents can vary from person to person, their documentation is crucial for protecting your own team and further improving research for the entire industry. Documenting exposure to critical incidents is key. So, what else can your organization do?

First Responder 52

First Responder Public Safety EMS First Response 52

ALiEM

JANUARY 26, 2024

Ciprofloxacin has been documented as a cause of IgA vasculitis. The patient stated that she was started on Cipro eyedrops 1 or 2 days prior to presentation for a possible eye infection. It was not on her palms or soles. She had no mucous membrane involvement. They are somewhat raised, non-blanching, not itchy, and non-tender.

EMS 183

EMS OR 183

ESO

DECEMBER 26, 2024

Improvements like longitudinal patient records have transformed episodic documentation into comprehensive patient narratives, aiding both EMS and community health providers in delivering coordinated care. iOS for EHR Coming soon, the new native ESO EHR iOS app is designed to make documenting patient data even easier and more efficient.

First Responder 105

First Responder Emergency Medical Services EMS Critical Care 105

High Performance EMS

JUNE 20, 2024

The documentation that is inherent in such a process also facilitates the reporting for performance reviews. Emergency medical care in the field should not be simply the first rung of a ladder to other health care careers, but a profession where providers can earn a living wage commensurate with the hazards of the care they afford to others.

EMS 240

EMS First Responder Emergency Response OR 240

EMS 12-Lead

SEPTEMBER 8, 2024

Paramedics increase the current slowly over nearly 3 minutes to 100ma where a documented mechanical capture (pulse palpation site not specified) was noted. He has a past medical history of HTN, HLD, DM, seizures, and ESRD with a regular hemodialysis schedule (per family, he adheres to his schedule meticulously).

Paramedic 230

Paramedic EMT EMT EMS 230

Pediatric EM Morsels

JULY 28, 2023

A critical MORSEL is that every child you treat for DKA needs to have an initial thorough neuro exam including cranial nerves and then frequent neuro reassessments … and document it ( so your colleagues who take over care for the kid can know if there has been a change )! or serum bicarbonate between 5-10 mmol/ L Severe : venous pH < 7.1

E-9-1-1 246

E-9-1-1 ALS OR Critical Care 246

ESO

DECEMBER 16, 2024

It’s an administrative burden that demands extensive documentation and reporting. A modern electronic patient care report (ePCR), like an ESO Electronic Health Record (EHR) , ensures that hospitals can easily capture documentation for standards, such as those required by The Joint Commission.

EMS 52

EMS OR 52

EMDocs

OCTOBER 3, 2023

This is also where keeping up with documentation starts to slip. You’ll need to put the following tasks in a rank order list: new patient evaluations, dispositions, managing critical or potentially critical patients, results review, team huddle, running the board, calling consults, doing procedures, and documentation.

EMR 122

EMR EMS OR Emergency Department 122

EMDocs

JULY 25, 2024

The nurse completes the Columbia-Suicide Severity Rating Scale (C-SSRS) and documents that the patient’s recent thoughts of killing himself and his detailed plan makes him “High Risk” for suicide. There is no documented handoff to the on-coming emergency physician (EP) who assumes care. ” 0700 : The PA-C goes off-shift.

ED 104

ED ALS Emergency Department OR 104

ACEP Now

DECEMBER 17, 2024

One of the first documented strikes among house staff officers took place in 1974 at Howard University here in Washington, D.C., Historically, labor unionization among health care workers is uncommon, 5 including among resident physicians, 6 and the prospect of striking even more so. This victory is about more than just numbers.

E-9-1-1 105

E-9-1-1 Emergency Department ALS OR 105

EMDocs

MAY 9, 2024

Exam documents that he is alert and oriented but “tired appearing” and “not appearing post-ictal.” Defense : The EP did address the seizure when he documented “not post-ictal.” There is no negligence, as the documentation supports reasonable judgment. The triage nurse records the event as a “seizure” lasting 7 minutes.

ED 105

ED EMS OR 105

ALiEM

JANUARY 22, 2024

Fever was documented to be 102°F and was not associated with any chills or rigors. A 40-year-old male, tailor by occupation, was brought to the Emergency Department with complaints of high-grade fever for the past 11 days. Case Question: What clinical condition is associated with eschars?

Emergency Department 161

Emergency Department OR 161

Irish College of Paramedics

FEBRUARY 15, 2025

A draft guidance document was developed after the completion of a national consultation process though an electronic survey with EMTs. A draft guidance document was developed after the completion of a national consultation process though an electronic survey with EMTs. Qualitative analyses were performed using NVivo (version 10).

Paramedic 40

Paramedic EMT EMT ALS 40

ESO

JANUARY 31, 2024

According to a recent study from ESO , decontamination procedures were only documented in 82% of all working fires incidents, and out of those exposures, only 4% documented all on-scene decontamination procedures. This leaves significant of room for improvement. What can the industry do?

Firefighter 105

Firefighter OR 105

Handtevy

MARCH 28, 2019

The amazing part of this story is that it took more than 20 years for the scientific community to prove this theory to be correct and for other doctors to accept it as standard practice. This interesting piece of history defines the term neophobia, or the fear of something new. Are there are evolutionary reasons for neophobia?

OR 52

OR Paramedic 52

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

These “allergies” are often poorly documented and could potentially be more accurately described as intolerance [1]. Background: Penicillin allergies are among the most reported drug allergies, with estimates suggesting that up to 10% of the US population claims to have a penicillin allergy. A pivotal study by Raja et al.

ICU 143

ICU Emergency Department ALS ED 143

EMDocs

JUNE 28, 2023

EMS report includes concern for CVA, with variable documentation of face and extremity weakness. EMS report includes concern for CVA, with variable documentation of face and extremity weakness. Nursing documentation includes the presence of a facial droop. He is transported to a different hospital as possible trauma.

EMS 94

EMS ED OR 94

AAAM

MARCH 6, 2025

In June, we hosted Understanding Accessibility: Practical Strategies for Inclusive Documents, Presentations, and Websites , which provided tips on presenting at conferences that are inclusive to those with disabilities or language barriers.

OR 52

OR 52

EMDocs

SEPTEMBER 26, 2024

An unknown EP reviews the report, determines that there is no reason to notify the patient, and documents nothing. It wasn’t, so you weren’t called, nor did the doc need to document anything. This patient’s history was either poorly taken or poorly documented. Too much weight was given to the EKG, CXR, and labs.

Emergency Department 97

Emergency Department ED Coronary ALS 97

EMDocs

AUGUST 22, 2024

13 Interventions may include: Ascertaining a patient’s preferred language early in the clinical encounter (during registration, for instance), and clearly documenting this preference in a place that is visible to all providers. Utilizing certified interpreters and documenting their use. Educating patients on their rights.

Emergency Department 104

Emergency Department ALS E-9-1-1 ED 104

NVFC

OCTOBER 22, 2024

Course attendees received an instructor guide, slides, an Emergency Response Guide (ERG), and a resource drive with dozens of forms and documents to assist in local hazmat response planning. Pipeline and Hazardous Materials Safety Administration. This is the NVFC’s second SPST grant.

First Responder 116

First Responder Emergency Response EMS OR 116

EMDocs

OCTOBER 10, 2024

Exam is normal except for tenderness as documented in the diagram. She never had a documented abdominal exam. I just failed to document it. The EP documented seeing the patient and agreed with the ARNP’s plan. There is no mention of an abdominal exam. She is given 60 mg IM ketorolac for thigh pain. It was benign.

ED 97

ED OR ICU 97

EMDocs

JUNE 13, 2024

We just don’t document it. If we don’t use printed instructions, document our verbal instructions regarding the most common side effects of the drug(s) being prescribed. Documenting our warnings should be standard care. Complications result in a total colectomy with its accompanying lifestyle changes. difficile colitis.

Emergency Department 98

Emergency Department ED EMS OR 98

The Good, The Bad & The Ugly Paramedic

JULY 1, 2020

In Australia, for example, AHPRA’s Paramedicine Board describes paramedics as "practitioners" throughout documentation regarding registration. As paramedics, whilst we often take great offence at being called ambulance drivers, the question is, when it’s our turn to drive, what exactly is it that we are providing?

Ambulance Driver 52

Ambulance Driver Paramedic Ambulance OR 52

The Skeptics' Guide to EM

OCTOBER 28, 2017

Stevens and colleagues updated their review in 2016 and concluded “sucrose is effective for reducing procedural pain” and “no serious side effects or harms have been documented with this intervention”. That rant relied upon a Cochrane SRMA by Stevens B et al 2013 and a randomized clinical trail published in Pediatrics by Gray L et al 2015.

ALS 130

ALS Emergency Department OR ED 130

EMDocs

OCTOBER 11, 2023

.” The tech cleans the wound and documents it as 2cm long and “ dirty.” The ED physician documents suturing a 3 cm laceration in a single layer, omitting any reference to any wound exploration, cleansing or debridement. I thought they were incidental “ bone islands” so I didn ’ t document them. I just didn ’ t document it.

ED 93

ED EMS OR 93

The Skeptics' Guide to EM

JANUARY 23, 2021

The American College of Emergency Physicians ( ACEP ) also has a number of documents discussing APPs in the ED. AEM January 2021 Case: A 50-year-old male presents to the Emergency Department (ED) with left lower quadrant abdominal pain. The patient is seen by an advanced practice provider (APP).

ED 130

ED ALS Emergency Department OR 130

Pediatric EM Morsels

JULY 5, 2024

It seems like just yesterday ( or maybe ~ a month ago ) when we served up a tasty morsel on the PECARN decision rule for intra-abdominal traumatic injuries in children. Our friends at the PECARN injury group have remained busy this spring with generating more externally validated clinical decision rules. High Risk (12.8% High Risk (12.8%

ALS 164

ALS OR ED Emergency Department 164

NAEMSP

APRIL 15, 2024

All cases with restraints should be clearly documented, in some systems medical control should be involved, QA of all these cases should be considered. Article Summary by Sarah Fabiano, MD, FACEP, FAAEM Kupas DF, Wydro GC, Tan DK, Kamin R, Harrell AJ 4th, Wang A. Prehosp Emerg Care 2021 Sep-Oct;25(5):721-3. doi: 10.1080/10903127.2021.1917736.

OR 52

OR Emergency Medical Technician Emergency Medical Services EMS 52

EMDocs

JUNE 9, 2023

We’re defining “protocol” here as a written document that provides oversight from the medical director about how to assess and treat patients. Protocols Every EMS agency should have protocols for dealing with agitated or violent patients. Sometimes these can also be referred to as guidelines, standing orders, policies, or procedures.

Emergency Medical Services 98

Emergency Medical Services EMS Emergency Department Ambulance 98