ED Charting and Coding: Medical Decision Making (MDM)
Editor’s Note (Jan 13, 2023): The new AMA CPT 2023 Documentation Guidelines have been published and the coding elements within the medical decision making section have been revamped. See the ACEP FAQ page on the 2023 Emergency Department Evaluation and Management (E/M) Guidelines. In this ED Charting and Coding Series, we have covered Introduction to ED Charting and Coding (PV Card); the History of Present Illness & Past Medical, Family, Social History; the Review of Systems; and the Physical Exam. At last we arrive at the crux of the chart: Medical Decision Making (MDM). In this final section, you show [+]
PV Card: Hip Injuries | Quick Reference Guide
Orthopedic injuries are commonly managed in the emergency department. Often a quick bedside reference card is needed to remind the clinician about the acute management decisions. This is the second of a series of orthopedic quick reference cards written by a team from the 2015-16 ALiEM Chief Resident Incubator. The first was on ankle and hindfoot fractures, and this card set covers hip injuries, such as hip dislocations and femur fractures. These cards were expert reviewed by Dr. Scott Sherman, co-editor of the Emergency Orthopedics textbook (Amazon), and illustrations were created by Dr. Mary Haas. [+]
I am Dr. Michelle Lall – How I Promote Wellness in EM
Dr. Michelle Lall, an Assistant Professor and Assistant Residency Director is dedicated to promoting work-life balance and resilience among her co-workers and nationally. She was inspired in part by her experience growing up as the daughter of a physician who worked long hours his whole life. In addition to promoting wellness through national committees, she has developed a multi-tiered approached involving faculty, residents, advanced practice providers, as well as significant others to promote wellness at every level in her department. [+]
MEdIC: The Case of the Overly Attentive Attending – Expert Review and Curated Community Commentary
The Case of the Overly Attentive Attending outlined an egregious scenario of a staff physician displaying sexually aggressive behaviour towards his junior resident, Samantha. The case also focuses on her inner struggle following the incident regarding how to proceed after being the victim of sexual harassment. This month, the MEdIC team (Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve Purdy, John Eicken, and Brent Thoma), hosted a discussion around this case with insights from the ALiEM community. We are proud to present to you the Curated Community Commentary and our 2 expert opinions. Thank-you to all participants for contributing to the very rich and very serious discussions [+]
ED Charting and Coding: Physical Exam (PE)
Editor’s Note (Jan 13, 2023): The new AMA CPT 2023 Documentation Guidelines have been published and the prior physical elements are no longer incorporated into the billing and coding guidelines. See the ACEP FAQ page on the 2023 Emergency Department Evaluation and Management (E/M) Guidelines. “What do I see, hear, and smell when I walk into the room?” While the oral boards challenge you to perform the physical exam in a certain way, the day to day examination of patients can vary dramatically. Centers for Medicare and Medicaid Services (CMS), however, has physical exam guidelines for billing that conform [+]
PV Card: Algorithm for acute bronchiolitis management
Bronchiolitis is a common lower respiratory tract infection in children less than 2 years old, and especially in those 3-6 months old. In a collaboration with the American Academy of Pediatrics’ (AAP) Section on Emergency Medicine Committee on Quality Transformation, we present a PV card summarizing the Section’s “Clinical Algorithm for Bronchiolitis in the Emergency Department Setting” (reproduced with permission).1 Dr. Shabnam Jain sums it up best in her expert peer review below: “In bronchiolitis, less is more.” [+]
ED Charting and Coding: Review of Systems
Editor’s Note (Jan 13, 2023): The new AMA CPT 2023 Documentation Guidelines have been published and the prior Review of Systems section is no longer incorporated into the billing and coding guidelines. See the ACEP FAQ page on the 2023 Emergency Department Evaluation and Management (E/M) Guidelines. The Review of Systems (ROS) was the most frustrating aspect of charting as an intern. Documenting at least 10 elements from systems seemingly unrelated to the chief complaint took as long as a physical exam and was much harder to remember. For efficiency, many of us include any pertinent positives and negatives [+]
New ALiEM turquoise socks now for sale
In anticipation of the upcoming holidays, we have a stock of brand new ALiEM turquoise socks for sale. We gave them out to our core team members at the recent American College of Emergency Physicians (ACEP) Scientific Assembly in 2016. Needless to say, they were a big hit. These are now available for online purchase (along with the remaining few blue ones that we will retire after this last stock runs out). Currently they are only available for purchase and shipment in the United States. Come join our extended ALiEM family! [+]
MEdIC Series: The Case of the Overly Attentive Attending
Welcome to season 4, episode 2 of the ALiEM Medical Education in Cases (MEdIC) series! Our team (Drs. Tamara McColl, Teresa Chan, John Eicken, Sarah Luckett-Gatopoulos, Eve Purdy, and Brent Thoma) is pleased to welcome you to our online community of practice where we discuss the practice of academic medicine! In this month’s case, a junior resident feels violated and shamed after a sexually aggressive encounter with an orthopedic attending physician. [+]
Magnesium for Rapid Atrial Fibrillation Rate-Control in the ED
We love magnesium in the Emergency Department. It’s been said that magnesium is second-line for everything (kind of like doxycycline). But what about rate/rhythm control in atrial fibrillation (AF)? The 2014 AHA/ACC/HRS guideline for the management of patients with AF doesn’t mention magnesium at all.1 Dr. Josh Farkas (@PulmCrit) wrote about magnesium infusions for atrial fibrillation and torsade last year. His post looked at its use for cardioversion, rhythm-control, and rate-control in critically-ill patients. Our post will focus specifically on the IV magnesium data for rate-control in ED-related settings. [+]