2013, ALS and ICU - Paramedicine Now

REBEL Core Cast 123.0 – Posterior Epistaxis

REBEL EM

MAY 29, 2024

The idea behind abx is to prevent things like AOM and TSS but neither should be much of an issue with short term placement ICU Admission? Traditional teaching is that these patients are at risk for life-threatening bradydysrhythmias and should go to the ICU Literature here is non-existent. PMID: 5569677 Zeyyan E et al.

ICU

ICU ALS ACS EMS

REBEL Cast Ep115 – Phenobarbital vs Lorazepam in Alcohol Withdrawal

REBEL EM

MARCH 23, 2023

Treatment options for alcohol withdrawal include benzodiazepines such as lorazepam, diazepam, or chlordiazepoxide, gabapentin, and phenobarbital (Buell et al.). Phenobarbital can be used as a monotherapy or in combination with benzodiazepines to treat alcohol withdrawal (Hawa et al.). Paper : Hawa F et al.

ICU

ICU Emergency Department ALS OR

The Current Status of Continuous-Seizure Management

ACEP Now

JULY 7, 2024

2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus). Neurology consultation should be initiated, and the patient should be admitted to the ICU. Zehtabchi S, Abdel Baki SG, Omurtag A, et al.

Emergency Department

Emergency Department Critical Care ALS ICU

REBEL Core Cast 94.0 – SBO

REBEL EM

JANUARY 25, 2023

Acad Emerg Med 2013; 20(6): 528-44. PMID: 23758299 Maung AA et al. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. Louis, Mosby, Inc., 2010, (Ch) 92: p 1216-1227.

ED

ED ALS OR ICU

The Science on Targeted Temperature Management

ACEP Now

APRIL 3, 2024

1,2 However, the European TTM1 trial in 2013 showed similar outcomes for those cooled to 33 degrees Celsius compared to 36 degrees Celsius, leading to a 2015 AHA class I recommendation of “cooling between 32 degrees Celsius-36 degrees Celsius.” In a multisite retrospective cohort study, a study by Nishikimi, et al., N Engl J Med.

Advanced Life Support

Advanced Life Support ALS Life Support CPR

Post-Intubation Sedation and Analgesia

Core EM

JANUARY 25, 2024

The reality of ever increasing ED volumes and longer boarding times to the ICU makes it imperative for emergency physicians to learn how to manage these critical patients. It was found that patients exposed to deep sedation in the ED had an independent higher incidence of continued deep sedation on ICU day one ( Fuller, 2019 ).

ICU

ICU Emergency Department Critical Care ALS

emDOCs Revamp: Alcohol Withdrawal

EMDocs

DECEMBER 18, 2024

Gortney J, Raub J, Patel P, et al. 2013; 88(9): 589-595. Sullivan J, Sykora K, Schneiderman J, et al. Borgundvaag B, Bellolio F, Miles I, et al. Strayer RJ, Friedman BW, Haroz R, et al. Maldonado JR, Sher Y, Ashouri JF, et al. Management of drug and alcohol withdrawal. N Engl JMed. 2003; 348:1786-1795.

E-9-1-1

E-9-1-1 Emergency Department ICU ED

Geriatric Trauma

Core EM

JANUARY 25, 2024

11 Geriatric trauma patients require increased immediate and delayed ICU resources compared to younger counterparts with the same injuries. Perdue &al. Caterino &al. Sterling &al. Liu &al. Gill &al. Demetriades D &al. Goode &al. Hasegawa &al. Li &al.

ALS

ALS ED ICU OR

The PROTECTION Trial – A Randomized Trial of Intravenous Amino Acids for Kidney Protection

REBEL EM

AUGUST 12, 2024

The authors of this study sought to test the hypothesis that intravenous amino acid therapy would lead to a lower occurrence of postoperative AKI when compared to placebo. Paper: Landoni G. Intravenous amino acid therapy for kidney protection in cardiac surgery a protocol for a multi-centre randomized blinded placebo controlled clinical trial.

ICU

ICU Operating Room Critical Care ALS

Beyond Ketamine: When to use Facilitated Intubation in the ED

EMDocs

SEPTEMBER 25, 2023

Despite the risk of hypotension and bradycardia, propofol has been shown in the ICU setting to be a safe and effective monotherapy intubation agent for hemodynamically unstable patients (19). References: Heffner AC et al. Resuscitation 2013; 84(11): 1500 – 4. PMID: 23911630 Kim WY et al. PMID: 23911630 Kim WY et al.

ED

ED Emergency Department ALS Paramedic

Hypothermic Cardiac Arrest: Pearls and Pitfalls

EMDocs

JANUARY 16, 2024

He requires low-dose epinephrine to maintain his mean arterial pressure (MAP) in the 60s mmHg and is transported to the cardiothoracic (CT) ICU. Carsten L, et al. 2013 Jan 24;368(4):394]. Monika BM, Martin D, Balthasar E, et al. Forti A, Brugnaro P, Rauch S, et al. 2018.09.018 Romlin BS, Winberg H, Janson M, et al.

Defibrillator

Defibrillator CPR Epinephrine Life Support

Unwrapping PEM excellence at IAEM23

Don't Forget the Bubbles

OCTOBER 19, 2023

Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. You’ve two options: Yes – give TXA No – don’t give TXA The 2013 CRASH 2 international multicentre RCT compared TXA with placebo in >20,000 adult trauma patients. However, Kornelson et al.’s

E-9-1-1

E-9-1-1 ED OR Emergency Department

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

Dr. Smith's ECG Blog

MAY 5, 2022

He was admitted to the ICU and transferred emergently to a facility where he could undergo emergent dialysis as a part of further evaluation and management. For an excellent State-of-the-Art Review on Brugada Syndrome — Please SEE this article by Brugada et al in JACC — Vol. The QRS is narrow and T waves are much less peaked.

E-9-1-1

E-9-1-1 OR STEMI ED

ABG Versus VBG in the Emergency Department

EMDocs

FEBRUARY 12, 2024

In this situation, an ABG should be obtained periodically for correlation, though this is more relevant for the intensive care unit (ICU) setting than in routine ED care (5, 9). References/Further Reading (1) Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. 2013 May;14(3):212-7. doi: 10.1136/emermed-2013-202879.

Emergency Department

Emergency Department E-9-1-1 ED ICU

Evaluating Chronic Obstructive Pulmonary Disease

ACEP Now

JUNE 14, 2024

4,6,11 Antibiotics Antibiotic use for AECOPD patients remains a contentious topic; however, data suggests AECOPD patients requiring admission, particularly to the ICU, should receive antibiotics. Adeloye D, Song P, Zhu Y, et al. Canut A, Martín-Herrero JE, Labora A, et al. Howton JC, Rose J, Duffy S, et al. Updated Feb.

ALS

ALS Coronary OR ED

Rethinking Fluid Resuscitation in Vaso-Occlusive Crisis: Is Lactated Ringer’s the Superior Choice?

REBEL EM

DECEMBER 23, 2024

saline (NS) solutions are both isotonic crystalloids widely used for intravenous fluid resuscitation across many contexts and disease states ( Myburgh 2013 ). To assess the clinical impact and relevance of these concerns, Alwang et al. PMID: 28423290 Kidwell K, Albo C, Pope M, et al. Lactated Ringer (LR) and 0.9% N Engl J Med.

ALS

ALS ED ACS EMR

Anterior OMI with RBBB has VF x 3: how to prevent further episodes of VF?

Dr. Smith's ECG Blog

APRIL 9, 2025

Smida T et al. As a result I got to witness first-hand how the incidence of primary VFib appeared to dramatically decrease in our ICU as a result of the new practice at that time of using prophylactic Lidocaine on acute MI patients. But it does show a strong association of better outcome with lidocaine vs. amiodarone.

Defibrillator

Defibrillator STEMI ED OR

emDOCs Revamp – Acute Chest Syndrome

EMDocs

JUNE 27, 2024

Critical Care Medicine 41(12):p A191, December 2013. Alkindi S, Al-Busaidi I, Al-Salami B, Raniga S, Pathare A, Ballas SK. Alghamdi FA, Al-Kasim F, Alshhada F, Ghareeb E, Azmet FR, Almudaibigh A, Baitalmal L, Alnawfal B, Alluqmani R. 2013 Jan-Mar;16(1):91-5. Epub 2013 Aug 7. 2020 Feb 12;10(1):2470.

E-9-1-1

E-9-1-1 ICU ACS EMS

IV fluids in the ED: When do we really need them?

EMDocs

JANUARY 20, 2025

9 In terms of assessing volume status in general, Joseph et al. 11 A study by Stephan et al. Since the 2010s multiple trials have explored the feasibility of fluid restrictive resuscitation both on initial resuscitation in the ED, as well as in the intensive care unit (ICU). Andrews et al. Similar to Andrews et al.,

ED

ED ALS Emergency Department Critical Care

Critical Kids: Phoenix Sepsis Criteria

EMDocs

JANUARY 16, 2025

Carlton EF, Gebremariam A, Maddux AB, et al. Zimmerman JJ, Banks R, Berg RA, et al; Life After Pediatric Sepsis Evaluation (LAPSE) Investigators. Weiss SL, Fitzgerald JC, Maffei FA, et al; SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. Zhao C, Xin MY, Li J, et al. Emerg Med J.

ALS

ALS Critical Care ICU Emergency Department

ToxCard: Acute Organophosphate Toxicity

EMDocs

JUNE 7, 2023

Disposition is often admission to an intensive care unit (ICU) setting. Further management and resuscitation were required, and she had a lengthy ICU stay of 21 days until she was extubated. References: Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure.

E-9-1-1

E-9-1-1 ICU Emergency Department ED

Spooky Scary Sequela: Clinical Factors Impacting Trauma Outcomes

FOAMfrat

NOVEMBER 21, 2024

Today, increased mortality rates, higher transfusion requirements, and lengthened ICU stays are recognized as proximate effects of the Trauma Triad. Jessica Dawkins Mills BSN, et al. 2013 Apr 17;10(6):747-50. EMS Tactical Paramedic Lethal Triad.” PubMed , StatPearls Publishing, 5 May 2024, www.ncbi.nlm.nih.gov/books/NBK603758/.

ICU

ICU Emergency Department OR ED

An EM Resident’s Guide to Basic Airway Management

Core EM

JANUARY 16, 2025

The 3/3/2 rule: Figure 3: how to perform the 3/3/2 rule (Image modified from UpToDate.com) If the patient has less than the specified measurement of 3, 3, or 2 fingers in these parameters, this is very specific (95%) for having a more difficult intubation (Mahmoodpoor, 2013)–although only about 25% sensitive.

E-9-1-1

E-9-1-1 EMS ALS OR

Paramedicine Now

REBEL Core Cast 123.0 – Posterior Epistaxis

REBEL Cast Ep115 – Phenobarbital vs Lorazepam in Alcohol Withdrawal

Trending Sources

The Current Status of Continuous-Seizure Management

REBEL Core Cast 94.0 – SBO

The Science on Targeted Temperature Management

Post-Intubation Sedation and Analgesia

emDOCs Revamp: Alcohol Withdrawal

Geriatric Trauma

The PROTECTION Trial – A Randomized Trial of Intravenous Amino Acids for Kidney Protection

Beyond Ketamine: When to use Facilitated Intubation in the ED

Hypothermic Cardiac Arrest: Pearls and Pitfalls

Unwrapping PEM excellence at IAEM23

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

ABG Versus VBG in the Emergency Department

Evaluating Chronic Obstructive Pulmonary Disease

Rethinking Fluid Resuscitation in Vaso-Occlusive Crisis: Is Lactated Ringer’s the Superior Choice?

Anterior OMI with RBBB has VF x 3: how to prevent further episodes of VF?

emDOCs Revamp – Acute Chest Syndrome

IV fluids in the ED: When do we really need them?

Critical Kids: Phoenix Sepsis Criteria

ToxCard: Acute Organophosphate Toxicity

Spooky Scary Sequela: Clinical Factors Impacting Trauma Outcomes

An EM Resident’s Guide to Basic Airway Management

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