Don't Forget the Bubbles

AUGUST 23, 2023

2018) “Sacred Pause Imitative in the ICU: A survey of ICU physicians and nurses”. 2014) “Death of a child in the emergency department” American Academy of Pediatrics. Oppressive quietness heavy with professionals’ suppressed emotions mixed with raw parental grief. That piercing parental cry rips through the room. Kapoor et al.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

Pediatric EM Morsels

MARCH 17, 2023

Since we all inhabit the same beautiful world , and sometimes we humans overtake previous habitats of animals, we inevitably will cross paths with an animal that bites us. Usually, animals bite from fear or defense of their offspring ( ex, Brown Recluse ). Sometimes it’s a beloved pet who gets surprised or has an “off” day ( Dog Bites and PTSD ).

Frozen Plasma 130

Frozen Plasma Plasma First Aid OR 130

EMDocs

APRIL 2, 2024

Check the pulse RSI= Resuscitation Sequence Intubation Hypoxia, Hypotension, and Acidosis are the reason patients code during/post intubation These patients are super high risk for all 4 Optimize first pass success – Induction agent + paralytic Unconscious patients will still have muscle tone Induction Ketamine or Etomidate at half doses (i.e.,

CPR 92

CPR STEMI Epinephrine ICU 92

Core EM

OCTOBER 2, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

Don't Forget the Bubbles

JUNE 30, 2023

They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups. You ask your anaesthetist to get ready to sedate or intubate depending on their status – Significant risk to the department – you make sure security is aware And your patient arrives.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

Emergency Medicine Ireland

OCTOBER 14, 2024

This has been moderately well studied with MIST-2 2011 and the Picollo trial (2014) being commonly quoted trials suggesting benefit. The major barrier to implementation in the ICU setting is the almost complete absence of ICU patients from these trial cohorts. 11, 1419–1425 (2014). LDH>1000 Sugar <2.2

Critical Care 52

Critical Care ICU ALS OR 52

EMDocs

JUNE 27, 2024

Left lower lung field end demonstrates expiratory wheezing on auscultation. Other lung fields unremarkable. smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02 mg/kg, max 0.4 C or 100.4

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

Don't Forget the Bubbles

JUNE 17, 2024

The team sits down for a hot debrief once the patient is stabilised and transferred to the ICU. 2014 Jun 26;23(12):653-9. While you are leading the resuscitation, one of your senior colleagues belittles a junior staff member for struggling to site an IV line. How do you manage this situation? cognitive rehearsal techniques ).

E-9-1-1 105

E-9-1-1 Critical Care CPR ICU 105

REBEL EM

MARCH 23, 2023

Chronic alcohol use causes changes to preserve homeostasis, and when the stimulus is removed, alcohol withdrawal results due to decreased inhibition via the GABA system and increased excitation via the glutamate system. Tolerance to alcohol can also result in cross-tolerance to benzodiazepines and to a lesser degree barbiturates.

ICU 52

ICU Emergency Department ALS OR 52

Don't Forget the Bubbles

JULY 5, 2023

This process of sickling and unsickling goes on and off until the erythrocyte membrane is no longer flexible. Irreversible sickle cells undergo either intravascular haemolysis or extravascular removal by the reticulo-endothelial system resulting in anaemia and splenic sequestration. Blood culture is pending. How would you evaluate this child’s pain?

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

EMDocs

JUNE 7, 2023

Disposition is often admission to an intensive care unit (ICU) setting. Questions: What is the most likely causative xenobiotic that led to these findings? Influenza vaccine Methanol Organophosphate Paraquat Are her symptoms reversible? Yes No What therapy or therapies are critical for this patient? 7 May lead to respiratory failure.

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

EMDocs

NOVEMBER 1, 2023

Pertinent physical examination findings: CV: Tachycardic, regular rhythm. Lungs: Tachypneic, decreased breath sounds left lung base. Abdomen: Soft, non-tender, without rebound or guarding. What is the likely diagnosis, and what are your initial steps in evaluation and management? upper endoscopy, transesophageal echo, etc.).

Critical Care 67

Critical Care ED EMS OR 67

EMDocs

OCTOBER 21, 2023

More common in the setting of atherosclerotic lesions than emboli, which typically occur with sudden onset of symptoms. Symptoms may range from days to months prior to stroke onset. As many as two-thirds of patients with BAO experience prodromal symptoms, including TIAs, minor strokes, or other symptoms.

EMS 73

EMS ALS OR ACS 73

AAEM RSA

AUGUST 27, 2020

The 48-hour group had a significantly longer length of stay in the ICU and time on mechanical ventilation amongst survivors, both of which were expected since they were kept at target temperature for longer, requiring more resources. The trial was conducted in 25 ICUs in France between 2014 and 2018. C to a goal of 36.5

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

EMDocs

APRIL 22, 2024

Time was of the essence, the patient was intubated, ACLS measures were continued, and POCUS was performed. The POCUS findings enabled EPs to confidently recognize findings consistent with hemodynamically unstable (formerly sub-massive or massive) PE. Multiorgan POCUS The diagnostic power of POCUS often resides in combining multiple ultrasound exams.

ED 81

ED NARCAN ALS OR 81

REBEL EM

JANUARY 25, 2023

Take Home Points SBO should be considered in all patients presenting with abdominal pain particularly if they have a prior abdominal surgical history Patients with SBO often have non-specific signs and symptoms. There is no history or physical exam feature that rules out the disease Lactate elevation is a late finding in SBO.

ED 52

ED ALS OR ICU 52

EMDocs

SEPTEMBER 25, 2023

Notable Physical Exam: General: Tripoding, severe respiratory distress. However, emergency physicians have recently faced a multitude of patients requiring ETI with anatomically and physiologically difficult airways; these patients increase the risk of a can’t intubate/can’t oxygenate scenario or significant hypoxemia, hypercarbia, or acidemia.

ED 65

ED Emergency Department ALS Paramedic 65

AAEM RSA

APRIL 1, 2021

There was no difference in the secondary outcomes of time to hemostasis, ventilator-free days, ICU-free days, disposition at 30 days, incidence of primary surgical procedures, and functional status at hospital discharge (measured as Glasgow Outcome Scale-Extended Score). Clinicians were blinded to treatment until delivery of blood products.

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

ECG & Echo Learning

OCTOBER 2, 2022

Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). J Cardiovasc Pharmacol Therap (2014). Several endogenous and synthetic agents exist and are frequently combined to achieve the desired hemodynamic outcome. Minimal chronotropic effect. Increases coronary blood flow.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

Dr. Smith's ECG Blog

MARCH 6, 2019

If for some reason the angiogram is delayed, they should receive maximal medical therapy in an ICU setting with continuous 12-lead ST segment monitoring under the close attention of a practitioner with advanced ECG interpretation training. The patient did well. Patel et al., Krucoff et al.) Patel et al. American Journal of Cardiology 1990.

STEMI 52

STEMI ALS ACS OR 52

Dr. Smith's ECG Blog

MARCH 11, 2019

The patient was managed in the ICU and had serial troponins. Here is data from a study we published in 2014 for type II NonSTEMI: Sandoval Y. You do NOT see this in normal variant STE, nor in pericarditis. He had no more ECGs recorded. First was 2.9 ng/mL and subsequentle dropped to 1.5 Beware of diagnosing type 2 MI.

OR 52

OR ACS ICU STEMI 52

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). How would an ABG even change the initial stabilization of any of these patients? What alternative testing can be done in these circumstances?

Emergency Department 94

Emergency Department E-9-1-1 ED ICU 94

Don't Forget the Bubbles

JANUARY 4, 2024

In 2014, the Royal College of Radiologists (RCR) Paediatric Trauma Protocols were published, recommending that CT chest imaging be appropriately limited to children in specific high-risk groups. Our team have scoured the literature, so you don’t have to… or it might spark an interest to go and have a look at the full article.

ED 129

ED ICU ALS OR 129

Don't Forget the Bubbles

MAY 3, 2023

This explorative review described insertion success rates, time to first insertion, and duration of IO function (time from insertion to IO failure, IV access insertion, transfer to ICU, or death). This time the PEM MSc team from QML , in association with DFTB, are taking over… Article 1: Insulin infusion in paediatric DKA – high or low?

CPR 52

CPR Emergency Department ALS ICU 52

AAEM RSA

SEPTEMBER 17, 2020

All treatments were given for the assigned time frame or until ICU discharge, whichever came first. In the control group, patients treated for severe sepsis or septic shock in the year prior to the initiation of triple therapy, hydrocortisone was used at the discretion of the intensive care unit (ICU) attending.

ICU 52

ICU E-9-1-1 ALS OR 52

EMDocs

JANUARY 6, 2024

You review his chart and note that he had a heart transplant in 2014 but has not followed up with a cardiologist for at least 3 years. His vital signs on arrival include HR: 67 bpm, BP: 101/74 mm Hg, RR: 18 bpm, T: 98.3 He also developed a cough and diffuse abdominal pain over the past few days. BNP should normalize after about 2 months.

EMS 63

EMS E-9-1-1 ACS Coronary 63

EMDocs

DECEMBER 18, 2023

The 2021 SSC no longer recommends the use of the quick sequential organ failure assessment (qSOFA) as a single screening tool for sepsis or septic shock compared to systemic inflammatory response syndrome (SIRS), national early warning score (NEWS), or modified early warning score (MEWS). vs. 0.91), positive predictive value (0.27

E-9-1-1 65

E-9-1-1 ALS Emergency Department Plasma 65

REBEL EM

NOVEMBER 11, 2024

What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018. 2 Vancomycin, in combination with either piperacillin-tazobactam or cefepime, is commonly used for empiric treatment in these cases. In 2021, Buckley et.

E-9-1-1 84

E-9-1-1 ALS ICU Critical Care 84