EMDocs

JUNE 27, 2024

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. 2015 May;169(4):492-505. Epub 2015 Mar 30. Roy A, Allareddy V, Lee M, Nalliah R, Rampa S, Allareddy V, Rotta A. 2020 Feb 12;10(1):2470.

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

Don't Forget the Bubbles

NOVEMBER 15, 2023

A 2015 study published in the Lancet demonstrated a reduction in hyponatraemia by adopting an isotonic strategy compared with a hypotonic strategy. Current practice is still isotonic fluids with a slight volume restriction, but there may/may not be another fluid shift coming… References Alobaidi R, Basu RK, Decaen A, et al.

Plasma 80

Plasma ALS ICU Critical Care 80

REBEL EM

AUGUST 7, 2023

Background Information: Delirium is a common and serious condition in patients in the intensive care unit (ICU). It is estimated to affect 30-50% of patients in the ICU and haloperidol is the most frequently used agent in treatment (3). Paper: Andersen-Ranberg NC,et al; AID-ICU Trial Group. N Engl J Med. 2022 Dec 29.

ICU 52

ICU ALS OR EMS 52

EMDocs

OCTOBER 21, 2023

All patients who receive thrombolytics for ischemic stroke should be admitted to a neurosurgical, neurologic, or medical ICU for management and monitoring, as this is shown to decrease mortality and length of stay. References: Gaillard F, Glick Y, Tatco V, et al. 2015 Jul;5(3):142-50. 61.4.496 Navi BB, Kamel H, Shah MP, et al.

EMS 74

EMS ALS OR ACS 74

AAEM RSA

AUGUST 27, 2020

Nielsen N, Wetterslev J, Cronberg T et al. By the time of the study by Nielsen et al. Kirkegaard H, Soreide E, de Haas, I et al. Kirkegaard et al. De Fazio C, Skrifvars MB, Soreide E et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. New Engl J Med. 2013;369(23):2197–2206.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

ACEP Now

MARCH 13, 2024

References Morley, Claire, et al. 2015):157-165. Kelen GD, Wolfe R, D’Onofrio G, et al. Conclusion/Recommendation ED crowding is a national patient safety issue driven by hospitals routinely operating over capacity. Hospitals have no financial incentive to reduce elective admissions to increase inpatient or ED capacity.

Emergency Department 52

Emergency Department ED ALS OR 52

EMDocs

MAY 25, 2023

Reference: Kapur J, Elm J, Chamberlain JM, et al. population at large Enrollment was terminated at an interim analysis due to predefined futility criteria that suggested that there was a 1% chance that carrying the trial to completion would demonstrate a most effect or least effective treatment. N Engl J Med. 2019; 381(22): 2103-2113.

Emergency Department 64

Emergency Department ICU OR ALS 64

EMDocs

NOVEMBER 1, 2023

Disposition : Admission to ICU with potential GI, IR, and/or surgical management. In: Tintinalli JE, Ma OJ, Yealy DM, et al., McGraw-Hill Education; 2015. May not be an option. If there will be a delay in definitive management and there is evidence of intra-thoracic gastric contents, consider chest tube placement. 2022;53:29-36.

Critical Care 67

Critical Care ED EMS OR 67

Emergency Medicine Ireland

OCTOBER 16, 2023

The incidence of dynamic LVOTO in those with septic shock is remarkably high and is reported to be 20% in one study from ICU echo guru Michel Slama. Critical Care 19 , 1–8 (2015). Left ventricular outflow tract obstruction in ICU patients. Chauvet, J.-L. Tribouilloy, C. & & Maizel, J.

Critical Care 52

Critical Care ICU OR ALS 52

REBEL EM

OCTOBER 31, 2022

Fujii 2022, Sevransky 2021) Contrary to the above trial, another RCT investigated patients in the ICU with sepsis and acute respiratory distress syndrome. Clinical Question: Does high-dose vitamin C improve survival and/or persistent organ dysfunction rates in septic patients in the ICU on vasopressors? Article: Lamontagne F et al.

ICU 52

ICU ALS OR EMS 52

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. Riskin (2015) showed that rudeness accounted for a 12% reduction in diagnostic and procedural performance in a simulated resuscitation. Frich JC, Brewster AL, Cherlin EJ, Bradley EH. 2015 May;30:656-74. BMC medicine.

E-9-1-1 105

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

Broome Docs

MARCH 28, 2024

Great evidence for button battery ingestions (if you are treating a dead pig) Chiew AL, Lin CS, Nguyen DT, Sinclair FAW, Chan BS, Solinas A. Casey wrote a protocol for peripheral noradrenaline 9 years ago… in 2015! PMID: 37738565 Bottom line: Evidence based medicine is important, even in infection control. Ann Emerg Med.

E-9-1-1 107

E-9-1-1 ICU Emergency Department ALS 107

REBEL EM

JANUARY 9, 2024

Additionally, multiple studies demonstrate increased harm with IV antibiotics such as increased rate of diarrhea ( Haran 2014 ), complications from IV placement ( Li 2015 ), and increased length of stay or cost ( Lorgelly 2010 ). PMID: 9114201 Siegel RE et al. PMID: 17090560 Castro-Guardiola A et al. PMID: 17567657 Rae N et al.

ALS 99

ALS ED ICU OR 99

REBEL EM

FEBRUARY 29, 2024

3, 4 It is the most common nosocomial infection in patients on mechanical ventilation, and one of the leading causes of nosocomial infection among all patients in the ICU. The low incidence could be a result of the systematic implementation of bundles known to decrease VAP incidence in the ICU. 4, 8 Paper: Dahyot-Fizelier, C.,

E-9-1-1 124

E-9-1-1 ICU OR ALS 124

REBEL EM

MARCH 30, 2023

Background: Previous observational studies published in 2015 (Geri 2015)(Vyas 2015) indicated that early cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA) might improve mortality and result in more favorable neurological outcomes. Article: How-Berlemont C, Lamhaut L, Diehl J, et al.

Coronary 83

Coronary CPR OR ICU 83

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 40

Advanced Life Support ALS Life Support CPR 40

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. PMID: 23911630 Kim WY et al. PMID: 23911630 Kim WY et al. PMID: 25402500 Forsythe SM et al.

ED 65

ED Emergency Department ALS OR 65

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. 2015 Jul;115(1):76-83. Epub 2015 May 19. Kulvatunyou N, Bauman ZM, Zein Edine SB, de Moya M, Krause C, Mukherjee K, Gries L, Tang AL, Joseph B, Rhee P. Br J Anaesth.

E-9-1-1 139

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

REBEL EM

JULY 14, 2022

Paper: Nassal MMJ, et al. An example using a real case I had while on call in the ICU: A 61-year-old female had a post-induction arrest on the wards/hospital telemetry floor after being intubated for airway protection. REFERENCES: Nassal MMJ, et al. PMID: 34968531 Rittenberger JC, et al. PMID: 21756969 Coppler PJ, et al.

ICU 52

ICU ALS OR CPR 52

REBEL EM

AUGUST 29, 2022

Another study reported an association with adrenocorticotropic hormone (ACTH) and slightly higher SOFA scores when etomidate was used, but there was no evidence of increased mortality (Bruder 2015). Article: Matchett G et al; EvK Clinical Trial Collaborators. Cochrane Database of Systematic Reviews 2015, Issue 1. PMID: 34904190.

MICU 52

MICU ICU OR Emergency Department 52

Don't Forget the Bubbles

JULY 5, 2023

They should be admitted to hospital in case of clinical deterioration to receive ICU treatment. This treatment is usually done in the ICU setting. Blood transfusions are indicated in major surgical procedures, acute priapism > 3 hours not responsive to treatment, severe acute chest syndrome with hypoxia requiring ICU.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126