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 52

ICU Emergency Department ALS OR 52

EMDocs

JUNE 22, 2024

2015 May;28(7):793-8. ” Am J Obstet Gynecol 201(5): 445 e441-413. link] Fong A, Chau CT, Pan D, Ogunyemi DA. Amniotic fluid embolism: antepartum, intrapartum and demographic factors. J Matern Fetal Neonatal Med. doi: 10.3109/14767058.2014.932766. Epub 2014 Jun 30. PMID: 24974876. Young BK, Florine Magdelijns P, Chervenak JL, Chan M.

EMS 95

EMS Ambulance FFP ICU 95

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Date: September 20th, 2021 Reference: Litell et al. Date: September 20th, 2021 Reference: Litell et al. It is the leading cause of death in the intensive care unit (ICU) in the US and the most expensive diagnosis. Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge.

EMR 100

EMR Emergency Department ICU ALS 100

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

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

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

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

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

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

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 73

EMS ALS OR ACS 73

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

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 63

Emergency Department ICU OR ALS 63

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

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

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 Paramedic 65

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

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 66

Critical Care ED EMS OR 66

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

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

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

ALiEM

OCTOBER 30, 2024

We have certainly seen patients who have pain which is controlled and still have psychomotor agitation and sympathetic activation, leading some to require ICU admission for dexmedetomidine and/or ketamine infusion. Multimodal medication options for fentanyl-xylazine withdrawal management in London et al. 2015 Apr 28;313(16):1636-44.

E-9-1-1 161

E-9-1-1 Naloxone Emergency Department ALS 161

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