Dr. Smith's ECG Blog

FEBRUARY 2, 2024

His temperature was brought back to normal over time in the ICU. Sci 5[4] 268-270, 2015 ) both highlight a likely association between acute development of ischemic J waves — and high risk of developing malignant ventricular arrhythmias ( My Comment in the September 23, 2020 post ). He was extubated and had normal neurologic function.

ICU 132

ICU OR ALS ED 132

ALiEM

MAY 19, 2023

In our emergency department, the RTs do not spend a lot of time going around measuring cuff pressures and usually save that until the patient reaches the ICU. Published July 13, 2015. The manometer referenced in numerous videos [6, 8] is actually a cuff manometer, or pressure gauge, to measure endotracheal cuff pressures.

E-9-1-1 245

E-9-1-1 Emergency Department ICU OR 245

EMDocs

JUNE 22, 2024

A) Amniotic fluid embolism B) Eclampsia C) Placental abruption D) Pulmonary embolism Answer: A Amniotic fluid embolism (AFE) is a rare but potentially fatal complication of pregnancy. AFE should be considered in a patient who experiences cardiorespiratory collapse during labor or shortly thereafter.

EMS 96

EMS Ambulance FFP ICU 96

Core EM

JANUARY 25, 2024

Background: An update to our 2015 post on HIET for beta-adrenergic receptor and calcium channel antagonists overdose. Disposition to ICU. Supplement additional dextrose prn, if hypoglycemia occurs do not stop the insulin, increase the rate of the dextrose drip. Titrate to end organ perfusion as MAP may not change significantly.

Overdose 246

Overdose ALS Epinephrine Critical Care 246

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

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 ). a low bioavailability can be overcome by giving a larger dose), bioavailability is still a good place to start.

ALS 100

ALS ICU ED OR 100

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

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. Ranges from ambulatory state to severe dementia or paralysis.

Coronary 83

Coronary CPR OR ICU 83

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. 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

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

It is the leading cause of death in the intensive care unit (ICU) in the US and the most expensive diagnosis. Since 2015, the Centers for Medicare & Medicaid Services (CMS) have indexed the quality of hospital care for sepsis to the SEP-1 core measure. mg/dl or 107 umol/L). Worldwide sepsis contributes to the death of 5.3

EMR 100

EMR Emergency Department ICU ALS 100

Broome Docs

MARCH 28, 2024

Casey wrote a protocol for peripheral noradrenaline 9 years ago… in 2015! Although I miss performing the procedure, these days I almost always leave the central line until the patient is stabilized and settled into their ICU bed. Is pregnancy a disease?

E-9-1-1 107

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

EMDocs

MAY 25, 2023

Design: Multi-centered, double-blinded, randomized trial PICO: Population: Inclusion Criteria: Age 2 years and older Must have been treated with a specified minimum dose of certain benzodiazepines for generalized convulsive seizures: Intravenous or rectal diazepam 0.3 mg/kg or 10 mg Intravenous lorazepam 0.1 mg/kg or 4 mg Intravenous midazolam 0.2

Emergency Department 63

Emergency Department ICU OR ALS 63

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

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. doi:10.1016/S0140-6736(14)61459-8 Overview: Intravenous fluid therapy in children and Young People In Hospital: Guidance (2015) NICE. everywhere outside the cells). Step 3 Less is more.

Plasma 80

Plasma ALS ICU Critical Care 80

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

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. Enrollees were then assigned to either TTM of 33ºC or 36ºC for 36 hours. C to a goal of 36.5

E-9-1-1 52

E-9-1-1 CPR ICU ALS 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). Duration of mechanical ventilation, ICU, and percentage of vasopressor use were not significantly different.

MICU 52

MICU ICU OR Emergency Department 52

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. Most dynamic LVOTO has SAM but not all SAM has LVOTO. Tribouilloy, C. & Pollick, C.,

Critical Care 52

Critical Care ICU OR ALS 52

ACEP Now

MARCH 13, 2024

When considering inter-hospital transfer, the patient’s goals of care should be paramount in guiding the process. Greater focus on this communication is needed, as data suggest poor agreement between sending facilities, patients, and receiving facilities as to why transfers were initiated.

Emergency Department 52

Emergency Department ED ALS OR 52

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

Emergency Medicine Ireland

MAY 3, 2021

the hyperaemic phase: about a quarter will have this at around day 3-7 and it seems ill defined but it’s suggestive you can lower your MAP targets here a bit Overall the basic bundle of interventions in the ICU for ICP include: * sedation – this is needed for the tube but also it reduces metabolic rate considerably and reduces ICP. . *

Critical Care 40

Critical Care ICU OR 40

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

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.” degrees Celsius. 5,6 In 2021, the TTM2 trial was published. degrees Celsius for 72 hours.

Advanced Life Support 40

Advanced Life Support ALS Life Support CPR 40

REBEL EM

JULY 14, 2022

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. Assigning a patient a single PCAC score upfront may implicitly bias clinicians familiar with the score in how they care for patients.

ICU 52

ICU ALS OR CPR 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

ALiEM

OCTOBER 30, 2024

The biggest change has been the gradual replacement of diacetylmorphine (heroin) by fentanyl and other synthetic opioids. Along the same time, a veterinary sedative, xylazine , became popular in Puerto Rico in individuals who used injection drugs [3]. We treat with wound care and reserve surgical management only for limbs that are no longer viable.

E-9-1-1 161

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

FEMinEM

JANUARY 26, 2021

As ACOG wrote in a 2015 Committee Opinion article, “Although there is a cognitive bias toward considering the risks of intervention, including the risk of inclusion in research, there is also a risk associated with failing to intervene and exclusion from research. Participants would receive either a placebo or the Moderna mRNA vaccine.

OR 52

OR ICU ED 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