REBEL EM

AUGUST 14, 2023

Article: Liu S, Yao C, Xie J, et al. They consecutively enrolled 1,817 ICU patients from 45 sites across China. Population: Inclusion Criteria: Age 18-75 years old SOFA score 2-13 Admitted to the ICU with a diagnosis of sepsis 3.0, “ Life-threatening organ dysfunction caused by a dysregulated host response to infection.”

ICU 98

ICU EMS OR ALS 98

EMDocs

SEPTEMBER 6, 2023

Removed from cooling at 102 and admitted to ICU. 2016 study published in American Journal of Emergency Medicine , “ Urinary obstruction is an important complicating factor in patients with septic shock due to urinary infection ” by Reyner et al. 2016 Apr;34(4):694-6. Immersion cooling completed with ice between body bags.

ACS 71

ACS ICU EMS ALS 71

REBEL EM

NOVEMBER 6, 2023

Paper: Hiruy A, et al. So with yet another confounding variable added (sicker patients at baseline in methylene blue group), the comparison of these two medications is yet again even more difficult There was no difference in ICU and hospital length of stays or hospital mortality between the two groups. REFERENCES: Hiruy A, et al.

Epinephrine 71

Epinephrine ICU ALS OR 71

REBEL EM

JUNE 8, 2023

Paper: Singer S, et al. References: Singer S, et al. PMID: 36108346 Cole JB, et al. PMID: 31270748 Maheshwari K, et al. The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. PMID: 29872882 Jones AE, et al. PMID: 17035422 Holler JG, et al. Am J Emerg Med.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

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 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. 2016 Dec;91(12):1185-1190. Epub 2016 Oct 3. Roy A, Allareddy V, Lee M, Nalliah R, Rampa S, Allareddy V, Rotta A. Annu Rev Pathol.

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

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. doi: 10.1136/neurintsurg-2016-012515. Epub 2016 Jul 15.

EMS 74

EMS ALS OR ACS 74

REBEL EM

AUGUST 31, 2023

Paper: van Baarle FLF et al. ICU: 42.6% vs 0% ICU length-of-stay: 9 days vs 7 days In-Hospital Mortality: 28.2% ICU Mortality: 56.7% Conversely, it may be reasonable to withhold prophylactic platelets for patients in the ICU setting due to trends of lower bleeding risk noted as well as more intensive bleeding monitoring.

ICU 58

ICU ALS OR EMS 58

REBEL EM

SEPTEMBER 26, 2022

Article: Kumar M et al. The TEG group had a shorter ICU length of stay in the first admission. Patients exclusively managed in the ICU which decreases applicability for patients in other locations Very small sample size of 96 patients No definition was provided for exclusion criteria of significant cardiopulmonary disease.

FFP 52

FFP E-9-1-1 ICU ALS 52

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. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. Laan DV, Vu TD, Thiels CA et al. Injury 2016; 47: 797– 804. Emerg Med J.

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

Emergency Medicine Ireland

OCTOBER 30, 2023

First up is the VASST trial, (Russel et al 2008 NEJM). Enrolled 800 fairly typical ICU patients, and found a 35% vs 39% mortality benefit favouring the vaso but of course this was below the somewhat arbitrary statistical significance. A somewhat underwhelming start Second is the VANISH trial by Gordon et al, JAMA 2016.

Critical Care 52

Critical Care ALS Coronary ICU 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). References Overgaard, Dzavik et al. Jentzer et al. Müllner M, Urbanek B, Havel C, et al. Lherm T, Troché G, Rossignol M, et al. Gattinoni L, Brazzi L, Pelosi P, et al. Circulation 2011.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

REBEL EM

FEBRUARY 2, 2023

2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). Paper: Mason JM, et al. These results were corroborated with other another study by Gritensko et al. References Mason JM, et al. 2018, PMID: 30571262 Gritsenko, Diana, et al. Am J Emerg Med.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

AAEM RSA

APRIL 1, 2021

Holcomb JB, Tilley BC, Baraniuk S, et al. 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). 2015;313(5):471-82.

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 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 66

ED Emergency Department ALS Paramedic 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. Left ventricular outflow tract obstruction in ICU patients. Current Opinion in Critical Care 22 , 260–266 (2016). Chauvet, J.-L. Critical Care 19 , 1–8 (2015). Tribouilloy, C. &

Critical Care 52

Critical Care ICU OR ALS 52

REBEL EM

AUGUST 29, 2022

Article: Matchett G et al; EvK Clinical Trial Collaborators. Duration of mechanical ventilation, ICU, and percentage of vasopressor use were not significantly different. Etomidate works on the GABA receptor, while ketamine works as an NMDA antagonist. Yet, both agents provide the same outcome, sedation. The answer remains uncertain.

MICU 52

MICU ICU OR Emergency Department 52

EMDocs

DECEMBER 18, 2023

1 This is a change from the 2016 SSC guidelines which suggested against corticosteroids. Disposition The SSC guidelines suggest that patients with septic shock or critical illness be moved to the intensive care unit (ICU) within six hours of presentation to the ED. References Evans L, Rhodes A, Alhazzani W, et al. 2022;22:76.

E-9-1-1 65

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

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. Epub 2016 Jun 9. 2016 Feb;33(2):152-4.

Emergency Department 94

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

AAEM RSA

SEPTEMBER 17, 2020

Marik P, Khangoora V, Rivera R, et al. All treatments were given for the assigned time frame or until ICU discharge, whichever came first. Keh D, Trips E, Marx G, et al. 2016:316(17);1775-85. Should steroids be used in patients with septic shock? 2017;151(6):1229-38. The primary outcome was hospital survival.

ICU 52

ICU E-9-1-1 ALS OR 52

EMDocs

JANUARY 6, 2024

Answer : Cardiac Transplant Complications Epidemiology: There were over 3,000 heart transplants in North America in 2016. Cardiogenic shock in the setting of acute rejection would warrant inotropic agents and ICU admission (C) , but these would not be indicated in cases of mild rejection, such as in this patient. Am J Emerg Med.

EMS 63

EMS E-9-1-1 ACS Coronary 63

FOAMfrat

NOVEMBER 28, 2024

." When a critical care team transports a patient from an outlying ER to your ICU, do you automatically set your own ventilator settings, or do you ever use the vent settings the critical care transport team had dialed in for transport? "That’s We don’t seem to see Ketamine infusions in the ICU often. Why is that? "Ketamine

E-9-1-1 52

E-9-1-1 Critical Care ICU EMS 52