Don't Forget the Bubbles

AUGUST 23, 2023

2016) “Implementation of a Post-Code Pause: Extending Post-Event Debriefing to Include Silence”. 2018) “Sacred Pause Imitative in the ICU: A survey of ICU physicians and nurses”. Oppressive quietness heavy with professionals’ suppressed emotions mixed with raw parental grief. That piercing parental cry rips through the room.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

Handtevy

AUGUST 15, 2022

Study Overview A recent research study titled “Sodium Bicarbonate Use During Pediatric Cardiopulmonary Resuscitation: A Secondary Analysis of the ICU-RESUScitation Project Trial” aimed to evaluate the associations between sodium bicarbonate use and outcomes during p-IHCA. 1.34; p = 0.621).

CPR 52

CPR ICU Overdose Critical Care 52

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

REBEL EM

AUGUST 31, 2023

ICU: 42.6% vs 0% ICU length-of-stay: 9 days vs 7 days In-Hospital Mortality: 28.2% ICU Mortality: 56.7% vs 0% ICU length-of-stay: 9 days vs 7 days In-Hospital Mortality: 28.2% ICU Mortality: 56.7% Non-inferiority margin was set at 2.5% later adjusted to INR > 3.0) Non-inferiority margin was set at 2.5%

ICU 57

ICU ALS OR EMS 57

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 74

EMS ALS OR ACS 74

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

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

Critical Care 52

Critical Care ICU OR ALS 52

Emergency Medicine Ireland

OCTOBER 30, 2023

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. This was closer to home in the UK, with 18 ICUs. Gordon, A.

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). JAMA 2016; 316:509. Several endogenous and synthetic agents exist and are frequently combined to achieve the desired hemodynamic outcome. Most agents exhibit both vasopressor and inotropic effects (Figure 1).

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

REBEL EM

NOVEMBER 30, 2023

Studies without IRB approval Studies older than 2016 Intervention: Administration of <30 mL/kg IV crystalloid fluids within three hours of sepsis identification. Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM.

E-9-1-1 120

E-9-1-1 ALS ACS ICU 120

REBEL EM

AUGUST 14, 2023

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.” 002) ICU-free days: Placebo 12.4%

ICU 98

ICU EMS OR ALS 98

The Skeptics' Guide to EM

DECEMBER 16, 2017

NEJM Dec 2016 Guest Skeptic: Dr. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. NEJM Dec 2016 Guest Skeptic: Dr. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. [display_podcast] Date: November 27th, 2017 Reference: Legriel et al.

ALS 100

ALS ICU Emergency Department Paramedic 100

REBEL EM

NOVEMBER 6, 2023

Background Information: Vasoplegic shock is defined as hypotension with normal or increased cardiac output and can commonly occur in post-cardiac surgery patients having received cardiopulmonary bypass. This dysregulation of vasodilation is associated with a mortality of close to 25%.

Epinephrine 70

Epinephrine ICU ALS OR 70

REBEL EM

JUNE 8, 2023

Epinephrine – 10ug/mL, 10mL syringe Phenylephrine – 100ug/mL, 10mL syringe Phenylephrine bolus doses from 100-200ug and epinephrine 10-20ug administered every 2-5 minutes pursuant to provider order Inclusion Criteria: Adults age >18 years old Received at least one bolus dose of phenylephrine or epinephrine pre-filled syringes Exclusion (..)

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

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

REBEL EM

SEPTEMBER 26, 2022

What They Did Single-center randomized controlled study design performed by the Department of Hepatology & Liver transplantation in New Delhi Study participants, investigator clinicians, data collectors, and data analysts were blinded Investigators recruited participants from February 27, 2016 – March 3, 2018.

FFP 52

FFP E-9-1-1 ICU ALS 52

Emergency Medicine Ireland

APRIL 5, 2021

Once upon time there was the AKIKI trial led by Gaudry and published in NEJM in 2016. Next enter the IDEAL-ICU trial by Barbar in 2018 which is yet another French multi centre RCT which randomised septic shock patients to CRRT or not at 12 hrs after meeting the F on the RIFLE criteria. I think both are worth covering.

Critical Care 40

Critical Care ICU OR 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 OR 65

EMDocs

JANUARY 6, 2024

Answer : Cardiac Transplant Complications Epidemiology: There were over 3,000 heart transplants in North America in 2016. A bedside cardiac ultrasound is performed which shows biventricular failure with a dilated inferior vena cava. What is most likely the cause for his symptoms? BNP should normalize after about 2 months.

EMS 63

EMS E-9-1-1 ACS Coronary 63

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). Based on 2019 American Heart Association (AHA) guidelines, amiodarone and digoxin have been suggested as alternative options in controlling ventricular rate refractory to first-line BBs and non-DHP CCBs.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

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

REBEL EM

AUGUST 29, 2022

Duration of mechanical ventilation, ICU, and percentage of vasopressor use were not significantly different. What They Did Prospective, randomized 1:1, parallel-assignment, open-label, single-center trial Randomization process: Sequentially numbered opaque, sealed envelope in blocks of 8 that directed the team to use either etomidate (0.2

MICU 52

MICU ICU OR Emergency Department 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

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