EMDocs

JUNE 22, 2024

” Obstet Gynecol 123(2 Pt 1): 337-348. link] Society for Maternal-Fetal Medicine. Electronic address, p. “Amniotic fluid embolism: diagnosis and management.” ” Am J Obstet Gynecol 215(2): B16-24. link] j.ajog.2016.03.012 2016.03.012 Patel, P., ” Clin Appl Thromb Hemost 25: 1076029619843338.

EMS 96

EMS Ambulance FFP ICU 96

EMS 12-Lead

AUGUST 22, 2022

A 65 y/o Female was admitted to the ICU for septic shock. The combination of prolonged QT and deep T wave inversion throughout the precordium is typical of Takotsubo syndrome, or Stress Cardiomyopathy – which can occur in the context of a physiologically distressed ICU patient, further compromising their hemodynamics. Friedman, M.,

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

His temperature was brought back to normal over time in the ICU. Osborn waves have been reported with hypercalcemia, brain injury, subarachnoid hemorrhage, Brugada syndrome, cardiac arrest from VFib — and — severe, acute ischemia resulting in acute MI ( See My Comment in the November 22, 2019 post on Dr. Smith’s Blog ).

ICU 135

ICU OR ALS ED 135

EMDocs

JUNE 27, 2024

Alkindi S, Al-Busaidi I, Al-Salami B, Raniga S, Pathare A, Ballas SK. 2019 Jan 24;14:263-292. Alghamdi FA, Al-Kasim F, Alshhada F, Ghareeb E, Azmet FR, Almudaibigh A, Baitalmal L, Alnawfal B, Alluqmani R. Critical Care Medicine 41(12):p A191, December 2013. 2020 Feb 12;10(1):2470. PMID: 32051480; PMCID: PMC7015921.

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

EMDocs

APRIL 10, 2024

Hemodynamics slowly begin to stabilize, and the patient is transferred to the ICU for further post-cardiac arrest care. McGraw Hill Companies, Inc; 2019. doi:10.1136/bcr-2019-233119 Neal JM, Barrington MJ, Fettiplace MR, et al. The patient remains hemodynamically unstable, and bolus of 1.5 2022;59:42-48. BMJ Case Rep.

E-9-1-1 93

E-9-1-1 Plasma Epinephrine EMS 93

EMS 12-Lead

MAY 8, 2022

Thankfully, the patient experienced an uncomplicated ICU stay and subsequently made a full recovery. The serum K returned 8.7, along with a pH 6.94, and an HCO3 of 5. Unfortunately, no ECG was captured after resuscitation. Wolters-Kluwer: Philadelphia, PA. [2] 2] Birnbaum, Y., Journal of Electrocardiology, 37 (3), 149-156. [3] Physiology.

STEMI 130

STEMI ED EMS Firefighter 130

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

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. Journal of Trauma and Injury 2019; 32(4): 238-242.

Emergency Department 94

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

EMDocs

JANUARY 16, 2024

He requires low-dose epinephrine to maintain his mean arterial pressure (MAP) in the 60s mmHg and is transported to the cardiothoracic (CT) ICU. Carsten L, et al. Higher Survival Chances of Hypothermic vs. Normothermic cardiac arrest patients with ECLS re-warming, Resuscitation, Volume 134, 2019, Pages 161-162, ISSN 0300-9572.

Defibrillator 84

Defibrillator CPR Epinephrine Life Support 84

EMDocs

JUNE 7, 2023

Disposition is often admission to an intensive care unit (ICU) setting. Further management and resuscitation were required, and she had a lengthy ICU stay of 21 days until she was extubated. References: Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure.

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

EMDocs

MAY 25, 2023

Reference: Kapur J, Elm J, Chamberlain JM, et al. 2019; 381(22): 2103-2113. If the adult patient has failed to stop seizing with two doses of benzodiazepines, rapid control of the seizure with either high dose propofol or ketamine can result in seizure cessation. N Engl J Med.

Emergency Department 64

Emergency Department ICU OR ALS 64

ACEP Now

MAY 9, 2024

Unfortunately, at least 13 deaths were subsequently reported in Miami-Dade County from 2019–2022, the three years immediately following the implementation of the subcutaneous injection regulation. Nearly half of all post-AFT patients presenting to our emergency departments required admission and six percent required ICU admission.

Emergency Department 52

Emergency Department Operating Room Critical Care ALS 52

REBEL EM

JULY 25, 2022

Click here for Direct Download of the Podcast Paper: Russell DW et al. References: Russell DW et al. PMID: 35707974 [ Access on Read by QxMD ] Janz DR et al. to 1.13; p = 0.03). REBEL Cast Ep111: The PrePARE II Trial – Fluid Bolus Prior to Intubation? No Bolus: 18.2% Absolute difference 2.8%; 95% CI -2.2% to 7.7%; p = 0.25

ALS 57

ALS Critical Care ICU OR 57

EMDocs

JUNE 3, 2023

Patients receiving thrombolysis will require ICU admission for neurologic monitoring. Rosh Review Website Link Further Reading [link] [link] [link] [link] [link] References: Stanislavsky A, Baba Y, Hacking C, et al. New York: McGraw-Hill; 2019. Fogwe DT, Sandhu DS, Goyal A, et al. Lui F, Foris LA, Willner K, et al.

EMS 74

EMS ALS OR ED 74

Emergency Medicine Ireland

JULY 3, 2023

It is important to realise that a referral to ICU for refractory cardiorenal syndrome may simply be a sign that the patient is reaching end of life. Circulation 139, e840–e878 (2019). This segues relatively nicely into a section of the document on palliative care. – Mullens, W., Verbrugge, F. Nijst, P. & & Tang, W.

Critical Care 96

Critical Care ACS OR ALS 96

EMDocs

APRIL 22, 2024

Alerhand et al described ten individual echocardiographic findings of RV strain that suggest PE. Marino’s the ICU book, Wolters Kluwer Health, pgs 105-109, 4th ed., VUMC Emergency Medicine, “RV Strain & TAPSE” YouTube Video [link] Farcy et al. Available from: [link] Meneveau, Nicolas, et al.

ED 82

ED NARCAN ALS OR 82

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Date: September 11th, 2019 Reference: Putzu et al. Date: September 11th, 2019 Reference: Putzu et al. Case: A 45-year-old female in the emergency department is being admitted to the intensive care unit (ICU) for septic shock secondary to urinary tract infection (UTI). Reference: Putzu et al.

ICU 130

ICU Critical Care ALS Emergency Department 130

REBEL EM

NOVEMBER 30, 2023

Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. Kuttab et al’s findings, constituting 45% of the review’s weight, suggest that administering <30cc/kg IVF is associated with increased odds of mortality, delayed hypotension, and increased ICU utilization. 2.89, p = 0.01.

E-9-1-1 120

E-9-1-1 ALS ACS ICU 120

REBEL EM

AUGUST 12, 2024

The authors of this study sought to test the hypothesis that intravenous amino acid therapy would lead to a lower occurrence of postoperative AKI when compared to placebo. Paper: Landoni G. Intravenous amino acid therapy for kidney protection in cardiac surgery a protocol for a multi-centre randomized blinded placebo controlled clinical trial.

ICU 80

ICU Critical Care Operating Room ALS 80

REBEL EM

FEBRUARY 19, 2024

Paper: Yerke JR et al. PMID: 37611862 Clinical Question: In patients treated in the ICU, can a protocol of peripheral IV catheter vasopressors safely reduce the number of days of CVC use and frequency of placement? References: Yerke JR et al. PMID: 37611862 Evans L et al. CHEST 2024. CHEST 2024. Crit Care Med 2021.

ICU 137

ICU EMS ALS OR 137

REBEL EM

OCTOBER 2, 2023

Mild to moderate DKA represents a subgroup of patients that often require admission to the ICU due to hospital policies not allowing insulin infusions outside of this clinical setting. Paper: Griffey RT et al. However, it is unclear if all degrees (mild, moderate, severe) of DKA require the same intensive treatment. tests/hr (0.8

ICU 104

ICU ED ALS OR 104

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. Fowler 2019) This concept and study design provided the framework for the Lessening Organ Dysfunction with Vitamin C (LOVIT) clinical trial. Article: Lamontagne F et al.

ICU 52

ICU ALS OR EMS 52

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

REBEL EM

FEBRUARY 8, 2024

Paper: Haber, EN et al. PMID: 38215002 Clinical Question: In critically ill adults in the ICU is noninvasive blood pressure (NIBP) monitoring similar (≤10% difference) to invasive arterial blood pressure (IABP) monitoring? References: Haber, EN et al. PMID: 38215002 Kaufmann T et al. J Intensive Care Med 2024.

ICU 125

ICU MICU ALS EMS 125

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. Frich JC, Brewster AL, Cherlin EJ, Bradley EH. 2019 May 31:bmjqs-2019. 2019 May;27(4):758-64. The junior staff member remains silent throughout the debrief and does not attend their shift the following day.

E-9-1-1 105

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

REBEL EM

JUNE 8, 2023

Paper: Singer S, et al. References: Singer S, et al. PMID: 36108346 Cole JB, et al. Epub 2019 Jul 3. 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.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

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 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. Paper: Owyang CG, et al. 2019 Aug; PMID: 30954692 Clinical Question: What is the impact of system factors in the implementation of standard-of-care LPV in critically ill ED patients admitted to the ICU?

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

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 70

Epinephrine ICU ALS OR 70

REBEL EM

JANUARY 9, 2024

This finding persists when looking at a number of other infections including skin and soft tissue infections (SSTI) ( First10EM ), pyelonephritis ( Strohmeier 2014 ) and even bone and joint infections ( Li 2019 ). PMID: 9114201 Siegel RE et al. PMID: 17090560 Castro-Guardiola A et al. PMID: 1664833 Addo-Yobo E, et al.

ALS 99

ALS ED ICU OR 99

REBEL EM

MARCH 30, 2023

The TOMAHAWK (Desch 2021), COACT (Abella 2019), and PEARL (Lemkes 2019) trials examined patients with OHCA without ST elevation with a shockable rhythm, and investigators found no difference in delayed versus emergency angiogram. Article: How-Berlemont C, Lamhaut L, Diehl J, et al. JAMA Cardiol. Published online June 08, 2022.

Coronary 83

Coronary CPR OR ICU 83

REBEL EM

JUNE 26, 2023

Click here for Direct Download of the Podcast Paper: Bouzat P et al. References: Bouzat P et al. PMID: 36942533 Innerhofer P et al. PMID: 28457980 Jehan F et al. PMID: 29664892 Zeeshan M et al. J Trauma Acute Care Surg 2019. High-quality studies are needed to determine the utility of this intervention.

FFP 145

FFP Frozen Plasma ALS Plasma 145

ACEP Now

APRIL 3, 2024

3,4 The Hyperion trial in 2019 demonstrated that TTM at 33 degrees Celsius was efficacious for non-shockable rhythms, reinforcing the guidelines recommendation for post-arrest TTM. In a multisite retrospective cohort study, a study by Nishikimi, et al., Group W, Nolan JP, et al. Nielsen N, Wetterslev J, et al.

Advanced Life Support 40

Advanced Life Support ALS Life Support CPR 40

ACEP Now

JUNE 14, 2024

In 2019, the global prevalence of COPD was estimated to be 10.3 4,6,11 Antibiotics Antibiotic use for AECOPD patients remains a contentious topic; however, data suggests AECOPD patients requiring admission, particularly to the ICU, should receive antibiotics. Adeloye D, Song P, Zhu Y, et al. Howton JC, Rose J, Duffy S, et al.

ALS 52

ALS Coronary OR Emergency Department 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 OR 65

Dr. Smith's ECG Blog

MARCH 6, 2019

I believe this is by far the most common outcome for this patient around the world in 2019. Current practice ranges widely, but based on my short experience and reports from other institutions, most of these patients are not being taken emergently to the cath lab in 2019. Patel et al., Krucoff et al.) Patel et al.

STEMI 52

STEMI ALS ACS OR 52

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