REBEL EM

APRIL 22, 2024

Population: Adult patients ( > 18 years of age) admitted to the ICU with COVID-19 and severe hypoxemia (defined as receiving supplemental O2 with a flow rate of at least 10L/min or receiving mechanical ventilation or non-invasive ventilation. Absolute number of days alive and out of hospital in 90 days.

Life Support 75

Life Support ICU EMS OR 75

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-9-1-1 126

E-9-1-1 ICU OR ALS 126

Critical Care Scenarios

NOVEMBER 1, 2020

A look at oncology-related emergencies in the ICU, with Leon Chen (@CCMNP), NYC nurse practitioner specializing in oncology critical care. 2019 Mar;20(2):316-322. Epub 2019 Feb 14. Takeaway lessons Extremely elevated leukocyte count should always raise suspicion for a “liquid tumor” such as leukemia. West J Emerg Med.

Critical Care 100

Critical Care ICU OR 100

Core EM

JANUARY 25, 2024

Disposition to ICU. 2007;33(11):2019-2024. McGraw-Hill Education, New York, 11th edition, 2019. Takes 30 minutes to see effect, temporize with traditional vasopressors (norepinephrine, vasopressin). Titrate to end organ perfusion as MAP may not change significantly. References: Yuan TH, Kerns WP, Tomaszewski CA, et al.

Overdose 246

Overdose ALS Epinephrine Critical Care 246

REBEL EM

AUGUST 12, 2024

PMID: 36038001 Clinical Question: In patients undergoing cardiac surgery with cardiopulmonary bypass, does the administration of intravenous amino acid therapy lead to lower occurrence of postoperative AKI when compared to placebo?

ICU 81

ICU Operating Room Critical Care ALS 81

REBEL EM

NOVEMBER 6, 2023

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.

Epinephrine 72

Epinephrine ICU ALS OR 72

The Skeptics' Guide to EM

JUNE 6, 2020

Respir Crit Care Med 2019. Respir Crit Care Med 2019. Max is then going to Georgetown to be an attending in both EM and ICU. Date: June 2nd, 2020 Reference: Permpikul et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Case: It’s another day in your emergency department (ED).

EMR 130

EMR ALS ICU Emergency Department 130

Emergency Medicine Ireland

OCTOBER 14, 2024

The major barrier to implementation in the ICU setting is the almost complete absence of ICU patients from these trial cohorts. And as we all know if there is a complication possible it’s almost definitely going to happen with greater frequency in the ICU cohort. 2019, (2019). Cochrane Database Syst.Rev.

Critical Care 52

Critical Care ICU ALS OR 52

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

NOVEMBER 16, 2019

Date: November 6th, 2019 Reference: Lascarrou et al. NEJM Oct 2019 Guest Skeptic: Dr. Laura Melville (@lmelville535) is an emergency physician in Brooklyn, New York, is a part of the New York ACEP Research Committee, ALL NYC EM, and is the NYP-Brooklyn Methodist Resident Research Director. Reference: Lascarrou et al.

ALS 100

ALS CPR ICU EMS 100

Pediatric EM Morsels

MARCH 17, 2023

Judge 2019) Best when given within 4 hours of the bite, but still effective within 24 hours Always give an entire vial of antivenom, never a partial vial. Published November 13, 2019. as far west as Texas Cottonmouths/Water Moccasins live in the southeastern U.S. It’s expensive, so if you’re giving some of a vial, give it all.

Frozen Plasma 130

Frozen Plasma Plasma First Aid OR 130

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. 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? J Crit Care.

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

Don't Forget the Bubbles

AUGUST 23, 2023

2018) “Sacred Pause Imitative in the ICU: A survey of ICU physicians and nurses”. 2019) “The presence of psychological trauma symptoms in resuscitation providers and an exploration of debriefing practices.” Cunningham T. 2018) “Benefits of using the pause after death in emergency departments: a Delphi study”. 112 (9),pp.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

Emergency Medicine Ireland

DECEMBER 3, 2020

With my deepest apologies to all the great ICU dieticians I have worked with, I just struggle to get excited over this stuff. I would highly recommend attending an excellent lecture given by your ICU dietician which is just possibly where this entire summary came from. As with all ICU nutrition EN is preferred over PN.

Critical Care 52

Critical Care ICU EMS OR 52

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-9-1-1 122

E-9-1-1 ALS ACS ICU 122

EMDocs

JUNE 22, 2024

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., “Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation.” ” Clin Appl Thromb Hemost 25: 1076029619843338.

EMS 95

EMS Ambulance FFP ICU 95

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 January 30, 2019. Hence, the RT’s are supposed to have them. Pearl 1: Check the units of pressure being used. 1950 May;131(5):781-9. Powell M, Journey JD.

E-9-1-1 245

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

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. Comparator: Delayed CAG: Patients were admitted to the ICU, and CAG was performed after 48-96 hours.

Coronary 83

Coronary CPR OR ICU 83

Core EM

OCTOBER 16, 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 145

Allergic Reaction Plasma ED Epinephrine 145

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. 2019 May 31:bmjqs-2019. 2019 May;27(4):758-64. While you are leading the resuscitation, one of your senior colleagues belittles a junior staff member for struggling to site an IV line. How do you manage this situation?

E-9-1-1 105

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

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 ). 2019; 380(5):425-436. The Cochrane database of systematic reviews. 2014; PMID: 25066627 Li HK et al.

ALS 100

ALS ICU ED OR 100

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 132

ICU OR ALS ED 132

Emergency Medicine Ireland

NOVEMBER 26, 2020

Diagnosis can be tricky and from an ICU perspective they’re probably sick enough to justify empiric treatment based on context without waiting for all the results. If they’re in ICU then the cotrimoxazole should be given with a chaser of steroids as this has a mortality altering effect. 2019 Sep;33(9):e13587.

Critical Care 40

Critical Care ICU OR 40

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. 40, 1234-41.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

Broome Docs

NOVEMBER 17, 2024

Epub 2019 Dec 13. Systematic Review: The Role of Intravenous and Oral Contrast in the Computed Tomography Evaluation of Acute Appendicitis. J Emerg Med. 2020 Jan;58(1):162-166. doi: 10.1016/j.jemermed.2019.10.034. 2019.10.034. PMID: 31843324 Bottom line: This information is not new. I was taught this in residency.

Epinephrine 62

Epinephrine Emergency Department Critical Care ICU 62

REBEL EM

SEPTEMBER 26, 2022

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. Hayes-Larson 2019).

FFP 52

FFP E-9-1-1 ICU ALS 52

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. doi:10.1016/j.ajem.2022.06.017

E-9-1-1 92

E-9-1-1 Plasma Epinephrine Life Support 92

REBEL EM

JUNE 8, 2023

Epub 2019 Jul 3. The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. PMID: 36108346 Cole JB, et al. Human Errors and Adverse Hemodynamic Events Related to “Push Dose Pressors” in the Emergency Department. J Med Toxicol. PMID: 31270748 Maheshwari K, et al. Intensive Care Med.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

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

EMDocs

JUNE 27, 2024

2019 Jan 24;14:263-292. May substitute levofloxacin if allergic to cephalosporin Anti-viral medications if indicated Oseltamivir for influenza Patients >14 days old Remdesivir for COVID Patients >28 days old and at least 7lbs (3.2 Predictors of impending acute chest syndrome in patients with sickle cell anaemia. Annu Rev Pathol.

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

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. Chapter 22: Electrolytes, Temperature, Central Nervous System Disease, and Miscellaneous Effects. McCance, K.

STEMI 130

STEMI ED EMS Firefighter 130

REBEL EM

JUNE 26, 2023

J Trauma Acute Care Surg 2019. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03

FFP 145

FFP Frozen Plasma ALS Plasma 145

Emergency Medicine Ireland

APRIL 5, 2021

There is an interesting concept called the furosemide stress test that was first described by Chawla in 2013 and then repeated by Rewa in 2019. This is one of the current generation of ICU mega trials where all the great and good critical trials groups get together and put out a trial to end all trials.

Critical Care 40

Critical Care ICU OR 40

EMDocs

MAY 25, 2023

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. Reference: Kapur J, Elm J, Chamberlain JM, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus.

Emergency Department 63

Emergency Department ICU OR ALS 63

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. Airway management should not be delayed. Remove patient clothing and wash patient thoroughly with soap and water if this is a dermal exposure.

E-9-1-1 83

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

AAEM RSA

JUNE 30, 2021

Many triple-certified physicians choose to divide their time between the emergency department (ED) and intensive care unit (ICU) for extra variability in their careers, staying sharp in both the high acuity and physiological management of the most ill and complex patients. Published online August 31, 2019. 2018; 15(3):431.

EMS 52

EMS Critical Care ICU Emergency Department 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. Nagendran 2019 in CCM. Intens Care Med 45 , 844–855 (2019). A somewhat underwhelming start Second is the VANISH trial by Gordon et al, JAMA 2016.

Critical Care 52

Critical Care ALS Coronary ICU 52