2021, E-9-1-1 and ICU - Paramedicine Now

Trick of Trade: Inflating the Esophageal Balloon of a Blakemore/Minnesota Tube without a Manometer

ALiEM

MAY 19, 2023

The SB tube was created in 1950 in order to help tamponade variceal bleeds [1]. Apply traction to the tube by tying a roller bandage to the end of it and then the other end to a 1 L bag of IV fluids. Pearl 1: Check the units of pressure being used. The conversion rate is: 1 cmH2O = 0.74 1950 May;131(5):781-9.

E-9-1-1

E-9-1-1 Emergency Department ICU OR

emDOCs Revamp – Acute Chest Syndrome

EMDocs

JUNE 27, 2024

Abdomen : ND, NT, no guarding or rebound MSK : Tenderness to palpation over L ribs 7-9 Derm : No rashes Imaging: Image 1: Case courtesy of Miriam Leiderer, Radiopaedia.org, rID: 81468 Chest radiograph (CXR) shows new left lower lobe opacity What’s most likely diagnosis? C or 100.4 mg/kg, max 0.4 C or 100.4 mg/kg, max 0.4

E-9-1-1

E-9-1-1 ICU ACS EMS

First10EM Journal Club: October 2022

Broome Docs

OCTOBER 31, 2022

Ketamine vs etomidate in ICU intubation ? 2022 Jan;48(1):78-91. Epub 2021 Dec 14. 2022 Sep;21(9):781-791. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. 2022 Jul 26:emermed-2021-211540. doi: 10.1136/emermed-2021-211540. Lancet Neurol.

E-9-1-1

E-9-1-1 Defibrillator ICU Critical Care

Penetrating chest trauma

Don't Forget the Bubbles

JUNE 30, 2023

He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. She calls out her findings: A – OK B – 1 puncture mark to the anterior left chest wall, covered with a three-sided dressing. Actively oozing.

E-9-1-1

E-9-1-1 FFP Plasma Emergency Department

Shifting the Paradigm: Can We Manage Mechanically Ventilated Patients with Occult Traumatic Pneumothorax Conservatively?

REBEL EM

MAY 8, 2023

Paper: Smith JA, Secombe P, Aromataris E. 2021 Dec 1;91(6):1025-1040. Only 1 RCT and 1 cohort study had only mechanically ventilated patients. References: Smith JA, Secombe P, Aromataris E. 2021 Dec 1;91(6):1025-1040. J Trauma Acute Care Surg. PMID: 34225346. 2,210 records were excluded after screening.

E-9-1-1

E-9-1-1 Critical Care ICU OR

TAME Trial: Mild Hypercapnia vs Normocapnia in Out-of-Hospital Cardiac Arrest

REBEL EM

AUGUST 21, 2023

This trial aimed to assess whether targeted therapeutic mild hypercapnia (TTMH) applied during the initial 24 hours of mechanical ventilation in the ICU can enhance neurological outcomes at the 6-month mark, as compared to standard care, which involves targeted normocapnia (TN). Epub 2021 Feb 8. 2021 Feb 18. Resuscitation.

Critical Care

Critical Care E-9-1-1 CPR ALS

Inotropes and Vasopressors: Doses, indications, contraindications and effects

ECG & Echo Learning

OCTOBER 2, 2022

Most agents exhibit both vasopressor and inotropic effects (Figure 1). Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). μg/kg/min Bolus : 1 mg IV every 3 to 5 min (max 0.2 mg/kg) IM: (1:1000): 0.1 J Intensive Care Med 2021; 36:101.

E-9-1-1

E-9-1-1 ALS Coronary Epinephrine

Resident Journal Review: Massive Transfusion Protocols (MTPs) in Traumatic Hemorrhage

AAEM RSA

APRIL 1, 2021

1 The American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP) Massive Transfusion in Trauma Guidelines leave a good amount of flexibility for hospitals regarding transfusion protocols, focusing more on systems-level aspects of designing and implementing MTPs.2,3 in the 1:1:1 group vs. 17.0%

E-9-1-1

E-9-1-1 Plasma ACS ALS

20-something with huge verapamil overdose and cardiogenic shock

Dr. Smith's ECG Blog

MAY 26, 2023

He was admitted to the ICU and was unstable, in shock, overnight. Learning Points: 1. Details of management extend beyond the scope of this ECG Blog — with reviews by Atemnkeng at al ( J Med Cases 12[9]:373-376, 2021 ) and Chakraborty & Hamilton ( StatPearls, 2023 ) available for interested readers.

Overdose

Overdose E-9-1-1 Coronary OR

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

Dr. Smith's ECG Blog

MAY 5, 2022

He was admitted to the ICU and transferred emergently to a facility where he could undergo emergent dialysis as a part of further evaluation and management. The 2 Questions that I would ask would be: Question #1: In the absence of any history — What are the major diagnose s suggested by the ECG in Figure-1 ? What is it?

E-9-1-1

E-9-1-1 OR STEMI ED

Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ALiEM

OCTOBER 30, 2024

Due in large part to the proliferation of anonymous chemical factories able to produce industrial volumes of inexpensive synthetic opioids without opium or other controlled precursors, fentanyl spilled into the United States, Canada, and Europe, heroin soon fell to market forces [1, 2]. Xylazine withdrawal is controversial.

E-9-1-1

E-9-1-1 Naloxone Emergency Department ALS

ABG Versus VBG in the Emergency Department

EMDocs

FEBRUARY 12, 2024

Introduction Arterial blood gas (ABG) or venous blood gas (VBG) testing is used to assess the pH and systemic carbon dioxide tension in patients, and, therefore, provide a more complete picture of their acid-base status than an isolated basic metabolic panel (BMP) (1). However, ABGs have many drawbacks compared to VBGs.

Emergency Department

Emergency Department E-9-1-1 ED ICU

Sepsis Updates Relevant to the Emergency Physician

EMDocs

DECEMBER 18, 2023

The most recent surviving sepsis campaign (SSC) guidelines were released in 2021, which provided 93 recommendations for evidence-based sepsis management. This was based on studies that demonstrated qSOFA was more specific but less sensitive than its counterparts (Table 1).

E-9-1-1

E-9-1-1 ALS Emergency Department Plasma

Is Pip-Tazo Harming Sepsis Patients?

REBEL EM

NOVEMBER 11, 2024

In 2021, Buckley et. What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018. Imbalances Between Treatment Groups : ICU Admissions : Higher in piperacillin-tazobactam (33% vs. 30%). 3 The same year, Ross et.

E-9-1-1

E-9-1-1 ALS ICU Critical Care

Paramedicine Now

Trick of Trade: Inflating the Esophageal Balloon of a Blakemore/Minnesota Tube without a Manometer

emDOCs Revamp – Acute Chest Syndrome

Trending Sources

First10EM Journal Club: October 2022

Penetrating chest trauma

Shifting the Paradigm: Can We Manage Mechanically Ventilated Patients with Occult Traumatic Pneumothorax Conservatively?

TAME Trial: Mild Hypercapnia vs Normocapnia in Out-of-Hospital Cardiac Arrest

Inotropes and Vasopressors: Doses, indications, contraindications and effects

Resident Journal Review: Massive Transfusion Protocols (MTPs) in Traumatic Hemorrhage

20-something with huge verapamil overdose and cardiogenic shock

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ABG Versus VBG in the Emergency Department

Sepsis Updates Relevant to the Emergency Physician

Is Pip-Tazo Harming Sepsis Patients?

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