Don't Forget the Bubbles

JUNE 12, 2023

It wasn’t until over 20 minutes later that they managed to secure an airway and transfer her to the ICU, where she died 13 days later. Having just completed my Paediatric ED placement, I donned the navy flight suit and spent two weeks learning how to deal with every conceivable le in-flight emergency.

ICU 145

ICU ED OR 145

EMDocs

JUNE 15, 2024

. #1: PREOXI RCT – Preoxygenation with Noninvasive Ventilation vs. Non-rebreather Mask Spoon Feed Noninvasive ventilation (NIV) was superior to a standard non-rebreather (NRB) oxygen mask for preoxygenation of critically ill ED or ICU patients requiring intubation, with a NNT of 11 to prevent 1 episode of hypoxemia <85%.

ICU 75

ICU Emergency Department ED OR 75

EMS 12-Lead

MAY 8, 2022

This is critical for the EMS provider, or ED clinician, as identification of Grade I ischemia (aka, HATW’s) addresses the culprit lesion at the earliest opportunity with excellent downstream prognosis for the patient. [2] The following ECG was captured upon arrival at the receiving ED. The ED resulted an 8.7 An ECG is recorded.

STEMI 130

STEMI ED EMS Firefighter 130

EMDocs

SEPTEMBER 25, 2023

However, RSI has never been shown to reduce the risk of aspiration in the ED (13) or during emergent OR cases (14). While RSI should remain the gold standard in the vast majority of patients in the ED, FI presents an additional technique to mitigate anatomic or physiologic risk. To date, ketamine has been the agent of choice (12).

ED 66

ED Emergency Department ALS Paramedic 66

REBEL EM

NOVEMBER 25, 2024

1 Conversely, the 2021 BOUGIE trial—a larger, multicenter randomized clinical trial conducted by the same investigators—found no significant difference in first-attempt intubation success between the bougie and an endotracheal tube with stylet among critically ill adults. in both groups in one study, and 1.1% in another study).

Operating Room 98

Operating Room Emergency Department ICU ALS 98

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

Don't Forget the Bubbles

JUNE 30, 2023

All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. In 2021, Evans and colleagues (1) compared adolescent mortality rates in adult, children’s and mixed major trauma centres across the UK. The ODP is caught up leaving theatres and has not yet made it down to ED.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). His blood sugar was normal en route to the ED, and his initial rhythm on the cardiac monitor was asystole. Accidental Hypothermia: 2021 Update. 2009;338:b2085.

Defibrillator 85

Defibrillator CPR Epinephrine Life Support 85

EMDocs

JUNE 27, 2024

An 8-year old male with a history of sickle cell anemia presents to the ED for evaluation of fever for 2 days and “feeling like I can’t get a full breath”. 768: Epidemiology of Hospital Based ED Visits due to Sickle Cell Crisis and Acute Chest Syndrome in Kids. 2021 Sep;194(5):899-907. Epub 2021 Jul 15. Hosp Pract (1995).

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

Dr. Smith's ECG Blog

OCTOBER 19, 2022

A patient had 3rd degree AV block in the ED. and the 2021 YouTube Review by ICU Advantage on "Temporary Pacemakers: Modes and Basic Settings". Thanks to our Electrophysiologists Omar Iqbal and Rehan Karim for the below strips and the explanations I will be giving on this post.

ED 52

ED ICU OR Emergency Department 52

AAEM RSA

APRIL 8, 2021

Gibney, MD Originally published: Common Sense March/April 2021 It definitely felt different this new year. I’m pretty sure she was downsized in April because of me and a letter she wrote about her concerns, especially since I would be on the COVID ICU and her coworkers had multiple comorbidities that made them high risk. Volner, K., &

ICU 52

ICU EMR OR ED 52

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Case A 25-year-old-female presented to the ED in cardiac arrest. Summary This case exemplifies the value of POCUS in cardiac arrest patients in the ED. EKG RV strain. 2014 May;145(5):950-957.

ED 82

ED NARCAN ALS OR 82

ACEP Now

MARCH 13, 2024

Emergency departments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. ED crowding impairs this mission. The Emergency Medical Treatment and Labor Act (EMTALA) mandates examination, treatment, and stabilization of anyone who comes to the ED.

Emergency Department 52

Emergency Department ED ALS OR 52

REBEL EM

NOVEMBER 3, 2022

In this post, we critically appraise the first systematic review and meta-analysis to compare the safety and efficacy of etomidate and ketamine as induction agents for RSI in the ED and prehospital setting. Pooled data from ED and prehospital were evaluated using an odds ratio with a 95% confidence interval. Article: Sharda SC et al.

ALS 52

ALS ICU ED Emergency Department 52

REBEL EM

MAY 8, 2023

2021 Dec 1;91(6):1025-1040. 95% Confidence Interval) Strengths: The study addresses a patient-centered clinical question that is relevant to ED practice. 2021 Dec 1;91(6):1025-1040. Paper: Smith JA, Secombe P, Aromataris E. J Trauma Acute Care Surg. PMID: 34225346. 2,230 records remained after the elimination of duplicates.

E-9-1-1 58

E-9-1-1 Critical Care ICU OR 58

ACEP Now

MAY 9, 2024

The procedure has soared in popularity as beauty standards have shifted and cosmetic surgery has become increasingly transparent on social media platforms, with reported cases in the United States increasing from 614 in 2002 to 61,387 by 2021, a nearly 10,000 percent increase. Aesthetic Plastic Surgery National Databank Statistics 2020–2021.

Emergency Department 52

Emergency Department Operating Room Critical Care ALS 52

REBEL EM

AUGUST 29, 2022

Duration of mechanical ventilation, ICU, and percentage of vasopressor use were not significantly different. All intubations were performed on hospitalized patients, limiting application to the ED population. Epub 2021 Dec 14. Day 28 survival rates for both ketamine and etomidate were not significantly different. PMID: 34904190.

MICU 52

MICU ICU OR Emergency Department 52

Dr. Smith's ECG Blog

MAY 26, 2023

mg/dL (sorry, Europeans, for the weird units) Here was the initial ED ECG: There is a junctional rhythm with retrograde P-waves (see the dip in the T-wave in lead II across the bottom; you can follow that up to all the other leads and see the retrograde P wave). He was admitted to the ICU and was unstable, in shock, overnight.

Overdose 91

Overdose E-9-1-1 Coronary OR 91

AAEM RSA

APRIL 1, 2021

The authors excluded those with devastating injuries (expected to die within one hour of admission), need for thoracotomy prior to receiving blood products, significant burns (>20% total body surface area), inhalation injuries, or receiving over five minutes of cardiopulmonary resuscitation prior to arrival or in the ED. 248(3):447-58.

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

Dr. Smith's ECG Blog

MAY 5, 2022

Submitted and written by Destiny Folk MD , peer reviewed by Meyers, Smith, Grauer, McLaren A man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. On arrival in the ED, he was hypotensive with a systolic blood pressure in the 70s.

E-9-1-1 52

E-9-1-1 OR STEMI ED 52

Don't Forget the Bubbles

JANUARY 4, 2024

This retrospective, observational study used data from the UK Trauma Audit & Research Network (TARN) between 2012 and 2021. Records of all children (defined age 0-16) on the TARN database who fulfilled the TARN criteria (had been admitted for longer than 72 hours, admitted to an ICU, or died in hospital) were included.

ED 129

ED ICU ALS OR 129

ALiEM

OCTOBER 30, 2024

Our experience: Traditionally, ED physicians do not like ordering urine drug screens (UDS). We have certainly seen patients who have pain which is controlled and still have psychomotor agitation and sympathetic activation, leading some to require ICU admission for dexmedetomidine and/or ketamine infusion. 2021 Aug 1;94:103086.

E-9-1-1 161

E-9-1-1 Naloxone Emergency Department ALS 161

EMDocs

FEBRUARY 12, 2024

As the only respiratory therapist in the ED has been paged and is starting BiPAP for this patient, an overhead call for two incoming trauma alerts from a multivehicle collision sounds. Because the RT responsible for drawing arterial blood gases is busy caring for these patients, ABGs will be delayed.

Emergency Department 94

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

EMDocs

DECEMBER 18, 2023

On arrival to the ED, her blood pressure is 84/36 mmHg with a heart rate of 110 beats per minute. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. The patient currently resides at a skilled nursing facility. Today, she would not get out of bed, prompting the facility to call EMS.

E-9-1-1 65

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

EMDocs

AUGUST 15, 2023

He was initially seen at a regional ED and was administered 10 vials of crotalidae equine immune F(ab’) 2 (ANAVIP®) antivenom before transfer to your referral center. Published online April 2021. His father confirmed the snake was a copperhead. link] Antivenom administration North American Crotalinae snakebites – UpToDate.

Emergency Department 82

Emergency Department OR EMS ED 82

REBEL EM

NOVEMBER 11, 2024

In 2021, Buckley et. They analyzed the electronic health records of patients presenting to the ED who met modified Center for Disease Control and Prevention (CDC) sepsis surveillance criteria and received empiric treatment with either vancomycin/piperacillin-tazobactam or vancomycin/cefepime. 3 The same year, Ross et. vs. 52.2%).

E-9-1-1 84

E-9-1-1 ALS ICU Critical Care 84

FOAMfrat

NOVEMBER 21, 2024

Today, increased mortality rates, higher transfusion requirements, and lengthened ICU stays are recognized as proximate effects of the Trauma Triad. upon ED arrival incur mortality rates of up to 3-5x that of patients without coagulopathy. 2021 Feb 1;90(2):396-402. 2021 Jul 19;13(7):e16487. normal value is between 0.8

ICU 118

ICU Emergency Department OR Ambulance 118