The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Date: September 20th, 2021 Reference: Litell et al. Date: September 20th, 2021 Reference: Litell et al. It is the leading cause of death in the intensive care unit (ICU) in the US and the most expensive diagnosis. Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge.

Emergency Department 100

Emergency Department EMR ICU ALS 100

The Skeptics' Guide to EM

MARCH 27, 2021

Date: March 17th, 2021 Guest Skeptic: Dr. Emil Ejersbo Iversen is an emergency medicine resident at the University Hospital of Zealand, Denmark. Date: March 17th, 2021 Guest Skeptic: Dr. Emil Ejersbo Iversen is an emergency medicine resident at the University Hospital of Zealand, Denmark. J Trauma Acute Care Surg.

ICU 100

ICU ALS Emergency Department ED 100

Silk City Blog

JANUARY 20, 2022

The overall incidence of developing venous thromboembolism (VTE) is approximately 17% in patients diagnosed with COVID-19, with a significantly higher rate in the ICU setting (Jiménez 2021). Some of these papers have been reviewed on REBEL EM.

ICU 52

ICU EMS 52

Broome Docs

OCTOBER 31, 2022

Ketamine vs etomidate in ICU intubation ? Epub 2021 Dec 14. 2022 Jul 26:emermed-2021-211540. doi: 10.1136/emermed-2021-211540. PMID: 22174322 Read Justin’s full written Articles of the Month at First10EM Ketamine vs etomidate in ICU intubation? Intensive Care Med. 2022 Jan;48(1):78-91. Emerg Med J.

E-9-1-1 52

E-9-1-1 Defibrillator ICU Critical Care 52

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

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. He died in Victoria, Australia, in 2021 after a period of prolonged brain injury sustained in a fully equipped metropolitan hospital.

ICU 145

ICU ED OR 145

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. Accessed December 17, 2021. Hence, the RT’s are supposed to have them. Pearl 1: Check the units of pressure being used. Acute variceal bleeding. Semin Respir Crit Care Med.

E-9-1-1 245

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

Core EM

JANUARY 25, 2024

Disposition to ICU. 2021; 59(12), 1282–1501. Takes 30 minutes to see effect, temporize with traditional vasopressors (norepinephrine, vasopressin). Titrate to end organ perfusion as MAP may not change significantly. Back up plans for mechanical support such as venous-arterial ECMO such be considered early for refractory patients.

Overdose 246

Overdose ALS Epinephrine Critical Care 246

REBEL EM

MARCH 23, 2023

The group that received phenobarbital had a higher maximum CIWA score than the group that received lorazepam, which could mean that phenobarbital was not as effective as lorazepam, although this is potentially confounded by patients who were transferred to the ICU were excluded from the study. Paper : Hawa F et al.

ICU 52

ICU Emergency Department ALS OR 52

EMDocs

JUNE 27, 2024

2021 Sep;194(5):899-907. Epub 2021 Jul 15. 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 Br J Haematol.

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

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 97

Critical Care E-9-1-1 CPR ALS 97

NAEMSP

FEBRUARY 15, 2023

The patient was dying while intubated in the ICU but was awake enough to engage in discussions with providers through writing about her wishes. Epub 2021 Mar 30. Epub 2021 Dec 1. Epub 2021 Feb 2. Epub 2021 Aug 31. 2021 Mar;35(3):584-591. Prehosp Emerg Care. 2022 May-Jun;26(3):364-369. PMID: 33689535.

Emergency Medical Services 52

Emergency Medical Services EMS CPR Paramedic 52

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. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Accidental Hypothermia: 2021 Update. The patient is extubated and decannulated four days later.

Defibrillator 84

Defibrillator CPR Epinephrine Life Support 84

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). 2021 Aug 1;133(2):374-378. 2021 Apr;47(2):365-372. 2021 Apr;47(2):365-372. PMID: 23903783. (4) 4) Chong WH, Saha BK, Medarov BI. Anesth Analg.

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

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

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. Even the preserved QRS duration is at risk of imminent death. Do not miss this fantastic tutorial from Dr. Jesse McLaren!

STEMI 130

STEMI ED EMS Firefighter 130

Core EM

JANUARY 25, 2024

The standard of care of treating DKA is fluid resuscitation, electrolyte management, and intravenous insulin infusion in the intensive care unit (ICU) setting for close glucose and electrolyte monitoring. Recent research aims at investigating the treatment of DKA with subcutaneous insulin in non-ICU settings. Image from cited article.

EMS 246

EMS ICU ED OR 246

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). J Intensive Care Med 2021; 36:101. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med 2021; 49:e1063. Lherm T, Troché G, Rossignol M, et al.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

ACEP Now

MARCH 13, 2024

Published online 2021:26. Conclusion/Recommendation ED crowding is a national patient safety issue driven by hospitals routinely operating over capacity. Hospitals have no financial incentive to reduce elective admissions to increase inpatient or ED capacity. Academic Emergency Medicine 22.2 2015):157-165.

Emergency Department 52

Emergency Department ED ALS OR 52

EMDocs

AUGUST 15, 2023

Published online April 2021. If you are concerned for elevated compartment pressures, the patient needs to be treated with antivenom. link] Antivenom administration North American Crotalinae snakebites – UpToDate. Accessed May 7, 2022. link] Highlights of prescribing information. Crotalidae Immune F(ab’)2 (Equine). Accessed May 7, 2022.

Emergency Department 82

Emergency Department OR EMS ED 82

Dr. Smith's ECG Blog

OCTOBER 28, 2022

Annals of Emergency Medicine 2021. He went into cardiogenic shock and is intubated in the cardiac ICU. The location of the infarct is clear, but that does not necessarily tell you what artery it is. Learn about the Smith-Modified Sgarbossa Criteria for Diagnosis of OMI Paced Rhythm: Dodd, Meyers, Smith, et al.

Coronary 52

Coronary Paramedic EMS ICU 52

REBEL EM

FEBRUARY 19, 2024

The 2021 Surviving Sepsis Campaign Guidelines suggest starting vasopressors peripherally rather than delaying infusion until a CVC is placed [2]. 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?

ICU 134

ICU EMS ALS OR 134

Dr. Smith's ECG Blog

OCTOBER 19, 2022

and the 2021 YouTube Review by ICU Advantage on "Temporary Pacemakers: Modes and Basic Settings". For those wanting more on Pacing — I like the PDF review of Pacing Basics by the University of Ottawa Heart Institute — and the user-friendly summary of Temporary Pacemaker Troubleshooting in the November 3, 2020 Life-In-The-Fast-Lane. —

ED 52

ED ICU OR Emergency Department 52

Medgadget

MAY 3, 2023

As of 2021, I lead our U.S. In 2021, 58 percent of physicians reported “administrative tasks” as the key contributor to their burnout. Estrampes: AI has the power to revolutionize healthcare providers’ administrative processes. Administrative responsibilities are a huge contributor to physician burnout.

Critical Care 81

Critical Care OR ICU 81

EMDocs

APRIL 22, 2024

Marino’s the ICU book, Wolters Kluwer Health, pgs 105-109, 4th ed., 2021 Apr;40(2):100852. Epub 2021 Mar 26. Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism. 2014 May;145(5):950-957. doi: 10.1378/chest.13-1087. PMID: 24092475. Marino, P. Tintinalli, J.E. Anaesth Crit Care Pain Med.

ED 82

ED NARCAN ALS OR 82

Core EM

JANUARY 25, 2024

2021 Background Prehospital trauma team activation criteria allow for prompt mobilization of personnel and resources. Read More PEMCAR iBook (Apple version) PEMCAR iBook (PDF) EMCAR – Prehospital Traumatic Narrow Pulse Pressure – J Surg Res 2021 Read More Prehospital hypotension is one of those criteria.

Operating Room 246

Operating Room EMS ED ICU 246

The Skeptics' Guide to EM

OCTOBER 3, 2021

Date: September 28th, 2021 Reference: Zampieri et al. JAMA 2021 Guest Skeptic: Dr. Aaron Skolnik is an Assistant Professor of Emergency Medicine at the Mayo Clinic Alix School of Medicine and Consultant in […] The post SGEM#347: It Don’t Matter to Me – Balanced Solution or Saline first appeared on The Skeptics Guide to Emergency Medicine.

OR 130

OR Critical Care ICU Plasma 130

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. to 19.3hrs); Reduction by 3.6hrs ED LOS was shorter for the SQuID cohort ICU Admissions: SQuID & Traditional (Post Intervention): 42.9%

ICU 100

ICU ED ALS OR 100

The Skeptics' Guide to EM

JANUARY 15, 2022

Intensive Care Med 2021 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a professor of Emergency Medical Services at Tacoma Community College’s paramedic program. Date: January 16th, 2022 Reference: Matchett, G. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial.

Emergency Medical Services 107

Emergency Medical Services Firefighter Critical Care Paramedic 107

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

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. Clinical Question: Does high-dose vitamin C improve survival and/or persistent organ dysfunction rates in septic patients in the ICU on vasopressors? N Engl J Med 2022.

ICU 52

ICU ALS OR EMS 52

REBEL EM

FEBRUARY 8, 2024

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? Paper: Haber, EN et al. Accuracy of Noninvasive Blood Pressure Monitoring in Critically Ill Adults. J Intensive Care Med 2024. to 2.47; p – 0.04

ICU 116

ICU MICU ALS EMS 116

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 63

Coronary CPR OR ICU 63

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

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 64

Epinephrine ICU ALS OR 64

Don't Forget the Bubbles

JUNE 30, 2023

In 2021, Evans and colleagues (1) compared adolescent mortality rates in adult, children’s and mixed major trauma centres across the UK. In 2021, Kulvatunyou, Bauman and colleagues compared the insertion of traditional 28-32Fr chest tubes with 14Fr pigtail catheters for drainage of traumatic haemothorax. 2021 Jul;38(7):488-494.

E-9-1-1 139

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

REBEL EM

SEPTEMBER 29, 2022

Ann Surg 2021. cc/kg/hour of LR Control: LR Bolus of 20 cc/kg (regardless of fluid status) followed by 3.0 cc/kg/hour of LR Design: Multicenter, multinational, open-label, parallel-group, randomized, controlled, superiority trial. PMID: 28266591 Ramirez-Maldonado E et al. PMID: 33196485 Post Peer Reviewed By: Salim R.

ICU 52

ICU ALS Critical Care OR 52