Pediatric EM Morsels

MARCH 17, 2023

In the US, the venomous snakes include rattlesnakes , copperheads, cottonmouths/water moccasins , and coral snakes [ CDC, 2021 ] Rattlesnakes live all across the United State s Copperheads inhabit the eastern U.S. Usually, animals bite from fear or defense of their offspring ( ex, Brown Recluse ).

Frozen Plasma 130

Frozen Plasma Plasma First Aid OR 130

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%. . #3:

ICU 74

ICU Emergency Department ED OR 74

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 105

ICU ED ALS OR 105

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? which was not statistically significant [2]. The biggest issue with this trial is there was only one blood pressure done per patient.

MICU 126

MICU ICU ALS EMS 126

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

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

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.

EMR 100

EMR Emergency Department ICU ALS 100

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. The manometer referenced in numerous videos [6, 8] is actually a cuff manometer, or pressure gauge, to measure endotracheal cuff pressures.

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. Supplement additional dextrose prn, if hypoglycemia occurs do not stop the insulin, increase the rate of the dextrose drip. Potassium Shifted intracellularly by insulin, total body potassium is normal Replete to goal 3-3.5 Titrate to end organ perfusion as MAP may not change significantly.

Overdose 246

Overdose ALS Epinephrine Critical Care 246

REBEL EM

NOVEMBER 6, 2023

Background Information: Vasoplegic shock is defined as hypotension with normal or increased cardiac output and can commonly occur in post-cardiac surgery patients having received cardiopulmonary bypass. This dysregulation of vasodilation is associated with a mortality of close to 25%.

Epinephrine 72

Epinephrine ICU ALS OR 72

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. 2018 Sep 11;362:k3843.

E-9-1-1 52

E-9-1-1 Defibrillator ICU Critical Care 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

EMDocs

JUNE 27, 2024

Left lower lung field end demonstrates expiratory wheezing on auscultation. Other lung fields unremarkable. smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02 mg/kg, max 0.4 C or 100.4

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

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. It’s longer than Max’s favourite TV show Brooklyn 99.

ICU 145

ICU ED OR 145

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). Paper: Eastwood G, et al. N Engl J Med. Epub 2023 Jun 15.

Critical Care 98

Critical Care E-9-1-1 CPR ALS 98

REBEL EM

MARCH 23, 2023

Chronic alcohol use causes changes to preserve homeostasis, and when the stimulus is removed, alcohol withdrawal results due to decreased inhibition via the GABA system and increased excitation via the glutamate system. Tolerance to alcohol can also result in cross-tolerance to benzodiazepines and to a lesser degree barbiturates.

ICU 52

ICU Emergency Department ALS OR 52

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

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. Cardiac surgery is immediately paged for consideration of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) for active rewarming. His point-of-care labs return with a potassium of 3.4

Defibrillator 84

Defibrillator CPR Epinephrine Life Support 84

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. RR 25-30.

E-9-1-1 139

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

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. These questionable practices led to a rash of bad outcomes.

Emergency Department 52

Emergency Department Operating Room Critical Care ICU 52

REBEL EM

SEPTEMBER 29, 2022

Ann Surg 2021. There are also potential harms to large volume fluid resuscitation including progression of pancreatitis and fluid overload with or without respiratory failure. Though the initial recommendation for aggressive fluid resuscitation was not based on substantial evidence, clinicians have been slow to pivot away from this approach.

ICU 52

ICU ALS Critical Care Emergency Department 52

EMS 12-Lead

MAY 8, 2022

Thankfully, the patient experienced an uncomplicated ICU stay and subsequently made a full recovery. This grading system is the time sensitive prelude to Q-wave (irreversible transmural scar) formation, as demonstrated in the image below. [1] 2] But there is also Sinus Tachycardia! Such a finding is most dramatic in Lead I, reproduced here.

STEMI 130

STEMI ED EMS Firefighter 130

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.

ICU 52

ICU EMR OR ED 52

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. His mental status is described as nodding off. Missouri Out of Hospital DNR Form is shown here.

Emergency Medical Services 52

Emergency Medical Services EMS CPR Paramedic 52

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. He complained of generalized weakness and left lower extremity numbness. He reported that 12 hours prior to arrival he used fentanyl and cocaine. Fluid resuscitation was initiated.

E-9-1-1 52

E-9-1-1 OR STEMI ED 52

REBEL EM

MAY 8, 2023

2021 Dec 1;91(6):1025-1040. Background: Clinically significant pneumothoraces in patients on mechanical ventilation can be dangerous as positive pressure ventilation can cause an increase in intrapleural pressure and trigger tension physiology. The pendulum is swinging towards conservative management for occult pneumothoraces. PMID: 34225346.

E-9-1-1 59

E-9-1-1 Critical Care ICU OR 59

ACEP Now

MARCH 13, 2024

When considering inter-hospital transfer, the patient’s goals of care should be paramount in guiding the process. Greater focus on this communication is needed, as data suggest poor agreement between sending facilities, patients, and receiving facilities as to why transfers were initiated.

Emergency Department 52

Emergency Department ED ALS OR 52

REBEL EM

SEPTEMBER 15, 2022

diuresis NOT natriuresis) A common clinical practice in the ICU is to use a loop diuretic as monotherapy or a loop diuretic in combination with a thiazide diuretic.This can commonly lead to hypernatremia, hypochloremia, and a metabolic alkalosis. Placebo: 30.5% RR 1.46; 95% CI 1.17 Placebo: 27.8% HR 1.07; 95% CI 0.78 Placebo: 30.5%

ALS 52

ALS ICU OR EMS 52

EMDocs

SEPTEMBER 25, 2023

Notable Physical Exam: General: Tripoding, severe respiratory distress. However, emergency physicians have recently faced a multitude of patients requiring ETI with anatomically and physiologically difficult airways; these patients increase the risk of a can’t intubate/can’t oxygenate scenario or significant hypoxemia, hypercarbia, or acidemia.

ED 65

ED Emergency Department ALS Paramedic 65

REBEL EM

NOVEMBER 3, 2022

What They Did: Performed a search of the following databases: Pubmed, Embase, Cochrane, and ClinicalTrials.gov up to and including June 1, 2021. Included studies assessed patients in the emergency department and prehospital setting, which limits the external validity to other treatment areas such as the ICU. OR: 1.13; 95% Cl: 0.95-1.36;

ALS 52

ALS ICU ED Emergency Department 52

REBEL EM

AUGUST 29, 2022

Duration of mechanical ventilation, ICU, and percentage of vasopressor use were not significantly different. What They Did Prospective, randomized 1:1, parallel-assignment, open-label, single-center trial Randomization process: Sequentially numbered opaque, sealed envelope in blocks of 8 that directed the team to use either etomidate (0.2

MICU 52

MICU ICU OR Emergency Department 52

ACEP Now

APRIL 3, 2024

5,6 In 2021, the TTM2 trial was published. degrees Celsius. Early work on TTM in 2002 showed benefit to cooling to 33 degrees Celsius, which subsequently influenced international resuscitation guidelines to recommend mild hypothermia at 32 degrees to 34 degrees Celsius in 2005. degrees Celsius for 72 hours. degrees Celsius for 72 hours.

Advanced Life Support 40

Advanced Life Support ALS Life Support CPR 40

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. Minimal chronotropic effect.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

EMDocs

APRIL 22, 2024

Time was of the essence, the patient was intubated, ACLS measures were continued, and POCUS was performed. The POCUS findings enabled EPs to confidently recognize findings consistent with hemodynamically unstable (formerly sub-massive or massive) PE. Multiorgan POCUS The diagnostic power of POCUS often resides in combining multiple ultrasound exams.

ED 81

ED NARCAN ALS OR 81

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. Great job!!

Coronary 52

Coronary Paramedic EMS ICU 52

Dr. Smith's ECG Blog

OCTOBER 19, 2022

and the 2021 YouTube Review by ICU Advantage on "Temporary Pacemakers: Modes and Basic Settings". Capture was obtained and a 12-lead ECG was recorded: What do you see here and what complication can occur? What does it mean that the pacing spike comes in the midst of the 5th and 6th native beats?

ED 52

ED ICU OR Emergency Department 52