The Skeptics' Guide to EM

JANUARY 15, 2022

Date: January 16th, 2022 Reference: Matchett, G. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Date: January 16th, 2022 Reference: Matchett, G. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial.

Emergency Medical Services 109

Emergency Medical Services Firefighter Critical Care Paramedic 109

ACEP Now

MAY 9, 2024

Unfortunately, at least 13 deaths were subsequently reported in Miami-Dade County from 2019–2022, the three years immediately following the implementation of the subcutaneous injection regulation. 6 Theoretically, ultrasound guidance should decrease this risk, which formed the basis for the 2022 Florida Medical Board regulation.

Emergency Department 52

Emergency Department Operating Room Critical Care ICU 52

Broome Docs

OCTOBER 31, 2022

Ketamine vs etomidate in ICU intubation ? Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. 2022 Jan;48(1):78-91. 2022 Sep;21(9):781-791. 2022 Sep 15;387(11):989-1000.

E-9-1-1 52

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

The Skeptics' Guide to EM

MARCH 18, 2023

She is also the […] The post SGEM #397: Give a Little Bit…of Oseltamivir to Pediatric Patients Admitted with Influenza first appeared on The Skeptics Guide to Emergency Medicine. Case: A 5-year-old child presents to the emergency department in the midst of flu season with three days of fever, upper respiratory symptoms, and malaise.

ICU 102

ICU Emergency Department OR 102

REBEL EM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). 2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). Am J Emerg Med. Am J Emerg Med.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

EMDocs

SEPTEMBER 19, 2023

Propofol utilized for sedation; patient admitted to ICU for EEG monitoring. Reference: emDOCs – NCSE Journal of Emergency Medicine – Review Case 4: 52-year-0ld male brought in by EMS with “code STEMI” ECG demonstrates ST depressions with rocket like T waves in V2-V4. 2022 Nov 15;80(20):1925-1960.

STEMI 100

STEMI Coronary Emergency Department ICU 100

REBEL EM

JUNE 8, 2023

Am J Emerg Med. 2022 Sep 5. If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergency department pharmacist. Clinical Bottom Line: Acute hypotension must be treated emergently in order to decrease morbidity and mortality. Am J Emerg Med.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

EMDocs

AUGUST 15, 2023

Published April 15, 2022. Accessed May 7, 2022. StatPearls Publishing; 2022. Accessed May 17, 2022. Accessed May 7, 2022. Accessed May 7, 2022. Accessed May 7, 2022. Accessed May 7, 2022. His father confirmed the snake was a copperhead. Treatment of snakebite poisoning. Am J Hosp Pharm.

Emergency Department 98

Emergency Department OR EMS ED 98

REBEL EM

OCTOBER 5, 2023

ClinicalTrials.gov: NCT02517489 7 Clinical Question: In adult patients with severe community-acquired pneumonia admitted to the ICU, does early hydrocortisone treatment, compared to standard therapy, reduce mortality at 28 days? ICU-acquired infections were observed in: 9.8% Patients enrolled from 31 Intensive Care Units in France.

Critical Care 94

Critical Care ICU E-9-1-1 ALS 94

Broome Docs

MARCH 28, 2024

Am J Emerg Med. 2022 Feb;52:85-91. A non-inferiority randomized controlled trial comparing nebulized ketamine to intravenous morphine for older adults in the emergency department with acute musculoskeletal pain. Dispelling myths and misconceptions about the treatment of acute hyperkalemia. doi: 10.1016/j.ajem.2021.11.030.

E-9-1-1 96

E-9-1-1 ICU Emergency Department ALS 96

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). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Am J Emerg Med. Published 2022 Jan 3. 2022;19(1):501.

Defibrillator 110

Defibrillator CPR Epinephrine Life Support 110

REBEL EM

MARCH 23, 2023

The 30-day emergency department readmission rate and all-cause 30-day readmission were significantly lower only when adjusted for propensity scores. Although CIWA has subjective components, when a patient has a CIWA in the 20s ICU transfer should be considered.

ICU 52

ICU Emergency Department ALS OR 52

Don't Forget the Bubbles

JUNE 30, 2023

They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups. Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality. 2022 Dec;57(12):986-993. c) Or, do both?

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

Dr. Smith's ECG Blog

JANUARY 9, 2024

She presented to the emergency department after a couple of days of chest discomfort. The pacing rate was increased without clinical improvement and the patient was transferred to the ICU for closer monitoring/treatment. She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia.

Coronary 119

Coronary ACS ED OR 119

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. Introduction: Civility Matters Healthcare environments, particularly emergency departments, are characterised by high levels of Volatility, Uncertainty, Complexity, and Ambiguity ( VUCA ). 2022 May 12;46(3):319-24.

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

NAEMSP

FEBRUARY 15, 2023

Sometimes they may benefit from transport to an emergency department if it is consistent with their care plan/wishes. The patient was dying while intubated in the ICU but was awake enough to engage in discussions with providers through writing about her wishes. 2022 Sep;36(8):1228-1241. Epub 2022 Aug 8.

Emergency Medical Services 52

Emergency Medical Services EMS CPR Paramedic 52

EMDocs

OCTOBER 21, 2023

All patients who receive thrombolytics for ischemic stroke should be admitted to a neurosurgical, neurologic, or medical ICU for management and monitoring, as this is shown to decrease mortality and length of stay. Updated 2022 Dec 22]. Updated 2022 Oct 15]. PMID: 27422968; PMCID: PMC5583675. Reinemeyer NE, Tadi P, Lui F.

EMS 98

EMS ALS OR ACS 98

ACEP Now

MAY 9, 2024

It has been well over a year since the controversial publication of the Agency for Healthcare Research and Quality (AHRQ) report on diagnostic errors in the emergency department (ED). After developing encephalopathy and hypoxemic respiratory failure, the patient was transferred to the ICU. Ann Emerg Med. JAMA Intern Med.

Emergency Department 52

Emergency Department ICU ALS ACS 52

REBEL EM

SEPTEMBER 29, 2022

Background: Standard emergency department management of acute pancreatitis has focused on aggressive hydration, analgesia and investigation for an underlying reversible cause (eg gallstones). NEJM 2022; 387: 989-1000. Recent evidence has challenged the routine use of aggressive hydration as unnecessary. Am J Gastroenterol 2017.

ICU 52

ICU ALS Critical Care Emergency Department 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. Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. 2022 Sep;24(6):579-581.

ED 98

ED NARCAN ALS OR 98

REBEL EM

NOVEMBER 3, 2022

Matchett 2022). Indian J Crit Care Med 2022. Inclusion: Articles compared the safety and efficacy of etomidate compared to k etamine, in patients of all age groups, as induction agents for RSI in the Emergency Department (ED) and prehospital settings. in the ketamine cohort compared to 12.4% in the etomidate cohort.

ALS 52

ALS ICU ED Emergency Department 52

ACEP Now

MAY 4, 2023

A 58-year-old male with a history of alcohol abuse presented to the emergency department (ED) as a category 2 trauma for a fall with a reported flail chest. 2022; 22(11):432-439. 2022; 276:221-234. Case FIGURE 1: Chest X-ray of multiple rib fractures (arrows). Click to enlarge.) References Mistry RN, Moore JE. J Surg Res.

EMS 52

EMS Operating Room ICU Emergency Department 52

ACEP Now

DECEMBER 10, 2023

A middle-aged male with squamous cell carcinoma and extensive metastases is brought to the emergency department (ED) after being found unresponsive following a believed suicide attempt (SA) by methadone ingestion. You ultimately begin a slow naloxone infusion and admit him to the medical ICU. Emerg Med Australas.

Naloxone 52

Naloxone Life Support Paramedic ALS 52

Don't Forget the Bubbles

OCTOBER 19, 2023

Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. The CAP-IT trial recruited children aged six months to 5 years with a diagnosis of community-acquired pneumonia on discharge from the emergency department or ward. Which brings us to PARIS-2.

E-9-1-1 81

E-9-1-1 ED OR Emergency Department 81

REBEL EM

AUGUST 29, 2022

Sharda 2022) Etomidate and ketamine act distinctly from each other. Etomidate Versus Ketamine for Emergency Endotracheal Intubation: A randomized Clinical Trial. Duration of mechanical ventilation, ICU, and percentage of vasopressor use were not significantly different. 2022 Jan;48(1):78-91.Epub Acad Emerg Med.

MICU 52

MICU ICU OR Emergency Department 52

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). Correlation and agreement between arterial and venous blood gas analysis in patients with hypotension-an emergency department-based cross-sectional study.

Emergency Department 98

Emergency Department E-9-1-1 ED ICU 98

REBEL EM

JULY 31, 2023

11 medical centers in the United States enrolled 1417 patients from 17 sites, including 7 emergency departments and 10 intensive care units. of intubations were performed in the emergency department. An emergency medicine resident or critical care fellow performed 91.5% 1420 patients were enrolled. of intubations.

Critical Care 98

Critical Care Emergency Department ICU OR 98

EMDocs

DECEMBER 18, 2023

Multiple studies published in 2022 have indicated that, despite disagreement surrounding prognostic accuracy, no such screening tool so far exists. Disposition The SSC guidelines suggest that patients with septic shock or critical illness be moved to the intensive care unit (ICU) within six hours of presentation to the ED. 2022;22:76.

E-9-1-1 93

E-9-1-1 ALS Emergency Department Plasma 93

EMDocs

JANUARY 6, 2024

A 63-year-old man presents to the emergency department for dyspnea on exertion. Cardiogenic shock in the setting of acute rejection would warrant inotropic agents and ICU admission (C) , but these would not be indicated in cases of mild rejection, such as in this patient. J Am Coll Emerg Physicians Open. Am J Emerg Med.

EMS 91

EMS E-9-1-1 ACS Coronary 91

EMDocs

JUNE 27, 2024

2022 Jul 5;328(1):57-68. Am J Emerg Med. 2022 Aug;58:235244. Epub 2022 Jun 11. Am J Emerg Med. 2022 Aug;58:235-244. Epub 2022 Jun 11. 2022 Aug 29;13:796837. Sickle Cell Disease: A Review. PMID: 35788790. Farooq S, Abu Omar M, Salzman GA. Acute chest syndrome in sickle cell disease.

E-9-1-1 98

E-9-1-1 ICU ACS EMS 98

REBEL EM

NOVEMBER 11, 2024

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%). 2022 Feb;67:134-140. vs. 52.2%). J Crit Care.

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E-9-1-1 ICU ALS Critical Care 108

The Skeptics' Guide to EM

FEBRUARY 22, 2025

Clinical Chemistry and Laboratory Medicine 2022; 60(5):786-792 Clin Chem Lab Med. 2022 Date: February 21, 2025 Guest Skeptic: Dr. Aaron Skolnik is an Assistant Professor of Emergency Medicine at the Mayo Clinic Alix School of Medicine and Vice Chair of Critical Care Medicine at Mayo Clinic Arizona.

Critical Care 153

Critical Care ICU ALS Emergency Department 153

REBEL EM

NOVEMBER 25, 2024

2 Moreover, the American Society of Anesthesiologists’ 2022 Practice Guidelines for Management of the Difficult Airway recommend the use of adjuncts like bougies in anticipated difficult airways but stop short of endorsing their routine universal use. Randomized controlled trials or comparative non-randomized observational studies.

Operating Room 105

Operating Room Emergency Department ICU ALS 105

FOAMfrat

NOVEMBER 21, 2024

Today, increased mortality rates, higher transfusion requirements, and lengthened ICU stays are recognized as proximate effects of the Trauma Triad. Hypothermia Hypothermia, defined as core temperature less than 35oC (95oF) has been identified in up to 2/3 of trauma patients upon arrival to the emergency department. Diagnostics.

ICU 119

ICU Emergency Department OR Ambulance 119

REBEL EM

DECEMBER 23, 2024

Target trial emulation is a methodologic framework to improve observational studies that begins by creating a hypothetical protocol for the ideal RCT, and then designing your observational protocol to emulate it as closely as possible ( Hernn 2022 ).

ALS 128

ALS ED ACS EMR 128

EMDocs

JANUARY 16, 2025

2022 Nov 1;176(11):e223554. Epub 2022 Nov 7. but PPV ranges from 25.1-39.5% years Internal validation cohort: 43,400 patients with mean age 3.7 years External validation cohort: 45,855 patients with mean age 2.6 0.38 (95% CI 0.20-0.39) 0.39) AUROC of 0.71-0.92 0.92 (95% CI 0.70-0.92) and PPV of 5.3-7.1% and PPV of 22.2% JAMA Pediatr.

ALS 96

ALS Critical Care ICU Emergency Department 96

Don't Forget the Bubbles

MARCH 24, 2025

Dexmedetomidine is currently licensed only for adult sedation in an ICU setting, but guidelines exist to support its off-licence use in paediatric intensive care (PICU). A recent REPEM survey across Europe found that up to 10% of Emergency Departments use Dexmed for procedural sedation in children. Adv Emerg Nurs J.

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E-9-1-1 Emergency Department ALS Critical Care 59