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. Updated 2022 Jun 5]. Hence, the RT’s are supposed to have them. Pearl 1: Check the units of pressure being used. PMID: 15411151 ; PMCID: PMC1616705. Powell M, Journey JD.

E-9-1-1 245

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

EMDocs

DECEMBER 9, 2023

Spoon Feed Advanced statistics emulating clinical trial protocols from an ICU database did not identify consistent differences in 30-day mortality when ICU patients were intubated early (within 8 hours of admission) or late (after 48 hours). 2022-007070. Clay Smith at @spoonfedEM , and sign up for email updates here. #1:

ICU 93

ICU ED OR 93

The Skeptics' Guide to EM

JANUARY 15, 2022

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

Emergency Medical Services 109

Emergency Medical Services Firefighter Critical Care Paramedic 109

EMDocs

FEBRUARY 20, 2024

2022 Sep 15;387(11):989-1000. Fluids in Pancreatitis #1 : de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. vs. Placebo 11.9%, NNT 18 Median Fluid Received: Aggressive: 7.8L (Range 6.5 to 9.8L) Moderate: 5.5L (Range 4.0 vs. 17.3%, aRR1.30 (0.78-2.18)

E-9-1-1 98

E-9-1-1 ICU ALS OR 98

Dr. Smith's ECG Blog

OCTOBER 23, 2023

She was admitted to the ICU where subsequent ECGs were performed: ECG at 12 hours QTc prolongation, resolution of T wave alternans ECG at 24 hours Sinus tachycardia with normalized QTc interval. She had an uneventful ICU course and was extubated for ongoing care with the inpatient psychiatric service. 2022 Jul;27(4):e12939.

ICU 130

ICU OR Defibrillator EMS 130

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

His temperature was brought back to normal over time in the ICU. We've discussed Osborn Waves ( both ischemic and hypothermic ) — on a number of occasions in Dr. Smith's ECG Blog ( Please check out My Comment at the bottom of the page in the February 8, 2022 post ). He was extubated and had normal neurologic function.

ICU 137

ICU OR ALS ED 137

EMDocs

NOVEMBER 29, 2023

2022 Sep 15;387(11):989-1000. EBM Update: Fluids in Pancreatitis, Hypertriglyceridemic Pancreatitis #1: de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. vs. Placebo 11.9%, NNT 18 Median Fluid Received: Aggressive: 7.8L (Range 6.5

E-9-1-1 91

E-9-1-1 ICU ALS OR 91

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

The Bottom Line

DECEMBER 9, 2022

Early Active Mobilization during Mechanical Ventilation in the ICU @chodgsonANZICRC @TEAMtrialICU. Background ICU Acquired weakness (ICUAW) is common with one systematic review reporting a median […]

ICU 52

ICU 52

EMDocs

SEPTEMBER 19, 2023

Propofol utilized for sedation; patient admitted to ICU for EEG monitoring. Learning points: Patients with LBBB and Sgarbossa/Smith-modified Sgarbossa criteria, posterior STEMI, hyperacute T waves, De Winter T waves should go to the cath lab per the 2022 ACC consensus statement. 2022 Nov 15;80(20):1925-1960. J Am Coll Cardiol.

STEMI 97

STEMI Coronary Emergency Department ICU 97

EMS 12-Lead

AUGUST 22, 2022

A 65 y/o Female was admitted to the ICU for septic shock. The combination of prolonged QT and deep T wave inversion throughout the precordium is typical of Takotsubo syndrome, or Stress Cardiomyopathy – which can occur in the context of a physiologically distressed ICU patient, further compromising their hemodynamics. Saini, A.,

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

REBEL EM

JUNE 8, 2023

2022 Sep 5. 2022 2022 Sep 5. The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Prior literature primarily focused on safety and medication errors, and while this study did the same, they also assessed variables associated with PDP response. Paper: Singer S, et al.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

ESO

MARCH 7, 2024

It’s built from ESO-compiled data consisting of 968,538 hospital records from 596 hospital systems that took place between January 1 st to December 31 st of 2022. Designed to be a point of reference for hospitals and trauma centers alike, the Trauma Index is the largest de-identified data trauma registry program in the country.

Operating Room 105

Operating Room ICU OR ED 105

REBEL EM

MARCH 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. 2019 Aug; PMID: 30954692 Clinical Question: What is the impact of system factors in the implementation of standard-of-care LPV in critically ill ED patients admitted to the ICU? Paper: Owyang CG, et al.

Emergency Department 52

Emergency Department ICU Critical Care EMR 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.

CPR 52

CPR ICU Overdose Critical Care 52

Dr. Smith's ECG Blog

OCTOBER 8, 2024

A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. For more on Precordial Swirl — See the October 15, 2022 post in Dr. Smith's ECG Blog ). She was worked as a full code, and ROSC was achieved. Later the next day, she went into cardiac arrest again. She could not be resuscitated.

OR 122

OR STEMI ICU Coronary 122

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. 2022 Aug 22. Ann Thorac Surg. Epub 2017 May 24.

ICU 71

ICU Epinephrine ALS OR 71

REBEL EM

AUGUST 31, 2023

ICU: 42.6% vs 0% ICU length-of-stay: 9 days vs 7 days In-Hospital Mortality: 28.2% ICU Mortality: 56.7% Conversely, it may be reasonable to withhold prophylactic platelets for patients in the ICU setting due to trends of lower bleeding risk noted as well as more intensive bleeding monitoring. Median hemoglobin: 8.2

ICU 58

ICU ALS OR EMS 58

EMDocs

APRIL 10, 2024

Hemodynamics slowly begin to stabilize, and the patient is transferred to the ICU for further post-cardiac arrest care. McGraw Hill; 2022. The patient remains hemodynamically unstable, and bolus of 1.5 mL/kg is given followed by a continuous infusion. J Med Toxicol. 2008;4(3):184-191. doi:10.1007/BF03161199 Olson K, Smollin C, eds.

E-9-1-1 111

E-9-1-1 Plasma Epinephrine Life Support 111

Dr. Smith's ECG Blog

JANUARY 9, 2024

The pacing rate was increased without clinical improvement and the patient was transferred to the ICU for closer monitoring/treatment. As I discussed in My Comment at the bottom of the page in the April 2, 2022 post in Dr. Smith's ECG Blog — I am aware of many cases of sustained VT in which the patient remained awake and alert for hours.

Coronary 119

Coronary ACS ED OR 119

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.

ICU 52

ICU Emergency Department ALS OR 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 97

EMS ALS OR ACS 97

Core EM

OCTOBER 2, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

REBEL EM

SEPTEMBER 29, 2022

NEJM 2022; 387: 989-1000. High-quality evidence demonstrating harms is needed to shift the paradigm. Article: de-Madaria E et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). cc/kg/hour of LR Control: LR Bolus of 20 cc/kg (regardless of fluid status) followed by 3.0 PMID: 36103415 Buxbaum JL et al.

ICU 52

ICU ALS Critical Care Emergency Department 52

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. 2022 May 12;46(3):319-24. While you are leading the resuscitation, one of your senior colleagues belittles a junior staff member for struggling to site an IV line. How do you manage this situation? Australian Health Review. Edmondson, Amy C.

E-9-1-1 105

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

Emergency Medicine Ireland

MAY 30, 2022

Like most things in ICU this is likely physiological wishful thinking rather than good science and it keeps us amused while the disease process resolves on its own. Bja Educ 22 , 216–223 (2022). Continuing our journey through the nephron we have the aldosterone receptor antagonists. Verbrugge, F. Eur Heart J 38 , 1872–1882 (2017).

Critical Care 52

Critical Care ICU OR 52

ACEP Now

MAY 4, 2023

Definitive treatment with surgical stabilization has been gaining favor, with current literature suggesting decreased ICU stays and fewer complications, especially with patients under 60 years old when taken to the operating room within 72 hours of injury. 2022; 22(11):432-439. 2022; 276:221-234. References Mistry RN, Moore JE.

EMS 52

EMS Operating Room ICU Emergency Department 52

REBEL EM

NOVEMBER 3, 2022

Matchett 2022). Indian J Crit Care Med 2022. Included studies assessed patients in the emergency department and prehospital setting, which limits the external validity to other treatment areas such as the ICU. Van Berkel 2017) In 2020 the NEAR study reported peri-intubation hypotension rates of 18.3% in the etomidate cohort.

ALS 52

ALS ICU ED Emergency Department 52

REBEL EM

FEBRUARY 2, 2023

2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). 2022 Sep 7. However, digoxin is known for its rate-control properties and its direct vagal effect on the atrioventricular node. Paper: Mason JM, et al. Am J Emerg Med. References Mason JM, et al. Am J Emerg Med.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

Dr. Smith's ECG Blog

JUNE 21, 2024

A patient in the ICU with significant underlying cardiac disease [HFrEF 30%, non-ischemic cardiomyopathy, LBBB s/p CRT-D (biventricular pacer), AVNRT s/p ablation a few yrs ago, hx sinus tachycardia while on max tolerated BB therapy] went into a regular wide-complex tachycardia after intubation for severe COPD exacerbation.

ICU 71

ICU OR 71

Medgadget

MAY 3, 2023

References [1] Elevating Digital Healthcare to Connect Devices, Aggregate Data and Empower People [2] Radiomed Customer Testimonial, [link] [3] AI helps radiologists spot pneumothorax faster on ICU chest x-rays [4] Physician Burnout & Depression Report 2022: Stress, Anxiety, and Anger , Medscape, March 2023 [5] Sustainable Healthcare Starts with (..)

Critical Care 80

Critical Care OR ICU 80

Dr. Smith's ECG Blog

JANUARY 6, 2023

Clin Cardiol 2022; [link] Labs included: hsTnI 156 ng/L, Hb 12 g/dL, WBC 12x10^9/L, Cr. The facility was not pressed to activate emergent transfer for PCI since the pain was improving and suggested we optimize pain control and admit to the Cardiac ICU. Unfortunately, they follow their own guidelines only 6% of the time!! Lupu L, et al.

ACS 52

ACS Coronary ICU STEMI 52

Core EM

JANUARY 25, 2024

The reality of ever increasing ED volumes and longer boarding times to the ICU makes it imperative for emergency physicians to learn how to manage these critical patients. It was found that patients exposed to deep sedation in the ED had an independent higher incidence of continued deep sedation on ICU day one ( Fuller, 2019 ).

ICU 246

ICU Emergency Department Critical Care ALS 246

REBEL EM

AUGUST 7, 2023

Background Information: Delirium is a common and serious condition in patients in the intensive care unit (ICU). It is estimated to affect 30-50% of patients in the ICU and haloperidol is the most frequently used agent in treatment (3). Paper: Andersen-Ranberg NC,et al; AID-ICU Trial Group. 2022 Dec 29. N Engl J Med.

ICU 52

ICU ALS OR EMS 52

Don't Forget the Bubbles

MARCH 21, 2025

Effectiveness of Nasal High-Flow Oxygen during apnoea on Hypoxaemia and Intubation Success in Paediatric Emergency and ICU Settings: a randomised, controlled, open-label trial. Its pragmatic design ensured that a broad range of clinical presentations were included across the ED and ICU settings. Thats exactly what Shane George et al.

ICU 108

ICU Critical Care ED OR 108

The Skeptics' Guide to EM

JULY 16, 2022

Date: July 16th, 2022 Reference: Lamontagne F et al. Date: July 16th, 2022 Reference: Lamontagne F et al. She is admitted to the intensive care unit (ICU) for septic shock. The ICU team is considering using Vitamin C therapy for this patient. Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit.

ICU 100

ICU ALS Critical Care Emergency Department 100

Emergency Medicine Ireland

MAY 27, 2024

Vasopressin has some animal data suggesting it causes less rise in PVR than our beloved noradrenaline but take that with an appropriately loosely defined portion of salt given that animal data is not ICU patients. Atrial fibrillation is something of a right of passage in the ICU. 2022 ESC Guidance McLaughlin, V. Souza, R. &

Critical Care 52

Critical Care ICU OR ALS 52