The Skeptics' Guide to EM

FEBRUARY 25, 2023

Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Reference: Cashen K, Reeder RW, Ahmed T, et al.

CPR 130

CPR ICU Critical Care Epinephrine 130

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]. Another minor difference is that the gastric balloon in the Minnesota tube holds 450-500 ccs of air, while the SB gastric balloon holds 250 ccs of air [2].

E-9-1-1 245

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

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

Pediatric EM Morsels

MARCH 17, 2023

Since we all inhabit the same beautiful world , and sometimes we humans overtake previous habitats of animals, we inevitably will cross paths with an animal that bites us. Usually, animals bite from fear or defense of their offspring ( ex, Brown Recluse ). Sometimes it’s a beloved pet who gets surprised or has an “off” day ( Dog Bites and PTSD ).

Frozen Plasma 130

Frozen Plasma Plasma First Aid OR 130

REBEL EM

MAY 29, 2023

What They Did: Single-center, parallel, double blind, randomized controlled trial performed in a medical-surgical ICU (Mexico) Both groups received: Adjunctive vasopressin initiated at a dose of 0.03 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4

ICU 145

ICU ALS Epinephrine OR 145

Broome Docs

OCTOBER 31, 2022

Ketamine vs etomidate in ICU intubation ? 2022 Jan;48(1):78-91. 2022 Sep;21(9):781-791. 2022 Sep 15;387(11):989-1000. 2022 Sep 18. 2022 Aug;41(4):101096. Epub 2022 Apr 28. 2022 Aug 3;11:100284. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial.

E-9-1-1 52

E-9-1-1 Defibrillator ICU 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 123

OR STEMI ICU Coronary 123

Don't Forget the Bubbles

JUNE 14, 2023

This post, from Ben Symon on XXX, is the first of our 2022 DFTB conference. We store the ability to look after a patient who’s on the edge of death for hours at a time in ICU nurses, and we saw the knowledge of where the hell anything is in the hospital in our wardies. Ben Symon is a pediatric emergency medicine physician.

ICU 135

ICU OR 135

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

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. 1: Early or Delayed Intubation in Critically Ill Patients? 2023.04.048.

ICU 95

ICU ED OR 95

EMDocs

NOVEMBER 29, 2023

Question: In adult patients admitted to the ICU with severe CAP, does hydrocortisone compared to placebo reduce 28-day all-cause mortality? 2022 Aug;48(8):1009-1023. Question: In adult patients admitted to the ICU with severe CAP, does methylprednisolone compared to placebo reduce 60-day all-cause? Intensive Care Med.

ICU 98

ICU CAD 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 131

ICU OR Defibrillator EMS 131

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. Reference: Matchett, G.

Emergency Medical Services 109

Emergency Medical Services Firefighter Critical Care Paramedic 109

Emergency Medicine Ireland

MAY 13, 2024

Part 1 will cover a broad overview of pulmonary hypertension and part 2 will focus on management strategies for a PH patient in the ICU. The definition of PH since the 2022 ESC guidelines is a mean PAP of 20mmHg on a right heart catheter. Saying a patient has PH does not really tell you very much. This is by far the commonest.

Critical Care 98

Critical Care ICU OR 98

The Skeptics' Guide to EM

MARCH 18, 2023

Outcome: * Primary Outcome: Hospital length of stay (LOS) * Secondary Outcomes: 7-day hospital readmission, late ICU transfer (on or after hospital day 2 after being admitted to general ward), composite outcome of in-hospital death or ECMO use. . JAMA Pediatr. JAMA Pediatr. JAMA Pediatr.

ICU 102

ICU Emergency Department OR 102

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. cc/kg/hour of LR Control: LR Bolus of 20 cc/kg (regardless of fluid status) followed by 3.0

E-9-1-1 98

E-9-1-1 ICU ALS OR 98

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 138

ICU OR ALS ED 138

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. In terms of monitoring should we be reaching for a PAC?

Critical Care 52

Critical Care ICU OR ALS 52

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. cc/kg/hour of LR Control: LR Bolus of 20 cc/kg (regardless of fluid status) followed by 3.0

E-9-1-1 94

E-9-1-1 ICU ALS OR 94

REBEL EM

AUGUST 12, 2024

Epub 2022 Aug 28. Intravenous amino acid therapy for kidney protection in cardiac surgery a protocol for a multi-centre randomized blinded placebo controlled clinical trial. The PROTECTION trial. Contemp Clin Trials.

ICU 81

ICU Operating Room Critical Care ALS 81

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? Admitted to participating ICUs with severe community-acquired pneumonia.

Critical Care 94

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

EMDocs

AUGUST 15, 2023

Avoid additional bites to yourself or the patient and move the patient safely away from the snake. Do NOT attempt to capture or kill the snake. Give analgesics for pain control but avoid NSAIDs due to their inhibitory effect on platelets Obtain initial labs including CBC, BMP, PT/INR, and fibrinogen.

Emergency Department 98

Emergency Department OR EMS ED 98

EMDocs

SEPTEMBER 19, 2023

Propofol utilized for sedation; patient admitted to ICU for EEG monitoring. Causes: Inadequately treated convulsive status, acute brain injury or structural lesion, infection, encephalopathy, medications/toxins Underlying cause is the most important factor in morbidity and mortality. CT demonstrated no acute, actionable findings.

STEMI 100

STEMI Coronary Emergency Department ICU 100

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.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

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 3, 2023

Answer : Cerebellar Stroke Epidemiology: 1-4% of cerebrovascular accidents occur in the cerebellum. 2 In the United States, approximately 795,000 people suffer from strokes every year. 3 Cerebellar strokes are associated with high morbidity and mortality. 2 Superior cerebellar artery strokes most often present with headache, gait ataxia, dysarthria.

EMS 98

EMS ALS OR ED 98

Dr. Smith's ECG Blog

JUNE 23, 2024

Given the presentation, the cardiologist stented the vessel and the patient returned to the ICU for ongoing critical care. The above said — it may prove insightful to take another look at the Wellens' Syndrome case instantly recognized by Dr. Smith in the August 12, 2022 post in Dr. Smith’s ECG Blog.

Coronary 118

Coronary CAD CPR Critical Care 118

REBEL EM

JUNE 8, 2023

2022 Sep 5. 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. The safety and efficacy of push dose vasopressors in critically ill adults. Am J Emerg Med.

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

EMDocs

APRIL 10, 2024

The majority of local anesthetics have a common structure of a lipophilic aromatic ring, a hydrophilic amine group, and a linking group. [2] 2] This linking group can be either an amide (e.g., lidocaine) or an ester (e.g., 6] Action of local anesthetics is dependent upon the molecule crossing the plasma membrane in a unionized form. [2] mL/kg/min.

E-9-1-1 111

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

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 110

Defibrillator CPR Epinephrine Life Support 110

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

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

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

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

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. However , this patient is having chest discomfort, and by definition then she should be considered not to be stable. Is this: 1. In either case, prompt cardioversion is indicated.

Coronary 119

Coronary ACS ED OR 119

Broome Docs

MARCH 28, 2024

2022 Feb;52:85-91. Although I miss performing the procedure, these days I almost always leave the central line until the patient is stabilized and settled into their ICU bed. Myths and misconceptions about the treatment of acute hyperkalemia Gupta AA, Self M, Mueller M, Wardi G, Tainter C. Am J Emerg Med. doi: 10.1016/j.ajem.2021.11.030.

E-9-1-1 96

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