2023, ACS and ICU - Paramedicine Now

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

JUNE 17, 2024

The patient was upgraded to the ICU for closer monitoring. showed that , when T-waves are inverted in precordial leads, if they are also inverted in lead III and V1, then pulmonary embolism is far more likely than ACS. looked at consecutive patients with PE, ACS, or neither. Kosuge et al. Witting et al. of controls.

E-9-1-1

E-9-1-1 ACS Emergency Department Coronary

Congestive Heart Failure and Sepsis: A Closer Look at Fluid Management

REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis [published online ahead of print, 2023 Aug 9]. References: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM.

E-9-1-1

E-9-1-1 ALS ACS ICU

emDOCs Revamp – Acute Chest Syndrome

EMDocs

JUNE 27, 2024

Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. Epub 2023 Nov 27. 2023 Apr;98(4):620-627. Epub 2023 Feb 6. -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

E-9-1-1

E-9-1-1 ICU ACS EMS

Diagnostic Errors, Revisited: Where Do We Go Wrong, and How Can We Change?

ACEP Now

MAY 9, 2024

After developing encephalopathy and hypoxemic respiratory failure, the patient was transferred to the ICU. Further diagnostic testing in the ICU identified salicylate toxicity. Available from: [link] Newman-Toker DE, Nassery N, Schaffer AC, et al. 2023 Mar-Apr;120(2):114-120. Comparative Effectiveness Review, No.

Emergency Department

Emergency Department ICU ALS ACS

EM@3AM: Basilar Artery Occlusion

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. 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. Accessed April 13, 2023.

EMS

EMS ALS OR ACS

A woman in her 50s with acute chest pain

Dr. Smith's ECG Blog

JANUARY 6, 2023

Smith comment: We have shown that use of opiates is associated with worse outcomes in ACS: Bracey, A. 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. OMI is not just an ECG diagnosis.

ACS

ACS Coronary ICU STEMI

A man in his 60s with syncope and ST depression. What does the ECG mean?

Dr. Smith's ECG Blog

OCTOBER 25, 2023

Moreover, the Queen is only supposed to be used with a high pretest probability of ACS/OMI. The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course. We just finished training version 2 with some cases of hypokalemia, so that is in the future. What does the ECG show?

Overdose

Overdose OR ACS ICU

AHA/NCS Statement on Critical Care Management of Post ROSC Patients

EMDocs

JANUARY 11, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association (AHA) and Neurocritical Care Society (NCS) released their 2023 Scientific Statement on the critical care management of post ROSC patients. Digestive Management Takeaway: Start enteral feeds when the patient gets to the ICU.

Critical Care

Critical Care E-9-1-1 OR ICU

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Dr. Smith's ECG Blog

JANUARY 9, 2024

Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? Cardioversion will address the rhythm problem immediately, also if the chest discomfort subsides when SR is restored, ischemia from ACS becomes much less likely. In either case, prompt cardioversion is indicated.

Coronary

Coronary ACS ED OR

A Seven-Step Approach to Massive Hemoptysis

ACEP Now

NOVEMBER 14, 2023

References Deshwal H, Sinha A, Mehta AC. Accessed October 11, 2023. If it is determined that the bleeding originates from one lung it is recommended to position the patient in lateral decubitus with the bleeding lung down to avoid contamination of the contralateral lung. Life-threatening hemoptysis. Semin Respir Crit Care Med.

E-9-1-1

E-9-1-1 ALS Emergency Department OR

Penetrating chest trauma

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. This post is part of the PEM Adventure at NEPTUNE 2023, hosted by Dani, Kat, Costas and Sarah. 2023 Jun;35(3):412-419. Brie-liiant! Trauma Surg Acute Care Open.

E-9-1-1

E-9-1-1 FFP Plasma Emergency Department

Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ALiEM

OCTOBER 30, 2024

We have certainly seen patients who have pain which is controlled and still have psychomotor agitation and sympathetic activation, leading some to require ICU admission for dexmedetomidine and/or ketamine infusion. 2023 Jan 1;53(1):140-2. 2022; 06/26/2023. 2023 Jun 1;36:89-91. 2023 Aug 1;89(2):231. 2023 [book].

E-9-1-1

E-9-1-1 Naloxone Emergency Department ALS

Beyond Ketamine: When to use Facilitated Intubation in the ED

EMDocs

SEPTEMBER 25, 2023

Despite the risk of hypotension and bradycardia, propofol has been shown in the ICU setting to be a safe and effective monotherapy intubation agent for hemodynamically unstable patients (19). References: Heffner AC et al. Etomidate is likely an agent of last resort for monotherapy due to the short duration of action (12).

ED

ED Emergency Department ALS Paramedic

EM@3AM: Crush Injury

EMDocs

OCTOBER 7, 2023

Accessed February 3, 2023. Goodman AD, Got CJ, Weiss AC. Accessed 21 February 2023. Accessed 15 August 2023. Chavez LO, Leon M, Einav S, Varon J. Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. Critical Care. 2016;20(1):135. Genthon A, Wilcox SR. J Emerg Med. 2014;46(2):313-319.

EMS

EMS E-9-1-1 Emergency Department ALS

The 70th Bubble Wrap – DFTB x MSc in PEM

Don't Forget the Bubbles

MAY 3, 2023

Published 2023 Feb 17. The Pediatric Bougie for the First Tracheal Intubation Attempt in Critically Ill Children [published online ahead of print, 2023 Feb 23]. 2023;S0196-0644(23)00030-6. Garabon JJW, Gunz AC, Ali A, Lim R. Crit Care Explor. 2023;5(2):e0857. doi:10.1097/CCE.0000000000000857 Ann Emerg Med. Garabon et al.

CPR

CPR Emergency Department ALS ICU

ABG Versus VBG in the Emergency Department

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). 2023 Mar 10;16(1):18. 11) Webb RK, Ralston AC, Runciman WB. proning patients, ECMO) (12). PMID: 24383789. (2) Int J Emerg Med. PMID: 11685301. (10)

Emergency Department

Emergency Department E-9-1-1 ED ICU

Paramedicine Now

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Congestive Heart Failure and Sepsis: A Closer Look at Fluid Management

Trending Sources

emDOCs Revamp – Acute Chest Syndrome

Diagnostic Errors, Revisited: Where Do We Go Wrong, and How Can We Change?

EM@3AM: Basilar Artery Occlusion

A woman in her 50s with acute chest pain

A man in his 60s with syncope and ST depression. What does the ECG mean?

AHA/NCS Statement on Critical Care Management of Post ROSC Patients

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

A Seven-Step Approach to Massive Hemoptysis

Penetrating chest trauma

Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

Beyond Ketamine: When to use Facilitated Intubation in the ED

EM@3AM: Crush Injury

The 70th Bubble Wrap – DFTB x MSc in PEM

ABG Versus VBG in the Emergency Department

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