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. 208 , 528–548 (2023). & Mathier, M.

Critical Care 52

Critical Care ICU OR ALS 52

REBEL EM

MAY 29, 2023

Paper: Ibarra-Estrada, M et al. Crit Care 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 95% CI 15.4

ICU 145

ICU ALS Epinephrine OR 145

ALiEM

JUNE 1, 2023

References Rosenson J, Clements C, Simon B, et al. StatPearls Publishing; 2023. Accessed April 16, 2023. Published March 29, 2023. Accessed April 18, 2023. More rigorous studies are needed determine dose thresholds that warrant hospital admission. The Journal of Emergency Medicine. 2013;44(3):592-598.e2.

Emergency Department 246

Emergency Department ICU ED OR 246

REBEL EM

JUNE 29, 2023

Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? REBEL EM Blog, June 1, 2023. Available at: HERE Branch KHR et al. Resus 2023. Back on June 1st, 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC?

CPR 145

CPR ICU EMS ALS 145

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. Paper: Griffey RT et al. Acad Emerg Med 2023. A more optimal, and promising, solution may be the use of SQ insulin in mild to moderate DKA.

ICU 105

ICU ED ALS OR 105

REBEL EM

OCTOBER 5, 2023

Paper: Dequin P, Meziani F, Quenot J, et al. 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%

Critical Care 94

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

EMOttawa

FEBRUARY 26, 2024

5 Usefulness: 3/5 Freund Y, et al. 2023 Dec 19;330(23):2267-2274. Methodology: 3.5/5

ICU 64

ICU ALS Critical Care 64

Broome Docs

SEPTEMBER 3, 2024

Epub 2023 Jul 31. Epub 2023 Oct 26. For the most part, central lines can be left to the ICU team during day time hours (and a good percentage of patients will never need one). Cook D, Deane A, Lauzier F, et al. Burton C, Mooney C, Sutton L, et al. … Adams C, Walsan R, McDonnell R, Schembri A. 2023.07.004.

E-9-1-1 109

E-9-1-1 Emergency Department ICU ALS 109

EMDocs

FEBRUARY 20, 2024

Fluids in Pancreatitis #1 : de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. 2: Li XW, Wang CH, Dai JW, et al. 2: Li XW, Wang CH, Dai JW, et al. 2023 Mar 22;27(1):122. These videos will cover post summaries, take homes on clinical condition, and EBM/guideline literature updates. N Engl J Med.

E-9-1-1 82

E-9-1-1 ICU ALS OR 82

ACEP Now

OCTOBER 15, 2023

Intravenous insulin infusions typically require treatment in highly monitored settings, such as an intensive care unit (ICU) or step-down unit for safety and due to the frequency and intensity of monitoring. ICU and step-down beds are a limited resource and generate higher hospital charges. ElSayed NA, Aleppo G, Aroda VR, et al.

ICU 104

ICU ALS ED Emergency Department 104

Broome Docs

MARCH 28, 2024

doi: 10.1136/emermed-2023-213285. 2023 Sep 21:ciad571. Great evidence for button battery ingestions (if you are treating a dead pig) Chiew AL, Lin CS, Nguyen DT, Sinclair FAW, Chan BS, Solinas A. 2023 Sep 19:S0196-0644(23)00671-6. 2023 Dec;193:109991. 2023 Aug 21:S0012-3692(23)05350-3. Emerg Med J.

E-9-1-1 107

E-9-1-1 ICU Emergency Department ALS 107

REBEL EM

NOVEMBER 30, 2023

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]. Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. Am J Emerg Med. 2023;73:34-39. 2.89, p = 0.01.

E-9-1-1 122

E-9-1-1 ALS ACS ICU 122

EMDocs

JUNE 22, 2024

2023 Dec 13;52(2):126-135. doi: 10.1515/jpm-2023-0365. Amniotic fluid embolism: a reappraisal. J Perinat Med. PMID: 38082418. “Amniotic fluid embolism.” ” Obstet Gynecol 123(2 Pt 1): 337-348. link] Society for Maternal-Fetal Medicine. Electronic address, p. “Amniotic fluid embolism: diagnosis and management.”

EMS 95

EMS Ambulance FFP ICU 95

EMDocs

NOVEMBER 29, 2023

EBM Update: Fluids in Pancreatitis, Hypertriglyceridemic Pancreatitis #1: de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. 2: Li XW, Wang CH, Dai JW, et al. 2: Li XW, Wang CH, Dai JW, et al. 2023 Mar 22;27(1):122. Today we focus on pancreatitis. N Engl J Med. 2022 Sep 15;387(11):989-1000.

E-9-1-1 66

E-9-1-1 ICU ALS OR 66

REBEL EM

NOVEMBER 6, 2023

Paper: Hiruy A, et al. 2023 Jul 19. 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. 2023 Jul 19.

Epinephrine 72

Epinephrine ICU ALS OR 72

Pediatric EM Morsels

MARCH 17, 2023

Accessed March 13, 2023. Available from: [link] Correa JA, Fallon SC, Cruz AT, et al. Accessed March 17, 2023. Sarkar S, Sinha R, Chaudhury AR, et al. Centers for Disease Control and Prevention. Published June 28, 2021. Meyers SE, Tadi P. Snake Toxicity. Updated 2022 Sep 19]. In: StatPearls [Internet]. J Pediatr Surg.

Frozen Plasma 130

Frozen Plasma Plasma First Aid OR 130

REBEL EM

JUNE 26, 2023

Click here for Direct Download of the Podcast Paper: Bouzat P et al. References: Bouzat P et al. PMID: 36942533 Innerhofer P et al. PMID: 28457980 Jehan F et al. PMID: 29664892 Zeeshan M et al. REBEL Cast Ep118: The PROCOAG Trial – 4F-PCC in Trauma Patients? Severe acute traumatic coagulopathy = PT >1.5

FFP 145

FFP Frozen Plasma ALS Plasma 145

REBEL EM

AUGUST 14, 2023

Article: Liu S, Yao C, Xie J, et al. 2023;e230780. They consecutively enrolled 1,817 ICU patients from 45 sites across China. Secondary Outcome Results: ICU mortality: placebo 20.0% 002) ICU-free days: Placebo 12.4% JAMA Intern Med. Patients were randomized in a 1:1 fashion. 906 randomized to the Placebo cohort.

ICU 98

ICU EMS OR ALS 98

REBEL EM

JULY 17, 2023

Click here for Direct Download of the Podcast Paper: Knack SKS et al. References: Knack SKS et al. REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? The Effect of Ketamine Versus Etomidate for Rapid Sequence Intubation on Maximum SOFA Score: A Randomized Clinical Trial. Range 5 to 9) Etomidate: 7.0 Range 5 to 9) Diff -0.2;

ED 98

ED ICU Emergency Department Overdose 98

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. Epub 2023 Jun 15.

Critical Care 98

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

REBEL EM

AUGUST 31, 2023

Paper: van Baarle FLF et al. 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.

ICU 59

ICU ALS OR EMS 59

EMDocs

JUNE 27, 2024

Alkindi S, Al-Busaidi I, Al-Salami B, Raniga S, Pathare A, Ballas SK. Alghamdi FA, Al-Kasim F, Alshhada F, Ghareeb E, Azmet FR, Almudaibigh A, Baitalmal L, Alnawfal B, Alluqmani R. Epub 2023 Nov 27. 2023 Apr;98(4):620-627. Epub 2023 Feb 6. Roy A, Allareddy V, Lee M, Nalliah R, Rampa S, Allareddy V, Rotta A.

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

Dr. Smith's ECG Blog

JUNE 17, 2024

The patient was upgraded to the ICU for closer monitoring. In fact, Kosuge et al. Stein et al. This is a paper worth reading : Marchik et al. Kosuge et al. Witting et al. This does not contradict the conclusions of Kosuge et al. studied ECG findings of PE in 6049 patients, 354 of whom had PE.

E-9-1-1 138

E-9-1-1 ACS Emergency Department Coronary 138

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. References: Gaillard F, Glick Y, Tatco V, et al. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

EMS 73

EMS ALS OR ACS 73

REBEL EM

SEPTEMBER 14, 2023

Zeymer HT et al. References: Zeymer HT et al. The benefits of this strategy may be outweighed by the risk of the device-related complications (i.e. bleeding, stroke, limb ischemia, and hemolysis). The evidence for this practice has been sparse until now. Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. Control: 53.4%

Life Support 137

Life Support Coronary CPR ICU 137

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. Carsten L, et al. link] Published February 12, 2023. Accessed September 30, 2023. link] Published April 13, 2023. Accessed September 30, 2023. 2009;338:b2085.

Defibrillator 84

Defibrillator CPR Epinephrine Life Support 84

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

His temperature was brought back to normal over time in the ICU. Rituparna et al — as well as Chauhan and Brahma ( Int. When due to hypothermia — there may be correlation between severity of hypothermia and the size of Osborn Waves ( See My Comment at the bottom of the page in the January 21, 2023 post in Dr. Smith’s ECG Blog ).

ICU 135

ICU OR ALS ED 135

ACEP Now

MAY 9, 2024

Taking a different approach than the authors of the AHRQ report, Auerbach et al used a “look back” approach to perform both qualitative and quantitative evaluations of the types and frequencies of errors occurring in hospital settings. After developing encephalopathy and hypoxemic respiratory failure, the patient was transferred to the ICU.

Emergency Department 52

Emergency Department ICU ALS ACS 52

Don't Forget the Bubbles

NOVEMBER 15, 2023

Current practice is still isotonic fluids with a slight volume restriction, but there may/may not be another fluid shift coming… References Alobaidi R, Basu RK, Decaen A, et al. Available at: [link] (Accessed: April 3, 2023). doi:10.1186/s13613-018-0402-x McNab S, Duke T, South M, et al. Crit Care Med. 2020;48:1034-1041.

Plasma 80

Plasma ALS ICU Critical Care 80

ACEP Now

APRIL 3, 2024

Current International Resuscitation Recommendations In August 2023, the American Heart Association and the International Liaison Committee on Resuscitation published a scientific advisory that derived three conclusions. In a multisite retrospective cohort study, a study by Nishikimi, et al., Group W, Nolan JP, et al.

Advanced Life Support 40

Advanced Life Support ALS Life Support CPR 40

EMDocs

JUNE 3, 2023

Patients receiving thrombolysis will require ICU admission for neurologic monitoring. Rosh Review Website Link Further Reading [link] [link] [link] [link] [link] References: Stanislavsky A, Baba Y, Hacking C, et al. Reference article, Radiopaedia.org (Accessed on 03 Jan 2023) [link] Ioannides K, Tadi P, Naqvi IA.

EMS 73

EMS ALS OR ED 73

ACEP Now

NOVEMBER 14, 2023

Atchinson PRA, Hatton CJ, Roginski MA, et al. Ittrich H, Bockhorn M, Klose H, et al. Li H, Ding X, Zhai S, et al. Kathuria H, Hollingsworth HM, Vilvendhan R, et al. Accessed October 11, 2023. Fekri MS, Hashemi-Bajgani SM, Shafahi A, et al. Wand O, Guber E, Guber A, et al. Semin Respir Crit Care Med.

E-9-1-1 52

E-9-1-1 ALS Emergency Department OR 52

EMDocs

NOVEMBER 1, 2023

Disposition : Admission to ICU with potential GI, IR, and/or surgical management. Accessed September 30, 2023. In: Tintinalli JE, Ma OJ, Yealy DM, et al., Accessed September 30, 2023. Accessed October 1, 2023. May not be an option. McGraw-Hill Education; 2014. accesssurgery.mhmedical.com/content.aspx?aid=1104586430

Critical Care 66

Critical Care ED EMS OR 66

EMDocs

FEBRUARY 26, 2024

A recent study by Gaborit et al. 16 In another study, a series of six HIV patients with confirmed PJP that were analyzed by Limonta et al. Case study, Radiopaedia.org (Accessed on 07 Dec 2023) [link] Laboratory Tests Cultures are infrequently employed in the diagnosis of PJP due to the challenges associated with growing the fungus.

E-9-1-1 87

E-9-1-1 ED ALS OR 87

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. Frich JC, Brewster AL, Cherlin EJ, Bradley EH. 2023 Mar 13. 2023 Oct 31;21(1):403. While you are leading the resuscitation, one of your senior colleagues belittles a junior staff member for struggling to site an IV line.

E-9-1-1 105

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

ACEP Now

MAY 9, 2024

JHS’ chart review project, which identified 163 patients presenting to the ED with gluteal AFT complications in a 30-month period between 2020 and 2023, provides one of the most comprehensive and informative datasets on the breadth of AFT complications as they are currently being performed. Al Jazeera. units per patient.

Emergency Department 52

Emergency Department Operating Room Critical Care ICU 52

Dr. Smith's ECG Blog

MAY 26, 2023

He was admitted to the ICU and was unstable, in shock, overnight. Severely ill patients from any etiology can have very abnormal ECGs = My Comment by K EN G RAUER, MD ( 5/26 /2023 ): = There are more questions than answers in today's case. Case Continued: He was stabilized on more calcium, pressors, and high dose insulin.

Overdose 92

Overdose E-9-1-1 Coronary OR 92