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. The SQuID Protocol (Subcutaneous Insulin in /diabetic Ketoacidosis): Impacts on ED Operational Metrics. Acad Emerg Med 2023. tests/hr (0.8

ICU 105

ICU ED ALS OR 105

The Skeptics' Guide to EM

JUNE 22, 2024

December 2023 Guest Skeptic: Dr. Anireddy Reddy is a pediatric intensive care attending physician in the Department of Anesthesiology and Critical Care Medicine at Children’s Hospital of Philadelphia. Dr. Anireddy Reddy Case: A 3-year-old girl presents to the emergency department (ED) with fever and respiratory distress.

Critical Care 133

Critical Care ICU ALS Emergency Department 133

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 Defibrillator 130

EMDocs

NOVEMBER 29, 2023

2023 May 25;388(21):1931-1941. Question: In adult patients admitted to the ICU with severe CAP, does hydrocortisone compared to placebo reduce 28-day all-cause mortality? Question: In adult patients admitted to the ICU with severe CAP, does methylprednisolone compared to placebo reduce 60-day all-cause? 2023 Jul 8;27(1):274.

ICU 80

ICU CAD ALS OR 80

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). 2023 Oct;164(4):885-891. Epub 2023 May 5. #2: 101,14 (2023): e1448-e1454.

ICU 67

ICU ED OR 67

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. 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? Available at: HERE Branch KHR et al.

CPR 145

CPR ICU EMS ALS 145

Broome Docs

SEPTEMBER 3, 2024

PMID: 38592662 Bottom line: Would you be happy if you kid follow-ed your footsteps into emergency medicine? 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). 2024 Jun;26(6):381-385. 2023.07.004.

E-9-1-1 109

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

EMDocs

JULY 8, 2023

. #1: DEVICE RCT – VL vs DL for Critically Ill Adults Spoon Feed Video laryngoscopy (VL) was associated with higher rates of first attempt intubation success compared to direct laryngoscopy (DL) for critically ill patients in the ICU and ED. 2023 Jun 2;e2023061350. 2023-061350. 2023 Jun 6;147(23):1748-1757.

ICU 66

ICU ED OR 66

Broome Docs

MARCH 28, 2024

doi: 10.1136/emermed-2023-213285. 2023 Sep 21:ciad571. 2023 Sep 19:S0196-0644(23)00671-6. 2023 Dec;193:109991. 2023 Aug 21:S0012-3692(23)05350-3. 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.

E-9-1-1 107

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

EMDocs

FEBRUARY 26, 2024

The ED clinician should inquire about a relevant history of HIV infection, malignancy, high-dose corticosteroid use, chemotherapy, organ transplant, or use of immunosuppressive drugs for other indications. She reports occasional central chest pain exacerbated by coughing. Image credit: Amini B, Pneumocystis carinii pneumonia. Int J STD AIDS.

E-9-1-1 87

E-9-1-1 ED ALS OR 87

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. Diabetes Care. 2009;32(7):1335-1343.

ICU 104

ICU ALS ED Emergency Department 104

Broome Docs

MAY 31, 2024

Do we need to intubate French drunkards in ED? 2023 Dec 19;330(23):2267-2274. 2023 Mar;64(3):400-404. 2023 Nov 28;27(1):465. 2023 Sep 8;9(1):73. Articles linked below and podcast available on your favourite player or YouTube over at the First10EM channel. doi: 10.1001/jama.2023.24391. 2023.24391. J Emerg Med.

E-9-1-1 97

E-9-1-1 ED Critical Care ICU 97

EMDocs

SEPTEMBER 25, 2023

However, RSI has never been shown to reduce the risk of aspiration in the ED (13) or during emergent OR cases (14). While RSI should remain the gold standard in the vast majority of patients in the ED, FI presents an additional technique to mitigate anatomic or physiologic risk. To date, ketamine has been the agent of choice (12).

ED 65

ED Emergency Department ALS Paramedic 65

EMDocs

JUNE 22, 2024

A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. 2023 Dec 13;52(2):126-135. doi: 10.1515/jpm-2023-0365. We’ll keep it short, while you keep that EM brain sharp. She had a precipitous delivery while the ambulance was pulling in. J Matern Fetal Neonatal Med. 2015 May;28(7):793-8.

EMS 95

EMS Ambulance FFP ICU 95

REBEL EM

AUGUST 14, 2023

2023;e230780. 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.” JAMA Intern Med.

ICU 98

ICU EMS OR ALS 98

EMDocs

JUNE 27, 2024

An 8-year old male with a history of sickle cell anemia presents to the ED for evaluation of fever for 2 days and “feeling like I can’t get a full breath”. 768: Epidemiology of Hospital Based ED Visits due to Sickle Cell Crisis and Acute Chest Syndrome in Kids. Epub 2023 Nov 27. Acute chest syndrome in sickle cell disease.

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

EMDocs

NOVEMBER 1, 2023

A 39-year-old male with history of achalasia with recent endoscopic dilation 24 hours prior presents to the ED for progressively worsening chest pain with radiation to his left shoulder. Disposition : Admission to ICU with potential GI, IR, and/or surgical management. In: Yuh DD, Vricella LA, Yang SC, Doty JR, eds.

Critical Care 66

Critical Care ED EMS OR 66

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

He was intubated on arrival at the ED for mental status and airway protection due to vomiting. His temperature was brought back to normal over time in the ICU. There is also large T wave inversion and long QT. Clinical context: A man in his 50s was found down outside in the cold, unresponsive but with intact vital signs.

ICU 132

ICU OR ALS ED 132

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). His blood sugar was normal en route to the ED, and his initial rhythm on the cardiac monitor was asystole. link] Published February 12, 2023. Ann Emerg Med.

Defibrillator 84

Defibrillator CPR Epinephrine Life Support 84

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). percent of ED visits resulted in preventable death as result of diagnostic error. Further diagnostic testing in the ICU identified salicylate toxicity.

Emergency Department 52

Emergency Department ICU ALS ACS 52

EMDocs

OCTOBER 21, 2023

Median time from ED arrival to diagnosis was 8 hours 24 min in one study, with only 19% being diagnosed within the 4.5-hour Median time from ED arrival to diagnosis was 8 hours 24 min in one study, with only 19% being diagnosed within the 4.5-hour Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Accessed April 13, 2023.

EMS 73

EMS ALS OR ACS 73

Dr. Smith's ECG Blog

JUNE 17, 2024

The patient was upgraded to the ICU for closer monitoring. The RR ( R espiratory R ate ) in today's case is recorded as 14/minute at the time the patient presented to the ED on the day after their initial presentation. I refer to My Comment in the March 4, 2023 post — in which I included a Table with ECG Findings of Acute PE.

E-9-1-1 137

E-9-1-1 ACS Emergency Department Coronary 137

EMDocs

JUNE 3, 2023

A 53-year-old female with a past medical history significant for hypertension presents to the ED with headache and dizziness. Patients receiving thrombolysis will require ICU admission for neurologic monitoring. Reference article, Radiopaedia.org (Accessed on 03 Jan 2023) [link] Ioannides K, Tadi P, Naqvi IA. Cerebellar Infarct.

EMS 73

EMS ALS OR ED 73

EMDocs

SEPTEMBER 7, 2024

A 70-year-old female with a past medical history of hypertension, coronary artery disease s/p 2x drug eluting stent placement one month ago, atrial fibrillation on apixaban presents to the ED with weakness and lightheadedness. A 25-year-old man presents to the ED via EMS after he sustained a gunshot wound to the left flank.

EMS 74

EMS E-9-1-1 Operating Room OR 74

Don't Forget the Bubbles

JUNE 17, 2024

The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. The team sits down for a hot debrief once the patient is stabilised and transferred to the ICU. 2023 Mar 13. 2023 Oct 31;21(1):403. 2020;10(6). Future Healthc J. InHealthcare 2024 Jan 22 (Vol.

E-9-1-1 105

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

EMDocs

OCTOBER 19, 2024

A 6-year-old girl presents to the ED with 1 day of fevers up to 104.1°F Published 2023. Patients with true cephalosporin allergy may be treated with vancomycin or clindamycin + levofloxacin or ciprofloxacin. [2][3][9] 2][3][9] Glucocorticoid were not shown to alter clinical course or patient outcomes. [2][3] Georgiaemsacademy.com.

EMS 86

EMS E-9-1-1 Epinephrine OR 86

REBEL EM

MAY 18, 2023

Patients were started on low-dose norepinephrine at a median time from ED arrival of 93 minutes compared to 192minutes in the standard care arm. The goal of the trial was to see if early vasopressors improved shock control by 6 hours. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4

OR 105

OR ICU EMS ED 105

Dr. Smith's ECG Blog

OCTOBER 23, 2023

On arrival to the ED the patient was intubated with normal vital signs. 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. No ischemic ST changes. Circulation. 2001 Nov 27;104(22):2722-7.

ICU 120

ICU OR Defibrillator EMS 120

Dr. Smith's ECG Blog

MAY 26, 2023

mg/dL (sorry, Europeans, for the weird units) Here was the initial ED ECG: There is a junctional rhythm with retrograde P-waves (see the dip in the T-wave in lead II across the bottom; you can follow that up to all the other leads and see the retrograde P wave). He was admitted to the ICU and was unstable, in shock, overnight.

Overdose 88

Overdose E-9-1-1 Coronary OR 88

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. Case A 25-year-old-female presented to the ED in cardiac arrest. Summary This case exemplifies the value of POCUS in cardiac arrest patients in the ED. EKG RV strain. 2014 May;145(5):950-957.

ED 81

ED NARCAN ALS OR 81

ACEP Now

NOVEMBER 14, 2023

One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. Accessed October 11, 2023. 6 Position the patient with the head of the bed at 30 to 45 degrees during intubation whenever possible, and use an 8.5 A special thanks to Drs. EMCrit blog website.

E-9-1-1 52

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

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. units per patient.

Emergency Department 52

Emergency Department Operating Room Critical Care ALS 52

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. This patient presented to the ED “after a couple of days of chest discomfort”. Remember that this patient presented to the ED “after a couple of days of chest discomfort”.

Coronary 99

Coronary ACS ED OR 99

ALiEM

OCTOBER 30, 2024

Our experience: Traditionally, ED physicians do not like ordering urine drug screens (UDS). 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.

E-9-1-1 161

E-9-1-1 Naloxone Emergency Department ALS 161

Don't Forget the Bubbles

JANUARY 4, 2024

2023; 4:e13041. Records of all children (defined age 0-16) on the TARN database who fulfilled the TARN criteria (had been admitted for longer than 72 hours, admitted to an ICU, or died in hospital) were included. 2023 Feb 14;329(6):472-481. 2023 Apr 4;329(13):1123. 2023 Feb 1;6(2):e230023. JACEP Open. 2022.24162.

ED 129

ED ICU ALS OR 129

Don't Forget the Bubbles

JUNE 30, 2023

All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. The ODP is caught up leaving theatres and has not yet made it down to ED. 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.

E-9-1-1 139

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

Dr. Smith's ECG Blog

OCTOBER 25, 2023

The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course. Another diagnostic ECG of a potentially deadly condition == MY Comment , by K EN G RAUER, MD ( 10/19 /2023 ): == Today's excellent case discussion by Drs. What does the ECG show? Also see the bizarre Bigeminy.

Overdose 112

Overdose OR ACS ICU 112