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. 2024 study [16]. 2024 Oct 8:S0735-6757(24)00523-0. Published online September 4, 2024. doi: 10.1016/j.ajem.2024.10.006].

E-9-1-1 161

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

Broome Docs

MARCH 28, 2024

2024 Jan 22;41(2):96-102. 2024 Jan 2;53(1):afad255. 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. 2024 Jan 29:jme-2023-109651. Emerg Med J. doi: 10.1136/emermed-2023-213285. Age Ageing. Is pregnancy a disease?

E-9-1-1 96

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

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

Date: September 12, 2024 Reference: Anderson et al. AEM August 2024. The use of direct oral challenges has been tried in the intensive care unit (ICU) setting to de-label patients. Koo et al showed that offering amoxicillin oral challenges to ICU patients with low-risk penicillin allergies.

ICU 141

ICU Emergency Department ALS ED 141

Broome Docs

JANUARY 27, 2025

2024 Nov 22;17(1):177. 2024 Nov 18:e245981. 2024 Oct 26;404(10463):1645-1656. 2024 Jun;23(6):577-587. Epub 2024 Apr 20. 2024 Oct 9. 2024 Dec 9. Garcia SI, Jacobson A, Moore GP, Frank J, Gifford W, Johnson S, Lazaro-Paulina D, Mullan A, Finch AS. Airway, breathing, cellphone: a new vital sign?

ED 101

ED OR ACS Critical Care 101

Broome Docs

MAY 31, 2024

Welcome to the June edition of the Journal Club for 2024. 2024 Apr 1:e240167. Welcome to the June edition of the Journal Club for 2024. Articles linked below and podcast available on your favourite player or YouTube over at the First10EM channel. JAMA Pediatr. doi: 10.1001/jamapediatrics.2024.0167.

E-9-1-1 82

E-9-1-1 ED Critical Care ICU 82

Dr. Smith's ECG Blog

JANUARY 2, 2025

CASE CONTINUED She was admitted to the ICU. For more on Torsades de Pointes vs PMVT See My Comment in the October 18, 2023 post and the September 2, 2024 post in Dr. Smith's ECG Blog ). Smith has provided excellent overview of measuring and correcting QT interval in scenarios where QRS duration is prolonged (e.g., J Am Coll Cardiol.

Coronary 116

Coronary OR Defibrillator ALS 116

EMDocs

JULY 20, 2024

Spoon Feed An international, multi-center RCT found that administering pantoprazole to intubated ICU patients lowered the rate of upper GI bleeding compared to placebo. Published online June 14, 2024. 2024 May;31(5):425-455. 2024 Jun;83(6):542-551. Epub 2024 Mar 2. N Engl J Med. Acad Emerg Med. doi: 10.1111/acem.14911.

Emergency Department 98

Emergency Department ICU OR 98

REBEL EM

FEBRUARY 19, 2024

CHEST 2024. PMID: 37611862 Clinical Question: In patients treated in the ICU, can a protocol of peripheral IV catheter vasopressors safely reduce the number of days of CVC use and frequency of placement? CHEST 2024. Peripheral Administration of Norepinephrine: A Prospective Observational Study. References: Yerke JR et al.

ICU 137

ICU EMS ALS OR 137

REBEL EM

FEBRUARY 29, 2024

3, 4 It is the most common nosocomial infection in patients on mechanical ventilation, and one of the leading causes of nosocomial infection among all patients in the ICU. Mimoz (2024). The low incidence could be a result of the systematic implementation of bundles known to decrease VAP incidence in the ICU. Lasocki, T.

E-9-1-1 122

E-9-1-1 ICU ALS OR 122

EMDocs

JUNE 15, 2024

Non-rebreather Mask Spoon Feed Noninvasive ventilation (NIV) was superior to a standard non-rebreather (NRB) oxygen mask for preoxygenation of critically ill ED or ICU patients requiring intubation, with a NNT of 11 to prevent 1 episode of hypoxemia <85%. 2024 Jun 13. #2: 2024 Mar 25:S0196-0644(24)00099-4. Ann Emerg Med.

ICU 98

ICU Emergency Department ED OR 98

REBEL EM

FEBRUARY 8, 2024

J Intensive Care Med 2024. PMID: 38215002 Clinical Question: In critically ill adults in the ICU is noninvasive blood pressure (NIBP) monitoring similar (≤10% difference) to invasive arterial blood pressure (IABP) monitoring? J Intensive Care Med 2024. Paper: Haber, EN et al. to 1.12; p = 0.03 to 0.99; p <0.01

ICU 125

ICU MICU ALS EMS 125

EMDocs

AUGUST 17, 2024

2024 Jun 14. Spoon Feed In ICU patients with traumatic brain injury (TBI) and anemia, transfusing blood to a liberal hemoglobin threshold (10 g/dL) compared to a restrictive threshold (7 g/dL) did not lead to better neurological outcomes at 6 months. 2024 Jun 13. Source Tenecteplase for Ischemic Stroke at 4.5 N Engl J Med.

ICU 96

ICU OR 96

Core EM

JANUARY 25, 2024

Disposition to ICU. 2007;33(11):2019-2024. Takes 30 minutes to see effect, temporize with traditional vasopressors (norepinephrine, vasopressin). Titrate to end organ perfusion as MAP may not change significantly. Back up plans for mechanical support such as venous-arterial ECMO such be considered early for refractory patients.

Overdose 246

Overdose ALS Epinephrine Critical Care 246

Core EM

OCTOBER 23, 2024

The patient was admitted to the Medical ICU for aggressive electrolyte replacement, q2h BMPs, and due to concern for decompensation as signaled by his elevated troponin. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. [link] Read More Hydrocortisone (a glucocorticoid) which decreases peripheral conversion of T4 to T3.

Emergency Department 130

Emergency Department Critical Care ICU Ambulance 130

REBEL EM

APRIL 22, 2024

Population: Adult patients ( > 18 years of age) admitted to the ICU with COVID-19 and severe hypoxemia (defined as receiving supplemental O2 with a flow rate of at least 10L/min or receiving mechanical ventilation or non-invasive ventilation. Lower vs higher oxygenation target and days alive without life support in COVID-19.

Life Support 74

Life Support ICU EMS OR 74

REBEL EM

APRIL 9, 2024

Podcast Direct Download: Link Release Date: April 16th, 2024 Show Notes The Visible Voices Podcast Dr. Glaucomflecken: Power of Ultrasound with Emergency Medicine Dr. Resa Lewiss Adaira I Landry MD Resa E Lewiss MD is a Professor of Emergency Medicine at the University of Alabama at Birmingham. Post Peer Reviewed By: Salim R.

EMS 58

EMS ICU 58

EMDocs

SEPTEMBER 7, 2024

Disposition: Consider ICU for many patients, especially if any signs of instability or repeatedly requiring blood products. Updated 2024 Jan 9]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Accessed on 27 May 2024) [link] Mandell, SP. Mortality can varies between 5-20%. J Emerg Med. 2012 Aug;43(2):e157-61.

EMS 98

EMS E-9-1-1 Operating Room OR 98

REBEL EM

AUGUST 12, 2024

PMID: 36038001 Clinical Question: In patients undergoing cardiac surgery with cardiopulmonary bypass, does the administration of intravenous amino acid therapy lead to lower occurrence of postoperative AKI when compared to placebo?

ICU 81

ICU Operating Room Critical Care ALS 81

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

His temperature was brought back to normal over time in the ICU. Altered Mental Status, Bradycardia == MY Comment , by K EN G RAUER, MD ( 2/2 /2024 ): == Dr. Meyers began today’s case with the clinical challenge of asking you to identify the underlying cause of ECG #2. He was extubated and had normal neurologic function.

ICU 138

ICU OR ALS ED 138

EMDocs

OCTOBER 19, 2024

Accessed August 11, 2024. Published 2024. Accessed August 11, 2024. 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. Published 2023.

EMS 110

EMS E-9-1-1 Epinephrine OR 110

Dr. Smith's ECG Blog

JUNE 17, 2024

The patient was upgraded to the ICU for closer monitoring. Accessed May 28, 2024. Supporting Kosuge, Ferrari found that anterior T-wave inversions were the most common ECG finding in massive PE. == MY Comment , by K EN G RAUER, MD ( 6/17 /2024 ): == Today's case by Drs. It is nearly pathognomonic for PE.

E-9-1-1 139

E-9-1-1 ACS Emergency Department Coronary 139

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. (TIMI 3 means the rate of passage of dye through the coronary artery is normal by angiography.) Lesions less than 70% are generally considered to be non-flow limiting. Two subsequent troponins were down trending.

Coronary 118

Coronary CAD CPR Critical Care 118

Dr. Smith's ECG Blog

OCTOBER 8, 2024

A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. Available from: [link] Click here to sign up for Queen of Hearts Access == MY Comment , by K EN G RAUER, MD ( 10/8 /2024 ): == It’s always easier to look back at a case from the comfort of one’s home — and to criticize decisions that were made.

OR 123

OR STEMI ICU Coronary 123

ACEP Now

JULY 7, 2024

Neurology consultation should be initiated, and the patient should be admitted to the ICU. April 2024. Accessed June 17, 2024. link] April 17, 2024. Accessed 4/30/2024. Specific antiepileptic therapy should be initiated with another agent, such as fosphenytoin, phenytoin, levetiracetam, or valproic acid.

Emergency Department 52

Emergency Department Critical Care ALS ICU 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. InHealthcare 2024 Jan 22 (Vol. 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? Future Healthc J. 2023 Mar 13.

E-9-1-1 105

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

ACEP Now

MAY 9, 2024

Nearly half of all post-AFT patients presenting to our emergency departments required admission and six percent required ICU admission. Accessed March 6, 2024. Accessed February 19, 2024. Accessed March 6, 2024. units per patient. Healing Is No Joke. The New York Times. Published May 11, 2022. Al Jazeera.

Emergency Department 52

Emergency Department Operating Room Critical Care ICU 52

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. Published 2024 Jan 19. In this case, the harm resulted directly from the initial failure to consider the correct diagnosis. BMJ Qual Saf.

Emergency Department 52

Emergency Department ICU ALS ACS 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

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. A bed side echocardiography revealed a severely depressed LVEF of about 20-25%. When looking at the above ECG you will find that the QRS following ventricular pacing is very long.

Coronary 119

Coronary ACS ED OR 119

EMDocs

APRIL 22, 2024

Marino’s the ICU book, Wolters Kluwer Health, pgs 105-109, 4th ed., Reference article, Radiopaedia.org (Accessed on 07 Feb 2024) [link] Lobo JL, Holley A, Tapson V. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism. PMID: 24092475.

ED 98

ED NARCAN ALS OR 98

ACEP Now

APRIL 3, 2024

Accessed March 26, 2024. Changing target temperature from 33 °C to 36 °C in the ICU management of out-of-hospital cardiac arrest: A before and after study. Adult advanced life support: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation.

Advanced Life Support 40

Advanced Life Support ALS Life Support CPR 40

ACEP Now

JUNE 14, 2024

4,6,11 Antibiotics Antibiotic use for AECOPD patients remains a contentious topic; however, data suggests AECOPD patients requiring admission, particularly to the ICU, should receive antibiotics. Accessed May 19, 2024. Management Oxygen Supplemental oxygen should not be withheld despite risk of hypercapnia. 5 mg plus ipratropium 0.5

ALS 52

ALS Coronary OR ED 52

EMDocs

JUNE 27, 2024

2024 Mar 12;14(1):5978. 2024 Jul;71(7):e31002. Epub 2024 Apr 21. 2024 Apr 5. 2024 Feb;71(2):e30781. May substitute levofloxacin if allergic to cephalosporin Anti-viral medications if indicated Oseltamivir for influenza Patients >14 days old Remdesivir for COVID Patients >28 days old and at least 7lbs (3.2

E-9-1-1 98

E-9-1-1 ICU ACS EMS 98

REBEL EM

NOVEMBER 11, 2024

Imbalances Between Treatment Groups : ICU Admissions : Higher in piperacillin-tazobactam (33% vs. 30%). For example, in this analysis, 33% of patients receiving piperacillin-tazobactam were admitted to the ICU, compared to 30% of those receiving cefepime. 2024 Jul 1;184(7):769-777. 2024 Feb;41(2):44-47. vs. 52.2%).

E-9-1-1 113

E-9-1-1 ALS ICU Critical Care 113

The Bottom Line

NOVEMBER 22, 2024

Intensive Care Med (2024); 50:1614–1621. Long-term effects of flexible visitation in the intensive care unit on family members’ mental health: 12-month results from a randomized clinical trial JMB de Souza et al.

ICU 73

ICU ALS 73

Broome Docs

NOVEMBER 17, 2024

2024 Aug;201:110266. Epub 2024 Jun 9. 2024 Jul;8(7):482-490. Epub 2024 Jun 4. 2024 May-Jun;22(3):230-232. 2024 Jun 22:S0196-0644(24)00232-4. 2024 Sep 16:e2415815. 2024 Jun 4;5(3):e13210. 2024 Sep 26;391(12):1108-1118. 2024 Aug;201:110266. Epub 2024 Jun 9. Resuscitation.

Epinephrine 61

Epinephrine Emergency Department Critical Care ICU 61

FOAMfrat

NOVEMBER 21, 2024

Today, increased mortality rates, higher transfusion requirements, and lengthened ICU stays are recognized as proximate effects of the Trauma Triad. PubMed , StatPearls Publishing, 5 May 2024, www.ncbi.nlm.nih.gov/books/NBK603758/. EMS Tactical Paramedic Lethal Triad.” Accessed 10 Oct. Jessica Dawkins Mills BSN, et al.

ICU 119

ICU Emergency Department OR ED 119