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

ALiEM

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. Multimodal medication options for fentanyl-xylazine withdrawal management in London et al. mg IVP Tizanidine 4 mg PO 0.15

E-9-1-1 161
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REBEL Core Cast 123.0 – Posterior Epistaxis

REBEL EM

VS abnormalities can drive this as well Strongly consider reversal of AC (this will typically come after control) Stopping the Bleeding PPE: these things bleed like stink. The idea behind abx is to prevent things like AOM and TSS but neither should be much of an issue with short term placement ICU Admission?

ICU 104
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Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

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. 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.

E-9-1-1 138
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Congestive Heart Failure and Sepsis: A Closer Look at Fluid Management

REBEL EM

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. Uchel et al’s contribution (21% weight) indicates that ≥30cc/kg IVF is linked to 2.5 Outcomes: Primary Outcome: In-hospital mortality. 2.89, p = 0.01.

E-9-1-1 121
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First10EM Journal Club: January 2025

Broome Docs

100% seems too good to be true Morello et al., Clin Exp Allergy. 2024 Oct 9. doi: 10.1111/cea.14565. Epub ahead of print. PMID: 39383344 Profundus Trial – Can we actually exclude acute aortic syndromes with this protocol? Diagnosis of acute aortic syndromes with ultrasound and D-dimer: the PROFUNDUS study. Emerg Med J. Epub 2018 Oct 25.

ED 101
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emDOCs Podcast – Episode 85: Tricky Cases Part 1

EMDocs

Removed from cooling at 102 and admitted to ICU. 2016 study published in American Journal of Emergency Medicine , “ Urinary obstruction is an important complicating factor in patients with septic shock due to urinary infection ” by Reyner et al. Reference: Reyner K, Heffner AC, Karvetski CH. Temperature starts to decrease.

ACS 97
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EM@3AM: Basilar Artery Occlusion

EMDocs

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. Arch Neurol.

EMS 98