REBEL EM

JULY 14, 2022

Paper: Nassal MMJ, et al. An example using a real case I had while on call in the ICU: A 61-year-old female had a post-induction arrest on the wards/hospital telemetry floor after being intubated for airway protection. REFERENCES: Nassal MMJ, et al. PMID: 34968531 Rittenberger JC, et al. PMID: 21756969 Coppler PJ, et al.

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ACEP Now

NOVEMBER 14, 2023

References Deshwal H, Sinha A, Mehta AC. 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. Fekri MS, Hashemi-Bajgani SM, Shafahi A, et al. Wand O, Guber E, Guber A, et al. Am J Emerg Med.

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Dr. Smith's ECG Blog

JANUARY 6, 2023

Lupu L, et al. 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. mg/dL, K 3.5 OMI is not just an ECG diagnosis.

ACS 52

ACS Coronary ICU STEMI 52

EMDocs

JANUARY 11, 2024

Hematologic Management Takeaway : They recommend a transfusion threshold < 9 g/dL in those with ACS, but several studies (MINT trial) and guidelines suggest 8 g/dL can be used. Digestive Management Takeaway: Start enteral feeds when the patient gets to the ICU. Administer VTE prophylaxis in the first 48 hours, preferably LMWH.

Critical Care 91

Critical Care E-9-1-1 OR ICU 91

Dr. Smith's ECG Blog

APRIL 20, 2018

I took part in her ICU care and she was extubated and stable to transfer to a stepdown unit after a few days. Patients like her are the reason we are advocating for a change in the ACS paradigm from STEMI to OMI. Her repeat ECHO showed an improving EF of 37%. Note that this is completely different from 'terminal QRS distortion'.

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Coronary STEMI EMS ACS 40

Don't Forget the Bubbles

JULY 5, 2023

Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. Older children and adults usually present with ACS 2-3 days after hospitalisation due to pulmonary infarction (in situ sickling), hypoventilation due to rib infarction (which may be exacerbated by recent narcotic administration) or fat embolism.

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REBEL EM

NOVEMBER 30, 2023

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.

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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. 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.

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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. Kulvatunyou N, Bauman ZM, Zein Edine SB, de Moya M, Krause C, Mukherjee K, Gries L, Tang AL, Joseph B, Rhee P. Laan DV, Vu TD, Thiels CA et al. Trauma Surg Acute Care Open.

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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. Arch Neurol.

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EMS ALS OR ACS 89

EMDocs

JUNE 7, 2023

Disposition is often admission to an intensive care unit (ICU) setting. Further management and resuscitation were required, and she had a lengthy ICU stay of 21 days until she was extubated. References: Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure.

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

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. PMID: 23911630 Kim WY et al. PMID: 23911630 Kim WY et al. PMID: 25402500 Forsythe SM et al.

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ED Emergency Department ALS Paramedic 79

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. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02

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EMDocs

OCTOBER 7, 2023

Oda J, Tanaka H, Yoshioka T, et al. Tanaka H, Oda J, Iwai A, et al. Goodman AD, Got CJ, Weiss AC. Chen CY, Lin YR, Zhao LL, et al. Wald R, Quinn RR, Luo J, et al. Somagutta MR, Pagad S, Sridharan S, et al. Crush Injuries with Impairment of Renal Function. 1941;1(4185):427-432. Am J Emerg Med. Critical Care.

EMS 89

EMS E-9-1-1 Emergency Department ALS 89

Don't Forget the Bubbles

MAY 3, 2023

Forestell B, Battaglia F, Sharif S, et al. Prekker ME, Bjorklund AR, Myers C, et al. O’Connell KJ, Sandler A, Dutta A, et al. O’Connell et al. O’Connell et al. Garabon JJW, Gunz AC, Ali A, Lim R. Garabon et al. Which way should we go? Crit Care Explor. 2023;5(2):e0857. Published 2023 Feb 17.

CPR 52

CPR Emergency Department ALS ICU 52

Dr. Smith's ECG Blog

MARCH 12, 2018

It is also true that anterior and inferior T-wave inversion could be consistent with reperfusion of a type III wraparound LAD occlusion, despite the fact that Kosuge et al showed that T-wave inversion in lead III is much more likely to be PE than ACS if your differential contains nothing else. Stein et al. Kosuge et al.

ACS 40

ACS Coronary ALS ICU 40

Broome Docs

JANUARY 27, 2025

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.

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ED OR ACS Critical Care 101

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

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

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EMDocs

JANUARY 6, 2024

10 Although this is not the same pathophysiology seen in ACS from an acute plaque rupture leading to coronary artery occlusion, patients can have relatively abrupt coronary ischemia causing ACS due to acute, concentric vessel narrowing. 3 Many will experience vague, nonspecific symptoms such as weakness or fatigue.

EMS 76

EMS E-9-1-1 ACS Coronary 76

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). References/Further Reading (1) Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. 11) Webb RK, Ralston AC, Runciman WB. PMID: 11685301. (10)

Emergency Department 98

Emergency Department E-9-1-1 ED ICU 98

REBEL EM

DECEMBER 23, 2024

To assess the clinical impact and relevance of these concerns, Alwang et al. Paper: Alwang AK, Law AC, Klings ES, Cohen RT, Bosch NA. PMID: 28423290 Kidwell K, Albo C, Pope M, et al. PMID: 24066745 Self WH, Semler MW, Wanderer JP, et al. PMID: 29485926 Semler MW, Self WH, Wanderer JP, et al. JAMA Intern Med.

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ALS ED ACS EMR 124

EMDocs

JANUARY 6, 2025

84 All patients with severe malaria need inpatient admission, ideally to the intensive care unit (ICU). 57 Adapted from: Long B, MacDonald A, Liang SY, et al. link] Rother B, Pierre G, Lombardo D, et al. link] Hummell AC, Cummings M. link] Franco JR, Cecchi G, Priotto G, et al. 57 Table 2. 2024;77:7-16.

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ED E-9-1-1 ALS Emergency Department 70