The Skeptics' Guide to EM

JULY 16, 2022

Date: July 16th, 2022 Reference: Lamontagne F et al. Date: July 16th, 2022 Reference: Lamontagne F et al. Salim is also the creator and founder of REBEL EM and REBEL Cast, a free, critical appraisal blog and podcast that try to cut down knowledge translation gaps of research to bedside clinical practice.

ICU 100

ICU ALS Critical Care Emergency Department 100

EMOttawa

FEBRUARY 26, 2024

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

ICU 64

ICU ALS Critical Care 64

REBEL EM

FEBRUARY 19, 2024

Paper: Yerke JR et al. 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? References: Yerke JR et al. PMID: 37611862 Evans L et al. CHEST 2024. CHEST 2024. Crit Care Med 2021.

ICU 137

ICU EMS ALS OR 137

REBEL EM

MAY 29, 2023

Paper: Ibarra-Estrada, M et al. 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 Limited, small studies on its use in septic shock do not make a clear argument for use. Crit Care 2023.

ICU 145

ICU ALS Epinephrine OR 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. However, it is unclear if all degrees (mild, moderate, severe) of DKA require the same intensive treatment. tests/hr (0.8

ICU 105

ICU ED ALS OR 105

REBEL EM

AUGUST 12, 2024

The authors of this study sought to test the hypothesis that intravenous amino acid therapy would lead to a lower occurrence of postoperative AKI when compared to placebo. Paper: Landoni G. Intravenous amino acid therapy for kidney protection in cardiac surgery a protocol for a multi-centre randomized blinded placebo controlled clinical trial.

ICU 81

ICU Critical Care Operating Room ALS 81

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

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. The low incidence could be a result of the systematic implementation of bundles known to decrease VAP incidence in the ICU. 4, 8 Paper: Dahyot-Fizelier, C.,

E-9-1-1 126

E-9-1-1 ICU OR ALS 126

FOAMfrat

NOVEMBER 21, 2024

Today, increased mortality rates, higher transfusion requirements, and lengthened ICU stays are recognized as proximate effects of the Trauma Triad. If all of that sounded like nonsense, you can read more about it in my ABG blog. Jessica Dawkins Mills BSN, et al. respectively. EMS Tactical Paramedic Lethal Triad.”

ICU 111

ICU Emergency Department OR Ambulance 111

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

His temperature was brought back to normal over time in the ICU. See our other blog posts of hypothermia and Osborn waves -- Massive Osborn Waves of Severe Hypothermia (23.6 Rituparna et al — as well as Chauhan and Brahma ( Int. He was extubated and had normal neurologic function. He did well and was discharged.

ICU 132

ICU OR ALS ED 132

REBEL EM

APRIL 22, 2024

Paper: Nielsen FM et al. 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. appeared first on REBEL EM - Emergency Medicine Blog.

Life Support 75

Life Support ICU EMS OR 75

REBEL EM

NOVEMBER 30, 2023

Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. Kuttab et al’s findings, constituting 45% of the review’s weight, suggest that administering <30cc/kg IVF is associated with increased odds of mortality, delayed hypotension, and increased ICU utilization. 2.89, p = 0.01.

E-9-1-1 122

E-9-1-1 ALS ACS ICU 122

REBEL EM

MARCH 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. Paper: Owyang CG, et al. 2019 Aug; PMID: 30954692 Clinical Question: What is the impact of system factors in the implementation of standard-of-care LPV in critically ill ED patients admitted to the ICU?

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

REBEL EM

JANUARY 9, 2024

Read More First10EM: Magical Thinking in Modern Medicine: IV Antibiotics for Cellulitis First10EM: Oral Antibiotics are Equivalent to IV (Again) – The OVIVA Trial References MacGregor RR, Graziani AL. PMID: 9114201 Siegel RE et al. PMID: 17090560 Castro-Guardiola A et al. PMID: 1664833 Addo-Yobo E, et al.

ALS 100

ALS ICU ED OR 100

REBEL EM

MARCH 23, 2023

Treatment options for alcohol withdrawal include benzodiazepines such as lorazepam, diazepam, or chlordiazepoxide, gabapentin, and phenobarbital (Buell et al.). Phenobarbital can be used as a monotherapy or in combination with benzodiazepines to treat alcohol withdrawal (Hawa et al.). Paper : Hawa F et al.

ICU 52

ICU Emergency Department ALS OR 52

REBEL EM

NOVEMBER 6, 2023

Paper: Hiruy A, et al. 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. REFERENCES: Hiruy A, et al.

Epinephrine 72

Epinephrine ICU ALS OR 72

REBEL EM

AUGUST 14, 2023

Article: Liu S, Yao C, Xie J, et al. 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.”

ICU 98

ICU EMS OR ALS 98

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. appeared first on REBEL EM - Emergency Medicine Blog. Severe acute traumatic coagulopathy = PT >1.5

FFP 145

FFP Frozen Plasma ALS Plasma 145

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-9-1-1 137

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

REBEL EM

JULY 17, 2023

Click here for Direct Download of the Podcast Paper: Knack SKS et al. References: Knack SKS et al. appeared first on REBEL EM - Emergency Medicine Blog. It is possible that the induction agent used could play an important role on hemodynamic effects in critically ill adults. 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 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

REBEL EM

JUNE 8, 2023

Paper: Singer S, et al. References: Singer S, et al. PMID: 36108346 Cole JB, et al. PMID: 31270748 Maheshwari K, et al. The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. PMID: 29872882 Jones AE, et al. PMID: 17035422 Holler JG, et al. Am J Emerg Med.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

REBEL EM

SEPTEMBER 26, 2022

Article: Kumar M et al. The TEG group had a shorter ICU length of stay in the first admission. Patients exclusively managed in the ICU which decreases applicability for patients in other locations Very small sample size of 96 patients No definition was provided for exclusion criteria of significant cardiopulmonary disease.

FFP 52

FFP E-9-1-1 ICU ALS 52

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. link] Petran J, et al.

Critical Care 98

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

REBEL EM

SEPTEMBER 14, 2023

Zeymer HT et al. References: Zeymer HT et al. PMID: 37634145 Post Peer Reviewed By: Anand Swaminathan, MD (Twitter/X: @EMSwami ) The post The ECLS-SHOCK Trial: ECPR in Infarct-Related Cardiogenic Shock appeared first on REBEL EM - Emergency Medicine Blog. bleeding, stroke, limb ischemia, and hemolysis). Control: 53.4%

Life Support 137

Life Support Coronary CPR ICU 137

REBEL EM

SEPTEMBER 29, 2022

Article: de-Madaria E et al. For More on This Topic Checkout: CorePendium: Pancreatic Disease Internet Book of Critical Care: Acute Pancreatitis EMCrit: Ep333 – The State of Fluids Show with the EMCrit Core Team The Bottom Line: Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis References: de-Madaria E et al.

ICU 52

ICU ALS Critical Care Emergency Department 52

REBEL EM

SEPTEMBER 5, 2022

Paper 1: Schmidt HJ et al. PMID: 360027567 [ Access on Read by QxMD ] Paper 2: Kjaergaard J et al. References: Schmidt HJ et al. PMID: 360027567 [ Access on Read by QxMD ] Kjaergaard J et al. A higher MAP may offer advantages due to improved cerebral perfusion pressure, however data is lacking. Liberal O2: 33.9%

ICU 52

ICU ALS OR CPR 52

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. EMCrit blog website. 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

REBEL EM

NOVEMBER 3, 2022

Article: Sharda SC et al. Included studies assessed patients in the emergency department and prehospital setting, which limits the external validity to other treatment areas such as the ICU. PMID: 21373823 Jabre P, Combes X, Lapostolle F, et al. PMID: 19573904 Van Berkel MA, Exline MC, Cape KM, et al. 2011;37(6):901-910.

ALS 52

ALS ICU ED Emergency Department 52

REBEL EM

SEPTEMBER 15, 2022

Paper: Mullens W et al. diuresis NOT natriuresis) A common clinical practice in the ICU is to use a loop diuretic as monotherapy or a loop diuretic in combination with a thiazide diuretic.This can commonly lead to hypernatremia, hypochloremia, and a metabolic alkalosis. References: Mullens W et al. PMID: 21366472 Bart BA et al.

ALS 52

ALS ICU OR EMS 52

REBEL EM

FEBRUARY 2, 2023

2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). Paper: Mason JM, et al. These results were corroborated with other another study by Gritensko et al. References Mason JM, et al. 2018, PMID: 30571262 Gritsenko, Diana, et al. Am J Emerg Med.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

Dr. Smith's ECG Blog

OCTOBER 28, 2022

I’m an avid reader of your blog, and wanted your valued opinion on this. Learn about the Smith-Modified Sgarbossa Criteria for Diagnosis of OMI Paced Rhythm: Dodd, Meyers, Smith, et al. He went into cardiogenic shock and is intubated in the cardiac ICU. Annals of Emergency Medicine 2021.

Coronary 52

Coronary Paramedic EMS ICU 52

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.

ICU 52

ICU ALS OR CPR 52

REBEL EM

JULY 25, 2022

Click here for Direct Download of the Podcast Paper: Russell DW et al. References: Russell DW et al. PMID: 35707974 [ Access on Read by QxMD ] Janz DR et al. appeared first on REBEL EM - Emergency Medicine Blog. to 1.13; p = 0.03). REBEL Cast Ep111: The PrePARE II Trial – Fluid Bolus Prior to Intubation?

ALS 59

ALS Critical Care ICU OR 59

Dr. Smith's ECG Blog

MAY 26, 2023

He was admitted to the ICU and was unstable, in shock, overnight. This was a very complex case and the details are too much for an ECG Blog, but suffice it to say that, s hortly thereafter, the patient had an asystolic arrest and was resuscitated. Case Continued: He was stabilized on more calcium, pressors, and high dose insulin.

Overdose 88

Overdose E-9-1-1 Coronary OR 88

REBEL EM

JANUARY 25, 2023

PMID: 23758299 Maung AA et al. PMID: 24532357 Oyasiji T et al. Rezaie, MD (Twitter: @srrezaie ) The post REBEL Core Cast 94.0 – SBO appeared first on REBEL EM - Emergency Medicine Blog. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 Louis, Mosby, Inc.,

ED 52

ED ALS OR ICU 52

EMDocs

FEBRUARY 9, 2024

Adapted from Dr. Smith’s EKG Blog. Source: [link] As you are calling the ICU and cardiology team, the patient has recurrence of her symptoms and repeat ECG shows return of the PVT. Figure 3/ Adapted from Wilde et al. A complete approach to treating cLQTS can be found in Wilde et al 2. She denies chest pain.

Defibrillator 71

Defibrillator OR ED ALS 71