REBEL EM

OCTOBER 5, 2023

1-6 We now have the Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial. Paper: Dequin P, Meziani F, Quenot J, et al. Patients enrolled from 31 Intensive Care Units in France. Demonstrating a significant reduction in mortality with a single medication in the critical care setting is challenging.

Critical Care 94

Critical Care ICU E-9-1-1 ALS 94

Don't Forget the Bubbles

NOVEMBER 22, 2023

Of these signs, mortality in children is associated with hepatomegaly and fever; meanwhile, mortality in adults is associated with hyperkalaemia, traumatic brain injury, propofol infusion rates >5mg kg -1 h -1 and ECG changes. 1998;8(6):491-9. Critical care (London, England). Critical care (London, England).

E-9-1-1 126

E-9-1-1 Critical Care Operating Room ALS 126

Pediatric EM Morsels

NOVEMBER 17, 2023

Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. Cuffed endotracheal tubes in pediatric intensive care. 1994 Jul;125(1):57-62. 2019 Sep;74(9):1186-1190. 2016 Feb;30(1):3-11. Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments.

E-9-1-1 187

E-9-1-1 Operating Room Emergency Department ALS 187

REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis [published online ahead of print, 2023 Aug 9]. Am J Emerg Med. 2023;73:34-39. Results: 26,069 studies met initial inclusion criteria.

E-9-1-1 122

E-9-1-1 ALS ACS ICU 122

REBEL EM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 5 Onset of VAP has been repeatedly shown to increase the number of ventilator days, intensive care length of stay, use of antimicrobials, medical costs, and mortality risk. 4, 8 Paper: Dahyot-Fizelier, C.,

E-9-1-1 119

E-9-1-1 ICU ALS OR 119

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. However, education and training for healthcare professionals traditionally prioritise ‘hard skills’, particularly critical care resuscitation. Here are ten things to think about: 1.

E-9-1-1 105

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

Don't Forget the Bubbles

JUNE 30, 2023

E – Temp 37.2 Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7% Last year, Kornelson et al. A retrospective cohort study in Japan by Maeda et al.

E-9-1-1 145

E-9-1-1 OR ALS Critical Care 145

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. N Engl J Med. Epub 2023 Jun 15.

E-9-1-1 96

E-9-1-1 Critical Care CPR ALS 96

EMDocs

JANUARY 4, 2024

1 In addition to intentional overdoses, there are multiple case studies of abuse (ingestion, insufflation, injection). QRS > 100 msec can give sodium bicarbonate 1-2 mEq/kg IV boluses. 9-12 Do not use this prophylactically in bupropion overdoses. 2014;52(9):969-72. In: Brent J, et al. Critical Care Toxicology.

Overdose 94

Overdose E-9-1-1 ALS Emergency Department 94

Don't Forget the Bubbles

FEBRUARY 26, 2024

In 2015, Silva et al. About PICSTAR PICSTAR is a trainee-led research network open to all doctors, nurses and allied health trainees within Paediatric Intensive Care. We are the trainee arm of the Paediatric Critical Care Society – Study Group (PCCS-SG) and work with them on research, audit and service evaluation.

E-9-1-1 72

E-9-1-1 Critical Care OR ALS 72

Don't Forget the Bubbles

AUGUST 28, 2023

The median age at diagnosis was 47 months (range 1-173 months). About PICSTAR PICSTAR is a trainee-led research network open to all doctors, nurses and allied health trainees within Paediatric Intensive Care. 2014;9(9):S102-S109. 0000000000000294 Carter BW, Benveniste MF, Madan R, et al. 2019;43(1):98-103.doi:10.1097/RCT.0000000000000782

Emergency Management 97

Emergency Management Emergency Manager E-9-1-1 ICU 97

Don't Forget the Bubbles

JANUARY 10, 2024

Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. Maitland K, Olupot-Olupot P, Kiguli S, et al. doi:10.1056/NEJMoa1900100 Maitland K, Kiguli S, Olupot-Olupot P, et al. The study asked TWO questions: 1. N Engl J Med. 2019;381(5):420-431.

E-9-1-1 78

E-9-1-1 ALS Critical Care OR 78

Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. Clinical Course of Children 1 to 24 Months Old With Positive Urine Cultures Without Pyuria. 2024;24(1):111-118. Giannoni, E., Pediatric Critical Care Medicine , 25 (3), pp.e117-e128. Acad Pediatr. doi:10.1016/j.acap.2023.06.023

E-9-1-1 75

E-9-1-1 Emergency Department OR ALS 75

ACEP Now

OCTOBER 11, 2024

1 Pediatric rapid sequence intubation (RSI) in the ED is associated with a higher frequency of failed first attempts and adverse effects than in adult patients. Paralytic agents include rocuronium at 1 mg/kg IV and succinylcholine at 1-2 mg/kg IV. References Long E, Sabato S, Babl FE. mg/kg IV, ketamine at 1.5–2

E-9-1-1 52

E-9-1-1 Emergency Department Advanced Life Support ALS 52

NAEMSP

APRIL 19, 2023

Current AHA guidelines do not recommend routine use of calcium in cardiac arrest (Panchal, et al., Calcium acts as a vasopressor and inotropic agent (Lindqwister, et al., This CI does include 1; and further and further analysis of the data showed that the likelihood that calcium has a beneficial effect (e.g.

E-9-1-1 52

E-9-1-1 Advanced Life Support Overdose CPR 52

Broome Docs

OCTOBER 31, 2022

Intensive Care Med. 2022 Jan;48(1):78-91. The PEACH trial: No body had a fit, so… we have no clue Peter-Derex L, Philippeau F, Garnier P, et al. 2022 Sep;21(9):781-791. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Epub 2021 Dec 14.

E-9-1-1 52

E-9-1-1 Defibrillator ICU Critical Care 52

ECG & Echo Learning

OCTOBER 2, 2022

Most agents exhibit both vasopressor and inotropic effects (Figure 1). Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). Careful electrocardiographic and hemodynamic monitoring with ECG , central vein catheter and intra-arterial catheter (A-line) is warranted.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

REBEL EM

MAY 8, 2023

Paper: Smith JA, Secombe P, Aromataris E. J Trauma Acute Care Surg. Only 1 RCT and 1 cohort study had only mechanically ventilated patients. However, this data was driven by a single small trial (Enderson et al.), References: Smith JA, Secombe P, Aromataris E. J Trauma Acute Care Surg. PMID: 34225346.

E-9-1-1 59

E-9-1-1 ICU Critical Care OR 59

AAEM RSA

AUGUST 27, 2020

Interventions during the acute phase of treatment post return of spontaneous circulation (ROSC) are therefore critical. 1 The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

ACEP Now

NOVEMBER 7, 2023

1 Overall, survival is poor following cardiac arrest, and is affected by factors including age, comorbidities, witnessed arrest, early CPR, early defibrillation, and return of spontaneous circulation (ROSC). References Go AS, Mozaffarian D, Roger VL, et al. Larribau R, Deham H, Niquille M, et al. 2018;13(9):e0204169.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

Dr. Smith's ECG Blog

MAY 5, 2022

It is critically important for all EM and critical care providers to have an intimate understanding of hyperkalemia and its ECG findings. The 2 Questions that I would ask would be: Question #1: In the absence of any history — What are the major diagnose s suggested by the ECG in Figure-1 ? What is it?

E-9-1-1 52

E-9-1-1 OR STEMI ED 52

FOAMfrat

JULY 1, 2023

Their recommendation, as I can tell, appears to come from two things: A paper by Levin NM et al. In fact, Herbstritt 2012, identified that there was "no significant difference to time to intubate, intubating conditions, or intubating success rate when using 1 to 1.2 mg/kg Rocuronium versus 1 to 1.5 Updated 2021 Oct 1].

E-9-1-1 52

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

Dr. Smith's ECG Blog

JULY 12, 2020

While calling for some help and arranging to have her transported to our critical care zone, I got this quick ultrasound which confirmed my suspicion: This quick view was all I was able to obtain in the circumstances. The cardiac monitor showed sinus rhythm but the automatic blood pressure cuff was not reading. Prac 15(17), 2017.

E-9-1-1 40

E-9-1-1 ED STEMI OR 40

EMDocs

FEBRUARY 12, 2024

Introduction Arterial blood gas (ABG) or venous blood gas (VBG) testing is used to assess the pH and systemic carbon dioxide tension in patients, and, therefore, provide a more complete picture of their acid-base status than an isolated basic metabolic panel (BMP) (1). However, ABGs have many drawbacks compared to VBGs.

Emergency Department 98

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

EMDocs

OCTOBER 7, 2023

1-3 Common causes: Natural disasters such as tornadoes or earthquakes 4,5 Structure or building collapses from home fires or bombings. Oda J, Tanaka H, Yoshioka T, et al. Tanaka H, Oda J, Iwai A, et al. Critical Care. 2016;20(1):135. Stahl K, Rastelli E, Schoser B. Chen CY, Lin YR, Zhao LL, et al.

EMS 98

EMS E-9-1-1 Emergency Department ALS 98

EMDocs

MAY 29, 2023

ESR and CRP are acute-phase reactants with concentrations that change in response to inflammation both acutely and chronically (1). ESR measures the rate at which red blood cells settle in a test tube, a factor of the concentration of fibrinogen in the blood, which increases during inflammation (1). References (1) Tennant F.

ED 58

ED E-9-1-1 Emergency Department OR 58

AAEM RSA

SEPTEMBER 17, 2020

Marik P, Khangoora V, Rivera R, et al. This retrospective before-and-after study was conducted at a single-center tertiary care referral hospital in the U.S. Keh D, Trips E, Marx G, et al. References Rhee C, Dantes R, Epstein L, et al. 2017;318(13):1241-9. Hatfield K, Dantes R, Baggs J, et al.

ICU 52

ICU E-9-1-1 ALS OR 52

EMDocs

JUNE 27, 2024

Abdomen : ND, NT, no guarding or rebound MSK : Tenderness to palpation over L ribs 7-9 Derm : No rashes Imaging: Image 1: Case courtesy of Miriam Leiderer, Radiopaedia.org, rID: 81468 Chest radiograph (CXR) shows new left lower lobe opacity What’s most likely diagnosis? 2022 Jul 5;328(1):57-68. 2020 Feb 12;10(1):2470.

E-9-1-1 98

E-9-1-1 ICU ACS EMS 98

REBEL EM

NOVEMBER 11, 2024

found no difference in mortality in critical care patients treated with vancomycin and piperacillin- tazobactam compared to vancomycin and cefepime or meropenem. Article: Chanderraj R, Admon AJ, He Y, et al. Comorbidity Index : Higher in the cefepime group (median 2 vs. 1). In 2021, Buckley et. 3 The same year, Ross et.

E-9-1-1 108

E-9-1-1 ICU ALS Critical Care 108

Don't Forget the Bubbles

DECEMBER 6, 2023

Their analyses revealed an association between social media use and e-cigarette and tobacco use. Parga-Belinkie JJ, et al. Balk SJ, et al. Abrams EM, et al. Yang K, et al. Varghese D, et al. Sanderson KR, et al. Huang N, et al. Hepnar L, et al. Chiu M, et al. Hemmingsen D, et al.

E-9-1-1 52

E-9-1-1 ALS OR Critical Care 52

EMDocs

OCTOBER 29, 2024

Chu CK, Delia E, Mograder A, Dwyer EM. Anaesth Intensive Care. 2017;45(1):12-20. Anaesth Intensive Care. 2017;45(1):12-20. doi:10.1016/S0033-0620(05)80036-2 Balik M, Novotny A, Suk D, et al. 2015;7(9):E365-E369. doi:10.3390/JCM13185344 Yamagishi T, Tanabe T, Fujita H, et al. 2018;12(1).

E-9-1-1 98

E-9-1-1 ICU Epinephrine EMS 98

EMDocs

MARCH 18, 2025

Episode 116: Massive Hemoptysis Definition: Hemoptysis is expectoration of blood from the respiratory tract; ranges from mild with small streaks of blood to cardiopulmonary compromise (1-5). Massive hemoptysis: no clear definition, ranges from 50 mL in a single expectoration to 100 mL in 24 hours to over 1 L in 48 hours.

E-9-1-1 82

E-9-1-1 FFP Critical Care ALS 82

FOAMfrat

NOVEMBER 28, 2024

Hoffman is the editor-in-chief of PulmCCM, a blog that frequently updates its readers on evidence and best practices in critical care medicine. I have always wondered how our work in the field affects a patient's care downstream. Journal of Intensive Care, 9 , 54. Al-Hassani, A., & Al-Thani, H.

E-9-1-1 52

E-9-1-1 ICU Critical Care EMS 52

Don't Forget the Bubbles

MARCH 24, 2025

While no paediatric studies have confirmed this, the DICE trial ( D exmedetomidine in I nfants undergoing C ooling for Neonatal E ncephalopathy) is underway. This makes it a valuable adjunct in multimodal sedation and analgesia strategies, particularly in paediatric critical care and procedural sedation. 2014;55(1):209-215.

E-9-1-1 59

E-9-1-1 Emergency Department ALS ICU 59

REBEL EM

FEBRUARY 24, 2025

1 They noticed how spontaneously breathing patients had their IVC collapse with inspiration; and ventilated patients had their IVC dilate during positive pressure ventilation. Jan 2015; PMID: 25559473 Airapetian N, et al. Di Nicol P, et al. Mar 2023; PMID: 36983218 Feissel M, et al. Intensive Care Med.

ALS 75

ALS E-9-1-1 Critical Care OR 75

This Podcast Will Kill You

MARCH 18, 2025

Canadian Journal of Gastroenterology and Hepatology, 2021(1), p.6679322. Nature reviews Disease primers, 5(1), p.47. Costanzo, Vincenzo, et al. Crosley, E. Obstetrics & Gynecology, 124(1), pp.120-133. Critical care clinics, 20(4), pp.609-615. Erez, Offer, et al. Dimitriadis, E.,

E-9-1-1 40

E-9-1-1 ALS Critical Care OR 40

Don't Forget the Bubbles

MARCH 31, 2025

Article 1: Should we rely on WBC to predict serious bacterial infection in children? Kemps N, Vermont C, Tan CD, et al. It was an observational multi-center study including >17,000 febrile children aged 0-18 across 12 European EDs over 1 year. A raised WBC count >1510^9/L count was significantly associated with SBI (aOR of 1.5,

E-9-1-1 59

E-9-1-1 Emergency Department ICU OR 59