Core EM

JANUARY 25, 2024

Disposition to ICU. References: Yuan TH, Kerns WP, Tomaszewski CA, et al. von Lewinski D, Bruns S, Walther S, et al. Cole JB, Corcoran JN, Engebretsen KM, et al. Holger JS, Engebretsen KM, Fritzlar SJ, et al. Kerns W, Schroeder D, Williams C, et al. Kline JA, Tomaszewski CA, Schroeder JD, et al.

Overdose 246

Overdose Epinephrine ALS Critical Care 246

EMDocs

JANUARY 11, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association (AHA) and Neurocritical Care Society (NCS) released their 2023 Scientific Statement on the critical care management of post ROSC patients. Statements: Initiate EN as soon as possible after ICU admission (100%, 20/20).

Critical Care 98

Critical Care E-9-1-1 OR ICU 98

Emergency Medicine Ireland

JULY 3, 2023

Welcome back to the tasty morsels of critical care podcast. This segues relatively nicely into a section of the document on palliative care. It is important to realise that a referral to ICU for refractory cardiorenal syndrome may simply be a sign that the patient is reaching end of life. – Mullens, W.,

Critical Care 96

Critical Care ACS OR ALS 96

The Skeptics' Guide to EM

OCTOBER 3, 2021

Date: September 28th, 2021 Reference: Zampieri et al. Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial. Date: September 28th, 2021 Reference: Zampieri et al. Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial.

OR 130

OR Critical Care ICU Plasma 130

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Reference: Cashen K, Reeder RW, Ahmed T, et al. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Pediatric Crit Care Med. Reference: Cashen K, Reeder RW, Ahmed T, et al. Pediatric Crit Care Med.

CPR 130

CPR ICU Critical Care Epinephrine 130

Emergency Medicine Ireland

MAY 27, 2024

Welcome back to the tasty morsels of critical care podcast. Vasopressin has some animal data suggesting it causes less rise in PVR than our beloved noradrenaline but take that with an appropriately loosely defined portion of salt given that animal data is not ICU patients. Care 11 , 77–83 (2022). Johnson, S. Barnett, C.

Critical Care 52

Critical Care ICU OR ALS 52

The Skeptics' Guide to EM

JUNE 22, 2024

Reference: Peters MJ, et al. Conservative versus liberal oxygenation targets in critically ill children (Oxy-picu): a UK multicentre, open, parallel-group, randomised clinical trial. Clinical Question: What is the optimal target for systematic oxygen in critically ill children receiving invasive ventilation?

Critical Care 141

Critical Care ICU ALS Emergency Department 141

Emergency Medicine Ireland

OCTOBER 14, 2024

Welcome back to the tasty morsels of critical care podcast. The major barrier to implementation in the ICU setting is the almost complete absence of ICU patients from these trial cohorts. Welcome back to the tasty morsels of critical care podcast. Many penumonias will develope a parapneumonic effusion.

Critical Care 52

Critical Care ICU ALS OR 52

The Skeptics' Guide to EM

JANUARY 15, 2022

Intensive Care Med 2021 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a professor of Emergency Medical Services at Tacoma Community College’s paramedic program. Date: January 16th, 2022 Reference: Matchett, G. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial.

Emergency Medical Services 109

Emergency Medical Services Firefighter Critical Care Paramedic 109

The Skeptics' Guide to EM

JULY 16, 2022

Date: July 16th, 2022 Reference: Lamontagne F et al. Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. Date: July 16th, 2022 Reference: Lamontagne F et al. Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. She is admitted to the intensive care unit (ICU) for septic shock.

ICU 100

ICU ALS Critical Care Emergency Department 100

Emergency Medicine Ireland

JUNE 10, 2024

Welcome back to the tasty morsels of critical care podcast. We’re much less likely to see this cohort in the critical care side of things. A follow up trial in 2011 by ICU steroid guru Djilalli Annane did not find a benefit. Intensive Care Medicine 37 , 486–492 (2011). How does it make people sick?

Critical Care 52

Critical Care EMS ICU ALS 52

REBEL EM

FEBRUARY 8, 2024

Paper: Haber, EN et al. Accuracy of Noninvasive Blood Pressure Monitoring in Critically Ill Adults. 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?

ICU 123

ICU MICU ALS EMS 123

Emergency Medicine Ireland

OCTOBER 30, 2023

Welcome back to the tasty morsels of critical care podcast. First up is the VASST trial, (Russel et al 2008 NEJM). Enrolled 800 fairly typical ICU patients, and found a 35% vs 39% mortality benefit favouring the vaso but of course this was below the somewhat arbitrary statistical significance. Gordon, A. Nagendran, M.

Critical Care 52

Critical Care ALS Coronary ICU 52

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-9-1-1 119

E-9-1-1 ICU ALS OR 119

Emergency Medicine Ireland

OCTOBER 16, 2023

Welcome back to the tasty morsels of critical care podcast. The incidence of dynamic LVOTO in those with septic shock is remarkably high and is reported to be 20% in one study from ICU echo guru Michel Slama. References Chapter 13, Oxford Textbook of Advanced Critical Care Echocardiography covers this nicely.

Critical Care 52

Critical Care ICU OR ALS 52

Don't Forget the Bubbles

AUGUST 23, 2023

Kapoor et al. 2018) “Sacred Pause Imitative in the ICU: A survey of ICU physicians and nurses”. Critical Care Medicine , 46 (1), pp. Southern Medical Journal. 112 (9),pp. Newell, J. & & MacNeil, G. 2012) “Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue”.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

REBEL EM

NOVEMBER 30, 2023

Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. 4 studies remained, with a total of 571 patients with sepsis and a history of CHF Critical Result: The weighted OR for death was significantly higher in the <30 × 3 vs. 30 × 3 OR = 1.81, 95% CI = 1.13–2.89, 2.89, p = 0.01.

E-9-1-1 122

E-9-1-1 ALS ACS ICU 122

Emergency Medicine Ireland

JULY 5, 2021

Welcome back to the tasty morsels of critical care podcast. Read More » Welcome back to the tasty morsels of critical care podcast. It is critical to understand that this is a test useful in follow up to confirm diagnosis and should not be involved in the decision whether or not to give adrenaline acutely.

Critical Care 40

Critical Care ICU ALS OR 40

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.

E-9-1-1 96

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

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 Operating Room Critical Care ALS 81

EMDocs

JUNE 22, 2024

Treatment is supportive with respiratory therapy, critical care, inotropic therapy, and cardiac life support. If AFE occurs during labor, immediate delivery is recommended. ” Obstet Gynecol 123(2 Pt 1): 337-348. link] Society for Maternal-Fetal Medicine. Electronic address, p. ” Am J Obstet Gynecol 215(2): B16-24.

EMS 111

EMS Ambulance FFP ICU 111

REBEL EM

JUNE 8, 2023

Paper: Singer S, et al. The safety and efficacy of push dose vasopressors in critically ill adults. References: Singer S, et al. The safety and efficacy of push dose vasopressors in critically ill adults. PMID: 36108346 Cole JB, et al. PMID: 31270748 Maheshwari K, et al. Intensive Care Med.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

Critical Care Scenarios

NOVEMBER 15, 2020

ICU time and ED time are different. In the ICU, we have a useful (albeit sometimes flexible) cap: our total number of beds.* References Patel KK, Young L, Howell EH, et al. This differs from the main questions of many of their consulting and admitting specialties.* Remember that nobody sees anyone else’s denominator.

ICU 100

ICU Life Support Emergency Department ED 100

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.

ED 101

ED OR ACS Critical Care 101

ACEP Now

OCTOBER 15, 2023

Intravenous insulin infusions typically require treatment in highly monitored settings, such as an intensive care unit (ICU) or step-down unit for safety and due to the frequency and intensity of monitoring. ICU and step-down beds are a limited resource and generate higher hospital charges. Diabetes Care. Diabetes Care.

ICU 80

ICU ALS ED Emergency Department 80

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. The result of this ED capacity strain and less than ideal patient to staff ratios has led to delays in interventions, treatments and care adjustments. Paper: Owyang CG, et al. J Crit Care.

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

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. The team sits down for a hot debrief once the patient is stabilised and transferred to the ICU. Conclusion Critical care resuscitation is stressful. Incivility can mean many things.

E-9-1-1 105

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

EMOttawa

FEBRUARY 26, 2024

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

ICU 68

ICU ALS Critical Care 68

ACEP Now

JULY 7, 2024

4 With the increasing utilization of EEG, especially continuous EEG, nonconvulsive seizures have been increasingly recognized and diagnosed as a cause of altered mental status in critically ill patients. Neurology consultation should be initiated, and the patient should be admitted to the ICU. Towne AR, Waterhouse EJ, Boggs JG, et al.

Emergency Department 52

Emergency Department Critical Care ALS ICU 52

Broome Docs

OCTOBER 31, 2022

Ketamine vs etomidate in ICU intubation ? The PEACH trial: No body had a fit, so… we have no clue Peter-Derex L, Philippeau F, Garnier P, et al. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Anaesth Crit Care Pain Med. 2018 Sep 11;362:k3843.

E-9-1-1 52

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

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). He requires low-dose epinephrine to maintain his mean arterial pressure (MAP) in the 60s mmHg and is transported to the cardiothoracic (CT) ICU. Carsten L, et al.

Defibrillator 110

Defibrillator CPR Epinephrine Life Support 110

EMDocs

NOVEMBER 1, 2023

4 Prompt consultation is imperative with thoracic surgery, interventional radiology (IR), gastroenterology (GI), and/or critical care. Disposition : Admission to ICU with potential GI, IR, and/or surgical management. In: Tintinalli JE, Ma OJ, Yealy DM, et al., Discuss with GI/surgeons prior to placement.

Critical Care 95

Critical Care ED EMS OR 95

Don't Forget the Bubbles

NOVEMBER 15, 2023

Current practice is still isotonic fluids with a slight volume restriction, but there may/may not be another fluid shift coming… References Alobaidi R, Basu RK, Decaen A, et al. Fluid Accumulation in Critically Ill Children. Crit Care Med. Ann Intensive Care. doi:10.1186/s13613-018-0402-x McNab S, Duke T, South M, et al.

Plasma 80

Plasma ALS ICU Critical Care 80

Don't Forget the Bubbles

AUGUST 28, 2023

You contact ICU, anaesthetics, ENT, and oncology with a plan to attempt more definitive imaging in the prone position (which Ginny tells you is much comfier) What’s the evidence for our emergent management? 0000000000000294 Carter BW, Benveniste MF, Madan R, et al. A CXR demonstrates a mediastinal mass. J Thorac Oncol.

Emergency Manager 97

Emergency Manager Emergency Management E-9-1-1 Critical Care 97

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

AAEM RSA

AUGUST 27, 2020

Nielsen N, Wetterslev J, Cronberg T et al. By the time of the study by Nielsen et al. However, the decade since the original Hypothermia after Cardiac Arrest trial had seen significant advances in pre-hospital, emergency department, and critical care that may have contributed to these outcomes. Kirkegaard et al.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

REBEL EM

SEPTEMBER 5, 2022

Recent studies on patients requiring critical care have demonstrated that hyperoxia is harmful and instead we should be targeting normoxia (SpO2>93%). Paper 1: Schmidt HJ et al. PMID: 360027567 [ Access on Read by QxMD ] Paper 2: Kjaergaard J et al. References: Schmidt HJ et al. Liberal O2: 33.9%

ICU 52

ICU ALS OR CPR 52