Don't Forget the Bubbles

MARCH 21, 2025

Thats exactly what Shane George et al. set out to explore in the Kids THRIVE study investigating whether NHF apnoeic oxygenation could improve intubation outcomes in critically unwell children needing emergency airway management. George S, Williams T, Humphreys S, et al.

ICU 108

ICU Critical Care ED OR 108

Pediatric EM Morsels

JULY 21, 2023

We use the GCS score in both trauma and medical patients, but where did this score come from? When is it useful and what does it tell us? Is it actually validated in children, like the Ottawa Ankle Rules or are we using a tool for something other than that for which it was designed and validated, like using Kocher criteria for knee and ankle joints?

Critical Care 246

Critical Care ALS Life Support OR 246

Core EM

JANUARY 25, 2024

A study by Duniec et al. Here are a handful of these studies and their conclusions: Nomura et al., Here are a handful of these studies and their conclusions: Nomura et al., of scans conducted and in <5 minutes in 100% of scans Ferre et al., times more attempts when adjusted for BMI Gottlieb et al.,

ALS 246

ALS Critical Care OR 246

The Skeptics' Guide to EM

FEBRUARY 11, 2023

Date: February 7, 2023 Reference: Cheskes et al. Date: February 7, 2023 Reference: Cheskes et al. Research interests include simulation-based assessment, transport medicine, and critical care analgesia. Reference: Cheskes et al. Defibrillation Strategies for Refractory Ventricular Fibrillation.

Defibrillator 142

Defibrillator Medical Transportation OR CPR 142

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. Instead, target 92-98%. Keep hemoglobin > 7 g/dL. Treat seizures if present.

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. Welcome back to the tasty morsels of critical care podcast. Today we tackle a somewhat nebulous syndrome. With me so far? And this indeed portends a poor prognosis.

Critical Care 96

Critical Care ACS OR ALS 96

Core EM

JANUARY 25, 2024

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. Disposition to ICU. Circulation.

Overdose 246

Overdose Epinephrine ALS ICU 246

Don't Forget the Bubbles

MAY 29, 2023

Incivility, whether during a critical case or during day-to-day practice, influences the overall culture of the workplace. Incivility, whether during a critical case or during day-to-day practice, influences the overall culture of the workplace. link] Isn’t it just ‘part of the job?’ Where do we go from here?

Critical Care 98

Critical Care E-9-1-1 Paramedicine Paramedicine 98

ALiEM

NOVEMBER 3, 2023

Reference Lin M, Phipps M, Chan TM, et al. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score.

Critical Care 211

Critical Care EMS Emergency Department ALS 211

REBEL EM

OCTOBER 5, 2023

Paper: Dequin P, Meziani F, Quenot J, et al. Patients enrolled from 31 Intensive Care Units in France. However, except for one trial, none showed a between-group difference regarding mortality. 1-6 We now have the Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial. N Engl J Med. 2023;388(21):1931-1941.

Critical Care 94

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

ALiEM

FEBRUARY 5, 2024

Reference Lin M, Phipps M, Chan TM, et al. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

Pediatric EM Morsels

JULY 28, 2023

A critical MORSEL is that every child you treat for DKA needs to have an initial thorough neuro exam including cranial nerves and then frequent neuro reassessments … and document it ( so your colleagues who take over care for the kid can know if there has been a change )! Neuroimaging is NOT required. GCS score is not sensitive enough.

E-9-1-1 246

E-9-1-1 ALS OR Critical Care 246

Core EM

JANUARY 25, 2024

Renal injury: isolated proteinuria or hematuria, moderate acute kidney injury with serum creatinine levels <2 mg/dL Skin: petechiae and purpura Despite severe thrombocytopenia, clinically significant bleeding is rare Figure 1.

Plasma 246

Plasma Frozen Plasma Emergency Department FFP 246

Pediatric EM Morsels

SEPTEMBER 22, 2023

Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Spinal shock is a phenomenon of transient, physiologic (rather than anatomic) complete loss of spinal cord function inferior to an injury. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues.

E-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Date: September 11th, 2019 Reference: Putzu et al. The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Critical Care Medicine. Date: September 11th, 2019 Reference: Putzu et al. Critical Care Medicine.

ICU 130

ICU Critical Care ALS Emergency Department 130

ALiEM

APRIL 12, 2024

If the catheter appears correctly positioned on AP chest x-ray but is malfunctioning, consider obtaining additional imaging to confirm placement [11]: Lateral view chest-xray, or Chest CT (can also help characterize the pleural effusion) References Gammie JS, Banks MC, Fuhrman CR, et al. doi: [link] Broder JS, Al-Jarani B, Lanan B, Brooks K.

E-9-1-1 183

E-9-1-1 ALS Critical Care Emergency Department 183

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. Guest Skeptic: Dr. Aaron Skolnik is an Assistant Professor of Emergency Medicine at the Mayo Clinic Alix School of Medicine and Consultant in the Department of Critical Care Medicine at Mayo Clinic Arizona.

ICU 133

ICU Plasma Critical Care ALS 133

Critical Care Scenarios

JUNE 14, 2020

The book Buy the new textbook (Bryan edited, Brandon authored a chapter) here or on Amazon: Concepts in Surgical Critical Care, First Edition ed. Figure 1 from Srour et al (vide infra). 1 mg/kg ketamine* 2 mg/kg propofol*.3 3 mg/kg etomidate* 4 mg/kg thiopental Resources The SAVIOR algorithm.

Critical Care 130

Critical Care ED ALS OR 130

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

[display_podcast] Date: September 21st, 2018 Reference: Kawano et al. Annals of EM May 2018 Guest Skeptic: Andrew Merelman is a critical care paramedic and first year medical student at Rocky Vista University in Colorado. display_podcast] Date: September 21st, 2018 Reference: Kawano et al.

BLS 130

BLS Defibrillator Critical Care CPR 130

Pediatric EM Morsels

OCTOBER 27, 2023

link] Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. Krug 2007] What If the Child is Obese or Emaciated?

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

ACEP Now

JULY 7, 2023

6,15,16 These studies were small but did suggest significantly higher rates of return of spontaneous circulation in the esmolol group compared to standard care. 6,15,16 These studies were small but did suggest significantly higher rates of return of spontaneous circulation in the esmolol group compared to standard care. Circulation.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

ALiEM

OCTOBER 14, 2023

Reference Lin M, Phipps M, Chan TM, et al. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

The Skeptics' Guide to EM

FEBRUARY 8, 2020

Date: January 29th, 2020 Reference: Perry et al. Stroke 2019 Guest Skeptic: Dr. Rory Spiegel is an EM/CC doctor who splits his time in the Emergency Department and Critical Care department. Date: January 29th, 2020 Reference: Perry et al. Reference: Perry et al. He also has this amazing #FOAMed blog called EM Nerd.

Emergency Department 130

Emergency Department Critical Care ALS EMS 130

ACEP Now

DECEMBER 7, 2024

In addition to the reduced risk for major bleeding, use of mechanical thrombectomy techniques has been shown to decrease hospital costs by reducing the need for post-procedural critical care following intervention. A massive PE, the most severe, causes hemodynamic instability and carries the most morbidity and mortality.

E-9-1-1 52

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

The Skeptics' Guide to EM

SEPTEMBER 3, 2017

[display_podcast] Date: September 2nd, 2017 Reference: Caputo et al. EmergeNcy Department use of Apneic Oxygenation versus usual care during rapid sequence intubation: A randomized controlled trial (The ENDAO Trial). display_podcast] Date: September 2nd, 2017 Reference: Caputo et al. Reference: Caputo et al.

Operating Room 130

Operating Room Emergency Department Critical Care ALS 130

The Skeptics' Guide to EM

JANUARY 9, 2021

Date: January 5th, 2021 Reference: Grunau et al. JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC?

EMS 130

EMS Emergency Medical Services CPR Critical Care 130

ACEP Now

APRIL 5, 2024

4,5 A recent study found that among 1102 critically ill adults, successful intubation on the first attempt was 80.4 References von Hellmann R, Fuhr N, et al. Koh LK, Kong CE, et al. Some important limitations of this analysis should be recognized. There was no analysis of operator experience or expertise. Ann Emerg Med.2024;83(2):132-144.

OR 73

OR ALS Emergency Department Critical Care 73

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? It’s unbalanced.

ICU 141

ICU Critical Care ALS Emergency Department 141

The Skeptics' Guide to EM

MARCH 25, 2023

Date: March 22, 2023 Reference: Hilsden et al. Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Trauma Surg Acute Care Open 2022 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care.

ED 130

ED Critical Care Emergency Department ALS 130

Don't Forget the Bubbles

NOVEMBER 22, 2023

Although this seems contradictory, it is important to recognise that whilst a very useful anaesthetic and sedative agent, potentially serious adverse events can occur when using a propofol infusion to sedate a critically ill child. Critical care (London, England). What are the clinical features of PRIS? References Bray RJ.

E-9-1-1 126

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

EMDocs

AUGUST 10, 2023

Reference: Yang P, Zhang Y, Zhang L, et al. This collection of posts features recently published must-know articles. Today we look at the DIRECT MT trial. Inclusion criteria: Enrolled patients over the age of 18 with acute ischemic stroke with CTA confirmed occlusion of ICA, or M1 or M2 segment of MCA Within 4.5 N Engl J Med.

OR 95

OR Critical Care ALS 95

Emergency Medicine Ireland

OCTOBER 14, 2024

Welcome back to the tasty morsels of critical care podcast. Welcome back to the tasty morsels of critical care podcast. Following on from our initial post in this entirely accidental series on “things you don’t want to find in the chest drain” we turn our eyes (if not our noses) to empyema. – M.,

Critical Care 52

Critical Care ICU ALS OR 52

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Reference: Cashen K, Reeder RW, Ahmed T, et al. Pediatric Crit Care Med. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Reference: Cashen K, Reeder RW, Ahmed T, et al. Pediatric Crit Care Med.

CPR 130

CPR ICU Critical Care Epinephrine 130

Pediatric EM Morsels

JULY 5, 2024

It seems like just yesterday ( or maybe ~ a month ago ) when we served up a tasty morsel on the PECARN decision rule for intra-abdominal traumatic injuries in children. Our friends at the PECARN injury group have remained busy this spring with generating more externally validated clinical decision rules. High Risk (12.8% High Risk (12.8%

ALS 164

ALS OR ED Emergency Department 164

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. Intensive Care Medicine 37 , 486–492 (2011). Welcome back to the tasty morsels of critical care podcast. Reading Oh Manual Chapter 83 Weaver, L.

Critical Care 52

Critical Care EMS ICU ALS 52

The Skeptics' Guide to EM

JANUARY 25, 2020

Date: January 9th, 2020 Reference: Casey et al. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. NEJM February 2019 Guest Skeptic: Andrew Merelman is a critical care paramedic and second year medical student at Rocky Vista University in Colorado. Date: January 9th, 2020 Reference: Casey et al.

EMS 100

EMS Critical Care Paramedic ALS 100

Critical Care Scenarios

MARCH 29, 2020

Cardiothoracic critical care PA Brendan Riordan (@concernecus) shows us his initial approach to the patient in cardiogenic shock, including initiating mechanical support, managing ECMO (plus Impella), and eventual weaning and discontinuation of support. Rule in the former by evaluating the ABG or SpO2 from the right upper extremity.*

Critical Care 100

Critical Care Life Support ALS OR 100