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

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.

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Defibrillator Medical Transportation OR CPR 139

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). A somewhat underwhelming start Second is the VANISH trial by Gordon et al, JAMA 2016. Intens Care Med 45 , 844–855 (2019). Welcome back to the tasty morsels of critical care podcast.

Critical Care 52

Critical Care ALS Coronary ICU 52

Core EM

JANUARY 25, 2024

Adapted from Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. μg/kg IV Maintenance dose: 0.5 – 15 μg/kg/hr Rapid onset. Short acting. Not affected by hepatic or renal failure. mg/kg IV followed by 0.05 – 0.4 mg/kg over several minutes 0.02 – 0.1 mg/kg 0.01 – 0.1

ICU 246

ICU Emergency Department Critical Care ALS 246

Core EM

JANUARY 25, 2024

Hosts: Joseph Offenbacher, MD Audrey Bree Tse, MD [link] Download Leave a Comment Tags: calcium , Critical Care , Endocrine Show Notes Swami’s CoreEM Post Hypocalcemia Repletion: IV calcium supplementation with 100-300 mg Ca2+ raises serum Ca2+ by 0.5 – 1.5 Hypocalcemia in the critically ill patient. Louis, Mosby, Inc.,

Critical Care 246

Critical Care ED ALS OR 246

Emergency Medicine Ireland

MAY 27, 2024

Welcome back to the tasty morsels of critical care podcast. Critical care management of the patient with pulmonary hypertension. Care 11 , 77–83 (2022). Welcome back to the tasty morsels of critical care podcast. Too little PEEP we have atelectasis and shunt and hypoxia and vasoconstriction.

Critical Care 52

Critical Care ICU OR ALS 52

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

Don't Forget the Bubbles

OCTOBER 2, 2024

Kochanek et al… Kochanek PM, Tasker RC, Carney N, Totten AM, Adelson PD, Selden NR, et al. Pediatric Critical Care Medicine. There was also a meta-analysis on this topic in the adult population by Schwimmbeck et al [6] in 2021. They received 2494 boluses of either mannitol or 3% hypertonic saline.

OR 49

OR Critical Care ALS Emergency Department 49

Emergency Medicine Ireland

OCTOBER 16, 2023

Welcome back to the tasty morsels of critical care podcast. References Chapter 13, Oxford Textbook of Advanced Critical Care Echocardiography covers this nicely. Critical Care 19 , 1–8 (2015). So let’s say we’re worried about our septic patient: within that cohort who is at risk? Chauvet, J.-L.

Critical Care 52

Critical Care ICU OR ALS 52

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

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

Emergency Medicine Ireland

JANUARY 23, 2023

Welcome back to the tasty morsels of critical care podcast. Today we are going to talk about triggering on the ventilator. The more clockwise you turn the knob the lower the flow in the circuit the patient has to generate and therefore the easier it is to trigger inspiration. Failure of triggering is very common.

Critical Care 52

Critical Care OR ALS 52

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

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 OR Life Support 246

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

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 ALS Epinephrine Critical Care 246

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 132

ICU Plasma Critical Care ALS 132

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

Broome Docs

OCTOBER 6, 2024

Turgeon AF, Fergusson DA, Clayton L,et al. PMID: 38238065 Oral vs IV ABs… another negative trial Nielsen AB, Holm M, Lindhard MS, et al. Trends in Anaesthesia and Critical Care. So follow along with the papers below and read to make up your own mind about the evidence presented. Too much ‘aint enough blood?

Critical Care 112

Critical Care ALS Emergency Department EMS 112

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.

Critical Care 133

Critical Care ICU ALS Emergency Department 133

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

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

REBEL EM

APRIL 29, 2024

Over the years emergency and critical care physicians have tried many ways to establish IV access in emergencies including the “crash” or “dirty” central line. If you are not familiar with this term, it’s the act of rapidly trying to place a central line (usually femoral), placing the needle for access over strict sterile precautions.

ALS 105

ALS Epinephrine Critical Care Emergency Department 105

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

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 67

OR Critical Care ALS 67

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

Date: August 30, 2023 Reference: Griffey et al. Date: August 30, 2023 Reference: Griffey et al. The flow nurse has similar questions for you and wants to know if she should clear out a bed in the critical care bay so that the patient can have appropriate nursing requirements for an insulin infusion.

ICU 201

ICU ED Critical Care ALS 201

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

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 Defibrillator 130

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

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

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 161

ALS OR ED Emergency Department 161

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

ACEP Now

JULY 7, 2024

Alternatively, the Neurocritical Care Society defines it as a seizure with five minutes or more of continuous clinical or EEG seizure activity, or recurrent seizure activity without recovery between seizures. Should emergency physicians rely on standard textbooks for diagnostic and treatment regimens?

Emergency Department 52

Emergency Department Critical Care ALS ICU 52

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

Pediatric EM Morsels

MAY 24, 2024

Sources Adelgais KM, Kuppermann N, Kooistra J, et al. Holmes JF, Lillis K, Monroe D, et al. Holmes JF, Yen K, Ugalde IT, et al. Miglioretti DL, Johnson E, Williams A, et al. Cohort of 12,000 children with blunt IAI were prospectively enrolled to determine the number of subjects requiring acute intervention . 2014.08.014.

ALS 161

ALS EMS Emergency Department OR 161

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.

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Emergency Medical Services Firefighter Critical Care Paramedic 107