Don't Forget the Bubbles

AUGUST 28, 2023

A biopsy is often ultimately required for a definitive diagnosis. 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? Why do we worry about the airway? J Thorac Oncol.

Emergency Management 96

Emergency Management Emergency Manager E-9-1-1 Critical Care 96

EMDocs

JUNE 3, 2023

Definitive diagnosis of cerebellar infarction is made with MRI of the brain, as CT imaging (both non-contrast and IV contrast) is often unremarkable and has poor sensitivity for cerebellar stroke. Patients receiving thrombolysis will require ICU admission for neurologic monitoring. Fogwe DT, Sandhu DS, Goyal A, et al.

EMS 74

EMS ALS OR ED 74

ACEP Now

MAY 9, 2024

9 PFE is only definitively diagnosed on autopsy and a high clinical suspicion must be maintained in high-risk patients. Nearly half of all post-AFT patients presenting to our emergency departments required admission and six percent required ICU admission. Al Jazeera. Mofid MM, Teitelbaum S, Suissa D, et al.

Emergency Department 52

Emergency Department Operating Room Critical Care ALS 52

Emergency Medicine Ireland

JULY 5, 2021

These still involve mast cell degranulation) The current guideline accepted definition goes like this serious, life threatening generalised or systemic hypersensitivity reaction that may or may not be immune (ie IgE) mediated While accurate this doesn’t really help me very much in knowing what it looks like. Treatment is adrenaline.

Critical Care 40

Critical Care ICU ALS OR 40

EMDocs

FEBRUARY 12, 2024

In this situation, an ABG should be obtained periodically for correlation, though this is more relevant for the intensive care unit (ICU) setting than in routine ED care (5, 9). References/Further Reading (1) Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. proning patients, ECMO) (12).

Emergency Department 94

Emergency Department E-9-1-1 ED ICU 94

REBEL EM

FEBRUARY 15, 2024

These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications. Paper: Freund Y et al. References: Freund Y et al.

ICU 141

ICU ALS ED OR 141

Don't Forget the Bubbles

OCTOBER 19, 2023

Babie Junior, or Bee for short, was the definition of a cute, delightful baby. Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. There’s a definite vogue to minimise immobilisation in children with fractures. However, Kornelson et al.’s

E-9-1-1 81

E-9-1-1 OR ED Emergency Department 81

ACEP Now

NOVEMBER 14, 2023

The definition of massive hemoptysis is variable across publications with expectorated blood volumes ranging from 100 to 1,000 mL per 24 hours, as these volumes are difficult to estimate for any given patient. Atchinson PRA, Hatton CJ, Roginski MA, et al. Ittrich H, Bockhorn M, Klose H, et al. Li H, Ding X, Zhai S, et al.

E-9-1-1 52

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

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

EMDocs

FEBRUARY 26, 2024

A recent study by Gaborit et al. 16 In another study, a series of six HIV patients with confirmed PJP that were analyzed by Limonta et al. Consequently, a definitive diagnosis of PJP necessitates the application of molecular, genetic, or direct visualization techniques on IS or BAL fluid to detect PJ. and specificity of 71.4%).

E-9-1-1 87

E-9-1-1 ED ALS OR 87

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

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-9-1-1 124

E-9-1-1 ICU OR ALS 124

REBEL EM

MARCH 27, 2023

Background Information: Obtaining definitive control of the airway, when indicated, is the responsibility of the emergency medicine physician. 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. J Crit Care. J Crit Care.

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

ACEP Now

APRIL 3, 2024

Several recent studies yield insights into this hypothesis: In a single site retrospective cohort study, Callaway et al demonstrated that TTM efficacy may be impacted by arrest severity.10 In a multisite retrospective cohort study, a study by Nishikimi, et al., Group W, Nolan JP, et al. Nielsen N, Wetterslev J, et al.

Advanced Life Support 40

Advanced Life Support ALS Life Support CPR 40

The Skeptics' Guide to EM

DECEMBER 16, 2017

[display_podcast] Date: November 27th, 2017 Reference: Legriel et al. display_podcast] Date: November 27th, 2017 Reference: Legriel et al. He is now stabilized, fosphenytoin is being infused, you are getting ready to ship him to the neuro-ICU and wonder if cooling him down would help. Reference: Legriel et al.

ALS 100

ALS ICU Emergency Department Paramedic 100

EMDocs

OCTOBER 7, 2023

6 Prolonged down time from falls, usually in the elderly Incidence is difficult to ascertain due to broad definition and that events that cause crush injuries are rather rare. Oda J, Tanaka H, Yoshioka T, et al. Tanaka H, Oda J, Iwai A, et al. A systematic review on the definition of rhabdomyolysis. 1941;1(4185):427-432.

EMS 73

EMS E-9-1-1 Emergency Department ALS 73

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 70

Epinephrine ICU ALS OR 70

EMDocs

SEPTEMBER 25, 2023

Also known as Facilitated intubation (FI), the use of intubating with only a sedative was an accepted alternative intubation technique prior to those definitive studies in the late 1990s but quickly was abandoned for RSI in all emergent endotracheal intubations (ETI) (8,9). References: Heffner AC et al. PMID: 23911630 Kim WY et al.

ED 65

ED Emergency Department ALS OR 65

Don't Forget the Bubbles

JUNE 17, 2024

The team sits down for a hot debrief once the patient is stabilised and transferred to the ICU. The lack of consistent definitions in the literature makes it difficult to report its true prevalence and hampers efforts to combat it. Frich JC, Brewster AL, Cherlin EJ, Bradley EH. How do you manage this situation?

E-9-1-1 105

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

REBEL EM

JANUARY 25, 2023

PMID: 23758299 Maung AA et al. PMID: 24532357 Oyasiji T et al. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1

ED 52

ED ALS OR ICU 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

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

Don't Forget the Bubbles

JUNE 30, 2023

They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups. REBOA increased deaths due to bleeding at three hours and 90 days and substantially delayed time to definitive haemorrhage control. Laan DV, Vu TD, Thiels CA et al. Cochran, C.,

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

Dr. Smith's ECG Blog

MARCH 6, 2019

Lead I has a definitively hyperacute T-wave without STE. If for some reason the angiogram is delayed, they should receive maximal medical therapy in an ICU setting with continuous 12-lead ST segment monitoring under the close attention of a practitioner with advanced ECG interpretation training. Patel et al., Krucoff et al.)

STEMI 52

STEMI ALS ACS OR 52

EMDocs

JANUARY 6, 2024

Cardiogenic shock in the setting of acute rejection would warrant inotropic agents and ICU admission (C) , but these would not be indicated in cases of mild rejection, such as in this patient. Rosh Review Website Link Further Reading Additional FOAM Resources: [link] [link] [link] References: Khush KK, Cherikh WS, Chambers DC, et al.

EMS 63

EMS E-9-1-1 ACS Coronary 63

AAEM RSA

APRIL 1, 2021

Holcomb JB, Tilley BC, Baraniuk S, et al. There was no difference in the secondary outcomes of time to hemostasis, ventilator-free days, ICU-free days, disposition at 30 days, incidence of primary surgical procedures, and functional status at hospital discharge (measured as Glasgow Outcome Scale-Extended Score). 2015;313(5):471-82.

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

Don't Forget the Bubbles

MAY 3, 2023

Forestell B, Battaglia F, Sharif S, et al. Prekker ME, Bjorklund AR, Myers C, et al. O’Connell KJ, Sandler A, Dutta A, et al. O’Connell et al. O’Connell et al. Garabon et al. Which way should we go? Crit Care Explor. 2023;5(2):e0857. Published 2023 Feb 17. doi:10.1097/CCE.0000000000000857

CPR 52

CPR Emergency Department ALS ICU 52

Dr. Smith's ECG Blog

JANUARY 6, 2023

Lupu L, et al. The facility was not pressed to activate emergent transfer for PCI since the pain was improving and suggested we optimize pain control and admit to the Cardiac ICU. Unfortunately, they follow their own guidelines only 6% of the time!! Clin Cardiol 2022; [link] Labs included: hsTnI 156 ng/L, Hb 12 g/dL, WBC 12x10^9/L, Cr.

ACS 52

ACS Coronary ICU STEMI 52

Dr. Smith's ECG Blog

MAY 5, 2022

He was admitted to the ICU and transferred emergently to a facility where he could undergo emergent dialysis as a part of further evaluation and management. For an excellent State-of-the-Art Review on Brugada Syndrome — Please SEE this article by Brugada et al in JACC — Vol. The QRS is narrow and T waves are much less peaked.

E-9-1-1 52

E-9-1-1 OR STEMI ED 52

Dr. Smith's ECG Blog

OCTOBER 26, 2011

Definition: total loss of R-wave means there is a QS-wave (a single deep deflection). The patient continued to have ischemia after PCI, and in fact had an episode of polymorphic VT shortly after while in the ICU. Claeys MJ, Bosmans J, Veenstra L, et al. Gibson CM, Cannon CP, Murphy SA, et al. This was recorded 2.5

STEMI 52

STEMI ALS ICU OR 52

Don't Forget the Bubbles

JULY 5, 2023

Haemoglobin electrophoresis: To reach a definitive diagnosis, Hb electrophoresis is used. They should be admitted to hospital in case of clinical deterioration to receive ICU treatment. This treatment is usually done in the ICU setting. Macharia AW et al. Sinkin JC, Wood BC, Sauerhammer TM, et al. Ware et al.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126