REBEL EM

APRIL 22, 2024

Paper: Nielsen FM et al. Population: Adult patients ( > 18 years of age) admitted to the ICU with COVID-19 and severe hypoxemia (defined as receiving supplemental O2 with a flow rate of at least 10L/min or receiving mechanical ventilation or non-invasive ventilation. appeared first on REBEL EM - Emergency Medicine Blog.

Life Support 67

Life Support ICU EMS OR 67

ACEP Now

JULY 7, 2024

35-year-old man presents by EMS with seizures. He has been seizing for 30 minutes, despite treatment of intravenous lorazepam by EMS. Neurology consultation should be initiated, and the patient should be admitted to the ICU. References Brophy GM, Bell R, Claassen J, et al. Zehtabchi S, Abdel Baki SG, Omurtag A, et al.

Emergency Department 52

Emergency Department Critical Care ALS ED 52

The Skeptics' Guide to EM

JUNE 6, 2020

Date: June 2nd, 2020 Reference: Permpikul et al. Date: June 2nd, 2020 Reference: Permpikul et al. Max is then going to Georgetown to be an attending in both EM and ICU. Reference: Permpikul et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Respir Crit Care Med 2019.

EMR 130

EMR ALS ICU Emergency Department 130

EMDocs

JUNE 27, 2024

Alkindi S, Al-Busaidi I, Al-Salami B, Raniga S, Pathare A, Ballas SK. Sundd P, Gladwin MT, Novelli EM. Alghamdi FA, Al-Kasim F, Alshhada F, Ghareeb E, Azmet FR, Almudaibigh A, Baitalmal L, Alnawfal B, Alluqmani R. Critical Care Medicine 41(12):p A191, December 2013. 2020 Feb 12;10(1):2470. Annu Rev Pathol.

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

The Skeptics' Guide to EM

MARCH 27, 2021

He has a passion for FOAMed and is the creator of the Danish EM platform www.akutmedicineren.dk. Reference: Schuster et al. Recent guidelines recommend admitting the patient to the intensive care unit (ICU), but the patient is eager to return home to her husband who is also well, and whom she claims will be able to help her.

ICU 100

ICU ALS Emergency Department ED 100

The Skeptics' Guide to EM

NOVEMBER 16, 2019

Date: November 6th, 2019 Reference: Lascarrou et al. NEJM Oct 2019 Guest Skeptic: Dr. Laura Melville (@lmelville535) is an emergency physician in Brooklyn, New York, is a part of the New York ACEP Research Committee, ALL NYC EM, and is the NYP-Brooklyn Methodist Resident Research Director. Reference: Lascarrou et al.

ALS 100

ALS CPR ICU EMS 100

Critical Care Scenarios

NOVEMBER 15, 2020

” is always, ultimately, the main question of the EM provider. 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. Remember that nobody sees anyone else’s denominator. JAMA Intern Med.

ICU 100

ICU Life Support Emergency Department ED 100

EMS 12-Lead

MAY 8, 2022

EMS found her acutely ill, mottled, dry mucous membranes, modestly hypotensive, and lethargic. This is critical for the EMS provider, or ED clinician, as identification of Grade I ischemia (aka, HATW’s) addresses the culprit lesion at the earliest opportunity with excellent downstream prognosis for the patient. [2] An ECG is recorded.

STEMI 130

STEMI ED EMS Firefighter 130

REBEL EM

MARCH 23, 2023

Treatment options for alcohol withdrawal include benzodiazepines such as lorazepam, diazepam, or chlordiazepoxide, gabapentin, and phenobarbital (Buell et al.). Phenobarbital can be used as a monotherapy or in combination with benzodiazepines to treat alcohol withdrawal (Hawa et al.). Paper : Hawa F et al.

ICU 52

ICU Emergency Department ALS OR 52

EMDocs

SEPTEMBER 6, 2023

Removed from cooling at 102 and admitted to ICU. Reference: EM@3AM – Heat Stroke Case 2: 40-year-0ld female feels unwell but no other specific complaints. Cooling blanket placed, but temperature increases to 107F. Immersion cooling completed with ice between body bags. Temperature starts to decrease. ROS unremarkable.

ACS 71

ACS ICU EMS ALS 71

EMS 12-Lead

AUGUST 22, 2022

A 65 y/o Female was admitted to the ICU for septic shock. The combination of prolonged QT and deep T wave inversion throughout the precordium is typical of Takotsubo syndrome, or Stress Cardiomyopathy – which can occur in the context of a physiologically distressed ICU patient, further compromising their hemodynamics. Friedman, M.,

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

Broome Docs

OCTOBER 31, 2022

Ketamine vs etomidate in ICU intubation ? PMID: 34904190 Not surprisingly, this paper has been covered by basically everyone who talks about research, so if you want to hear some other opinions, check out the SGEM , REBEL EM , or St. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial.

E-9-1-1 52

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

EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch. Carsten L, et al.

Defibrillator 84

Defibrillator CPR Epinephrine Life Support 84

REBEL EM

AUGUST 7, 2023

Background Information: Delirium is a common and serious condition in patients in the intensive care unit (ICU). It is estimated to affect 30-50% of patients in the ICU and haloperidol is the most frequently used agent in treatment (3). Paper: Andersen-Ranberg NC,et al; AID-ICU Trial Group. N Engl J Med. 2022 Dec 29.

ICU 52

ICU ALS OR EMS 52

Dr. Smith's ECG Blog

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. The patient was upgraded to the ICU for closer monitoring. In fact, Kosuge et al. Stein et al. This is a paper worth reading : Marchik et al. Kosuge et al. Witting et al. What do you think?

E-9-1-1 139

E-9-1-1 ACS Emergency Department ALS 139

REBEL EM

AUGUST 31, 2023

Paper: van Baarle FLF et al. ICU: 42.6% vs 0% ICU length-of-stay: 9 days vs 7 days In-Hospital Mortality: 28.2% ICU Mortality: 56.7% Conversely, it may be reasonable to withhold prophylactic platelets for patients in the ICU setting due to trends of lower bleeding risk noted as well as more intensive bleeding monitoring.

ICU 55

ICU ALS OR EMS 55

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. link] Petran J, et al.

Critical Care 97

Critical Care E-9-1-1 CPR ALS 97

REBEL EM

SEPTEMBER 5, 2022

Paper 1: Schmidt HJ et al. PMID: 360027567 [ Access on Read by QxMD ] Paper 2: Kjaergaard J et al. References: Schmidt HJ et al. PMID: 360027567 [ Access on Read by QxMD ] Kjaergaard J et al. A higher MAP may offer advantages due to improved cerebral perfusion pressure, however data is lacking. Liberal O2: 33.9%

ICU 52

ICU ALS OR CPR 52

EMDocs

APRIL 10, 2024

Authors: Alex Rogers, MD (EM Resident Physician, Christus Spohn/Texas A&M University School of Medicine, Corpus Christi, TX); J.D. Hemodynamics slowly begin to stabilize, and the patient is transferred to the ICU for further post-cardiac arrest care. doi:10.1136/bcr-2019-233119 Neal JM, Barrington MJ, Fettiplace MR, et al.

E-9-1-1 93

E-9-1-1 Plasma Epinephrine EMS 93

REBEL EM

SEPTEMBER 14, 2023

Zeymer HT et al. References: Zeymer HT et al. PMID: 37634145 Post Peer Reviewed By: Anand Swaminathan, MD (Twitter/X: @EMSwami ) The post The ECLS-SHOCK Trial: ECPR in Infarct-Related Cardiogenic Shock appeared first on REBEL EM - Emergency Medicine Blog. bleeding, stroke, limb ischemia, and hemolysis). Control: 53.4%

Life Support 133

Life Support Coronary CPR ALS 133

Pediatric EM Morsels

MARCH 17, 2023

Available from: [link] Correa JA, Fallon SC, Cruz AT, et al. Sarkar S, Sinha R, Chaudhury AR, et al. doi:10.1186/1757-1626-1-16 The post Snake Bites and Children appeared first on Pediatric EM Morsels. Snake Toxicity. Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

Frozen Plasma 130

Frozen Plasma First Aid Plasma OR 130

EMDocs

AUGUST 15, 2023

link] Kanaan NC, Ray J, Stewart M, et al. If you are concerned for elevated compartment pressures, the patient needs to be treated with antivenom. Accessed May 7, 2022. link] Buchanan JT, Thurman J. Crotalidae Envenomation. In: StatPearls. StatPearls Publishing; 2022. Accessed May 17, 2022. Wilderness Environ Med. 2015;26(4):472-487.

Emergency Department 82

Emergency Department OR EMS ED 82

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

Critical Care 67

Critical Care ED EMS OR 67

REBEL EM

JULY 25, 2022

Click here for Direct Download of the Podcast Paper: Russell DW et al. References: Russell DW et al. PMID: 35707974 [ Access on Read by QxMD ] Janz DR et al. appeared first on REBEL EM - Emergency Medicine Blog. to 1.13; p = 0.03). REBEL Cast Ep111: The PrePARE II Trial – Fluid Bolus Prior to Intubation?

ALS 55

ALS Critical Care ICU OR 55

EMDocs

JUNE 7, 2023

Disposition is often admission to an intensive care unit (ICU) setting. Further management and resuscitation were required, and she had a lengthy ICU stay of 21 days until she was extubated. References: Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure.

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

EMDocs

FEBRUARY 12, 2024

Authors: Rachel Kelly, MD ( EM Resident Physician, Stony Brook University Hospital); Robert Nocito, MD (EM Attending Physician, Stony Brook University Hospital) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. A systematic review and meta-analysis.

Emergency Department 94

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

Emergency Medicine Ireland

JULY 5, 2021

. * NSAIDs, Aspirin * Radiology contrast * Protamine * Chlorhexidine is a common and often overlooked cause * Rare beasts like mast cell disorders like systemic mastocytosis Tryptase gets a lot of attention (not without reason) in both anaesthesia and EM circles. Peak levels occur ~15-120 mins post event and decline predictably (T1/2 ~2hrs).

Critical Care 40

Critical Care ICU ALS OR 40

Dr. Smith's ECG Blog

OCTOBER 28, 2022

Learn about the Smith-Modified Sgarbossa Criteria for Diagnosis of OMI Paced Rhythm: Dodd, Meyers, Smith, et al. Unfortunately, many or most physicians, including EM and cardiology, do not know this and too many also are too arrogant to learn from a paramedic. He went into cardiogenic shock and is intubated in the cardiac ICU.

Coronary 52

Coronary Paramedic EMS ICU 52

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? See their website for more: [link] References Carter BW, Marom EM, Detterbeck FC. A CXR demonstrates a mediastinal mass.

Emergency Management 96

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

REBEL EM

OCTOBER 5, 2023

Paper: Dequin P, Meziani F, Quenot J, et al. ClinicalTrials.gov: NCT02517489 7 Clinical Question: In adult patients with severe community-acquired pneumonia admitted to the ICU, does early hydrocortisone treatment, compared to standard therapy, reduce mortality at 28 days? ICU-acquired infections were observed in: 9.8%

Critical Care 93

Critical Care ICU E-9-1-1 ALS 93

EMDocs

APRIL 22, 2024

EMS verbalized concern to EPs that an “intracranial bleed” may have precipitated the event. Alerhand et al described ten individual echocardiographic findings of RV strain that suggest PE. Marino’s the ICU book, Wolters Kluwer Health, pgs 105-109, 4th ed., Available from: [link] Meneveau, Nicolas, et al. 10,11 Vid 1.

ED 82

ED NARCAN ALS OR 82

EMDocs

OCTOBER 7, 2023

We’ll keep it short, while you keep that EM brain sharp. A 17-year-old girl, in moderate distress, is brought in by EMS after a motor vehicle collision. EMS reports that she was “pinned” underneath the dashboard, and it took several hours to extricate her. Oda J, Tanaka H, Yoshioka T, et al. 1941;1(4185):427-432.

EMS 73

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

REBEL EM

FEBRUARY 19, 2024

Paper: Yerke JR et al. PMID: 37611862 Clinical Question: In patients treated in the ICU, can a protocol of peripheral IV catheter vasopressors safely reduce the number of days of CVC use and frequency of placement? References: Yerke JR et al. PMID: 37611862 Evans L et al. CHEST 2024. CHEST 2024. Crit Care Med 2021.

ICU 134

ICU EMS ALS OR 134

REBEL EM

FEBRUARY 15, 2024

Paper: Freund Y et al. PMID: 38019968 Clinical Question: In patients with suspected acute poisoning and GCS <9, is a conservative airway strategy of withholding intubation associated with a reduction in death, ICU LOS, and hospital LOS compared with routine practice of intubation? References: Freund Y et al.

ICU 140

ICU ALS ED OR 140

EMDocs

JANUARY 6, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University School of Medicine, St. Louis, MO); Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine, St. We’ll keep it short, while you keep that EM brain sharp. A 64-year-old male presents by EMS to the ED with shortness of breath.

EMS 63

EMS E-9-1-1 ACS Coronary 63

The Skeptics' Guide to EM

JULY 16, 2022

Date: July 16th, 2022 Reference: Lamontagne F et al. Date: July 16th, 2022 Reference: Lamontagne F et al. Salim is also the creator and founder of REBEL EM and REBEL Cast, a free, critical appraisal blog and podcast that try to cut down knowledge translation gaps of research to bedside clinical practice.

ICU 100

ICU ALS Critical Care Emergency Department 100

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 74

ICU Critical Care Operating Room ALS 74