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

REBEL EM

MAY 29, 2023

Paper: Ibarra-Estrada, M et al. What They Did: Single-center, parallel, double blind, randomized controlled trial performed in a medical-surgical ICU (Mexico) Both groups received: Adjunctive vasopressin initiated at a dose of 0.03 Limited, small studies on its use in septic shock do not make a clear argument for use. Crit Care 2023.

ICU 145

ICU ALS Epinephrine OR 145

REBEL EM

JANUARY 18, 2024

Paper: Varney J et al. PMID: 35387313 Clinical Question: Do prehospital antibiotics impact 28 day mortality, length of stay in the hospital and ICU length of stay for patients triggering sepsis compared to usual care (No prehospital antibiotics)? References: Varney J et al. Health Sci Rep 2022. to 0.97; p = 0.02 to 0.97; p = 0.02

ICU 130

ICU ALS EMS 130

REBEL EM

JUNE 29, 2023

Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? REBEL EM Blog, June 1, 2023. Available at: HERE Branch KHR et al. Back on June 1st, 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? Resus 2023.

CPR 144

CPR ICU EMS ALS 144

EMDocs

JUNE 3, 2023

We’ll keep it short, while you keep that EM brain sharp. Patients receiving thrombolysis will require ICU admission for neurologic monitoring. Rosh Review Website Link Further Reading [link] [link] [link] [link] [link] References: Stanislavsky A, Baba Y, Hacking C, et al. Fogwe DT, Sandhu DS, Goyal A, et al.

EMS 97

EMS ALS OR ED 97

REBEL EM

MAY 29, 2024

The idea behind abx is to prevent things like AOM and TSS but neither should be much of an issue with short term placement ICU Admission? Traditional teaching is that these patients are at risk for life-threatening bradydysrhythmias and should go to the ICU Literature here is non-existent. PMID: 5569677 Zeyyan E et al.

ICU 96

ICU ALS ACS EMS 96

EMDocs

OCTOBER 21, 2023

We’ll keep it short, while you keep that EM brain sharp. All patients who receive thrombolytics for ischemic stroke should be admitted to a neurosurgical, neurologic, or medical ICU for management and monitoring, as this is shown to decrease mortality and length of stay. References: Gaillard F, Glick Y, Tatco V, et al.

EMS 97

EMS ALS OR ACS 97

The Skeptics' Guide to EM

OCTOBER 3, 2021

Date: September 28th, 2021 Reference: Zampieri et al. Date: September 28th, 2021 Reference: Zampieri et al. Case: A 66-year-old woman is brought in by EMS from home with lethargy and hypotension. Reference: Zampieri et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9%

OR 130

OR Critical Care ICU Plasma 130

Dr. Smith's ECG Blog

JANUARY 2, 2025

Bogossian et al. (1) Bogossian H, Frommeyer G, Ninios I, Hasan F, Nguyen QS, Karosiene Z, Mijic D, Kloppe A, Suleiman H, Bandorski D, et al. Dodd KW, Elm KD, Dodd EM, Smith SW. CASE CONTINUED She was admitted to the ICU. However, in order to correct for rate , one needs a full QT interval. Heart Rhythm [Internet].

Coronary 116

Coronary OR Defibrillator ALS 116

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

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

REBEL EM

FEBRUARY 8, 2024

Paper: Haber, EN et al. 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? References: Haber, EN et al. PMID: 38215002 Kaufmann T et al. J Intensive Care Med 2024.

ICU 117

ICU MICU ALS EMS 117

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.

CPR 100

CPR ALS ICU EMS 100

REBEL EM

OCTOBER 2, 2023

Mild to moderate DKA represents a subgroup of patients that often require admission to the ICU due to hospital policies not allowing insulin infusions outside of this clinical setting. Paper: Griffey RT et al. However, it is unclear if all degrees (mild, moderate, severe) of DKA require the same intensive treatment. tests/hr (0.8

ICU 97

ICU ED ALS OR 97

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

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 94

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

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

DECEMBER 16, 2017

[display_podcast] Date: November 27th, 2017 Reference: Legriel et al. display_podcast] Date: November 27th, 2017 Reference: Legriel et al. Case: Johnny is a 22-year-old male patient who presents to the emergency department via EMS with a seizure. Reference: Legriel et al. He is known to have poorly controlled epilepsy.

ALS 100

ALS ICU Emergency Department Paramedic 100

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-9-1-1 111

E-9-1-1 ICU ALS OR 111

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

REBEL EM

NOVEMBER 30, 2023

Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. Kuttab et al’s findings, constituting 45% of the review’s weight, suggest that administering <30cc/kg IVF is associated with increased odds of mortality, delayed hypotension, and increased ICU utilization. 2.89, p = 0.01.

E-9-1-1 118

E-9-1-1 ALS ACS ICU 118

REBEL EM

JUNE 26, 2023

Click here for Direct Download of the Podcast Paper: Bouzat P et al. References: Bouzat P et al. PMID: 36942533 Innerhofer P et al. PMID: 28457980 Jehan F et al. PMID: 29664892 Zeeshan M et al. appeared first on REBEL EM - Emergency Medicine Blog. Severe acute traumatic coagulopathy = PT >1.5

FFP 139

FFP Frozen Plasma ALS Plasma 139

ACEP Now

JANUARY 4, 2025

The specialty, he said, spoke to his interest in surgery and EMS in a way that family medicine did not. A closer look, though, also shows the technology of the daya bulky, two-way radio for communicating with EMS, metal gurneys, glass saline bottles, and portable ECG monitors the size of a small shopping cart. I like the excitement.

ED 52

ED Emergency Department Ambulance CPR 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 97

ICU EMS OR ALS 97

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 96

ACS ICU EMS ALS 96

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 74

Life Support ICU EMS OR 74

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

REBEL EM

JANUARY 9, 2024

You decide she is stable to be discharged home on levofloxacin (See REBEL EM for antibiotic coverage in CAP ) but consider giving her a first dose intravenously. PMID: 9114201 Siegel RE et al. PMID: 17090560 Castro-Guardiola A et al. PMID: 1664833 Addo-Yobo E, et al. PMID: 15451221 Atkinson M et al. Pneumonia 2017.

ALS 95

ALS ICU ED OR 95

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 109

Defibrillator CPR Epinephrine Life Support 109

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 Coronary 139

REBEL EM

JULY 17, 2023

Click here for Direct Download of the Podcast Paper: Knack SKS et al. References: Knack SKS et al. appeared first on REBEL EM - Emergency Medicine Blog. It is possible that the induction agent used could play an important role on hemodynamic effects in critically ill adults. Range 5 to 9) Etomidate: 7.0 Range 5 to 9) Diff -0.2;

ED 93

ED ICU Emergency Department Overdose 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 ICU 133

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-9-1-1 111

E-9-1-1 Plasma Epinephrine Life Support 111

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

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 Plasma First Aid OR 130

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. Paper: Owyang CG, et al. 2019 Aug; PMID: 30954692 Clinical Question: What is the impact of system factors in the implementation of standard-of-care LPV in critically ill ED patients admitted to the ICU?

Emergency Department 52

Emergency Department ICU Critical Care EMR 52