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 137

ICU EMS ALS OR 137

EMDocs

OCTOBER 29, 2024

Authors: Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA), Katey DG Osborne, 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!

E-9-1-1 87

E-9-1-1 ICU Epinephrine EMS 87

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 132

ICU ALS EMS 132

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 74

EMS ALS OR ACS 74

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 74

EMS ALS OR ED 74

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.

MICU 126

MICU ICU ALS EMS 126

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

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 145

CPR ICU EMS ALS 145

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

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 105

ICU ED ALS OR 105

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

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

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

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-9-1-1 126

E-9-1-1 ICU OR ALS 126

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 75

Life Support ICU EMS OR 75

REBEL EM

NOVEMBER 25, 2024

Paper: von Hellmann R, Fuhr N, Maia IWA, et al. Intubation performed in all settings (out-of-hospital, emergency department, ICU, and operating room). Clinically Diverse Patient Population : The study included patients from varied clinical settings (ED, ICU, OR, and pre-hospital). PMID: 29800096 Driver BE et al.

Operating Room 59

Operating Room Emergency Department ICU ALS 59

FOAMfrat

NOVEMBER 21, 2024

Today, increased mortality rates, higher transfusion requirements, and lengthened ICU stays are recognized as proximate effects of the Trauma Triad. EMS Tactical Paramedic Lethal Triad.” Jessica Dawkins Mills BSN, et al. PubMed , StatPearls Publishing, 5 May 2024, www.ncbi.nlm.nih.gov/books/NBK603758/. Accessed 10 Oct.

ICU 117

ICU Emergency Department OR Ambulance 117

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

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

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

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-9-1-1 122

E-9-1-1 ALS ACS ICU 122

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 100

ALS ICU ED OR 100

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 ICU 52

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

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

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

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

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 76

E-9-1-1 ICU ACS EMS 76

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

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 72

Epinephrine ICU ALS OR 72

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 98

ED ICU Emergency Department Overdose 98

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

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 145

FFP Frozen Plasma ALS Plasma 145

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 85

Defibrillator CPR Epinephrine Life Support 85

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 59

ICU ALS OR EMS 59