EMS 12-Lead

AUGUST 22, 2022

A 65 y/o Female was admitted to the ICU for septic shock. Beats 9-12 : Continuation of the previously described events, all inducible by the pause (and thus, prolongation of refractoriness) created by the PVC of Beat 8. She was critically ill despite aggressive vasopressor therapy. References Chiale, P. JACC, Vol 23, No 3; 724-32.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

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. 0.83 (0.66 – 1.13) NO Adverse Events 51.7%

Life Support 74

Life Support ICU EMS OR 74

REBEL EM

AUGUST 31, 2023

Paper: van Baarle FLF et al. ICU: 42.6% 4.70) in grade 2-4 bleeding event Subgroup analysis revealed a higher risk of grade 2-4 bleeding was noted with decreasing platelet counts, and the greatest benefit of platelet transfusion is likely to be in those patients with a lower platelet count. ICU: 42.6% N Engl J Med.

ICU 58

ICU ALS OR EMS 58

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

APRIL 10, 2024

While not specifically reviewed in this post, check out the methemoglobinemia tox card for more information about one of the other known events that can occur with local anesthetic administration. Hemodynamics slowly begin to stabilize, and the patient is transferred to the ICU for further post-cardiac arrest care. BMJ Case Rep.

E-9-1-1 111

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

ACEP Now

JULY 7, 2024

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. Towne AR, Waterhouse EJ, Boggs JG, et al. Huff JS, Melnick ER, Tomaszewski CA, et al. Paliwal P, Wakerley BR, Yeo LLL, et al.

Emergency Department 52

Emergency Department Critical Care ALS ICU 52

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. Once a sufficiently high level is achieved, modelling of behaviours and episodes of retaliation can perpetuate the behaviours far beyond the initial event. Frich JC, Brewster AL, Cherlin EJ, Bradley EH. British journal of nursing.

E-9-1-1 105

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

Emergency Medicine Ireland

JULY 5, 2021

Peak levels occur ~15-120 mins post event and decline predictably (T1/2 ~2hrs). The ALS guidance is all about the IM and this should continue to be the case though there is a caveat for IV adrenaline use by “experts” in quotation marks. Treatment is adrenaline.

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. He went into cardiogenic shock and is intubated in the cardiac ICU. The main premise of my qualitative approach — is to be suspicious of an acute cardiac event when you see ST-T wave findings that shouldn't be there.

Coronary 52

Coronary Paramedic ICU EMS 52

Dr. Smith's ECG Blog

MARCH 12, 2018

It is also true that anterior and inferior T-wave inversion could be consistent with reperfusion of a type III wraparound LAD occlusion, despite the fact that Kosuge et al showed that T-wave inversion in lead III is much more likely to be PE than ACS if your differential contains nothing else. Stein et al. Kosuge et al.

ACS 40

ACS Coronary ALS ICU 40

Don't Forget the Bubbles

MARCH 21, 2025

Thats exactly what Shane George et al. George S, Williams T, Humphreys S, et al. Effectiveness of Nasal High-Flow Oxygen during apnoea on Hypoxaemia and Intubation Success in Paediatric Emergency and ICU Settings: a randomised, controlled, open-label trial. Lancet Respiratory Medicine. Hypoxaemia occurred in 12.8%

ICU 108

ICU Critical Care ED OR 108

Dr. Smith's ECG Blog

JULY 12, 2020

I found a well appearing young lady in the room with her parents who witnessed the event. She denied having any symptoms before or after the event, and she was asymptomatic on my initial exam. She was diagnosed with pericarditis and spent one day in the hospital without events. Prac 15(17), 2017.

E-9-1-1 40

E-9-1-1 ED STEMI OR 40

Core EM

JANUARY 25, 2024

Disposition to ICU. 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.

Overdose 246

Overdose ALS Epinephrine Critical Care 246

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. To confirm VAP, events were defined in a standardized approach using the American Thoracic Society criteria. 4, 8 Paper: Dahyot-Fizelier, C.,

E-9-1-1 121

E-9-1-1 ICU ALS OR 121

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 141

ICU ALS ED OR 141

REBEL EM

JUNE 26, 2023

This could potentially help improve thrombin generation, reduce blood product consumption, but also could increase the risk of thromboembolic events. Click here for Direct Download of the Podcast Paper: Bouzat P et al. Additionally, the use of 4F-PCC resulted in a higher rate of thromboembolic events compared to placebo.

FFP 144

FFP Frozen Plasma ALS Plasma 144

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

The Skeptics' Guide to EM

JUNE 4, 2017

[display_podcast] Date: June 3rd, 2017 Reference: Sierink et al. display_podcast] Date: June 3rd, 2017 Reference: Sierink et al. Huber-Wagner et al ( Lancet 2009 ) showed a mortality reduction in a retrospective database study of patients who have had a pan scan. Reference: Sierink et al. Lancet August 2016.

OR 130

OR ALS CPR ICU 130

The Skeptics' Guide to EM

OCTOBER 3, 2021

Date: September 28th, 2021 Reference: Zampieri et al. Date: September 28th, 2021 Reference: Zampieri et al. In the two large trials, this benefit was seen as a reduction in a composite outcome of major adverse kidney events within 30 days (MAKE-30). Reference: Zampieri et al. Lactated Ringer’s or Plasmalyte 148) over 0.9%

OR 130

OR Critical Care ICU Plasma 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

EMDocs

JUNE 22, 2024

The absence of preeclampsia symptoms prior to the acute event makes eclampsia less likely. Eclampsia (B) is characterized by the onset of seizures in a woman with preeclampsia (hypertension and proteinuria), but it typically does not present with the sudden onset of respiratory distress and profound hypotension described here. link] j.ajog.2016.03.012

EMS 111

EMS FFP Ambulance ICU 111

REBEL EM

AUGUST 21, 2023

Background Information: Cardiac arrest is a devastating event that imposes considerable human and financial burdens. Paper: Eastwood G, et al. PMID: 37318140 Mckenzie N, et al Arterial carbon dioxide tension has a nonlinear association with survival after out-of-hospital cardiac arrest: A multicentre observational study.

E-9-1-1 97

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

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? 70 events in the hydrocortisone group. N Engl J Med.

Critical Care 94

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

EMDocs

SEPTEMBER 25, 2023

The trade off to using FI for these challenging airways is the consideration of an aspiration event, the initial indication for RSI. First pass success (FPS) is key as increased attempts correlate to increased desaturation (>10%) events (~10% on first attempt, ~30% on second attempt, ~60% for 4+ attempts) (15).

ED 93

ED Emergency Department ALS Paramedic 93

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

Don't Forget the Bubbles

AUGUST 23, 2023

This simple intervention aims to acknowledge the tragic and unexpected event humanely and respectfully. The Pause creates an opportunity for loved ones and healthcare workers to respectfully honour the patient and the significant event they have been involved in before moving on to the next task ahead. Kapoor et al. 23 (2), pp.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

EMDocs

DECEMBER 18, 2023

1 The rationale for the shift away from normal saline in 2021 derived from multiple trials, including the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) and Saline Against Lactated Ringer’s or Plasma-Lyte in the Emergency Department (SALT ED). References Evans L, Rhodes A, Alhazzani W, et al. Intensive Care Med.

E-9-1-1 93

E-9-1-1 ALS Emergency Department Plasma 93

Don't Forget the Bubbles

MAY 3, 2023

Forestell B, Battaglia F, Sharif S, et al. Results of this study showed that the use of low-dose insulin infusion led to similar clinical outcomes and fewer adverse events compared to the standard-dose insulin infusion. units/kg/hr ) is as efficacious as standard-dose, with fewer adverse events. O’Connell et al.

CPR 52

CPR Emergency Department ALS ICU 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

AAEM RSA

AUGUST 27, 2020

Nielsen N, Wetterslev J, Cronberg T et al. By the time of the study by Nielsen et al. The authors also investigated harms in both groups and determined no significant difference in adverse events between both groups. Kirkegaard H, Soreide E, de Haas, I et al. Kirkegaard et al. New Engl J Med. 2017;318(4):341–350.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

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 98

ED NARCAN ALS OR 98

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

REBEL EM

SEPTEMBER 15, 2022

Paper: Mullens W et al. diuresis NOT natriuresis) A common clinical practice in the ICU is to use a loop diuretic as monotherapy or a loop diuretic in combination with a thiazide diuretic.This can commonly lead to hypernatremia, hypochloremia, and a metabolic alkalosis. References: Mullens W et al. PMID: 21366472 Bart BA et al.

ALS 52

ALS ICU OR EMS 52

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

OCTOBER 19, 2023

Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. And importantly, adverse event rates were both low and equivalent in both groups. However, Kornelson et al.’s For those in the standard therapy arm, escalation of care meant high flow.

E-9-1-1 81

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

Dr. Smith's ECG Blog

MARCH 6, 2019

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.) Patel et al. Krucoff et al. Schomig et al.

STEMI 52

STEMI ALS ACS ICU 52

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. Chen CY, Lin YR, Zhao LL, et al. Wald R, Quinn RR, Luo J, et al.

EMS 97

EMS E-9-1-1 Emergency Department ALS 97