The Skeptics' Guide to EM

MAY 25, 2024

Reference: Borgundvaag et al. This is based, in large part, on indirect evidence illustrating the benefits of adjunctive phenobarbital including, but not limited to, reduction on the need for intubation, decreased hospital length of stay, decreased ICU admission and length of stay.

ED 252

ED Emergency Department ICU ALS 252

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

Date: September 12, 2024 Reference: Anderson et al. A pivotal study by Raja et al. The use of direct oral challenges has been tried in the intensive care unit (ICU) setting to de-label patients. Koo et al showed that offering amoxicillin oral challenges to ICU patients with low-risk penicillin allergies.

ICU 141

ICU Emergency Department ALS ED 141

The Skeptics' Guide to EM

JANUARY 20, 2024

Reference: Zaoutis T, et al. Reference: Zaoutis T, et al. Reference: Zaoutis T, et al. Short-course Therapy for Urinary Tract Infections in Children: the SCOUT randomized clinical trial. JAMA Pediatr. Short-course Therapy for Urinary Tract Infections in Children: the SCOUT randomized clinical trial. JAMA Pediatr. JAMA Pediatr.

Emergency Department 187

Emergency Department ALS ICU OR 187

ALiEM

JUNE 1, 2023

References Rosenson J, Clements C, Simon B, et al. Several studies have indicated that dosing with phenobarbital (PO or IV) is safe and effective at decreasing the need for escalating doses of benzodiazepines for EtOH withdrawal [1-6]. More rigorous studies are needed determine dose thresholds that warrant hospital admission. 2012.07.056.

Emergency Department 246

Emergency Department ICU ED OR 246

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

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 102

ICU ALS ACS EMS 102

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Reference: Cashen K, Reeder RW, Ahmed T, et al. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Reference: Cashen K, Reeder RW, Ahmed T, et al. Background: We often manage patients in cardiac arrest in the ED or the intensive care unit (ICU).

CPR 130

CPR ICU Critical Care Defibrillator 130

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

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 123

ICU MICU ALS EMS 123

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

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. CASE CONTINUED She was admitted to the ICU. However, in order to correct for rate , one needs a full QT interval. Then we can correct that modified QT for heart rate. 2014;11:22732277.

Coronary 115

Coronary OR Defibrillator ALS 115

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 102

ICU ED ALS OR 102

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

EMDocs

FEBRUARY 20, 2024

Fluids in Pancreatitis #1 : de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. 2: Li XW, Wang CH, Dai JW, et al. 2: Li XW, Wang CH, Dai JW, et al. These videos will cover post summaries, take homes on clinical condition, and EBM/guideline literature updates. Today we focus on pancreatitis. N Engl J Med.

E-9-1-1 98

E-9-1-1 ICU ALS OR 98

The Skeptics' Guide to EM

MARCH 27, 2021

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. Reference: Schuster et al. J Trauma Acute Care Surg. J Trauma Acute Care Surg.

ICU 100

ICU ALS ED Emergency Department 100

EMDocs

NOVEMBER 29, 2023

EBM Update: Fluids in Pancreatitis, Hypertriglyceridemic Pancreatitis #1: de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. 2: Li XW, Wang CH, Dai JW, et al. 2: Li XW, Wang CH, Dai JW, et al. These videos will cover post summaries, take homes on clinical condition, and EBM/guideline literature updates.

E-9-1-1 95

E-9-1-1 ICU ALS OR 95

The Skeptics' Guide to EM

JANUARY 15, 2022

0.3mg/kg IV * Outcome: * Primary Outcome: 7-day survival * Secondary Outcomes: 28-day survival, duration of mechanical ventilation, ICU length of stay, need for vasopressor use, SOFA scores and an assessment of a new diagnosis of adrenal insufficiency by the treating critical care teams. Date: January 16th, 2022 Reference: Matchett, G.

Emergency Medical Services 109

Emergency Medical Services Firefighter Critical Care Paramedic 109

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

ACEP Now

OCTOBER 15, 2023

Intravenous insulin infusions typically require treatment in highly monitored settings, such as an intensive care unit (ICU) or step-down unit for safety and due to the frequency and intensity of monitoring. ICU and step-down beds are a limited resource and generate higher hospital charges. ElSayed NA, Aleppo G, Aroda VR, et al.

ICU 80

ICU ALS ED Emergency Department 80

The Skeptics' Guide to EM

NOVEMBER 16, 2019

Date: November 6th, 2019 Reference: Lascarrou et al. Date: November 6th, 2019 Reference: Lascarrou et al. But two earlier randomized controlled trials ( Hypothermia after Cardiac Arrest Study Group 2002 and Bernard et al 2002 ) showed benefit for good neurologic outcome when TTM was initiated in the hospital after ROSC was achieved.

ALS 100

ALS CPR ICU EMS 100

REBEL EM

JANUARY 9, 2024

Read More First10EM: Magical Thinking in Modern Medicine: IV Antibiotics for Cellulitis First10EM: Oral Antibiotics are Equivalent to IV (Again) – The OVIVA Trial References MacGregor RR, Graziani AL. PMID: 9114201 Siegel RE et al. PMID: 17090560 Castro-Guardiola A et al. PMID: 1664833 Addo-Yobo E, et al.

ALS 98

ALS ICU ED OR 98

Broome Docs

SEPTEMBER 3, 2024

For the most part, central lines can be left to the ICU team during day time hours (and a good percentage of patients will never need one). Cook D, Deane A, Lauzier F, et al. Burton C, Mooney C, Sutton L, et al. Don’t stress, just give the PPI and carry on. Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation.

E-9-1-1 95

E-9-1-1 Emergency Department ICU ALS 95

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

ACEP Now

JANUARY 4, 2025

I am not one to sit down and look at an ECG or sodium potassium in the ICU, Dr. Clarke said. References Huecker MR, Shreffler J, Platt M, et al. Nelson DAF, Nelson MA, Shank JC, et al. Same Beating Heart Throughout all these changes over the decades, Dr. Clarke is still in love with the specialty. I like the excitement.

ED 52

ED Emergency Department Ambulance CPR 52

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. The HOT-COVID Randomized Controlled Trial.

ICU 74

ICU Life Support EMS OR 74

REBEL EM

JULY 17, 2023

Click here for Direct Download of the Podcast Paper: Knack SKS et al. References: Knack SKS et al. It is possible that the induction agent used could play an important role on hemodynamic effects in critically ill adults. REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? Range 5 to 9) Etomidate: 7.0 Range 5 to 9) Diff -0.2;

ED 97

ED ICU Emergency Department Overdose 97

Broome Docs

JANUARY 27, 2025

100% seems too good to be true Morello et al., Clin Exp Allergy. 2024 Oct 9. doi: 10.1111/cea.14565. Epub ahead of print. PMID: 39383344 Profundus Trial – Can we actually exclude acute aortic syndromes with this protocol? Diagnosis of acute aortic syndromes with ultrasound and D-dimer: the PROFUNDUS study.

ED 101

ED OR ACS Critical Care 101

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

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

His temperature was brought back to normal over time in the ICU. Rituparna et al — as well as Chauhan and Brahma ( Int. Norepinephrine was started, and another ECG was recorded: The patient was rewarmed with external rewarming, heated humidified air via ventilator circuit, warm IV fluid, and Arctic sun device.

ICU 137

ICU OR ALS ED 137

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.

ICU 71

ICU Epinephrine ALS OR 71

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

OCTOBER 21, 2023

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. 61.4.496 Navi BB, Kamel H, Shah MP, et al. Arch Neurol.

EMS 98

EMS ALS OR ACS 98

Broome Docs

OCTOBER 31, 2022

Ketamine vs etomidate in ICU intubation ? The PEACH trial: No body had a fit, so… we have no clue Peter-Derex L, Philippeau F, Garnier P, et al. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. 2018 Sep 11;362:k3843. doi: 10.1136/bmj.k3843. N Engl J Med.

E-9-1-1 52

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

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 58

ICU ALS OR EMS 58

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

NOVEMBER 15, 2023

Current practice is still isotonic fluids with a slight volume restriction, but there may/may not be another fluid shift coming… References Alobaidi R, Basu RK, Decaen A, et al. doi:10.1186/s13613-018-0402-x McNab S, Duke T, South M, et al. Regenmortel N Van, Verbrugghe W, Roelant E, et al. Crit Care Med. 2020;48:1034-1041.

Plasma 80

Plasma ALS ICU Critical Care 80

Emergency Medicine Ireland

OCTOBER 14, 2024

The major barrier to implementation in the ICU setting is the almost complete absence of ICU patients from these trial cohorts. And as we all know if there is a complication possible it’s almost definitely going to happen with greater frequency in the ICU cohort. An Effective and Safe Alternative to Surgery. – M.,

Critical Care 52

Critical Care ICU ALS OR 52