ALiEM

JUNE 1, 2023

References Rosenson J, Clements C, Simon B, et al. Author information T. 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]. The Journal of Emergency Medicine. 2013;44(3):592-598.e2. 2012.07.056.

Emergency Department 246

Emergency Department ICU ED OR 246

REBEL EM

MARCH 27, 2023

Background Information: Obtaining definitive control of the airway, when indicated, is the responsibility of the emergency medicine physician. 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. J Crit Care. J Crit Care.

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

REBEL EM

MARCH 23, 2023

Background information : Alcohol has potentiating effects on the inhibitory GABA neurotransmission system and inhibitory effects on the excitatory glutamate neurotransmission system. Treatment options for alcohol withdrawal include benzodiazepines such as lorazepam, diazepam, or chlordiazepoxide, gabapentin, and phenobarbital (Buell et al.).

ICU 52

ICU Emergency Department ALS OR 52

REBEL EM

NOVEMBER 6, 2023

Background Information: Vasoplegic shock is defined as hypotension with normal or increased cardiac output and can commonly occur in post-cardiac surgery patients having received cardiopulmonary bypass. Paper: Hiruy A, et al. This dysregulation of vasodilation is associated with a mortality of close to 25%. J Cardiothorac Vasc Anesth.

Epinephrine 72

Epinephrine ICU ALS OR 72

REBEL EM

NOVEMBER 30, 2023

Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. It’s not mentioned whether the authors attempted to identify additional studies by checking the references of the selected articles or by contacting the original paper authors for more information. 2.89, p = 0.01.

E-9-1-1 122

E-9-1-1 ALS ACS ICU 122

REBEL EM

SEPTEMBER 26, 2022

It provides highly descriptive, real-time information on clot formation, clot strength, platelet function, and fibrinolysis, which is superior to traditional coagulation tests such as INR, aPTT, and platelet count. Article: Kumar M et al. The TEG group had a shorter ICU length of stay in the first admission. Hepatology.

FFP 52

FFP E-9-1-1 ICU ALS 52

REBEL EM

JUNE 8, 2023

Background Information: Acute Hypotension is associated with increased morbidity and mortality. Paper: Singer S, et al. The retrospective design of this study omitted assessment of ventricular dysrhythmias related to push dose pressor administration, as they were reliant on information in the EMR. References: Singer S, et al.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

ACEP Now

MAY 9, 2024

Taking a different approach than the authors of the AHRQ report, Auerbach et al used a “look back” approach to perform both qualitative and quantitative evaluations of the types and frequencies of errors occurring in hospital settings. After developing encephalopathy and hypoxemic respiratory failure, the patient was transferred to the ICU.

Emergency Department 52

Emergency Department ICU ALS ACS 52

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 98

ED ICU Emergency Department Overdose 98

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

Dr. Smith's ECG Blog

JUNE 17, 2024

If this EKG were handed to you to screen from triage without any clinical information, what would you think? 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-9-1-1 137

E-9-1-1 ACS Emergency Department Coronary 137

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.

Critical Care 98

Critical Care E-9-1-1 CPR ALS 98

REBEL EM

SEPTEMBER 14, 2023

Zeymer HT et al. We don’t know any of this information unfortunately and all are key in patient selection The median lactate level before revascularization was 6.9mmol/L (Range 4.6 References: Zeymer HT et al. The benefits of this strategy may be outweighed by the risk of the device-related complications (i.e. Control: 53.4%

Life Support 137

Life Support Coronary CPR ICU 137

Don't Forget the Bubbles

NOVEMBER 15, 2023

You retrieve the below relevant information… Vital signs : T 40, HR 140, BP 75/40 (52) Examination : mucous membranes slightly dry, skin turgor normal, mild dependent pitting oedema Bloods: Na 146, K 5.2, doi:10.1186/s13613-018-0402-x McNab S, Duke T, South M, et al. Regenmortel N Van, Verbrugghe W, Roelant E, et al.

Plasma 80

Plasma ALS ICU Critical Care 80

REBEL EM

JULY 14, 2022

Background Information: Multiple illness severity scores have been developed for use after out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). Unfortunately, these rely on information that is not immediately available to providers in the early hours following return of spontaneous circulation (ROSC).

ICU 52

ICU ALS OR CPR 52

EMDocs

FEBRUARY 26, 2024

A recent study by Gaborit et al. 16 In another study, a series of six HIV patients with confirmed PJP that were analyzed by Limonta et al. In cases where suggestive features are already present on LUS, a chest X-ray (CXR) may offer no additional diagnostic information and may expose the patient to unnecessary radiation.

E-9-1-1 87

E-9-1-1 ED ALS OR 87

EMDocs

JANUARY 16, 2024

He requires low-dose epinephrine to maintain his mean arterial pressure (MAP) in the 60s mmHg and is transported to the cardiothoracic (CT) ICU. Carsten L, et al. Monika BM, Martin D, Balthasar E, et al. Forti A, Brugnaro P, Rauch S, et al. 2018.09.018 Romlin BS, Winberg H, Janson M, et al. 2009;338:b2085.

Defibrillator 84

Defibrillator CPR Epinephrine Life Support 84

AAEM RSA

AUGUST 27, 2020

Nielsen N, Wetterslev J, Cronberg T et al. By the time of the study by Nielsen et al. Kirkegaard H, Soreide E, de Haas, I et al. Kirkegaard et al. De Fazio C, Skrifvars MB, Soreide E et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. New Engl J Med. 2013;369(23):2197–2206.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

REBEL EM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). 2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). Paper: Mason JM, et al. Am J Emerg Med.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

EMDocs

OCTOBER 21, 2023

While MRI is more resource and time intensive, studies have shown that a 6-minute protocol can give sufficient information to dictate treatment in the right setting. References: Gaillard F, Glick Y, Tatco V, et al. 61.4.496 Navi BB, Kamel H, Shah MP, et al. link] Burns JD, Rindler RS, Carr C, et al. Arch Neurol.

EMS 73

EMS ALS OR ACS 73

REBEL EM

MARCH 30, 2023

Article: How-Berlemont C, Lamhaut L, Diehl J, et al. Comparator: Delayed CAG: Patients were admitted to the ICU, and CAG was performed after 48-96 hours. There is very little information on the methodology of the meta-analysis. JAMA Cardiol. Published online June 08, 2022.

Coronary 83

Coronary CPR OR ICU 83

REBEL EM

MAY 8, 2023

Contacted authors of included studies for additional information when necessary Checked multiple trial registries for unpublished literature Included studies from multiple countries Included all ages Included all languages Investigators assessed quality with standardized critical appraisal instruments from the Joanna Briggs Institute (JBI).

E-9-1-1 59

E-9-1-1 Critical Care ICU OR 59

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 93

E-9-1-1 Plasma Epinephrine Life Support 93

REBEL EM

AUGUST 29, 2022

Article: Matchett G et al; EvK Clinical Trial Collaborators. Duration of mechanical ventilation, ICU, and percentage of vasopressor use were not significantly different. There was no information on the proportion of patients experiencing cardiovascular collapse before induction of anesthesia. The answer remains uncertain.

MICU 52

MICU ICU OR Emergency Department 52

Emergency Medicine Ireland

JULY 3, 2023

Hopefully in a few minutes you’ll at least have a few morsels more of information to stave off all the trainees who are undoubtedly much smarter than you on the ward round. It is important to realise that a referral to ICU for refractory cardiorenal syndrome may simply be a sign that the patient is reaching end of life.

Critical Care 96

Critical Care ACS OR ALS 96

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. to 1.13; p = 0.03). REBEL Cast Ep111: The PrePARE II Trial – Fluid Bolus Prior to Intubation? No Bolus: 18.2% Absolute difference 2.8%; 95% CI -2.2% to 7.7%; p = 0.25

ALS 59

ALS Critical Care ICU OR 59

EMDocs

APRIL 22, 2024

Although POCUS exams are learned individually, scanning condition-related anatomic areas provides EPs with critical information, improving the opportunity to rule-in a diagnosis more confidently. Alerhand et al described ten individual echocardiographic findings of RV strain that suggest PE. 10,11 Vid 1. SubX4 Asystole RV > LV.

ED 81

ED NARCAN ALS OR 81

ACEP Now

MAY 9, 2024

JHS’ chart review project, which identified 163 patients presenting to the ED with gluteal AFT complications in a 30-month period between 2020 and 2023, provides one of the most comprehensive and informative datasets on the breadth of AFT complications as they are currently being performed. Al Jazeera. units per patient.

Emergency Department 52

Emergency Department Operating Room Critical Care ALS 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. Exposure impairs information sharing and overall team collaboration. Frich JC, Brewster AL, Cherlin EJ, Bradley EH. The junior staff member remains silent throughout the debrief and does not attend their shift the following day.

E-9-1-1 105

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

ALiEM

OCTOBER 30, 2024

Clinical impact: Rather than arguing with the patient about the likelihood of this phenomenon occurring and whether this is a true allergy, the patient is informed that they do not need to immediately start treatment to receive care in the hospital. Multimodal medication options for fentanyl-xylazine withdrawal management in London et al.

E-9-1-1 161

E-9-1-1 Naloxone Emergency Department ALS 161

Don't Forget the Bubbles

JULY 5, 2023

They should be admitted to hospital in case of clinical deterioration to receive ICU treatment. This treatment is usually done in the ICU setting. Blood transfusions are indicated in major surgical procedures, acute priapism > 3 hours not responsive to treatment, severe acute chest syndrome with hypoxia requiring ICU.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

EMDocs

JANUARY 11, 2024

Evaluate and treat seizures or SE after CA in the context of other available clinical information because other systemic factors may influence the occurrence of seizures or SE and the effectiveness of treatment (90%, 18/20). Digestive Management Takeaway: Start enteral feeds when the patient gets to the ICU. Start low and go slow.

Critical Care 75

Critical Care E-9-1-1 OR ICU 75

Dr. Smith's ECG Blog

APRIL 20, 2018

However, this additional information was supportive. I took part in her ICU care and she was extubated and stable to transfer to a stepdown unit after a few days. Armstrong et al attempted to study it but may have included too many 'obvious' cases - the criteria from that paper would certainly have missed this case.

Coronary 52

Coronary STEMI EMS ACS 52

REBEL EM

OCTOBER 31, 2022

Fujii 2022, Sevransky 2021) Contrary to the above trial, another RCT investigated patients in the ICU with sepsis and acute respiratory distress syndrome. Clinical Question: Does high-dose vitamin C improve survival and/or persistent organ dysfunction rates in septic patients in the ICU on vasopressors? Article: Lamontagne F et al.

ICU 52

ICU ALS OR EMS 52

Dr. Smith's ECG Blog

MAY 5, 2022

He was admitted to the ICU and transferred emergently to a facility where he could undergo emergent dialysis as a part of further evaluation and management. Can YOU mentally apply this information to the initial ECG in today's case? The QRS is narrow and T waves are much less peaked. What should ECG #1A look like? 72; Issue 9; 2018.

E-9-1-1 52

E-9-1-1 OR STEMI ED 52

EMDocs

AUGUST 15, 2023

link] Kanaan NC, Ray J, Stewart M, et al. Unified Treatment Algorithm for the management of crotalid snakebite in the United States: results of an evidence-informed consensus workshop. link] Highlights of prescribing information. Accessed May 7, 2022. link] Buchanan JT, Thurman J. Crotalidae Envenomation. In: StatPearls.

Emergency Department 81

Emergency Department OR EMS ED 81

REBEL EM

JULY 31, 2023

REBEL Cast Ep121: The Battle of the Blades – VL vs DL Click here for Direct Download of the Podcast Article: Prekker ME, Driver BE, Trent SA, et al. Patients appeared to have a similar prognosis at the start of the trial, and the collected demographic information was well-balanced. N Engl J Med. 2023;10.1056/NEJMoa2301601.

Critical Care 98

Critical Care Emergency Department ICU OR 98