The Skeptics' Guide to EM

OCTOBER 3, 2021

Date: September 28th, 2021 Reference: Zampieri et al. Date: September 28th, 2021 Reference: Zampieri et al. Clinical Question: Does administration of a balanced solution (Plasma-Lyte 148) during intensive care unit (ICU) stay, compared with saline solution, result in improved 90-day survival in critically ill patients?

OR 130

OR Critical Care ICU Plasma 130

Core EM

JANUARY 25, 2024

11 Geriatric trauma patients require increased immediate and delayed ICU resources compared to younger counterparts with the same injuries. Perdue &al. Caterino &al. Sterling &al. Liu &al. Gill &al. Demetriades D &al. Goode &al. Hasegawa &al. Li &al.

ALS 246

ALS ED ICU OR 246

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

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 Epinephrine ALS ICU 246

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]. barbiturates or benzodiazepines). The Journal of Emergency Medicine. 2013;44(3):592-598.e2. 2012.07.056.

Emergency Department 246

Emergency Department ICU ED OR 246

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. T-waves are quite tall and possibly peaked (HyperK?), but potassium returned normal. What is the QT interval? Heart Rhythm [Internet].

Coronary 117

Coronary OR Defibrillator ALS 117

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 186

Emergency Department ALS ICU OR 186

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?

ICU 139

ICU ALS ED OR 139

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Date: September 11th, 2019 Reference: Putzu et al. Date: September 11th, 2019 Reference: Putzu et al. Case: A 45-year-old female in the emergency department is being admitted to the intensive care unit (ICU) for septic shock secondary to urinary tract infection (UTI). You are ready to call the ICU and get her admitted.

ICU 130

ICU Critical Care ALS Emergency Department 130

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 140

ICU Emergency Department ALS ED 140

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

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

The Skeptics' Guide to EM

APRIL 22, 2023

Date: April 20, 2023 Reference: Franklin D, et al. Date: April 20, 2023 Reference: Franklin D, et al. Previous research has shown that HFNC can lower the rate of escalation of care but showed no impact on admission to the intensive care unit (ICU) or length of stay [1]. Reference: Franklin D, et al.

ICU 130

ICU Emergency Department ALS ED 130

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

The Skeptics' Guide to EM

JUNE 22, 2024

Reference: Peters MJ, et al. Reference: Peters MJ, et al. Conservative versus liberal oxygenation targets in critically ill children (Oxy-picu): a UK multicentre, open, parallel-group, randomised clinical trial. But like many interventions, there are potential harms and benefits. While the term “benefits” implies a positive outcome.

ICU 138

ICU Critical Care ALS Emergency Department 138

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

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 134

ICU EMS ALS OR 134

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? Accuracy of Noninvasive Blood Pressure Monitoring in Critically Ill Adults. J Intensive Care Med 2024.

ICU 117

ICU MICU ALS EMS 117

EMDocs

NOVEMBER 29, 2023

EBM Update: Steroids in Severe CAP and CT in Post ROSC OHCA #1: Dequin PF, Meziani F, Quenot JP, et al; CRICS-TriGGERSep Network. Question: In adult patients admitted to the ICU with severe CAP, does hydrocortisone compared to placebo reduce 28-day all-cause mortality? Reyes LF, Garcia E, Ibáñez-Prada ED, et al. N Engl J Med.

ICU 89

ICU CAD ALS OR 89

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. She is admitted to the intensive care unit (ICU) for septic shock. The ICU team is considering using Vitamin C therapy for this patient. Reference: Lamontagne F et al. Guest Skeptic: Dr. Salim R.

ICU 100

ICU ALS Critical Care Emergency Department 100

Broome Docs

JANUARY 27, 2025

100% seems too good to be true Morello et al., Welcome to the first episode of the Broomedocs podcast for 2025. Justin and I are back for more nerdy goodness to make you smarter in the Resus room, or at a pub trivia night more likley… wether it is about salt correction, dissection or infection we can help you out! Listen in and learn!

ED 101

ED OR ACS Critical Care 101

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? Hydrocortisone in severe community-acquired pneumonia.

Critical Care 94

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

REBEL EM

JUNE 29, 2023

Available at: HERE Branch KHR et al. The CT FIRST Trial: Should We Pan-CT After ROSC?, REBEL EM Blog, June 1, 2023. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. Resus 2023.

CPR 144

CPR ICU EMS ALS 144

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. 1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 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.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

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

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. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022 Sep 15;387(11):989-1000. cc/kg/hour of LR Control: LR Bolus of 20 cc/kg (regardless of fluid status) followed by 3.0

E-9-1-1 97

E-9-1-1 ICU ALS OR 97

REBEL EM

JUNE 26, 2023

Click here for Direct Download of the Podcast Paper: Bouzat P et al. High-quality studies are needed to determine the utility of this intervention. REBEL Cast Ep118: The PROCOAG Trial – 4F-PCC in Trauma Patients? Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 to 2.10; P = 0.03 to 3.33; P = 0.72 to 2.10; P = 0.03

FFP 139

FFP Frozen Plasma ALS Plasma 139

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

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 Emergency Department ED 100

Critical Care Scenarios

NOVEMBER 15, 2020

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. .* Goals of care starts in the ED, and not with lip service. Emergency staff have limited bandwidth. .* Emergency staff have limited bandwidth.

ICU 100

ICU Life Support Emergency Department ED 100

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

EMDocs

JUNE 22, 2024

A) Amniotic fluid embolism B) Eclampsia C) Placental abruption D) Pulmonary embolism Answer: A Amniotic fluid embolism (AFE) is a rare but potentially fatal complication of pregnancy. AFE should be considered in a patient who experiences cardiorespiratory collapse during labor or shortly thereafter.

EMS 110

EMS FFP Ambulance ICU 110

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

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

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