Emergency Medicine Ireland

MAY 27, 2024

Vasopressin has some animal data suggesting it causes less rise in PVR than our beloved noradrenaline but take that with an appropriately loosely defined portion of salt given that animal data is not ICU patients. Atrial fibrillation is something of a right of passage in the ICU. In terms of monitoring should we be reaching for a PAC?

Critical Care 52

Critical Care ICU OR ALS 52

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

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 176

Emergency Department ALS ICU OR 176

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

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.

Critical Care 132

Critical Care ICU ALS Emergency Department 132

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 80

ICU CAD ALS OR 80

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 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

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 83

E-9-1-1 ICU ALS OR 83

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

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. Do you still suggest emergency medicine to your students? Don’t stress, just give the PPI and carry on.

E-9-1-1 109

E-9-1-1 Emergency Department ICU ALS 109

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.

Life Support 67

Life Support ICU EMS OR 67

ACEP Now

JULY 7, 2024

Should emergency physicians rely on standard textbooks for diagnostic and treatment regimens? Or should recent literature guide diagnosis and management? Status epilepticus has previously been defined as seizure(s) greater than or equal to 30 minutes in which the patient does not regain normal mental status between seizures.

Emergency Department 52

Emergency Department Critical Care ALS ED 52

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 96

EMS Ambulance FFP ICU 96

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. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022 Sep 15;387(11):989-1000. to 9.8L) Moderate: 5.5L (Range 4.0

E-9-1-1 66

E-9-1-1 ICU ALS OR 66

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

Don't Forget the Bubbles

AUGUST 23, 2023

Kapoor et al. 2018) “Sacred Pause Imitative in the ICU: A survey of ICU physicians and nurses”. Oppressive quietness heavy with professionals’ suppressed emotions mixed with raw parental grief. That piercing parental cry rips through the room. Our bodies primed for the fight. Or exhausted from it. Some feel a nothingness.

Emergency Department 98

Emergency Department ICU ALS Critical Care 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 Emergency Department ED 100

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

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

EMDocs

JUNE 27, 2024

Left lower lung field end demonstrates expiratory wheezing on auscultation. Other lung fields unremarkable. smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02 mg/kg, max 0.4 C or 100.4

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

Dr. Smith's ECG Blog

JUNE 17, 2024

The patient was upgraded to the ICU for closer monitoring. In fact, Kosuge et al. Stein et al. Stein et al. This is a paper worth reading : Marchik et al. Kosuge et al. Witting et al. This does not contradict the conclusions of Kosuge et al. inverted T-waves in V1 and V2, 1.8; of controls.

E-9-1-1 139

E-9-1-1 ACS Emergency Department ALS 139

REBEL EM

AUGUST 21, 2023

This trial aimed to assess whether targeted therapeutic mild hypercapnia (TTMH) applied during the initial 24 hours of mechanical ventilation in the ICU can enhance neurological outcomes at the 6-month mark, as compared to standard care, which involves targeted normocapnia (TN). Paper: Eastwood G, et al. N Engl J Med. Epub 2023 Jun 15.

Critical Care 97

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

Pediatric EM Morsels

MARCH 17, 2023

Since we all inhabit the same beautiful world , and sometimes we humans overtake previous habitats of animals, we inevitably will cross paths with an animal that bites us. Usually, animals bite from fear or defense of their offspring ( ex, Brown Recluse ). Sometimes it’s a beloved pet who gets surprised or has an “off” day ( Dog Bites and PTSD ).

Frozen Plasma 130

Frozen Plasma First Aid Plasma OR 130

REBEL EM

SEPTEMBER 14, 2023

Zeymer HT et al. The benefits of this strategy may be outweighed by the risk of the device-related complications (i.e. bleeding, stroke, limb ischemia, and hemolysis). The evidence for this practice has been sparse until now. Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. Control: 53.4% D ECLS: 18.2% Control 8.7%

Life Support 133

Life Support Coronary CPR ALS 133

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

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

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

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% No large, randomized study has yet determined the noninferiority of omitting prophylactic platelet transfusions in thrombocytopenic patients undergoing CVC placement. N Engl J Med.

ICU 55

ICU ALS OR EMS 55

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

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Date: September 20th, 2021 Reference: Litell et al. Date: September 20th, 2021 Reference: Litell et al. It is the leading cause of death in the intensive care unit (ICU) in the US and the most expensive diagnosis. Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge.

Emergency Department 100

Emergency Department EMR ICU ALS 100

REBEL EM

SEPTEMBER 5, 2022

Paper 1: Schmidt HJ et al. PMID: 360027567 [ Access on Read by QxMD ] Paper 2: Kjaergaard J et al. A higher MAP may offer advantages due to improved cerebral perfusion pressure, however data is lacking. Oxygen Targets in Comatose Survivors of Cardiac Arrest. Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest.

ICU 52

ICU ALS OR CPR 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 134

ICU OR ALS ED 134

EMDocs

SEPTEMBER 6, 2023

Removed from cooling at 102 and admitted to ICU. 2016 study published in American Journal of Emergency Medicine , “ Urinary obstruction is an important complicating factor in patients with septic shock due to urinary infection ” by Reyner et al. Cooling blanket placed, but temperature increases to 107F. Temperature starts to decrease.

ACS 71

ACS ICU EMS ALS 71

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. Cardiac surgery is immediately paged for consideration of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) for active rewarming. His point-of-care labs return with a potassium of 3.4

Defibrillator 84

Defibrillator CPR Epinephrine Life Support 84

ACEP Now

DECEMBER 10, 2023

You ultimately begin a slow naloxone infusion and admit him to the medical ICU. References Nowland R, Steeg S, Quinlivan L, et al. Wilson MP, Moutier C, Wolf L, et al. Brody, BD, Meltzer EC, Feldman D, et al. His POLST says comfort measure only (CMO) and we should respect his wishes.” You order IV potassium and magnesium.

Naloxone 52

Naloxone Life Support ALS Paramedic 52