EMDocs

JANUARY 11, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association (AHA) and Neurocritical Care Society (NCS) released their 2023 Scientific Statement on the critical care management of post ROSC patients. Neurocrit Care. 2023 Dec 1. Treat seizures if present.

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REBEL EM

OCTOBER 5, 2023

1-6 We now have the Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial. Patients enrolled from 31 Intensive Care Units in France. Patients admitted to the ICU with severe community-acquired pneumonia were randomized in a 1:1 ratio to receive hydrocortisone or a placebo.

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ACEP Now

DECEMBER 7, 2024

1 A wide spectrum of severity exists in PE presentations, ranging from mild shortness of breath to cardiac arrest. In addition to the reduced risk for major bleeding, use of mechanical thrombectomy techniques has been shown to decrease hospital costs by reducing the need for post-procedural critical care following intervention.

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Pediatric EM Morsels

NOVEMBER 17, 2023

Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. Cuffed endotracheal tubes in pediatric intensive care. 1994 Jul;125(1):57-62. 2019 Sep;74(9):1186-1190. 2016 Feb;30(1):3-11. Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments.

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Don't Forget the Bubbles

NOVEMBER 22, 2023

Of these signs, mortality in children is associated with hepatomegaly and fever; meanwhile, mortality in adults is associated with hyperkalaemia, traumatic brain injury, propofol infusion rates >5mg kg -1 h -1 and ECG changes. 1998;8(6):491-9. Critical care (London, England). Why does PRIS occur? Folino, T.B.

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Don't Forget the Bubbles

JUNE 17, 2024

The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. However, education and training for healthcare professionals traditionally prioritise ‘hard skills’, particularly critical care resuscitation. Here are ten things to think about: 1.

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REBEL EM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 5 Onset of VAP has been repeatedly shown to increase the number of ventilator days, intensive care length of stay, use of antimicrobials, medical costs, and mortality risk. 4, 8 Paper: Dahyot-Fizelier, C.,

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REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis [published online ahead of print, 2023 Aug 9]. References: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM.

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Broome Docs

MAY 31, 2024

Freund Y, Viglino D, Cachanado M, Cassard C, Montassier E, Douay B, Guenezan J, Le Borgne P, Yordanov Y, Severin A, Roussel M, Daniel M, Marteau A, Peschanski N, Teissandier D, Macrez R, Morere J, Chouihed T, Roux D, Adnet F, Bloom B, Chauvin A, Simon T. PMID: 37019501 Pulmonary primatology is harder than you may think Drew T, Võ ML, Wolfe JM.

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Don't Forget the Bubbles

JUNE 30, 2023

E – Temp 37.2 Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7% J Trauma Acute Care Surg. 2013 Mar;17(10):1-79. in the TXA group vs 53.7%

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FOAMfrat

APRIL 22, 2024

This kid had sticks go through his cheek from running with a lollipop, hit by a car, almost kidnapped, attacked by a dog, and almost burnt his house down by throwing a 9-volt battery in the trash. Prehosp Emerg Care. 2024 Mar 15:1-9. Robichaud L, Ross D, Proulx MH, Légaré S, Vacon C, Xue X, Segal E.

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Don't Forget the Bubbles

FEBRUARY 26, 2024

About PICSTAR PICSTAR is a trainee-led research network open to all doctors, nurses and allied health trainees within Paediatric Intensive Care. We are the trainee arm of the Paediatric Critical Care Society – Study Group (PCCS-SG) and work with them on research, audit and service evaluation. 2007 Jan 1;25(1):6-9.

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REBEL EM

AUGUST 21, 2023

Figure 2 : Extended Glasgow Outcome Scale (GOS-E) (credit: Doc_HG ) Secondary Modified Rankin Score Secondary outcomes included death within 6 months. Monitoring cerebral pressures is crucial in assessing the impact of interventions, especially in critical care scenarios.

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Don't Forget the Bubbles

AUGUST 28, 2023

The median age at diagnosis was 47 months (range 1-173 months). About PICSTAR PICSTAR is a trainee-led research network open to all doctors, nurses and allied health trainees within Paediatric Intensive Care. 2014;9(9):S102-S109. 2019;43(1):98-103.doi:10.1097/RCT.0000000000000782 2019;19(1):2126.doi:10.1016/j.bjae.2018.10.001

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Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. Clinical Course of Children 1 to 24 Months Old With Positive Urine Cultures Without Pyuria. 2024;24(1):111-118. Giannoni, E., Pediatric Critical Care Medicine , 25 (3), pp.e117-e128. Acad Pediatr. doi:10.1016/j.acap.2023.06.023

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ACEP Now

OCTOBER 11, 2024

1 Pediatric rapid sequence intubation (RSI) in the ED is associated with a higher frequency of failed first attempts and adverse effects than in adult patients. Paralytic agents include rocuronium at 1 mg/kg IV and succinylcholine at 1-2 mg/kg IV. References Long E, Sabato S, Babl FE. mg/kg IV, ketamine at 1.5–2

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Broome Docs

OCTOBER 31, 2022

Intensive Care Med. 2022 Jan;48(1):78-91. 2022 Sep;21(9):781-791. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Preventing radial arterial catheter failure in critical care – Factoring updated clinical strategies and techniques.

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Don't Forget the Bubbles

JANUARY 10, 2024

Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. The study asked TWO questions: 1. Immediate vs delayed transfusion In uncomplicated severe anaemia, immediate blood transfusion did not alter mortality at 1- or six months compared to controls.

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Dr. Smith's ECG Blog

SEPTEMBER 11, 2018

I activated the cath lab and brought her to the critical care area. My comments address a few additional differences between the 3 ECGs that were done in this case — with focus on how to put the subtleties I describe in perspective in view of the overall picture ( Figure-1 ). The presence of artifact should be noted in ECG #1.

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REBEL EM

MAY 8, 2023

Paper: Smith JA, Secombe P, Aromataris E. J Trauma Acute Care Surg. Only 1 RCT and 1 cohort study had only mechanically ventilated patients. References: Smith JA, Secombe P, Aromataris E. J Trauma Acute Care Surg. The pendulum is swinging towards conservative management for occult pneumothoraces.

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NAEMSP

APRIL 19, 2023

This CI does include 1; and further and further analysis of the data showed that the likelihood that calcium has a beneficial effect (e.g. The overall conclusion was that as less than 1% of cardiac arrest etiologies fall into a group that would potentially benefit from calcium, that routine use should be avoided (Padrao, et.

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Paramedic Training Spot

DECEMBER 8, 2021

Basic Combat Training Basic Combat Training , or BCT, is approximately 10 weeks and will take place at 1 of the 4 locations available. In more than 40 after-action reports, or AARs, from actual combat situations, the key issue with treating critically ill or severely injured casualties was lack of flight paramedics.

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ECG & Echo Learning

OCTOBER 2, 2022

Most agents exhibit both vasopressor and inotropic effects (Figure 1). Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). Careful electrocardiographic and hemodynamic monitoring with ECG , central vein catheter and intra-arterial catheter (A-line) is warranted.

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Dr. Smith's ECG Blog

MAY 5, 2022

It is critically important for all EM and critical care providers to have an intimate understanding of hyperkalemia and its ECG findings. The 2 Questions that I would ask would be: Question #1: In the absence of any history — What are the major diagnose s suggested by the ECG in Figure-1 ? What is it?

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AAEM RSA

AUGUST 27, 2020

Interventions during the acute phase of treatment post return of spontaneous circulation (ROSC) are therefore critical. 1 The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC.

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FOAMfrat

JULY 1, 2023

In fact, Herbstritt 2012, identified that there was "no significant difference to time to intubate, intubating conditions, or intubating success rate when using 1 to 1.2 mg/kg Rocuronium versus 1 to 1.5 mg/kg Rocuronium versus 1 to 1.5 Updated 2021 Oct 1]. Crit Care Med. Updated 2021 May 9]. Ann Emerg Med.

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Dr. Smith's ECG Blog

JULY 12, 2020

While calling for some help and arranging to have her transported to our critical care zone, I got this quick ultrasound which confirmed my suspicion: This quick view was all I was able to obtain in the circumstances. Figure-1: The 1st, 3rd, 4th, 5th and 6th ECGs shown above in this case ( See Text ). mm STE depression in aVL.

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EMDocs

FEBRUARY 12, 2024

Introduction Arterial blood gas (ABG) or venous blood gas (VBG) testing is used to assess the pH and systemic carbon dioxide tension in patients, and, therefore, provide a more complete picture of their acid-base status than an isolated basic metabolic panel (BMP) (1). However, ABGs have many drawbacks compared to VBGs.

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EMDocs

JANUARY 4, 2024

1 In addition to intentional overdoses, there are multiple case studies of abuse (ingestion, insufflation, injection). QRS > 100 msec can give sodium bicarbonate 1-2 mEq/kg IV boluses. 9-12 Do not use this prophylactically in bupropion overdoses. 2014;52(9):969-72. Critical Care Toxicology. Eds (2017).

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EMDocs

OCTOBER 7, 2023

1-3 Common causes: Natural disasters such as tornadoes or earthquakes 4,5 Structure or building collapses from home fires or bombings. Critical Care. 2016;20(1):135. Stahl K, Rastelli E, Schoser B. 2012;27 Suppl 1:i1-67. Critical Care. Genthon A, Wilcox SR. J Emerg Med. 2014;46(2):313-319.

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EMDocs

MAY 29, 2023

ESR and CRP are acute-phase reactants with concentrations that change in response to inflammation both acutely and chronically (1). ESR measures the rate at which red blood cells settle in a test tube, a factor of the concentration of fibrinogen in the blood, which increases during inflammation (1). References (1) Tennant F.

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ACEP Now

NOVEMBER 7, 2023

1 Overall, survival is poor following cardiac arrest, and is affected by factors including age, comorbidities, witnessed arrest, early CPR, early defibrillation, and return of spontaneous circulation (ROSC). 2018;13(9):e0204169. Margey R, Browne L, Murphy E, et al. Cortez E, Krebs W, Davis J, et al. Resuscitation.

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AAEM RSA

SEPTEMBER 17, 2020

Keh D, Trips E, Marx G, et al. 2017;318(13):1241-9. Crit Care Med. 2013;369(9):840-51. Critical Care. 2018;22(1): 283. The goal and achieved mean arterial pressures (MAPs) were not provided; these could affect vasopressor use. 2016:316(17);1775-85. Hatfield K, Dantes R, Baggs J, et al. New Engl J Med.

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EMDocs

JUNE 27, 2024

Abdomen : ND, NT, no guarding or rebound MSK : Tenderness to palpation over L ribs 7-9 Derm : No rashes Imaging: Image 1: Case courtesy of Miriam Leiderer, Radiopaedia.org, rID: 81468 Chest radiograph (CXR) shows new left lower lobe opacity What’s most likely diagnosis? 2022 Jul 5;328(1):57-68. 2020 Feb 12;10(1):2470.

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REBEL EM

NOVEMBER 11, 2024

found no difference in mortality in critical care patients treated with vancomycin and piperacillin- tazobactam compared to vancomycin and cefepime or meropenem. What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018.

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Don't Forget the Bubbles

DECEMBER 6, 2023

Their analyses revealed an association between social media use and e-cigarette and tobacco use. Rodríguez-Gutiérrez E et al. Venturini E, et al.Eur J Pediatr. 2023 Nov 1:e2023063289. 2023 Nov 9:e2023063113. López-Fernández E, et al. Durá-Travé T, Gallinas-Victoriano F. Eur J Pediatr. 2023 Nov 15.

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Don't Forget the Bubbles

AUGUST 13, 2023

There is a 1:3 or 30% risk of recurrence of the febrile convulsions and occur within 2 years of the first episode. There is a very low risk of developing epilepsy following febrile convulsions (approximately 2% following simple seizures and 5% following complex seizures as compared to 1% in the general population).

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