Don't Forget the Bubbles

FEBRUARY 26, 2024

A 6-year-old known asthmatic presents to ED with a two-day history of cough and coryza, worsening wheeze and work of breathing over the last day. About PICSTAR PICSTAR is a trainee-led research network open to all doctors, nurses and allied health trainees within Paediatric Intensive Care. Pediatric Critical Care Medicine.

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E-9-1-1 Critical Care OR ALS 72

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. Eds (2017). Critical Care Toxicology.

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Overdose E-9-1-1 ALS Emergency Department 94

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. Arch Dis Child Fetal Neonatal Ed. Giannoni, E., Pediatric Critical Care Medicine , 25 (3), pp.e117-e128.

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ACEP Now

OCTOBER 11, 2024

Introduction Pediatric intubations in the emergency department (ED) occur at only a tenth the frequency of adult intubations. 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. References Long E, Sabato S, Babl FE.

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Dr. Smith's ECG Blog

SEPTEMBER 11, 2018

The ED was incredibly busy, with 40 patients waiting in triage for beds (all of whom I had already screened), so we put her in a chair in triage. I activated the cath lab and brought her to the critical care area. Figure-1: Comparison of the 3 ECGs in this case ( See text below ). So I was not entirely convinced.

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E-9-1-1 Critical Care ED OR 52

REBEL EM

MAY 8, 2023

Paper: Smith JA, Secombe P, Aromataris E. J Trauma Acute Care Surg. 95% Confidence Interval) Strengths: The study addresses a patient-centered clinical question that is relevant to ED practice. 95% Confidence Interval) Strengths: The study addresses a patient-centered clinical question that is relevant to ED practice.

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E-9-1-1 ICU Critical Care OR 58

Dr. Smith's ECG Blog

MAY 5, 2022

Submitted and written by Destiny Folk MD , peer reviewed by Meyers, Smith, Grauer, McLaren A man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. On arrival in the ED, he was hypotensive with a systolic blood pressure in the 70s. What is it?

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ACEP Now

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. On ED presentation, he is unresponsive and the monitor shows ventricular fibrillation. 2018;13(9):e0204169. Margey R, Browne L, Murphy E, et al. Cortez E, Krebs W, Davis J, et al. Larribau R, Deham H, Niquille M, et al. Resuscitation.

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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. The ED catheter was removed at that point and she did not require any further procedures.

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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 of Succinylcholine during RSI in an ED setting." [1] mg/kg Rocuronium versus 1 to 1.5 Updated 2021 Oct 1].

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EMDocs

FEBRUARY 12, 2024

As the only respiratory therapist in the ED has been paged and is starting BiPAP for this patient, an overhead call for two incoming trauma alerts from a multivehicle collision sounds. Because the RT responsible for drawing arterial blood gases is busy caring for these patients, ABGs will be delayed.

Emergency Department 98

Emergency Department E-9-1-1 ED ICU 98

EMDocs

MAY 29, 2023

Louis); Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case A 54-year-old female with a past medical history of rheumatoid arthritis presents to the emergency department (ED) with generalized fatigue. In the ED her vitals are T 99.6°F, What Are ESR and CRP?

ED 58

ED E-9-1-1 Emergency Department OR 58

EMDocs

JUNE 27, 2024

An 8-year old male with a history of sickle cell anemia presents to the ED for evaluation of fever for 2 days and “feeling like I can’t get a full breath”. 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 2022 Jul 5;328(1):57-68. C or 100.4 mg/kg, max 0.4 C or 100.4

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E-9-1-1 ICU ACS EMS 98

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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E-9-1-1 ICU ALS Critical Care 113

Don't Forget the Bubbles

AUGUST 13, 2023

Febrile seizure is one of the common presentations in the paediatric ED, causing significant parental anxiety (especially following the first episode). Some common misconceptions such as use of antipyretics to prevent febrile convulsions or it leading to epilepsy in future can be prevented by good parental education during ED visit.

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EMDocs

OCTOBER 29, 2024

A 43-year-old male with a history of mitral valve regurgitation s/p valvular replacement, hypertension, hyperlipidemia was evaluated in the ED for septic shock secondary to a pyelonephritis with a renal abscess. Chu CK, Delia E, Mograder A, Dwyer EM. Anaesth Intensive Care. 2017;45(1):12-20. 2015;7(9):E365-E369.

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E-9-1-1 ICU Epinephrine EMS 98

EMDocs

MARCH 18, 2025

Episode 116: Massive Hemoptysis Definition: Hemoptysis is expectoration of blood from the respiratory tract; ranges from mild with small streaks of blood to cardiopulmonary compromise (1-5). Massive hemoptysis: no clear definition, ranges from 50 mL in a single expectoration to 100 mL in 24 hours to over 1 L in 48 hours.

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Don't Forget the Bubbles

MARCH 24, 2025

While no paediatric studies have confirmed this, the DICE trial ( D exmedetomidine in I nfants undergoing C ooling for Neonatal E ncephalopathy) is underway. This makes it a valuable adjunct in multimodal sedation and analgesia strategies, particularly in paediatric critical care and procedural sedation.

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Don't Forget the Bubbles

MARCH 31, 2025

Article 1: Should we rely on WBC to predict serious bacterial infection in children? It was an observational multi-center study including >17,000 febrile children aged 0-18 across 12 European EDs over 1 year. A raised WBC count >1510^9/L count was significantly associated with SBI (aOR of 1.5, 2023 Nov;7(1):e002094.

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E-9-1-1 Emergency Department ICU OR 59

REBEL EM

FEBRUARY 24, 2025

1 They noticed how spontaneously breathing patients had their IVC collapse with inspiration; and ventilated patients had their IVC dilate during positive pressure ventilation. You need not be sad regarding the lack of Swan Ganz catheters in your ED. Crit Care Med. Critical Care Medicine. Mar 2004; PMID: 15090949.

ALS 74

ALS E-9-1-1 Critical Care OR 74

Core EM

JANUARY 16, 2025

While this guide isnt exhaustive, its designed by residents, for residents, to provide practical tips and foundational knowledge thats crucial in the fast-paced, high-stakes environment of the ED. Introduction Airway management is a critical ED skill to master. Just the uvula but not the pillars, class 2.

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