Don't Forget the Bubbles

MAY 29, 2023

A study of teams over a 1-year period highlights that people witnessing incivility are also affected, which could lead to individuals feeling unsupported in their teams. Incivility, whether during a critical case or during day-to-day practice, influences the overall culture of the workplace. link] Isn’t it just ‘part of the job?’

Critical Care 98

Critical Care E-9-1-1 Paramedicine Paramedicine 98

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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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.

Critical Care 94

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

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. In a systematic review of 10 RCTs comparing cuffed vs. uncuffed ETTs. 1.70) and 0.78 (0.46–1.35), vs uncuffed 3.0-4.7%)

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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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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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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

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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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% Pupils are equal and reactive. This is not good. This is not good. This is not good.

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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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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.

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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. As clinicians, we need to be prepared. What causes a mediastinal mass? Don’t ignore them!

Emergency Management 97

Emergency Management Emergency Manager E-9-1-1 Critical Care 97

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. Simulation allows EMS clinicians to train for scenarios they may encounter in the field.

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Don't Forget the Bubbles

FEBRUARY 26, 2024

Add in PEFR <33% and SpO2 <92% Management of acute asthma* * as per BTS guidelines Acute asthma is managed in a stepwise fashion using the following guidelines. Intubation, however, can be a significant challenge in these patients.

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EMDocs

JANUARY 4, 2024

1 In addition to intentional overdoses, there are multiple case studies of abuse (ingestion, insufflation, injection). Background: Bupropion is used increasingly as an antidepressant and is used for weight management, smoking cessation, ADHD and eating disorders. In 2020, bupropion was the 18 th most-prescribed medication in the USA.

Overdose 94

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. 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. Acad Pediatr. doi:10.1016/j.acap.2023.06.023

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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. It’s important we think about ways and means to do this with both population-based and targeted approaches. Which children should receive blood?

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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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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. What is the most appropriate treatment at this time? 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. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Epub 2021 Dec 14.

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REBEL EM

MAY 8, 2023

Paper: Smith JA, Secombe P, Aromataris E. Only 1 RCT and 1 cohort study had only mechanically ventilated patients. Occult pneumothoraces are those not suspected clinically or not evident on plain radiographs but later identified on computerized tomography (CT) imaging. 2,230 records remained after the elimination of duplicates.

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Paramedic Training Spot

DECEMBER 8, 2021

If you’ve been struggling to decide between serving as a Soldier in the United States Army or becoming a paramedic , venture no further; you’ve come to the right place. In this article, we will explore the intersection between the medical profession and military service. Let’s start with defining the subject of our discussion today—the paramedic.

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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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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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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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E-9-1-1 ALS Coronary Epinephrine 52

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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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. 2011;13(8):1157–65.

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Defibrillator E-9-1-1 ALS Epinephrine 52

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 Ask yourself, "Will the pre-existing condition remain following recovery from Succinylcholine?"

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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. She returned to normal within 30 seconds to a minute. She said she had never had any episode like this before.

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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). What alternative testing can be done in these circumstances?

Emergency Department 98

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

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. 6 Motor vehicle collisions that produce significant challenges to passenger extrication. Genthon A, Wilcox SR.

EMS 98

EMS E-9-1-1 Emergency Department ALS 98

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). What Are ESR and CRP?

ED 58

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

AAEM RSA

SEPTEMBER 17, 2020

This retrospective before-and-after study was conducted at a single-center tertiary care referral hospital in the U.S. Patients were excluded if pregnant or had limitations of care. Keh D, Trips E, Marx G, et al. The treatment group received hydrocortisone 50mg every 6 hours for 7 days, IV vitamin C 1.5g 2016:316(17);1775-85.

ICU 52

ICU E-9-1-1 ALS OR 52

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? Other lung fields unremarkable. C or 100.4 mg/kg, max 0.4

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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. found no difference in mortality in critical care patients treated with vancomycin and piperacillin- tazobactam compared to vancomycin and cefepime or meropenem.

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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. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research. Prevention is often a very economical but potent form of medicine.

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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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