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Aaron Skolnik is an Assistant Professor of Emergency Medicine at the Mayo Clinic Alix School of Medicine and Consultant in the Department of CriticalCare Medicine at Mayo Clinic Arizona. He is board certified in Emergency Medicine, Medical Toxicology, Addiction Medicine, Internal Medicine-CriticalCare, and Neurocritical Care.
We’ll keep it short, while you keep that EM brain sharp. According to EMS, she was in labor at home and delivered the newborn shortly after they had loaded her into the ambulance. Treatment is supportive with respiratory therapy, criticalcare, inotropic therapy, and cardiac life support. link] j.ajog.2016.03.012
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? Patients enrolled from 31 Intensive Care Units in France. ICU-acquired infections were observed in: 9.8%
Aaron Skolnik is an Assistant Professor of Emergency Medicine at the Mayo Clinic Alix School of Medicine and Consultant in the Department of CriticalCare Medicine at Mayo Clinic Arizona. Case: A 66-year-old woman is brought in by EMS from home with lethargy and hypotension. Reference: Zampieri et al.
Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU. With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog.
Welcome back to the tasty morsels of criticalcare podcast. As an EM trainee doing intensive care I will confess that I struggle to work up the enthusiasm to cover a nutrition guideline. Read More » Welcome back to the tasty morsels of criticalcare podcast. As with all ICU nutrition EN is preferred over PN.
Welcome back to the tasty morsels of criticalcare podcast. Read More » Welcome back to the tasty morsels of criticalcare podcast. After 2 years of frequent, if not daily use of the bronch, I find it hard to see how I would manage in an ICU without it. Why might we pull out the bronch in the ICU?
Welcome back to the tasty morsels of criticalcare podcast. I have previously covered this on the old tasty morsels of EM series back when i was doing my EM fellowship exams. The classic EM example is the whole family who present with flu symptoms and no fever and even the dog is sick. How does it make people sick?
Salim is also the creator and founder of REBEL EM and REBEL Cast, a free, critical appraisal blog and podcast that try to cut down knowledge translation gaps of research to bedside clinical practice. She is admitted to the intensive care unit (ICU) for septic shock. Reference: Lamontagne F et al.
Esophageal Balloon Tamponade Devices – Linton-Nachlas, Sengstaken-Blakemore, Minnesota Tubes (image courtesy of Dr. Mark Ramzy at REBEL EM) What are esophageal balloon tamponade devices? It is time to MacGyver a method that allows you to know the esophageal balloon pressure that you are generating to avoid an esophageal rupture.
Welcome back to the tasty morsels of criticalcare podcast. Given that a lot of ICU bed days are given over to managing SAH, I felt it might have warranted its own chapter. Though i’ll admit that that question is delving much more into the realm of EM than hard core crit care.
Welcome back to the tasty morsels of criticalcare podcast. Today we’ll cover some key exam content, all be it not something you’re likely to run into in the ICU too often. Your ICU probably has it and you’ve typically only seen it as part of management of a potential organ donor in brain death.
Accuracy of Noninvasive Blood Pressure Monitoring in Critically Ill Adults. J Intensive Care Med 2024. 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? to 1.12; p = 0.03
Welcome back to the tasty morsels of criticalcare podcast. Read More » Welcome back to the tasty morsels of criticalcare podcast. I am guilty of over teaching this myself having delivered not one , but 2 talks on the subject, and even a prior tasty morsel of EM on the subject. Today we’re looking at asthma.
Welcome back to the tasty morsels of criticalcare podcast. DKA is bread and butter for criticalcare providers. Read More » Welcome back to the tasty morsels of criticalcare podcast. DKA is bread and butter for criticalcare providers.
Welcome back to the tasty morsels of criticalcare podcast. Read More » Welcome back to the tasty morsels of criticalcare podcast. References: Oh’s Manual Chapter 47 Tasty Morsels of EM 116 It covers Oh’s Manual Chapter 47 looking.
Pursuing an emergency medicine residency affords a fast-paced, often unpredictable environment with a diversity of patients unique to the specialty, while the life of an internist involves rounding, longitudinal patient care, and long contemplative sessions pertaining to pathophysiology and diagnosis. Martinez J.
Welcome back to the tasty morsels of criticalcare podcast. Read More » Welcome back to the tasty morsels of criticalcare podcast. Oh is quite pro IV infusions and certainly in the ICU and OT this is ubiquitous and generally well done in my experience. Today we look at anaphylaxis. Today we look at anaphylaxis.
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. The low incidence could be a result of the systematic implementation of bundles known to decrease VAP incidence in the ICU. 4, 8 Paper: Dahyot-Fizelier, C.,
The knowledge contained will hopefully be sufficient to allow you to not look completely clueless on the ICU round when the topic of PR3+ve ANCA vasculitis comes up. As such this hopefully will occupy the niche of “exam prep/board review” in the already somewhat crowded criticalcare podcast scene.
” is always, ultimately, the main question of the EM provider. ICU time and ED time are different. In the ICU, we have a useful (albeit sometimes flexible) cap: our total number of beds.* This differs from the main questions of many of their consulting and admitting specialties.*
His daughter immediately started CPR and another family member called EMS. When EMS arrived the patient was in ventricular fibrillation. Given the presentation, the cardiologist stented the vessel and the patient returned to the ICU for ongoing criticalcare. Two subsequent troponins were down trending.
In response to this critical issue, the TAME Cardiac Arrest Trial has been launched as a definitive phase III multi-center randomized controlled trial for resuscitated cardiac arrest patients. Monitoring cerebral pressures is crucial in assessing the impact of interventions, especially in criticalcare scenarios.
Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!
2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. The result of this ED capacity strain and less than ideal patient to staff ratios has led to delays in interventions, treatments and care adjustments. J Crit Care. Paper: Owyang CG, et al.
Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. 4 studies remained, with a total of 571 patients with sepsis and a history of CHF Critical Result: The weighted OR for death was significantly higher in the <30 × 3 vs. 30 × 3 OR = 1.81, 95% CI = 1.13–2.89, 2.89, p = 0.01.
Boswell (EM and CCM) of the University of Maryland, perhaps the busiest center in the country for COVID-related ECMO. Boswell (EM and CCM) of the University of Maryland, perhaps the busiest center in the country for COVID-related ECMO. An overview of VV ECMO with a focus on COVID-19, with Dr. Kimberly A. Data remains slim,
The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Intensive Care Med. Rezaie, MD (Twitter: @srrezaie ) The post The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults appeared first on REBEL EM - Emergency Medicine Blog. J Med Toxicol. Am J Emerg Med.
Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch. 2009;338:b2085.
Ketamine vs etomidate in ICU intubation ? PMID: 34904190 Not surprisingly, this paper has been covered by basically everyone who talks about research, so if you want to hear some other opinions, check out the SGEM , REBEL EM , or St. Anaesth Crit Care Pain Med. Tips for radial artery art lines Imbrìaco G, Monesi A, Spencer TR.
35-year-old man presents by EMS with seizures. He has been seizing for 30 minutes, despite treatment of intravenous lorazepam by EMS. 4 With the increasing utilization of EEG, especially continuous EEG, nonconvulsive seizures have been increasingly recognized and diagnosed as a cause of altered mental status in critically ill patients.
You contact ICU, anaesthetics, ENT, and oncology with a plan to attempt more definitive imaging in the prone position (which Ginny tells you is much comfier) What’s the evidence for our emergent management? See their website for more: [link] References Carter BW, Marom EM, Detterbeck FC. A CXR demonstrates a mediastinal mass.
Recent studies on patients requiring criticalcare have demonstrated that hyperoxia is harmful and instead we should be targeting normoxia (SpO2>93%). Background: Hypoxemia and hypoperfusion are important factors in outcomes after ROSC. Liberal O2 (PaO2 13 to 14kPa (98 to 105mmHg) Initial FiO2 set at 0.6 Liberal O2: 33.9%
2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). This could have biased the results in favor of amiodarone as we’ve covered this before on REBEL EM before The IV amiodarone group required less additional HR control agents to control increased heart rate.
For More on This Topic Checkout: CorePendium: Pancreatic Disease Internet Book of CriticalCare: Acute Pancreatitis EMCrit: Ep333 – The State of Fluids Show with the EMCrit Core Team The Bottom Line: Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis References: de-Madaria E et al. cc/kg/hour.
PrePARE Investigators; Pragmatic CriticalCare Research Group. Effect of Fluid Bolus on Cardiovascular Collapse Among Critically Ill Adults Undergoing Tracheal Intubation (PrePARE): A Randomised Controlled Trial. appeared first on REBEL EM - Emergency Medicine Blog. No Bolus: 18.2% Absolute difference 2.8%; 95% CI -2.2%
appeared first on REBEL EM - Emergency Medicine Blog. 2,230 records remained after the elimination of duplicates. 2,210 records were excluded after screening.
EMS verbalized concern to EPs that an “intracranial bleed” may have precipitated the event. Marino’s the ICU book, Wolters Kluwer Health, pgs 105-109, 4th ed., CriticalCare Emergency Medicine, McGraw-Hill, pgs 129-132, 2nd ed., Tintinalli, J.E.
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. EMS arrived and found him awake and alert. The QRS is narrow and T waves are much less peaked.
We’ll keep it short, while you keep that EM brain sharp. A 17-year-old girl, in moderate distress, is brought in by EMS after a motor vehicle collision. EMS reports that she was “pinned” underneath the dashboard, and it took several hours to extricate her. CriticalCare. CriticalCare. 2016;20(1):135.
Background: The ongoing debate between video laryngoscopy (VL) and direct laryngoscopy (DL) has ignited intense debate within the emergency medicine and criticalcare communities. An emergency medicine resident or criticalcare fellow performed 91.5% 1420 patients were enrolled. of intubations.
Authors: Rachel Kelly, MD ( EM Resident Physician, Stony Brook University Hospital); Robert Nocito, MD (EM Attending Physician, Stony Brook University Hospital) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St.
CriticalCare Medicine 41(12):p A191, December 2013. Sundd P, Gladwin MT, Novelli EM. May substitute levofloxacin if allergic to cephalosporin Anti-viral medications if indicated Oseltamivir for influenza Patients >14 days old Remdesivir for COVID Patients >28 days old and at least 7lbs (3.2 2020 Feb 12;10(1):2470.
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