EMDocs

SEPTEMBER 7, 2024

A 70-year-old female with a past medical history of hypertension, coronary artery disease s/p 2x drug eluting stent placement one month ago, atrial fibrillation on apixaban presents to the ED with weakness and lightheadedness. A 25-year-old man presents to the ED via EMS after he sustained a gunshot wound to the left flank.

EMS 98

EMS E-9-1-1 Operating Room OR 98

REBEL EM

JUNE 8, 2023

This study chose a relevant topic to analyze that could influence acute management in the ED and has a fairly larger sample size of patients to do so. The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. J Med Toxicol. Epub 2019 Jul 3. PMID: 31270748 Maheshwari K, et al. Am J Emerg Med.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

REBEL EM

MARCH 27, 2023

Background Information: Obtaining definitive control of the airway, when indicated, is the responsibility of the emergency medicine physician. 2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. Paper: Owyang CG, et al. J Crit Care.

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

Core EM

OCTOBER 2, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% In: Marx J, ed. In: Wolfson A, ed.

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

Dr. Smith's ECG Blog

OCTOBER 23, 2023

On arrival to the ED the patient was intubated with normal vital signs. She was admitted to the ICU where subsequent ECGs were performed: ECG at 12 hours QTc prolongation, resolution of T wave alternans ECG at 24 hours Sinus tachycardia with normalized QTc interval. No ischemic ST changes.

ICU 130

ICU OR Defibrillator EMS 130

Dr. Smith's ECG Blog

JANUARY 9, 2024

However , this patient is having chest discomfort, and by definition then she should be considered not to be stable. The pacing rate was increased without clinical improvement and the patient was transferred to the ICU for closer monitoring/treatment. This patient presented to the ED “after a couple of days of chest discomfort”.

Coronary 118

Coronary ACS ED OR 118

Don't Forget the Bubbles

AUGUST 28, 2023

A biopsy is often ultimately required for a definitive diagnosis. 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? Arch Dis Child Educ Pract Ed. RadioGraphics.

Emergency Management 97

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

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. The team sits down for a hot debrief once the patient is stabilised and transferred to the ICU. The junior staff member remains silent throughout the debrief and does not attend their shift the following day.

E-9-1-1 105

E-9-1-1 Critical Care CPR ICU 105

Emergency Medicine Ireland

OCTOBER 28, 2020

TTP is a lovely ICU diagnosis. TTP is a lovely ICU diagnosis. Not so much for the patient but it’s one of those ones that is niche enough to not have been picked up via the usual filters of ED, medical team to the ward. There is a definitely a chance to shine and make the diagnosis.

Critical Care 40

Critical Care Plasma FFP ICU 40

REBEL EM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). 2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU).

Emergency Department 52

Emergency Department ALS Critical Care ED 52

REBEL EM

JANUARY 25, 2023

3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 A normal lactate does not rule out the diagnosis Plain X-rays perform poorly in making or ruling out the diagnosis. Louis, Mosby, Inc., 2010, (Ch) 92: p 1216-1227.

ED 52

ED ALS OR ICU 52

ACEP Now

MAY 4, 2023

A 58-year-old male with a history of alcohol abuse presented to the emergency department (ED) as a category 2 trauma for a fall with a reported flail chest. Case FIGURE 1: Chest X-ray of multiple rib fractures (arrows). Click to enlarge.) The patient had been drinking with friends when he was witnessed to trip and fall a distance of one step.

EMS 52

EMS Operating Room ICU Emergency Department 52

Dr. Smith's ECG Blog

JULY 22, 2012

Course : A CT of the head, neck, chest, abdomen and pelvis showed no other unanticipated injuries and she was admitted to the ICU. In the ED, ultrasound showed hemopericardium with tamponade. An ED thoracotomy was done and the pericardium drained and internal compressions continued.

Coronary 52

Coronary ICU OR ED 52

AAEM RSA

APRIL 8, 2021

Gibney, MD Originally published: Common Sense March/April 2021 It definitely felt different this new year. I’m pretty sure she was downsized in April because of me and a letter she wrote about her concerns, especially since I would be on the COVID ICU and her coworkers had multiple comorbidities that made them high risk.

ICU 52

ICU EMR OR ED 52

Dr. Smith's ECG Blog

JANUARY 6, 2023

The patient vomited once and given the more intense pain decided to come to the ED. 2-hour hsTn: 615 ng/L; bedside ED echo (without contrast) did not show a clear wall motion abnormality (WMA). Tonight’s episode did not improve with simethicone and Tums as it had previously. No history of GIB, dysuria, or GU symptoms. Abstract 556.

ACS 52

ACS Coronary ICU STEMI 52

Dr. Smith's ECG Blog

JULY 12, 2020

More specific information such as definitive RV diastolic collapse was not indicated or available at this time given the obvious clinical context. We obtained access and monitoring, but she showed no signs of improvement, and we judged that an intervention must be done in the ED without delay. She was discharged home in good condition.

E-9-1-1 40

E-9-1-1 ED STEMI OR 40

Dr. Smith's ECG Blog

MARCH 11, 2019

The patient was managed in the ICU and had serial troponins. Figure-1: The first 2 ECGs shown in this case ( See text ). == C OMMENT : As per Dr. Smith — E CG # 1 was the initial tracing on this patient who presented to the ED already intubated for respiratory failure. It is not yet available, but this is your way to get on the list.

OR 52

OR ACS ICU STEMI 52

EMDocs

FEBRUARY 26, 2024

The ED clinician should inquire about a relevant history of HIV infection, malignancy, high-dose corticosteroid use, chemotherapy, organ transplant, or use of immunosuppressive drugs for other indications. She reports occasional central chest pain exacerbated by coughing. Int J STD AIDS. 2019;30(2):188-193. Am J Emerg Med. 2013;31(2):401-405.

E-9-1-1 111

E-9-1-1 ED ALS OR 111

REBEL EM

FEBRUARY 15, 2024

Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications. References: Freund Y et al.

ICU 141

ICU ALS ED OR 141

EMDocs

SEPTEMBER 25, 2023

Also known as Facilitated intubation (FI), the use of intubating with only a sedative was an accepted alternative intubation technique prior to those definitive studies in the late 1990s but quickly was abandoned for RSI in all emergent endotracheal intubations (ETI) (8,9). To date, ketamine has been the agent of choice (12).

ED 92

ED Emergency Department ALS Paramedic 92

EMDocs

OCTOBER 19, 2024

2][3] Definitive diagnosis is made by laryngoscopy or bronchoscopy showing normal or mildly erythematous epiglottis and an erythematous, edematous trachea with thick mucopurulent exudates. [3] Labs and x-ray can be nonspecific, and definitive diagnosis is made with direct visualization. ampicillin-sulbactam).

EMS 111

EMS E-9-1-1 Epinephrine OR 111

REBEL EM

AUGUST 14, 2023

They consecutively enrolled 1,817 ICU patients from 45 sites across China. Population: Inclusion Criteria: Age 18-75 years old SOFA score 2-13 Admitted to the ICU with a diagnosis of sepsis 3.0, “ Life-threatening organ dysfunction caused by a dysregulated host response to infection.” 002) ICU-free days: Placebo 12.4%

ICU 98

ICU EMS OR ALS 98

EMDocs

JUNE 3, 2023

A 53-year-old female with a past medical history significant for hypertension presents to the ED with headache and dizziness. Definitive diagnosis of cerebellar infarction is made with MRI of the brain, as CT imaging (both non-contrast and IV contrast) is often unremarkable and has poor sensitivity for cerebellar stroke.

EMS 97

EMS ALS OR ED 97

EMS 12-Lead

MAY 8, 2022

They are definitely high in amplitude and, intermittently, appear to disproportionately tower over the respective QRS. This is critical for the EMS provider, or ED clinician, as identification of Grade I ischemia (aka, HATW’s) addresses the culprit lesion at the earliest opportunity with excellent downstream prognosis for the patient. [2]

STEMI 130

STEMI ED EMS Firefighter 130

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. Very rarely are the ED team allowed to stand, in silence, with a purpose. 2018) “Sacred Pause Imitative in the ICU: A survey of ICU physicians and nurses”. This gives rise to feelings of failure alongside the feelings of grief.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

Don't Forget the Bubbles

JUNE 30, 2023

All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. The ODP is caught up leaving theatres and has not yet made it down to ED. They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

ACEP Now

NOVEMBER 14, 2023

One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. The definition of massive hemoptysis is variable across publications with expectorated blood volumes ranging from 100 to 1,000 mL per 24 hours, as these volumes are difficult to estimate for any given patient.

E-9-1-1 52

E-9-1-1 ALS Emergency Department OR 52

Don't Forget the Bubbles

MAY 3, 2023

This single-centre academic urban institution in the United States (US) undertook a 10-year retrospective observational study of paediatric intubation and bougie use in their emergency department (ED). During a 6-month period, paediatric patients (< 18 years old) who underwent tracheal intubation in their ED were included in the study.

CPR 52

CPR Emergency Department ALS ICU 52

ACEP Now

MAY 9, 2024

It has been well over a year since the controversial publication of the Agency for Healthcare Research and Quality (AHRQ) report on diagnostic errors in the emergency department (ED). percent of ED visits resulted in preventable death as result of diagnostic error. Further diagnostic testing in the ICU identified salicylate toxicity.

Emergency Department 52

Emergency Department ICU ALS ACS 52

Don't Forget the Bubbles

OCTOBER 19, 2023

Babie Junior, or Bee for short, was the definition of a cute, delightful baby. You, however, are working an ED shift, and when you see the name “Barbie Junior” on your computer screen, your heart does a flutter. It can be in started in the ED, and many of us are already using it. What were Barbie and Ken to do?

E-9-1-1 81

E-9-1-1 ED OR Emergency Department 81

Dr. Smith's ECG Blog

JULY 24, 2018

Upon arrival in the ICU, before getting Continuous Veno-Venous Hemodialysis (CVVHD), his potassium had risen again to 7.8 Of course this must be followed immediately with definitive therapies and potassium source control if possible. Bottom Line: Hyperkalemia is an increasingly common ED diagnosis that must not be missed.

Epinephrine 52

Epinephrine ICU Coronary EMS 52

ACEP Now

MAY 9, 2024

JHS’ chart review project, which identified 163 patients presenting to the ED with gluteal AFT complications in a 30-month period between 2020 and 2023, provides one of the most comprehensive and informative datasets on the breadth of AFT complications as they are currently being performed. units per patient.

Emergency Department 52

Emergency Department Operating Room Critical Care ICU 52

Dr. Smith's ECG Blog

MARCH 6, 2019

She was asymptomatic at the time of this ECG recorded on arrival to our ED: What do you think? Lead I has a definitively hyperacute T-wave without STE. Clearly, if repeat ECG showed more diffuse, increased ST elevation — a definitive diagnosis of a STEMI would more easily be made. V2 still has STE and hyperacute T-waves.

STEMI 52

STEMI ALS ACS OR 52

AAEM RSA

APRIL 1, 2021

The authors excluded those with devastating injuries (expected to die within one hour of admission), need for thoracotomy prior to receiving blood products, significant burns (>20% total body surface area), inhalation injuries, or receiving over five minutes of cardiopulmonary resuscitation prior to arrival or in the ED.

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

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.

E-9-1-1 52

E-9-1-1 OR STEMI ED 52

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. proning patients, ECMO) (12).

Emergency Department 98

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

EMDocs

JANUARY 6, 2024

A 64-year-old male presents by EMS to the ED with shortness of breath. 1 There are over 50,000 visits related to heart transplant in the United States each year and over half of these patients are admitted to the hospital from the ED. In boarding patients, anti-rejection medications may need to be ordered from the ED.

EMS 90

EMS E-9-1-1 ACS Coronary 90