ACEP Now

MAY 4, 2023

EMS recognized a chest wall deformity with movement of the chest wall, and a splint was devised and taped around his chest for what was suspected to be a flail chest. The post Case Report: EMS Says Flail Chest, But Is It? 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

EMS 12-Lead

AUGUST 22, 2022

A 65 y/o Female was admitted to the ICU for septic shock. They are not premature, by definition. Paco Dardon (@PacoDardon), and it’s a privilege to present it as a formal review due to the many pathophysiological, and electrophysiological, phenomenon at play. She was critically ill despite aggressive vasopressor therapy.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

REBEL EM

JUNE 8, 2023

The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. 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. Epub 2019 Jul 3. Intensive Care Med.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

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? Why do we worry about the airway? J Thorac Oncol.

Emergency Management 97

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

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

REBEL EM

NOVEMBER 6, 2023

So with yet another confounding variable added (sicker patients at baseline in methylene blue group), the comparison of these two medications is yet again even more difficult There was no difference in ICU and hospital length of stays or hospital mortality between the two groups. REFERENCES: Hiruy A, et al.

ICU 71

ICU Epinephrine ALS OR 71

Emergency Medicine Ireland

FEBRUARY 6, 2023

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. The scene fades and the time jumps and the question stem now is in the ICU on day 5.

Critical Care 52

Critical Care ICU EMS OR 52

Emergency Medicine Ireland

DECEMBER 24, 2020

When you compare it with older definitions like AKIN and RIFLE you can see that not a great deal has changed. While iI hear it is technically possible to get someone admitted to hospital without a CT, it seems that most people I find in the ICU the next day will have had some imaging done (which I really don’t complain about).

Critical Care 40

Critical Care ICU EMS 40

Emergency Medicine Ireland

MAY 16, 2022

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. We definitely see much less of this than we used to. Oh’s manual devotes a whole chapter, number 35 to the subject.

Critical Care 40

Critical Care ICU OR EMS 40

REBEL EM

FEBRUARY 2, 2023

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.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

Emergency Medicine Ireland

JULY 5, 2021

These still involve mast cell degranulation) The current guideline accepted definition goes like this serious, life threatening generalised or systemic hypersensitivity reaction that may or may not be immune (ie IgE) mediated While accurate this doesn’t really help me very much in knowing what it looks like. .

Critical Care 40

Critical Care ICU ALS OR 40

REBEL EM

JANUARY 25, 2023

Rezaie, MD (Twitter: @srrezaie ) The post REBEL Core Cast 94.0 – SBO appeared first on REBEL EM - Emergency Medicine Blog. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 0.27 – 0.83

ED 52

ED ALS OR ICU 52

EMDocs

OCTOBER 19, 2024

We’ll keep it short, while you keep that EM brain sharp. 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] 2][3][9] Glucocorticoid were not shown to alter clinical course or patient outcomes. [2][3]

EMS 111

EMS E-9-1-1 Epinephrine OR 111

EMDocs

JUNE 3, 2023

We’ll keep it short, while you keep that EM brain sharp. 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. Her symptoms have been constant over the last two weeks. 1998; 29(8):1550-1555.

EMS 98

EMS ALS OR ED 98

REBEL EM

FEBRUARY 15, 2024

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. Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. References: Freund Y et al.

ICU 141

ICU ALS ED OR 141

REBEL EM

FEBRUARY 29, 2024

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.,

E-9-1-1 119

E-9-1-1 ICU ALS OR 119

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

EMS 12-Lead

MAY 8, 2022

EMS found her acutely ill, mottled, dry mucous membranes, modestly hypotensive, and lethargic. They are definitely high in amplitude and, intermittently, appear to disproportionately tower over the respective QRS. Thankfully, the patient experienced an uncomplicated ICU stay and subsequently made a full recovery.

STEMI 130

STEMI ED EMS Firefighter 130

REBEL EM

AUGUST 21, 2023

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.

E-9-1-1 97

E-9-1-1 Critical Care CPR ALS 97

EMDocs

FEBRUARY 26, 2024

Authors: Kamoga Dickson, MD (EM Resident Physician, Makerere University of Health Sciences); Jessica Pelletier, DO (EM Education Fellow, Washington University in St. Consequently, a definitive diagnosis of PJP necessitates the application of molecular, genetic, or direct visualization techniques on IS or BAL fluid to detect PJ.

E-9-1-1 111

E-9-1-1 ED ALS OR 111

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). We don’t want to go backwards!

ED 95

ED Emergency Department ALS Paramedic 95

REBEL EM

SEPTEMBER 26, 2022

The TEG group had a shorter ICU length of stay in the first admission. Patients exclusively managed in the ICU which decreases applicability for patients in other locations Very small sample size of 96 patients No definition was provided for exclusion criteria of significant cardiopulmonary disease. Furthermore, 14.3%

FFP 52

FFP E-9-1-1 ICU ALS 52

Don't Forget the Bubbles

MAY 3, 2023

EMS Use and Success Rates of Intraosseous Infusion for Pediatric Resuscitations: A Large Regional Health System Experience. undertook a retrospective review of 49 patients aged 0-17 years who had ≥1 EZ-IO insertion attempt by EMS responders in Canada in the context of cardiac arrest or a peri-arrest state if IV access was unobtainable.

CPR 52

CPR Emergency Department ALS ICU 52

Don't Forget the Bubbles

JUNE 30, 2023

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. REBOA increased deaths due to bleeding at three hours and 90 days and substantially delayed time to definitive haemorrhage control. c) Or, do both? 2014 Sep;45(9):1287-95.

E-9-1-1 139

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

ACEP Now

NOVEMBER 14, 2023

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. Bourke Tillmann and Scott Weingart for their expertise on the EM Cases podcast that inspired this column.

E-9-1-1 52

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

Dr. Smith's ECG Blog

JULY 24, 2018

He had been given 3 grams Ca gluconate by EMS. 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. Ortho and nephrology were consulted.

Epinephrine 52

Epinephrine ICU Coronary EMS 52

Dr. Smith's ECG Blog

MARCH 6, 2019

Lead I has a definitively hyperacute T-wave without STE. If for some reason the angiogram is delayed, they should receive maximal medical therapy in an ICU setting with continuous 12-lead ST segment monitoring under the close attention of a practitioner with advanced ECG interpretation training. V2 still has STE and hyperacute T-waves.

STEMI 52

STEMI ALS ACS ICU 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. EMS arrived and found him awake and alert. The QRS is narrow and T waves are much less peaked.

E-9-1-1 52

E-9-1-1 OR STEMI ED 52

EMDocs

OCTOBER 7, 2023

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. A systematic review on the definition of rhabdomyolysis.

EMS 98

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

EMDocs

JANUARY 6, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University School of Medicine, St. Louis, MO); Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine, St. We’ll keep it short, while you keep that EM brain sharp. A 64-year-old male presents by EMS to the ED with shortness of breath.

EMS 93

EMS E-9-1-1 ACS Coronary 93

EMDocs

FEBRUARY 12, 2024

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. proning patients, ECMO) (12).

Emergency Department 98

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

REBEL EM

NOVEMBER 11, 2024

4 The 2023 ACORN Trial ( covered here on REBEL EM ) randomized 2,511 patients requiring antipseudomonal coverage to receive either cefepime or piperacillin-tazobactam. independence of the instrument from unmeasured confounders), which cannot be definitively proven in an observational study. In 2021, Buckley et. vs. 52.2%).

E-9-1-1 108

E-9-1-1 ALS ICU Critical Care 108

FOAMfrat

NOVEMBER 28, 2024

That said, complications tied directly to intubation in the field—like aspiration—tend to be more common due to the conditions EMS providers work under compared to the controlled environment of a hospital. "I’d say that EMS providers already do a phenomenal job managing complex airways in challenging conditions. Why is that? "Ketamine

E-9-1-1 52

E-9-1-1 Critical Care ICU EMS 52

Dr. Smith's ECG Blog

APRIL 9, 2025

The incidence varies from 2% to 19% depending on the definition of primary. Methods: Adult, non-traumatic OHCA patients in the ESO Data Collaborative 2018-2023 datasets who experienced OHCA prior to EMS arrival, presented with a shockable rhythm, and received amiodarone or lidocaine during resuscitation were evaluated for inclusion.

Defibrillator 63

Defibrillator STEMI ED Coronary 63

EMDocs

FEBRUARY 8, 2025

Well keep it short, while you keep that EM brain sharp. The most appropriate disposition for this patient is admission to an ICU due to increasing oxygen requirements, high mortality rates of IPA, and IDSA recommendation for bronchoscopy with lavage/tissue sampling. COPD, cystic fibrosis), HIV/AIDS, cancer, immunosuppressed (i.e.

ED 77

ED E-9-1-1 EMS ICU 77

Dr. Smith's ECG Blog

MARCH 6, 2025

Fortunately , you don't need to make a definite diagnosis. She was critically ill and required noninvasive positive pressure ventilation and ICU admission for suspected infectious respiratory illness. But the superior axis with positive QRS in V1 is difficult to reconcile with an accessory pathway.

Coronary 95

Coronary ICU OR Defibrillator 95

EMDocs

JANUARY 16, 2025

Authors: Kyle Smiley (EM Resident, BAMC, San Antonio, TX) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Welcome to Critical Kids, an emDOCs series focused on pediatric emergency medicine. Pediatric emergencies are challenging. Well provide summaries of the evidence to support your decisions at the bedside.

ALS 97

ALS Critical Care ICU Emergency Department 97