EMDocs

APRIL 2, 2024

Check the pulse RSI= Resuscitation Sequence Intubation Hypoxia, Hypotension, and Acidosis are the reason patients code during/post intubation These patients are super high risk for all 4 Optimize first pass success – Induction agent + paralytic Unconscious patients will still have muscle tone Induction Ketamine or Etomidate at half doses (i.e.,

CPR 92

CPR STEMI Epinephrine ICU 92

ACEP Now

MAY 9, 2024

After developing encephalopathy and hypoxemic respiratory failure, the patient was transferred to the ICU. Further diagnostic testing in the ICU identified salicylate toxicity. The diagnostic error was therefore classified as relating to the delays associated with testing and its effect on subsequent definitive management.

Emergency Department 52

Emergency Department ICU ALS ACS 52

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. 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. Psychological harm occurs. Cunningham T. Southern Medical Journal. 112 (9),pp.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

Emergency Medicine Ireland

MARCH 7, 2022

However in ICM there is a need to have a broad understanding of what some of the haematological acronyms might mean given that a fair number of these patients end up in the ICU. Most of this post will be navigating the basics of the diseases rather than super specific ICU management. Sepsis is probably number 1 on the list.

Critical Care 52

Critical Care Plasma ICU OR 52

EMDocs

NOVEMBER 1, 2023

2 Despite advances in imaging and surgical methods, overall mortality approaches 20%, which doubles to 40% with delays to definitive management exceeding than 24 hours. If there will be a delay in definitive management and there is evidence of intra-thoracic gastric contents, consider chest tube placement. May not be an option.

Critical Care 67

Critical Care ED EMS OR 67

Emergency Medicine Ireland

MARCH 22, 2021

ICU level pre eclampsia is. ICU level pre eclampsia is rare. And given that the definitive treatment is removing the baby from the mother, it turns out that this will typically have been done before we even get involved. Firstly some definitions. Read More » Welcome back to the tasty morsels of critical care podcast.

Critical Care 40

Critical Care ICU OR 40

Emergency Medicine Ireland

FEBRUARY 8, 2021

SBS is not a common thing to find in the ICU and the most likely context here is going to be receiving someone from the operating theatre who has had. There are some poor souls who as a result of SBS are dependant on long term TPN who may also appear in ICU from time to time and a working knowledge would be useful.

Critical Care 40

Critical Care ICU OR 40

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

Emergency Medicine Ireland

OCTOBER 28, 2020

TTP is a lovely ICU diagnosis. TTP is a lovely ICU diagnosis. There is a definitely a chance to shine and make the diagnosis. Welcome back to the tasty morsels of critical care podcast. 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.

Critical Care 40

Critical Care Plasma FFP ICU 40

Emergency Medicine Ireland

JANUARY 14, 2021

This can be found in ~20% of cirrhotics and the key clinical finding is hypoxia that gets better when lying flat, otherwise known as platypnea-orthodeoxia which is probably more common in ASDs but hepatopulmonary syndrome is definitely on the list. The pathogenesis is unclear but nitric oxide plays a role.

Critical Care 52

Critical Care ICU OR 52

Emergency Medicine Ireland

OCTOBER 17, 2022

We talk a lot about cerebral protective measures in the ICU and hopefully this will give you a little of the basic physiological background. The brain apparently receives 15% of the cardiac output, though I imagine by the end of a typical ICU on call shift, that proportion will have dropped quite significantly.

Critical Care 40

Critical Care ICU Plasma OR 40

Emergency Medicine Ireland

MAY 16, 2022

We definitely see much less of this than we used to. I suspect that’s largely due to better access and provision of primary care but there remains a cohort of fairly brittle folk out there who will occasional crop up in resus or the ICU. Oh’s manual devotes a whole chapter, number 35 to the subject.

Critical Care 40

Critical Care ICU OR EMS 40

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?

Emergency Management 96

Emergency Management Emergency Manager E-9-1-1 Critical Care 96

ACEP Now

MAY 4, 2023

The chest X-ray showed multiple displaced right rib fractures and chest wall subcutaneous emphysema without definitive evidence of a pneumothorax, as well as right lower lobe atelectasis versus contusion (Figure 1). Trauma imaging was performed including bedside X-rays of the chest and pelvis.

EMS 52

EMS Operating Room ICU Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 23, 2023

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. She had an uneventful ICU course and was extubated for ongoing care with the inpatient psychiatric service.

ICU 123

ICU OR Defibrillator EMS 123

Emergency Medicine Ireland

FEBRUARY 11, 2021

Plasmapheresis (or PLEX) is one of the machines we tend not to have responsibility for in the ICU. Plasmapheresis (or PLEX) is one of the machines we tend not to have responsibility for in the ICU. Unlike CRRT we tend to defer to another specialty to do this. Read More » Welcome back to the tasty morsels of critical care podcast.

Critical Care 40

Critical Care Plasma ICU OR 40

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

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.

Critical Care 97

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

EMS 12-Lead

MAY 8, 2022

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. Closer inspection will show that it is Sinus, after all. Are the T waves truly hyperacute, though?

STEMI 130

STEMI ED EMS Firefighter 130

EMDocs

JUNE 3, 2023

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. Patients receiving thrombolysis will require ICU admission for neurologic monitoring.

EMS 74

EMS ALS OR ED 74

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

ACEP Now

MAY 9, 2024

9 PFE is only definitively diagnosed on autopsy and a high clinical suspicion must be maintained in high-risk patients. Nearly half of all post-AFT patients presenting to our emergency departments required admission and six percent required ICU admission. units per patient.

Emergency Department 52

Emergency Department Operating Room Critical Care ALS 52

EMDocs

FEBRUARY 12, 2024

In this situation, an ABG should be obtained periodically for correlation, though this is more relevant for the intensive care unit (ICU) setting than in routine ED care (5, 9). Bottom Line : VBGs, whether obtained peripherally or centrally, tend to be slightly more acidotic and exhibit higher PCO 2 values than concomitant ABGs.

Emergency Department 94

Emergency Department E-9-1-1 ED ICU 94

Emergency Medicine Ireland

MARCH 27, 2023

Oh Chapter 37 is dedicated to NIV in the ICU and is probably worth some time given that this is a common respiratory support both in the ICU and throughout the hospital. On an ICU vent this would be described as 5/5. On an ICU vent this would be described as 5/5. Welcome back to the tasty morsels of critical care podcast.

Critical Care 52

Critical Care ICU OR 52

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 140

ICU ALS ED OR 140

Don't Forget the Bubbles

OCTOBER 19, 2023

Babie Junior, or Bee for short, was the definition of a cute, delightful baby. Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. There’s a definite vogue to minimise immobilisation in children with fractures. Which brings us to PARIS-2.

E-9-1-1 81

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

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

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. At that time his diastolic blood pressure was also hovering between 45 and 55 mmHg.

Epinephrine 52

Epinephrine ICU Coronary EMS 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. Normal RBBB has no ST elevation in any lead, though sometimes there is an exception when there is abscnce of R'-wave, as in V2 here.

Coronary 52

Coronary ICU OR ED 52

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-9-1-1 113

E-9-1-1 ICU OR ALS 113

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. Given that 85% of SAH is aneurysmal, and they need definitive treatment likely not available in your hospital then getting that angio done is certainly a priority. Welcome back to the tasty morsels of critical care podcast.

Critical Care 52

Critical Care ICU EMS OR 52

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

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. 2 Death from hemoptysis is akin to drowning, so airway considerations usually take precedence over hemodynamic considerations.

E-9-1-1 52

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

Dr. Smith's ECG Blog

MARCH 11, 2019

The patient was managed in the ICU and had serial troponins. Finally — there has been further evolution of the subtle ST-T wave abnormalities in leads V2, V5 and V6 — which now all show definite ST-T wave flattening in ECG #2. It is not yet available, but this is your way to get on the list. He had no more ECGs recorded. First was 2.9

OR 52

OR ACS ICU STEMI 52

REBEL EM

JUNE 8, 2023

The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Potential to Impact Current Practice: Initiatives should be made at the institution level to develop in-service education sessions, policies and procedures for the safe administration of PDPs in the acute hypotensive period. J Med Toxicol.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

Don't Forget the Bubbles

JUNE 17, 2024

The team sits down for a hot debrief once the patient is stabilised and transferred to the ICU. The lack of consistent definitions in the literature makes it difficult to report its true prevalence and hampers efforts to combat it. How do you manage this situation?

E-9-1-1 105

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

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.

Epinephrine 64

Epinephrine ICU ALS OR 64