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 115

CPR STEMI Epinephrine ICU 115

Broome Docs

JANUARY 27, 2025

These results are not definitive, but considering the rarity of demyelination, and the magnitude of the mortality results, this should probably influence clinical practice until we get the proper RCTs. WOMAN are so negative WOMAN-2 Trial Collaborators.

ED 101

ED OR ACS Critical Care 101

The Skeptics' Guide to EM

DECEMBER 16, 2017

He is now stabilized, fosphenytoin is being infused, you are getting ready to ship him to the neuro-ICU and wonder if cooling him down would help. His oxygen saturation begins to drop and you decide to intubate and mechanically ventilate. Background: We have covered hypothermia a number of times on the SGEM.

ALS 100

ALS ICU Emergency Department Paramedic 100

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 94

Critical Care ED EMS OR 94

Emergency Medicine Ireland

DECEMBER 3, 2020

With my deepest apologies to all the great ICU dieticians I have worked with, I just struggle to get excited over this stuff. I would highly recommend attending an excellent lecture given by your ICU dietician which is just possibly where this entire summary came from. As with all ICU nutrition EN is preferred over PN.

Critical Care 52

Critical Care ICU EMS OR 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

EMDocs

SEPTEMBER 7, 2024

Disposition: Consider ICU for many patients, especially if any signs of instability or repeatedly requiring blood products. The time taken to measure serum hemoglobin and hematocrit (B) and await a result would delay definitive surgical control of likely ongoing hemorrhage given this patient’s incomplete response to fluid resuscitation.

EMS 98

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

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 130

ICU OR Defibrillator EMS 130

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

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

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

Emergency Medicine Ireland

OCTOBER 14, 2024

The major barrier to implementation in the ICU setting is the almost complete absence of ICU patients from these trial cohorts. And as we all know if there is a complication possible it’s almost definitely going to happen with greater frequency in the ICU cohort. LDH>1000 Sugar <2.2

Critical Care 52

Critical Care ICU ALS OR 52

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 97

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

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

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

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. Is this: 1. The QRS duration measured in lead II (shown below) is about 6.5

Coronary 118

Coronary ACS ED OR 118

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

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

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%

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

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

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

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

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

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

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

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

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). Unfortunately, without knowing what dose and at what time first line medications were given before second line agents were administered, precludes any definitive conclusions from being made regarding this trial.

Emergency Department 52

Emergency Department ALS Critical Care 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

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

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

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 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

ED 52

ED ALS OR ICU 52

Dr. Smith's ECG Blog

OCTOBER 26, 2011

Definition: total loss of R-wave means there is a QS-wave (a single deep deflection). The patient continued to have ischemia after PCI, and in fact had an episode of polymorphic VT shortly after while in the ICU. Persistence of ST elevation helps to determine state of the myocardium after reperfusion. This was recorded 2.5

STEMI 52

STEMI ALS ICU OR 52

Dr. Smith's ECG Blog

JANUARY 6, 2023

The facility was not pressed to activate emergent transfer for PCI since the pain was improving and suggested we optimize pain control and admit to the Cardiac ICU. Repeat ECG: The cath lab at our nearest referral center was contacted while the patient was in CT and again following the results and repeat labs.

ACS 52

ACS Coronary ICU STEMI 52

ACEP Now

APRIL 3, 2024

12–13 These are challenging studies to draw definitive conclusions from, however they suggest that some of these post-TTM1 patients who were cooled to 36 degrees Celsius did worse, supporting the notion that there exists a subset of patients who benefit from cooling to 33 degrees Celsius. Crit Care Med. 2020;48(3):362-9. Resuscitation.

Advanced Life Support 40

Advanced Life Support ALS Life Support CPR 40

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

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. A CT was obtained later and showed appropriate positioning of the catheter: She was admitted to the ICU and the catheter was used several times to withdraw more fluid.

E-9-1-1 40

E-9-1-1 ED STEMI OR 40