Critical Care Scenarios

AUGUST 14, 2022

We look at the rib fracture patient requiring ICU admission, including a discussion of surgical repair, with Dr. Ron Barbosa (@rbarbosa91), Portland trauma surgeon and SICU director at Legacy Emmanual Medical Center. ICU admission in rib fracture patients is still most often a matter of clinician judgment and bed availability.*

ICU 100

ICU OR 100

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] Question: What’s the next step in your evaluation and treatment, and what is the potentially life-threatening diagnosis?

EMS 110

EMS E-9-1-1 Epinephrine OR 110

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

Emergency Medicine Ireland

MAY 13, 2024

Part 1 will cover a broad overview of pulmonary hypertension and part 2 will focus on management strategies for a PH patient in the ICU. The definition of PH since the 2022 ESC guidelines is a mean PAP of 20mmHg on a right heart catheter. Saying a patient has PH does not really tell you very much. This is by far the commonest.

Critical Care 98

Critical Care ICU OR 98

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

Critical Care Scenarios

NOVEMBER 1, 2020

A look at oncology-related emergencies in the ICU, with Leon Chen (@CCMNP), NYC nurse practitioner specializing in oncology critical care. Acyclovir for viral prophylaxis and posaconazole for fungal (galactomannan and beta-d glucan are helpful)* The blast count is suggestive of leukemia, but definite diagnosis will require bone marrow biopsy.*

Critical Care 100

Critical Care ICU OR 100

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. Welcome back to the tasty morsels of critical care podcast. Still to be proven but commonly tried.

Critical Care 52

Critical Care ICU OR 52

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. Reference: Legriel et al.

ALS 100

ALS ICU Emergency Department Paramedic 100

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

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. 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.

Critical Care 93

Critical Care ED EMS OR 93

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 131

ICU OR Defibrillator EMS 131

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”. Oppressive quietness heavy with professionals’ suppressed emotions mixed with raw parental grief. That piercing parental cry rips through the room. 112 (9),pp.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

EMDocs

SEPTEMBER 7, 2024

Disposition: Consider ICU for many patients, especially if any signs of instability or repeatedly requiring blood products. Disposition: Consider ICU for many patients, especially if any signs of instability or repeatedly requiring blood products. Majority of RPH will stabilize on their own and not require intervention.

EMS 97

EMS E-9-1-1 Operating Room OR 97

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

REBEL EM

JUNE 8, 2023

Epinephrine – 10ug/mL, 10mL syringe Phenylephrine – 100ug/mL, 10mL syringe Phenylephrine bolus doses from 100-200ug and epinephrine 10-20ug administered every 2-5 minutes pursuant to provider order Inclusion Criteria: Adults age >18 years old Received at least one bolus dose of phenylephrine or epinephrine pre-filled syringes Exclusion (..)

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

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

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? As clinicians, we need to be prepared.

Emergency Manager 97

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

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. Paper: Eastwood G, et al. Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest. N Engl J Med. Epub 2023 Jun 15.

E-9-1-1 98

E-9-1-1 Critical Care CPR ALS 98

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

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. You ask your anaesthetist to get ready to sedate or intubate depending on their status – Significant risk to the department – you make sure security is aware And your patient arrives.

E-9-1-1 139

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

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. Answer : Cerebellar Stroke Epidemiology: 1-4% of cerebrovascular accidents occur in the cerebellum. Dizziness and vomiting are less commonly seen.

EMS 97

EMS ALS OR ED 97

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. In either case, prompt cardioversion is indicated.

Coronary 119

Coronary ACS ED OR 119

REBEL EM

NOVEMBER 6, 2023

Background Information: Vasoplegic shock is defined as hypotension with normal or increased cardiac output and can commonly occur in post-cardiac surgery patients having received cardiopulmonary bypass. This dysregulation of vasodilation is associated with a mortality of close to 25%.

Epinephrine 71

Epinephrine ICU ALS OR 71

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 What are your options?

Critical Care 52

Critical Care ICU ALS 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? cognitive rehearsal techniques ).

E-9-1-1 105

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

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. Further diagnostic testing in the ICU identified salicylate toxicity. Of these, the authors identified 550 (23.0 6 Three cases, Hall v.

Emergency Department 52

Emergency Department ICU ALS ACS 52

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.

FFP 52

FFP E-9-1-1 ICU ALS 52

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

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

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

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

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

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

MAY 5, 2022

He was admitted to the ICU and transferred emergently to a facility where he could undergo emergent dialysis as a part of further evaluation and management. He complained of generalized weakness and left lower extremity numbness. He reported that 12 hours prior to arrival he used fentanyl and cocaine. Fluid resuscitation was initiated.

E-9-1-1 52

E-9-1-1 OR STEMI ED 52

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. Welcome back to the tasty morsels of critical care podcast. Unlike CRRT we tend to defer to another specialty to do this.

Critical Care 40

Critical Care Plasma ICU OR 40