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

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

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

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

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

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 124

ICU OR Defibrillator EMS 124

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 Management 96

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

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

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.

Critical Care 98

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

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

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

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

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

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

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 74

EMS ALS OR ED 74

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). The splint consisted of a folded blanket placed over the mobile segment and held in place with tape.

EMS 52

EMS Operating Room ICU Emergency Department 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). How would an ABG even change the initial stabilization of any of these patients? What alternative testing can be done in these circumstances?

Emergency Department 94

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

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. With a little more digging however, you will also find women like Nelly Baptiste telling The New York Times , “When the pain came yesterday, I was like: I want my old body back” after undergoing a BBL in Miami.

Emergency Department 52

Emergency Department Operating Room Critical Care ALS 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. Treatment is adrenaline.

Critical Care 40

Critical Care ICU ALS OR 40

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. , but after more than 40 years of courtship, Ken proposed to Barbie. days compared to 1.50 days in the standard oxygen group.

E-9-1-1 81

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

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

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.

ICU 141

ICU ALS ED OR 141

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 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. A 6 yo girl had significant trauma from an MVC, with head injury (initial GCS 10, but no intracranial bleeding) and mild orthopedic injuries. She was intubated.

Coronary 52

Coronary ICU OR ED 52

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. His history was significant only for IV heroin abuse, but he denied any recent use.

Epinephrine 52

Epinephrine ICU Coronary EMS 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. 1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 4, 8 Paper: Dahyot-Fizelier, C.,

E-9-1-1 124

E-9-1-1 ICU OR ALS 124

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. You do NOT see this in normal variant STE, nor in pericarditis. He had no more ECGs recorded. First was 2.9

OR 52

OR ACS ICU STEMI 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

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

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

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

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

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

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

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 102

Coronary ACS ED OR 102