Critical Care Scenarios

SEPTEMBER 18, 2024

“Definitive” TRALI (there is no longer a less definite category) is defined as: * No evidence of lung injury prior to transfusion * Onset within 6 hours after end of transfusion * P/F ratio <300 or SaO2 <92% on room air * Radiographic evidence of bilateral infiltrates with n.

OR 152

OR 152

ALiEM

OCTOBER 28, 2024

Case Question: What is the definitive management for a nephroblastoma? The definitive management of a Wilms tumor is a multidisciplinary approach, with primary nephrectomy followed by a tailored chemotherapy regimen as the gold-standard treatment in the US. fusion_text] Additional Images Physical Exam Vitals : Temp 97.9 °F

ED 161

ED OR 161

The Skeptics' Guide to EM

DECEMBER 21, 2019

Only then would there be definitive evidence for the efficacy of parachutes. Mathew Reeves is a Professor and Interim Chair of the Department of Epidemiology and Biostatistics at the College of Human Medicine at MSU. Dr. Joshua Reynolds is […] The post SGEM Xtra: NNT – WET or DRI first appeared on The Skeptics Guide to Emergency Medicine.

OR 100

OR ALS ED 100

The Skeptics' Guide to EM

JANUARY 30, 2021

This was based on two definitions. Steve is currently an Assistant Professor in the Department of Family Medicine at Western University (London, Ontario) […] The post SGEM#317: Dese Bones Gonna Heal Again – With or Without a Non-Selective NSAID first appeared on The Skeptics Guide to Emergency Medicine. J Bone Joint Surg Am.

OR 130

OR ALS 130

Core EM

JANUARY 25, 2024

The definitive treatment of a necrotizing soft tissue infection is surgical debridement and removal of the necrotic tissue. It is a rapidly progressing infection that moves along fascial planes, often evading the immune system. This is a tricky diagnosis that can often be inconspicuous, so clinical gestalt is key. 2014;15(1):111-113.

E-9-1-1 246

E-9-1-1 Emergency Department OR 246

ACEP Now

JULY 7, 2023

17,18 Given this, the advent of extracorporeal membrane oxygenation (ECMO) presents an opportunity to bridge care between traditional resuscitation of refractory VF patients in the ED and more definitive management in the catheterization lab. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. amiodarone or lidocaine).

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

ALiEM

JUNE 10, 2024

Emergency physicians often face the challenge of deciding whether to proceed with imaging, given the potential risks associated with ionizing radiation from CT scans. High Risk (>12.1% sensitivity and 99.9% High Risk (>12.1% sensitivity and 99.9%

Emergency Department 317

Emergency Department ED OR 317

First 10 EM

OCTOBER 21, 2024

Let’s see if I can get myself cancelled by a group of physicians that are definitely smarter than me.) I love toxicologists, but it’s time for someone to call them out. (I I also love ranting. I am sick of the anti-science rhetoric.

OR 104

OR 104

EMDocs

NOVEMBER 6, 2023

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. This post will focus on the key parts of the guideline that affect ED evaluation and management. Top 10 Take Home Pearls 1.

Naloxone 94

Naloxone OR Overdose BLS 94

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Smith : this ECG is definitely not OMI, but could be mistaken for Swirl pattern, which is a septal OMI with STE in V1 and STD in V6. This new ECG was still interpreted as STEMI and the patient was taken to the cath lab where the angiogram showed completely normal coronary arteries throughout. Unfortunately no echo was available.

OR 116

OR STEMI EMS ED 116

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

This has led to variability in EMS protocols, with some agencies including naloxone in their cardiac arrest protocols while others do not specifically recommend it, highlighting a gap in definitive guidance [6]. Your partner asks if you want to administer naloxone as well. Today’s study looks at the role of naloxone in OHCA.

Naloxone 242

Naloxone NARCAN Overdose CPR 242

Core EM

JULY 23, 2024

Hosts: Jonathan Kobles, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Agitation , psychiatry , Toxicology Show Notes Background/Epidemiology • Definition and Scope : Agitation encompasses behaviors from restlessness to severe altered mental states. IV/IM Regimens : • Medications : Droperidol, haloperidol, midazolam, ketamine.

Emergency Department 233

Emergency Department OR 233

Paramedics World

JANUARY 3, 2024

Feeling tired, weary, or exhausted? These sensations of fatigue seem to be an inevitable part of modern life. We blame fatigue on lack of sleep, overwork, stress, not enough exercise,… The post Fatigue: Is It Simple Tiredness or an Underlying Illness? appeared first on Paramedics World.

OR 52

OR Paramedic 52

Core EM

NOVEMBER 1, 2023

We discuss Electrical Storm (VT storm) and how to care for the very irritable heart. Monomorphic vs polymorphic (Torsades) may change management Wide QRS Fusion best Capture beats Concordance AV-dissociation Lab tests: Potassium, magnesium, troponins, TFTs, etc.

OR 130

OR 130

Core EM

JANUARY 25, 2024

Definition: Catatonia: A behavioral motor dysregulation syndrome marked by an inability to move normally despite full physical capacity, which can occur in the context of many underlying psychiatric and general medical disorders [4]. Epidemiology : Who typically suffers from catatonia? Who typically suffers from malignant catatonia?

MICU 246

MICU Emergency Department OR ED 246

Emergency Medicine Ireland

SEPTEMBER 30, 2024

As a reminder of the basics which I of course knew implicitly and definitely did not have to resort to wikipedia to check… Chyle is largely formed in the small intestine as the gut transports free fatty acids from the intestinal lumen. Today we look at quite a niche topic, that of chylothorax. PN is naturally an option here.

Critical Care 98

Critical Care OR 98

EMS 12-Lead

APRIL 9, 2024

Many of the changes seen are reminiscent of LVH with “strain,” and downstream Echo may very well corroborate such a suspicion, but since the ECG isn’t the best tool for definitively establishing the presence of LVH, we must favor a subendocardial ischemia pattern, instead. He awoke earlier that morning in his usual state of health.

Coronary 290

Coronary ACS CAD ED 290

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 87

EMS E-9-1-1 Epinephrine OR 87

Pediatric EM Morsels

AUGUST 23, 2024

Concussion – Presentation [ Silverberg, 2023 ] There is no definitive test to diagnose concussion in the ED. It does NOT have structural brain damage visible on standard neuroimaging. In the research setting, abnormalities can be found via functional, blood flow, or metabolic imaging.

Emergency Department 270

Emergency Department OR ED EMS 270

First 10 EM

SEPTEMBER 23, 2024

I definitely talk to people about smoking, but aside from brief counseling and occasionally prescribing nicotine replacement for […] The post Smoking cessation in the emergency department (The COSTED trial) appeared first on First10EM.

Emergency Department 81

Emergency Department OR EMS 81

Core EM

JANUARY 25, 2024

Differentiating between the two is difficult as multiple proposed diagnostic criteria have yet to demonstrate sufficient sensitivity or specificity for a definitive diagnosis. The differential diagnosis for this patient includes Ventricular Tachycardia (VT) and Supraventricular Tachycardia (SVT) with aberrancy. Brady WJ, Skiles J.

Coronary 246

Coronary Emergency Department ED OR 246

Dr. Smith's ECG Blog

MAY 7, 2024

My response: "Definitely not polymorphic VT. Definitely atrial fibrillation. Here is the post cardioversion ECG: Definite pre-excitation (delta waves due to accessory pathway, "bypass tract"). Here is his presenting ECG, which was sent to me real time, along with the 2nd ECG below: Regular Narrow Fast without P-waves.

ALS 116

ALS OR 116

The Good, The Bad & The Ugly Paramedic

JULY 1, 2020

In the prehospital environment, there’s no doubt about it, someone has to drive when a patient needs to be transported to definitive care. As paramedics, whilst we often take great offence at being called ambulance drivers, the question is, when it’s our turn to drive, what exactly is it that we are providing?

Ambulance Driver 52

Ambulance Driver Paramedic Ambulance OR 52

ALiEM

NOVEMBER 1, 2024

This patient’s story was very consistent with a CHF exacerbation but POCUS allowed us to quickly identify a PE and get the patient on track to definitive management. Clot in transit once identified requires immediate action because it is associated with such high mortality in patients. Right heart thrombi in pulmonary embolism.

ED 161

ED OR 161

The Skeptics' Guide to EM

NOVEMBER 16, 2024

One definition of AI is a computer system capable of performing tasks that typically require human intelligence, such as pattern recognition, decision-making, and language processing. The Chief of EM wants to be sure that any new system they introduce will enhance workflow and not add to clinicians’ cognitive burden.

ICU 142

ICU Emergency Department ALS EMS 142

Dr. Smith's ECG Blog

DECEMBER 29, 2018

The T-waves are not definitively hyperacute. There is definite v oltage for LVH. Clearly, more information is needed before a definite decision can be reached — but the “onus of proof” is on the clinician to rule out acute LAD occlusion. There is a small amount of STE in V2 and V3, with a very small amount of STD in V4-V6.

OR 52

OR STEMI Coronary ED 52

High Performance EMS

AUGUST 9, 2024

No matter how you decide to distinguish the priority of each request, it is triaged to standardize the rules for a consistent response definition. A brief delay on the low-priority call to obtain an appropriate match should not impact the immediate outcome or, potentially more importantly, the results of the next serious one.

BLS 264

BLS CAD Advanced Life Support Life Support 264

Dr. Smith's ECG Blog

OCTOBER 24, 2018

Therefore, this does not meet the definition of myocardial infarction ( 4th Universal Definition of MI ), which requires at least one troponin above the 99% reference range. You can see the deficiency of the definition of MI. Because there is reciprocal ST depression in aVL, this should not be called early repol. But maybe not.

E-9-1-1 52

E-9-1-1 STEMI ACS Coronary 52

Don't Forget the Bubbles

JUNE 19, 2023

However, there are no agreed-upon definitions for growth restriction, and there are significant knowledge gaps. Refer to your local or national guidelines to decide whether a patient is SGA or not, but remember that, depending on which definition is used, both over- and underdiagnosis can occur.

ALS 143

ALS OR 143

Dr. Smith's ECG Blog

NOVEMBER 14, 2024

I responded: "Definite inferior OMI. The RV marginal branch must have a takeoff that is more distal than usual, as this is definitely an RV MI. The initial ECG shows definite ST-T wave abnormalities in 11/12 leads — with marked hyperacute T waves in lead III ( within the 1st RED rectangle in Figure-1 ). What do you think?

ED 116

ED Coronary Paramedic OR 116

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

There is definite reperfusion. There was definite evolution of the ECG. He had been smoking an opiate and suddenly collapsed. He was ventilated with BVM on arrival. He awoke with naloxone. This EKG was recorded as part of a standing order for critical care. He denied any CP or SOB. Maybe there is some spontaneous reperfusion?

Overdose 52

Overdose OR Coronary ACS 52

REBEL EM

NOVEMBER 13, 2024

Obtain emergency orthopedics consultation for all open joints and administer antibiotics and update tetanus in all patients REBEL Core Cast 131.0 – Traumatic Arthrotomy Click here for Direct Download of the Podcast. cefazolin or cefuroxime) If risk factors for MRSA present, use agent with activity against MRSA (i.e.

ED 102

ED OR EMS 102

The Skeptics' Guide to EM

DECEMBER 7, 2019

Most of the definition is in the name itself. * The name was not reassuring and the definition was vague. The Journal of Pediatrics published a systematic review of literature regarding the Management of ALTE in 2013 and one of the findings was that there was very little agreement in the literature on how to apply the definition.

CPR 130

CPR ALS OR 130

Core EM

JULY 23, 2024

We review Acute Respiratory Distress Syndrome Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Critical Care , Pulmonary Show Notes Definition of ARDS: Non-cardiogenic pulmonary edema characterized by acute respiratory failure.

Critical Care 130

Critical Care OR 130

EMT Training Station

APRIL 5, 2023

With this in mind, it’s essential to show our appreciation and support for these incredible individuals. From practical tools and gadgets to thoughtful tokens of appreciation, these carefully-selected gifts are guaranteed to bring a smile to the face of the life-saving professional in your life.

EMT 52

EMT EMT Paramedic OR 52

REBEL EM

AUGUST 7, 2023

Background: Getting a definitive airway in a critically ill trauma patient can be a stressful situation. PMID: 37058727 Clinical Question: Does delayed sequence intubation decrease peri-intubation hypoxia in trauma patients requiring definitive airway control compared to rapid sequence intubation? Anesth Analg 2023.

ALS 98

ALS OR EMS 98

ALiEM

SEPTEMBER 29, 2023

In cases where the nature of the missile is known, plain films or POCUS may be a reasonable first step, but CT imaging would be definitive. A 49-year-old male was triaged to the Fast Track area with complaints of an abrasion to the neck following an assault. He now presents requesting “Neosporin.”

ALS 177

ALS OR 177