EMDocs

SEPTEMBER 7, 2024

1 Risk Factors: 1-4 Spontaneous Anticoagulants (Apixaban, Rivaroxaban, etc.) Older Age (median age of 70 years) 1 Abnormal vasculature/neoplasm of the kidney (e.g., 5 Clinical Presentation: 1-3 Variable presentation but may present with dropping hemoglobin/hematocrit without other findings in spontaneous cases.

EMS 98

EMS E-9-1-1 Operating Room OR 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. Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J. 2014 Jun 26;23(12):653-9. 2020 Jan 1;35(1):70-6. How do you manage this situation?

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

Broome Docs

MAY 31, 2024

Freund Y, Viglino D, Cachanado M, Cassard C, Montassier E, Douay B, Guenezan J, Le Borgne P, Yordanov Y, Severin A, Roussel M, Daniel M, Marteau A, Peschanski N, Teissandier D, Macrez R, Morere J, Chouihed T, Roux D, Adnet F, Bloom B, Chauvin A, Simon T. PMID: 37019501 Pulmonary primatology is harder than you may think Drew T, Võ ML, Wolfe JM.

E-9-1-1 82

E-9-1-1 ED Critical Care ICU 82

Don't Forget the Bubbles

AUGUST 28, 2023

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? The median age at diagnosis was 47 months (range 1-173 months). 2014;9(9):S102-S109. 2019;43(1):98-103.doi:10.1097/RCT.0000000000000782

Emergency Management 97

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

Broome Docs

OCTOBER 31, 2022

Ketamine vs etomidate in ICU intubation ? 2022 Jan;48(1):78-91. 2022 Sep;21(9):781-791. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. PMID: 22174322 Read Justin’s full written Articles of the Month at First10EM Ketamine vs etomidate in ICU intubation?

E-9-1-1 52

E-9-1-1 Defibrillator ICU Critical Care 52

Dr. Smith's ECG Blog

MAY 26, 2023

He was admitted to the ICU and was unstable, in shock, overnight. Learning Points: 1. Details of management extend beyond the scope of this ECG Blog — with reviews by Atemnkeng at al ( J Med Cases 12[9]:373-376, 2021 ) and Chakraborty & Hamilton ( StatPearls, 2023 ) available for interested readers. What is going on here?

Overdose 98

Overdose E-9-1-1 Coronary OR 98

Dr. Smith's ECG Blog

DECEMBER 13, 2019

On review of systems the patient reported back pain for approximately 1 week which he was treating with NSAIDs with minimal relief. in the ICU but survived with excellent function. 15-9/6/2017 ). Figure-1: Excerpt from ESC review on acute pericarditis ( See text ). There is no more than minimal PR segment depression.

E-9-1-1 52

E-9-1-1 ACS Coronary CAD 52

REBEL EM

MAY 8, 2023

Paper: Smith JA, Secombe P, Aromataris E. Only 1 RCT and 1 cohort study had only mechanically ventilated patients. References: Smith JA, Secombe P, Aromataris E. The pendulum is swinging towards conservative management for occult pneumothoraces. J Trauma Acute Care Surg. 2021 Dec 1;91(6):1025-1040. in ICC group, 5.8%

E-9-1-1 58

E-9-1-1 Critical Care ICU OR 58

EMDocs

JANUARY 11, 2024

The neurologic section was divided into (1) brain oxygenation, perfusion, edema, and intracranial pressure (ICP); (2) seizures and the ictal-interictal continuum (IIC); and (3) sedation and analgesia. Digestive Management Takeaway: Start enteral feeds when the patient gets to the ICU. 2023 Dec 1. Start low and go slow.

Critical Care 98

Critical Care E-9-1-1 OR ICU 98

Dr. Smith's ECG Blog

JULY 12, 2020

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. 1 week later (about 1 week prior to the tamponade visit) she had a follow up outpatient visit and this ECG was recorded: Appears to show resolving findings.

E-9-1-1 40

E-9-1-1 ED STEMI OR 40

EMDocs

DECEMBER 18, 2024

Initial vital signs: HR 136 BPM, BP 172/82 mmHg, RR 24, T 37.2C, SpO2 97% RA Physical examination: General: restless, mildly agitated CV: tachycardic, regularly regular, diaphoretic, Abdomen: Soft, NT, ND, intermittently dry heaving Neuro: tremulous in bilateral arms and hands, tongue fasciculations What do you suspect as the diagnosis?

E-9-1-1 106

E-9-1-1 Emergency Department ICU ED 106

REBEL EM

FEBRUARY 29, 2024

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

E-9-1-1 119

E-9-1-1 ICU ALS OR 119

REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis [published online ahead of print, 2023 Aug 9]. References: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM.

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E-9-1-1 ALS ACS ICU 121

EMDocs

FEBRUARY 26, 2024

1 While PJP gained significant recognition among HIV-positive adults during the early AIDS epidemic, the growing utilization of immunosuppressants has resulted in an increased incidence of the disease in individuals who are HIV-negative. 9 The signs and symptoms of PJP infection are non-specific. for detecting pulmonary opacities.

E-9-1-1 111

E-9-1-1 ED ALS OR 111

EMDocs

OCTOBER 19, 2024

to 1 case per 100,000 children. 2][3][9] Hypoxia, respiratory muscle retractions, fatigue, altered mental status, and decreased breath sounds are signs indicative of impending airway failure. [2] 2][3][9] Glucocorticoid were not shown to alter clinical course or patient outcomes. [2][3] 2017;7(1):16-23. Rev Infect Dis.

EMS 111

EMS E-9-1-1 Epinephrine OR 111

EMDocs

DECEMBER 18, 2023

This was based on studies that demonstrated qSOFA was more specific but less sensitive than its counterparts (Table 1). 1 Since 2021, attempts to identify a single screening tool with optimal sensitivity and specificity to predict which patients will develop sepsis or septic shock have been ongoing.

E-9-1-1 94

E-9-1-1 ALS Emergency Department Plasma 94

Don't Forget the Bubbles

JUNE 30, 2023

He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. She calls out her findings: A – OK B – 1 puncture mark to the anterior left chest wall, covered with a three-sided dressing. Actively oozing.

E-9-1-1 139

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

REBEL EM

AUGUST 21, 2023

This trial aimed to assess whether targeted therapeutic mild hypercapnia (TTMH) applied during the initial 24 hours of mechanical ventilation in the ICU can enhance neurological outcomes at the 6-month mark, as compared to standard care, which involves targeted normocapnia (TN). Paper: Eastwood G, et al. Resuscitation. Epub 2021 Feb 8.

Critical Care 97

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

Dr. Smith's ECG Blog

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. C Examination notable for diaphoresis, 1+ bilateral lower extremity edema, regular heart rate and rhythm, and no signs of respiratory distress with normal breath sounds. The patient was upgraded to the ICU for closer monitoring.

E-9-1-1 138

E-9-1-1 ACS Emergency Department Coronary 138

Broome Docs

MARCH 28, 2024

PMID: 34890894 Myth 1: Kayexalate is safe and useful. 2024 Jan 2;53(1):afad255. Yerke JR, Mireles-Cabodevila E, Chen AY, Bass SN, Reddy AJ, Bauer SR, Kokoczka L, Dugar S, Moghekar A. Casey wrote a protocol for peripheral noradrenaline 9 years ago… in 2015! Am J Emerg Med. 2022 Feb;52:85-91. doi: 10.1016/j.ajem.2021.11.030.

E-9-1-1 96

E-9-1-1 ICU Emergency Department ALS 96

REBEL EM

SEPTEMBER 26, 2022

2020;71(1):235-246. Article: Kumar M et al. Thromboelastography-Guided Blood Component Use in Patients With Cirrhosis With Nonvariceal Bleeding: A Randomized Controlled Trial. Hepatology. Significant coagulopathy: INR > 1.8 Significant coagulopathy: INR > 1.8 Significant coagulopathy: INR > 1.8

FFP 52

FFP E-9-1-1 ICU ALS 52

REBEL EM

OCTOBER 5, 2023

1-6 We now have the Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial. ClinicalTrials.gov: NCT02517489 7 Clinical Question: In adult patients with severe community-acquired pneumonia admitted to the ICU, does early hydrocortisone treatment, compared to standard therapy, reduce mortality at 28 days?

Critical Care 94

Critical Care ICU E-9-1-1 ALS 94

ECG & Echo Learning

OCTOBER 2, 2022

Most agents exhibit both vasopressor and inotropic effects (Figure 1). Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). μg/kg/min Bolus : 1 mg IV every 3 to 5 min (max 0.2 mg/kg) IM: (1:1000): 0.1 De Backer D, Creteur J, Silva E, Vincent JL.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

Don't Forget the Bubbles

OCTOBER 19, 2023

Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. The bottom line is: Early high-flow nasal cannula oxygen started in the ED resulted in a longer length of hospital stay than standard oxygen therapy in children aged 1 – 4 with respiratory failure.

E-9-1-1 81

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

AAEM RSA

AUGUST 27, 2020

1 The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC. Kirkegaard H, Soreide E, de Haas, I et al. De Fazio C, Skrifvars MB, Soreide E et al. 2019;23(1):1–9.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

ACEP Now

NOVEMBER 14, 2023

1 However, it is important to understand that death from hemoptysis is almost always due to hypoxia or asphyxiation (blood impedes gas exchange in the lungs, typically because of bleeding from high-pressure bronchial arteries into the lungs) as opposed to hemodynamic instability. 2021;42(1):145-159. Life-threatening hemoptysis.

E-9-1-1 52

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

AAEM RSA

APRIL 1, 2021

1 The American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP) Massive Transfusion in Trauma Guidelines leave a good amount of flexibility for hospitals regarding transfusion protocols, focusing more on systems-level aspects of designing and implementing MTPs.2,3 in the 1:1:1 group vs. 17.0%

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 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. The 2 Questions that I would ask would be: Question #1: In the absence of any history — What are the major diagnose s suggested by the ECG in Figure-1 ? What is it?

E-9-1-1 52

E-9-1-1 OR STEMI ED 52

EMDocs

FEBRUARY 12, 2024

Introduction Arterial blood gas (ABG) or venous blood gas (VBG) testing is used to assess the pH and systemic carbon dioxide tension in patients, and, therefore, provide a more complete picture of their acid-base status than an isolated basic metabolic panel (BMP) (1). However, ABGs have many drawbacks compared to VBGs.

Emergency Department 98

Emergency Department E-9-1-1 ED ICU 98

EMDocs

OCTOBER 7, 2023

1-3 Common causes: Natural disasters such as tornadoes or earthquakes 4,5 Structure or building collapses from home fires or bombings. 2016;20(1):135. Stahl K, Rastelli E, Schoser B. 2012;27 Suppl 1:i1-67. 6 Motor vehicle collisions that produce significant challenges to passenger extrication. Critical Care. J Emerg Med.

EMS 98

EMS E-9-1-1 Emergency Department ALS 98

EMDocs

JANUARY 6, 2024

1 Indications for transplant include: Non-ischemic cardiomyopathy (49%) Ischemic cardiomyopathy (35%) Restrictive cardiomyopathy (4%) Retransplantation following failed prior transplant (3%) Hypertrophic cardiomyopathy (3%) Congenital heart disease (3%) Valvular cardiomyopathy (3%) The median survival after heart transplant is over 12 years.

EMS 92

EMS E-9-1-1 ACS Coronary 92

AAEM RSA

SEPTEMBER 17, 2020

All treatments were given for the assigned time frame or until ICU discharge, whichever came first. In the control group, patients treated for severe sepsis or septic shock in the year prior to the initiation of triple therapy, hydrocortisone was used at the discretion of the intensive care unit (ICU) attending. 2016:316(17);1775-85.

ICU 52

ICU E-9-1-1 ALS OR 52

REBEL EM

NOVEMBER 11, 2024

What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018. Imbalances Between Treatment Groups : ICU Admissions : Higher in piperacillin-tazobactam (33% vs. 30%). 9 Instrumental Variable Analysis? vs. 52.2%).

E-9-1-1 108

E-9-1-1 ALS ICU Critical Care 108

EMDocs

OCTOBER 29, 2024

He was started appropriately on vancomycin and cefepime and accepted for ICU admission but remains in the ED due to boarding and bed lock. Left ventricular outflow tract obstruction in ICU patients. Chu CK, Delia E, Mograder A, Dwyer EM. 2017;45(1):12-20. He has clinically deteriorated and required intubation.

E-9-1-1 98

E-9-1-1 ICU Epinephrine EMS 98

FOAMfrat

NOVEMBER 28, 2024

." When a critical care team transports a patient from an outlying ER to your ICU, do you automatically set your own ventilator settings, or do you ever use the vent settings the critical care transport team had dialed in for transport? "That’s We don’t seem to see Ketamine infusions in the ICU often. Henderson, E.

E-9-1-1 52

E-9-1-1 Critical Care ICU EMS 52

Don't Forget the Bubbles

MARCH 24, 2025

While no paediatric studies have confirmed this, the DICE trial ( D exmedetomidine in I nfants undergoing C ooling for Neonatal E ncephalopathy) is underway. Dexmedetomidine is currently licensed only for adult sedation in an ICU setting, but guidelines exist to support its off-licence use in paediatric intensive care (PICU).

E-9-1-1 59

E-9-1-1 Emergency Department ALS Critical Care 59

EMDocs

JUNE 27, 2024

Abdomen : ND, NT, no guarding or rebound MSK : Tenderness to palpation over L ribs 7-9 Derm : No rashes Imaging: Image 1: Case courtesy of Miriam Leiderer, Radiopaedia.org, rID: 81468 Chest radiograph (CXR) shows new left lower lobe opacity What’s most likely diagnosis? C or 100.4 mg/kg, max 0.4 C or 100.4 mg/kg, max 0.4

E-9-1-1 98

E-9-1-1 ICU ACS EMS 98