ACEP Now

MAY 9, 2024

Complications of Gluteal AFT The pale, prone patient with multiple surgical drains and a constrictive faja has become a common site in the Jackson Memorial Hospital Emergency Department. Nearly half of all post-AFT patients presenting to our emergency departments required admission and six percent required ICU admission.

Emergency Department 52

Emergency Department Operating Room Critical Care ALS 52

ALiEM

JUNE 1, 2023

Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? Is phenobarbital safe for the treatment of EtOH withdrawal in the ED? The Journal of Emergency Medicine. Open Access Emerg Med. Well not exactly.

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Emergency Department ICU ED OR 246

The Skeptics' Guide to EM

APRIL 27, 2024

Prehospital Emergency Care. Date: April 25, 2024 Guest Skeptic: Missy Carter is a PA working in an ICU in the Tacoma area and an adjunct faculty member with the Tacoma Community College paramedic program. When emergency department (ED) staff roll her to remove her clothing her humeral intraosseous (IO) is dislodged.

ICU 195

ICU Defibrillator CPR Paramedic 195

Broome Docs

SEPTEMBER 3, 2024

CJEM debate series: #StillTheOne-while more challenging than ever, emergency medicine is still the best career path available for medical students. PMID: 38592662 Bottom line: Would you be happy if you kid follow-ed your footsteps into emergency medicine? As loud as a construction site: Noise levels in the emergency department.

E-9-1-1 109

E-9-1-1 Emergency Department ICU ALS 109

The Skeptics' Guide to EM

APRIL 22, 2023

Michael Falk is a Pediatric Emergency Medicine attending at Mount Sinai Medical Center and Associate Professor of Emergency Medicine at the Icahn School of Medicine in New York. Case: A 14-month-old boy presents to the emergency department (ED) with two days of upper respiratory symptoms and respiratory distress.

ICU 130

ICU Emergency Department ALS ED 130

The Skeptics' Guide to EM

JUNE 22, 2024

Anireddy Reddy is a pediatric intensive care attending physician in the Department of Anesthesiology and Critical Care Medicine at Children’s Hospital of Philadelphia. Dr. Anireddy Reddy Case: A 3-year-old girl presents to the emergency department (ED) with fever and respiratory distress.

Critical Care 132

Critical Care ICU ALS Emergency Department 132

EMDocs

JUNE 15, 2024

. #1: PREOXI RCT – Preoxygenation with Noninvasive Ventilation vs. Non-rebreather Mask Spoon Feed Noninvasive ventilation (NIV) was superior to a standard non-rebreather (NRB) oxygen mask for preoxygenation of critically ill ED or ICU patients requiring intubation, with a NNT of 11 to prevent 1 episode of hypoxemia <85%.

ICU 75

ICU Emergency Department ED OR 75

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Reference: Cashen K, Reeder RW, Ahmed T, et al. Pediatric Crit Care Med.

CPR 130

CPR ICU Critical Care Defibrillator 130

Critical Care Scenarios

NOVEMBER 15, 2020

A few rapid-fire cases from the emergency department, with Dr. Seth Trueger (@mdaware), emergency physician at Northwestern University and digital media editor for JAMA Network Open. Takeaway lessons Many decisions in the ED are less about what to do, and more about when to do it. Emergency staff have limited bandwidth.

ICU 100

ICU Life Support Emergency Department ED 100

Don't Forget the Bubbles

AUGUST 23, 2023

In most Emergency Departments, staff are allotted little of that scarce resource, time, to begin processing what has just occurred. The Pause Jonathon Bartels worked as an Emergency Nurse in America in 2009. After the death of a young person in the Emergency Department, he initiated ‘ The Pause.’ 23 (2), pp.

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Emergency Department ICU ALS Critical Care 98

ACEP Now

JULY 7, 2024

1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED). 2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus).

Emergency Department 52

Emergency Department Critical Care ALS ED 52

The Skeptics' Guide to EM

MARCH 27, 2021

2020 Case: A 74-year-old woman who suffered a fall earlier today presents to the emergency department (ED) and is found to have five rib fractures to her right thorax, but no other injury. His team found grip strength was weakly correlated with frailty in older ED patients [6]. J Trauma Acute Care Surg.

ICU 100

ICU ALS Emergency Department ED 100

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. The patient was upgraded to the ICU for closer monitoring. What do you think? ng/mL, BNP 2790, and lactate 3.7.

E-9-1-1 139

E-9-1-1 ACS Emergency Department ALS 139

The Skeptics' Guide to EM

JUNE 6, 2020

Max is then going to Georgetown to be an attending in both EM and ICU. Case: It’s another day in your emergency department (ED). The triage nurse places a 61 year-old-man with fever, hypotension, cough into the smallest room in the ED. You scan through the EMR and see the blood pressure is 60/40.

EMR 130

EMR ALS ICU Emergency Department 130

ACEP Now

MAY 9, 2024

It has been well over a year since the controversial publication of the Agency for Healthcare Research and Quality (AHRQ) report on diagnostic errors in the emergency department (ED). percent of ED visits resulted in preventable death as result of diagnostic error. Ann Emerg Med. JAMA Intern Med.

Emergency Department 52

Emergency Department ICU ALS ACS 52

Dr. Smith's ECG Blog

OCTOBER 19, 2022

A patient had 3rd degree AV block in the ED. A transvenous pacer was placed in the Emergency Department by the emergency physicians. and the 2021 YouTube Review by ICU Advantage on "Temporary Pacemakers: Modes and Basic Settings".

ED 52

ED ICU OR Emergency Department 52

EMDocs

SEPTEMBER 19, 2023

On ED arrival GCS is 3, there are rapid eye movements to the right but no other apparent seizure activity. Propofol utilized for sedation; patient admitted to ICU for EEG monitoring. Official diagnosis requires EEG, which is not something we can typically obtain in the ED. They administer two doses of 10 mg midazolam IM.

STEMI 72

STEMI Coronary Emergency Department EMS 72

Emergency Medicine Ireland

MARCH 4, 2021

GBS is a clinically important diagnosis for both the emergency department and the ICU. GBS is a clinically important diagnosis for both the emergency department and the ICU. In the ICU the diagnosis is usually fairly easy as they come with a label of possible GBS in the referral.

Critical Care 40

Critical Care ICU Plasma Emergency Department 40

ACEP Now

DECEMBER 10, 2023

A middle-aged male with squamous cell carcinoma and extensive metastases is brought to the emergency department (ED) after being found unresponsive following a believed suicide attempt (SA) by methadone ingestion. You ultimately begin a slow naloxone infusion and admit him to the medical ICU. Am J Emerg Med.

Naloxone 52

Naloxone Life Support ALS Paramedic 52

EMDocs

JUNE 7, 2023

F, HR 48, RR 28, BP 104/62, SPO2 88% on non-rebreather mask The patient’s friend who brought her to the ED tells you the patient made suicidal statements earlier in the day and was found in her yard shed. These are send-out labs with turn-around times that make them unlikely to affect the ED course or guide treatment. BMC Res Notes.

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

The Skeptics' Guide to EM

NOVEMBER 16, 2019

Case: A 59-year-old woman comes is brought into your emergency department (ED) by EMS in cardiac arrest. The patient achieved return of spontaneous circulation (ROSC) on arrival to the ED. She had a witnessed arrest, and CPR was initiated by bystanders.

ALS 100

ALS CPR ICU EMS 100

EMDocs

JUNE 27, 2024

An 8-year old male with a history of sickle cell anemia presents to the ED for evaluation of fever for 2 days and “feeling like I can’t get a full breath”. 768: Epidemiology of Hospital Based ED Visits due to Sickle Cell Crisis and Acute Chest Syndrome in Kids. Acute chest syndrome in sickle cell disease. Hosp Pract (1995).

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

EMDocs

MAY 25, 2023

This increases applicability or ED care. population at large Enrollment was terminated at an interim analysis due to predefined futility criteria that suggested that there was a 1% chance that carrying the trial to completion would demonstrate a most effect or least effective treatment. Study included children, as well as adults.

Emergency Department 64

Emergency Department ICU OR ALS 64

EMDocs

AUGUST 15, 2023

He was initially seen at a regional ED and was administered 10 vials of crotalidae equine immune F(ab’) 2 (ANAVIP®) antivenom before transfer to your referral center. His father confirmed the snake was a copperhead. If you are concerned for elevated compartment pressures, the patient needs to be treated with antivenom.

Emergency Department 82

Emergency Department OR EMS ED 82

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Am J Emerg Med. It is unclear how long he was down.

Defibrillator 84

Defibrillator CPR Epinephrine Life Support 84

AAEM RSA

JUNE 30, 2021

Many triple-certified physicians choose to divide their time between the emergency department (ED) and intensive care unit (ICU) for extra variability in their careers, staying sharp in both the high acuity and physiological management of the most ill and complex patients.

EMS 52

EMS Critical Care ICU Emergency Department 52

REBEL EM

MARCH 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. Paper: Owyang CG, et al. J Crit Care. J Crit Care.

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

EMDocs

SEPTEMBER 25, 2023

However, RSI has never been shown to reduce the risk of aspiration in the ED (13) or during emergent OR cases (14). While RSI should remain the gold standard in the vast majority of patients in the ED, FI presents an additional technique to mitigate anatomic or physiologic risk. We don’t want to go backwards!

ED 65

ED Emergency Department ALS OR 65

Don't Forget the Bubbles

AUGUST 28, 2023

Five-year-old Ginny presents to the Emergency Department with a syncopal episode. 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? RadioGraphics.

Emergency Management 96

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

ACEP Now

MAY 4, 2023

A 58-year-old male with a history of alcohol abuse presented to the emergency department (ED) as a category 2 trauma for a fall with a reported flail chest. Case FIGURE 1: Chest X-ray of multiple rib fractures (arrows). Click to enlarge.)

EMS 52

EMS Operating Room ICU Emergency Department 52

Don't Forget the Bubbles

OCTOBER 19, 2023

You, however, are working an ED shift, and when you see the name “Barbie Junior” on your computer screen, your heart does a flutter. It can be in started in the ED, and many of us are already using it. Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy.

E-9-1-1 81

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

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. EKG RV strain. PMID: 24092475.

ED 82

ED NARCAN ALS OR 82

EMDocs

FEBRUARY 26, 2024

The ED clinician should inquire about a relevant history of HIV infection, malignancy, high-dose corticosteroid use, chemotherapy, organ transplant, or use of immunosuppressive drugs for other indications. Am J Emerg Med. She reports occasional central chest pain exacerbated by coughing. Int J STD AIDS. 2019;30(2):188-193.

E-9-1-1 87

E-9-1-1 ED ALS OR 87

REBEL EM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). 2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). Am J Emerg Med. 2022 Sep 7.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

REBEL EM

JULY 17, 2023

Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of an induction agent and a neuroblocking agent in quick succession. REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? Click here for Direct Download of the Podcast Paper: Knack SKS et al. Range 5 to 9) Diff -0.2;

ED 97

ED ICU Emergency Department Overdose 97

EMDocs

OCTOBER 21, 2023

Median time from ED arrival to diagnosis was 8 hours 24 min in one study, with only 19% being diagnosed within the 4.5-hour All patients who receive thrombolytics for ischemic stroke should be admitted to a neurosurgical, neurologic, or medical ICU for management and monitoring, as this is shown to decrease mortality and length of stay.

EMS 74

EMS ALS OR ACS 74

ACEP Now

OCTOBER 15, 2023

Intravenous insulin infusions typically require treatment in highly monitored settings, such as an intensive care unit (ICU) or step-down unit for safety and due to the frequency and intensity of monitoring. ICU and step-down beds are a limited resource and generate higher hospital charges. Acad Emerg Med. JAMA Netw Open.

ICU 104

ICU ALS ED Emergency Department 104