Core EM

JANUARY 25, 2024

Background: The immediate post intubation period in the ED is a critical time for continued patient stabilization. The reality of ever increasing ED volumes and longer boarding times to the ICU makes it imperative for emergency physicians to learn how to manage these critical patients.

ICU 246

ICU Emergency Department Critical Care ALS 246

The Skeptics' Guide to EM

JULY 27, 2024

They were randomized to ceftriaxone 2gm intravenous (IV) in the ambulance or usual cares (fluids and supplementary oxygen) until arrive to the ED. The primary outcome reported was no statistical difference in mortality at 28 days (8% in both groups) despite giving antibiotics 96 minutes earlier [2].

ICU 190

ICU ALS Ambulance OR 190

EMCrit Project

AUGUST 26, 2022

It is unacceptable to have the rates of Awareness during Paralysis seen in a recent ED sedation study--We are better than this. EMCrit Project by Scott Weingart, MD FCCM.

ICU 100

ICU ED 100

The Skeptics' Guide to EM

APRIL 27, 2024

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. Prehospital Emergency Care. February 2024.

ICU 193

ICU Defibrillator CPR Paramedic 193

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 Epinephrine 130

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? If not, you probably should be. Another old drug for a new indication, right? Well not exactly. In short, yes.

Emergency Department 246

Emergency Department ICU ED OR 246

CanadiEM

JUNE 4, 2024

You are on-call – covering medicine and ICU admissions – while overseeing 20 admitted patients. You receive 3 new admissions from the ED, but you still have to move 2 sick patients to the ICU. Your wards are at capacity. You also have to prepare 3 discharges for the next morning.

ICU 52

ICU ED 52

Core EM

JANUARY 25, 2024

More than 1/3 of geriatric trauma patients presenting to the ED after a fall return to the ED or die within one year of initial evaluation. 4 Elderly patients, who comprise only 8-12% of total ED major trauma cases, represent a disproportionate 15-30% of trauma mortalities and costs. of those report a fall-related injury.

ALS 246

ALS ED ICU OR 246

The Bottom Line

JANUARY 10, 2024

In acutely ill adults (ED / ICU) does the administration of cefipime or piperacillin-tazobactam (pip-taz) result in an increased incidence of AKI or death by day 14?

ICU 62

ICU ED OR 62

The Skeptics' Guide to EM

JUNE 22, 2024

Dr. Anireddy Reddy Case: A 3-year-old girl presents to the emergency department (ED) with fever and respiratory distress. Your ED team quickly intubates her and places her on a ventilator. Her parents tell you that she has been sick for almost a week and her symptoms seem to be getting worse. Her oxygen saturation is 78% on room air.

Critical Care 133

Critical Care ICU ALS Emergency Department 133

The Skeptics' Guide to EM

APRIL 22, 2023

Case: A 14-month-old boy presents to the emergency department (ED) with two days of upper respiratory symptoms and respiratory distress. Previous research has shown that HFNC can lower the rate of escalation of care but showed no impact on admission to the intensive care unit (ICU) or length of stay [1]. He has a cough, fever of 38.5°C,

ICU 130

ICU Emergency Department ALS ED 130

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

EMDocs

NOVEMBER 29, 2023

Question: In adult patients admitted to the ICU with severe CAP, does hydrocortisone compared to placebo reduce 28-day all-cause mortality? Question: In adult patients admitted to the ICU with severe CAP, does methylprednisolone compared to placebo reduce 60-day all-cause? Reyes LF, Garcia E, Ibáñez-Prada ED, et al.

ICU 80

ICU CAD ALS OR 80

Core Ultrasound

MARCH 25, 2024

For example a pt in the ED with sepsis, and a collapsible IVC, dry lungs and no peripheral edema is more likely to benefit from fluid than be harmed Take that same pt, with the same US and physical exam findings and make it 72-hrs later in the ICU after 6-10 L. For this we use clinical judgement, US findings, PE findings.

ICU 246

ICU ED OR 246

Critical Care Scenarios

NOVEMBER 15, 2020

Takeaway lessons Many decisions in the ED are less about what to do, and more about when to do it. Takeaway lessons * Many decisions in the ED are less about what to do, and more about when to do it. Goals of care starts in the ED, and not with lip service. ICU time and ED time are different.

ICU 100

ICU Life Support Emergency Department ED 100

EMergucate

MAY 1, 2020

40 year old healthy ICU nurse, works with COVID-19 patients. She was brought to ED by ambulance after collapsing in a shower. Her pulse rate was 120 and blood pressure was 120/80. Her blood gases (…

ICU 100

ICU Ambulance ED 100

University of Maryland Department of Emergency Med

JULY 17, 2023

Central Venous Catheter (CVC; aka central line) placement is a common procedure in both the ED and ICU, and while overall quite safe, does ca. Click to view the rest

ICU 58

ICU ED 58

EMDocs

DECEMBER 9, 2023

Spoon Feed Advanced statistics emulating clinical trial protocols from an ICU database did not identify consistent differences in 30-day mortality when ICU patients were intubated early (within 8 hours of admission) or late (after 48 hours). Clay Smith at @spoonfedEM , and sign up for email updates here. #1: Neurology vol.

ICU 68

ICU ED OR 68

Broome Docs

SEPTEMBER 3, 2024

PMID: 38592662 Bottom line: Would you be happy if you kid follow-ed your footsteps into emergency medicine? For the most part, central lines can be left to the ICU team during day time hours (and a good percentage of patients will never need one). Maybe ED is not the best place for all patients! 2024 Jun;26(6):381-385.

E-9-1-1 99

E-9-1-1 Emergency Department ICU ALS 99

Critical Care Scenarios

NOVEMBER 29, 2020

Looking at the workflow of a fresh post-op open heart surgery patient, as well as what to do when it devolves into cardiac tamponade, with (returning) guest Brendan Riordan, cardiothoracic ICU PA (@concernecus) at the University of Washington, and his NP colleague Kris Ramilo (@krsrml0). Audio quality was a bit dodgy in this one; sorry all!–eds.]

ICU 100

ICU Epinephrine OR ED 100

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. Reference: Schuster et al.

ICU 100

ICU ALS Emergency Department ED 100

EMDocs

JUNE 22, 2024

A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. We’ll keep it short, while you keep that EM brain sharp. She had a precipitous delivery while the ambulance was pulling in. The newborn is doing well, but the mother is complaining of shortness of breath and chest pain.

EMS 96

EMS Ambulance FFP ICU 96

Dr. Smith's ECG Blog

OCTOBER 19, 2022

A patient had 3rd degree AV block in the ED. and the 2021 YouTube Review by ICU Advantage on "Temporary Pacemakers: Modes and Basic Settings". Thanks to our Electrophysiologists Omar Iqbal and Rehan Karim for the below strips and the explanations I will be giving on this post.

ED 52

ED ICU OR Emergency Department 52

Critical Care Scenarios

JULY 11, 2021

Our guest is trauma surgeon Dr. Dennis Kim ( @traumaicurounds ), associate professor of Clinical Surgery at UCLA and medical director of the Harbor-UCLA Medical Center SICU, as well as host of the Trauma ICU Rounds podcast. Traction splinting is usually not done in the ED.

Operating Room 100

Operating Room ICU ED OR 100

EMDocs

JULY 8, 2023

. #1: DEVICE RCT – VL vs DL for Critically Ill Adults Spoon Feed Video laryngoscopy (VL) was associated with higher rates of first attempt intubation success compared to direct laryngoscopy (DL) for critically ill patients in the ICU and ED.

ICU 67

ICU ED OR 67

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). Am J Emerg Med.

Emergency Department 52

Emergency Department Critical Care ALS ICU 52

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

Don't Forget the Bubbles

AUGUST 23, 2023

Very rarely are the ED team allowed to stand, in silence, with a purpose. 2018) “Sacred Pause Imitative in the ICU: A survey of ICU physicians and nurses”. It gives us permission to stop, breathe, recognise the enormity of what has happened, and provide a platform for acknowledgement. Cunningham T. Southern Medical Journal.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

EMDocs

OCTOBER 10, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. She is diagnosed with “groin pain” and advised to return the next day for US or x-ray if not improved or to go to the ED if worse. She admitted to the ICU for “DKA.” Again, no abdominal exam is recorded.

ED 71

ED OR ICU 71

EMS 12-Lead

MAY 8, 2022

This is critical for the EMS provider, or ED clinician, as identification of Grade I ischemia (aka, HATW’s) addresses the culprit lesion at the earliest opportunity with excellent downstream prognosis for the patient. [2] The following ECG was captured upon arrival at the receiving ED. The ED resulted an 8.7 An ECG is recorded.

STEMI 130

STEMI ED EMS Firefighter 130

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 76

E-9-1-1 ICU ACS EMS 76

EMDocs

FEBRUARY 12, 2024

As the only respiratory therapist in the ED has been paged and is starting BiPAP for this patient, an overhead call for two incoming trauma alerts from a multivehicle collision sounds. Because the RT responsible for drawing arterial blood gases is busy caring for these patients, ABGs will be delayed.

Emergency Department 94

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

Don't Forget the Bubbles

JUNE 12, 2023

It wasn’t until over 20 minutes later that they managed to secure an airway and transfer her to the ICU, where she died 13 days later. Having just completed my Paediatric ED placement, I donned the navy flight suit and spent two weeks learning how to deal with every conceivable le in-flight emergency.

ICU 145

ICU ED OR 145

Critical Care Scenarios

APRIL 27, 2020

Takeaway lessons * We can undo most things except death, so in most cases, a short trial (perhaps 3 days) of fully aggressive care after an ICU admission is reasonable to help clarify the eventual prognosis. See Part 2 here. Set clear guideposts for when you’ll regroup to make more decisions about the direction of care.*

ICU 100

ICU ED OR 100

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. Its rareish but common enough that you.

Critical Care 40

Critical Care ICU Plasma Emergency Department 40

Emergency Medicine Ireland

FEBRUARY 21, 2022

I don’t think I’ve ever looked after a true myasthenic crisis in the ICU. I don’t think I’ve ever looked after a true myasthenic crisis in the ICU. I have made the diagnosis twice de novo in the ED (or at least admitted them with that as the leadning diagosis) so it is out there. Likely because.

Critical Care 40

Critical Care ICU ED OR 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. You order IV potassium and magnesium.

Naloxone 52

Naloxone Life Support Paramedic ALS 52