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

Core EM

OCTOBER 2, 2024

In: Marx J, ed. In: Wolfson A, ed. Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3%

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

REBEL EM

JUNE 8, 2023

Background Information: Acute Hypotension is associated with increased morbidity and mortality. This study chose a relevant topic to analyze that could influence acute management in the ED and has a fairly larger sample size of patients to do so. Continuous vasopressor infusions have previously been the mainstay of treatment.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

EMDocs

APRIL 10, 2024

These medications are a vital tool in the care of ED patients, from simple local analgesia for a laceration repair to regional analgesia for painful procedures. Hemodynamics slowly begin to stabilize, and the patient is transferred to the ICU for further post-cardiac arrest care. doi:10.1007/BF03161199 Olson K, Smollin C, eds.

E-9-1-1 111

E-9-1-1 Plasma Epinephrine Life Support 111

Don't Forget the Bubbles

JUNE 17, 2024

The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. The team sits down for a hot debrief once the patient is stabilised and transferred to the ICU. Exposure impairs information sharing and overall team collaboration.

E-9-1-1 105

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

REBEL EM

MAY 8, 2023

95% Confidence Interval) Strengths: The study addresses a patient-centered clinical question that is relevant to ED practice. 95% Confidence Interval) Strengths: The study addresses a patient-centered clinical question that is relevant to ED practice. 2,230 records remained after the elimination of duplicates. in ICC group, 5.8%

E-9-1-1 58

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

EMDocs

OCTOBER 21, 2023

While MRI is more resource and time intensive, studies have shown that a 6-minute protocol can give sufficient information to dictate treatment in the right setting. While MRI is more resource and time intensive, studies have shown that a 6-minute protocol can give sufficient information to dictate treatment in the right setting.

EMS 97

EMS ALS OR ACS 97

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).

Emergency Department 52

Emergency Department ALS Critical Care ED 52

Dr. Smith's ECG Blog

DECEMBER 13, 2019

I texted this to Dr. Smith without any information, and this was his reply: "This could be pericarditis but probably is normal variant." in the ICU but survived with excellent function. Q UESTION # 2 : ECG #4 was obtained from the patient in this case about 1 month later, when he returned to the ED for an unrelated problem.

E-9-1-1 52

E-9-1-1 ACS Coronary CAD 52

Dr. Smith's ECG Blog

APRIL 20, 2018

This is her pre-hospital ECG: This is her first ECG in the ED: What do you think? She also received an additional nitro in the ED after receiving aspirin and nitro via EMS. However, this additional information was supportive. Case A 30 something y.o. I did not appreciate any significant ST elevation.

Coronary 40

Coronary STEMI EMS ACS 40

Dr. Smith's ECG Blog

JULY 12, 2020

They informed me that she had just been hospitalized 10 days ago for "some fluid around the heart" and was discharged after one day without incident. More specific information such as definitive RV diastolic collapse was not indicated or available at this time given the obvious clinical context.

E-9-1-1 40

E-9-1-1 ED STEMI OR 40

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. mg/kg over several minutes 0.02 – 0.1

ICU 246

ICU Emergency Department Critical Care ALS 246

Don't Forget the Bubbles

MARCH 21, 2025

Effectiveness of Nasal High-Flow Oxygen during apnoea on Hypoxaemia and Intubation Success in Paediatric Emergency and ICU Settings: a randomised, controlled, open-label trial. A total of eleven intensive care units (ten PICUs and one non-maternity NICU) and four emergency departments (EDs) took part in the study.

ICU 108

ICU Critical Care ED OR 108

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. She reports occasional central chest pain exacerbated by coughing. for detecting pulmonary opacities. and 62.5%, respectively.

E-9-1-1 111

E-9-1-1 ED ALS OR 111

REBEL EM

JUNE 29, 2023

REBEL Cast Ep119: A Discussion with Scott Weingart on the CT FIRST Trial Click here for Direct Download of the Podcast Timing Is 6hrs reasonable because most pts excluded because of this Right before heading up to ICU seems good 1st couple hours after ROSC…pts are high risk for re-coding Where Not single coverage or stand-alone EDs Optimize and transfer…scans (..)

CPR 145

CPR ICU EMS ALS 145

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 97

ICU CAD ALS OR 97

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. Unified Treatment Algorithm for the management of crotalid snakebite in the United States: results of an evidence-informed consensus workshop. BMC Emerg Med.

Emergency Department 98

Emergency Department OR EMS ED 98

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. Case A 25-year-old-female presented to the ED in cardiac arrest. 1-3 As many as 25% of acute PE cases present as sudden cardiac death. 10,11 Vid 1. EKG RV strain.

ED 98

ED ALS NARCAN OR 98

REBEL EM

MAY 18, 2023

Patients were started on low-dose norepinephrine at a median time from ED arrival of 93 minutes compared to 192minutes in the standard care arm. The goal of the trial was to see if early vasopressors improved shock control by 6 hours. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4

OR 103

OR ICU EMS ED 103

REBEL EM

JULY 14, 2022

Background Information: Multiple illness severity scores have been developed for use after out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). Unfortunately, these rely on information that is not immediately available to providers in the early hours following return of spontaneous circulation (ROSC).

ICU 52

ICU ALS OR CPR 52

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). His blood sugar was normal en route to the ED, and his initial rhythm on the cardiac monitor was asystole. It is unclear how long he was down.

Defibrillator 110

Defibrillator CPR Epinephrine Life Support 110

Dr. Smith's ECG Blog

JUNE 17, 2024

If this EKG were handed to you to screen from triage without any clinical information, what would you think? The patient was upgraded to the ICU for closer monitoring. The RR ( R espiratory R ate ) in today's case is recorded as 14/minute at the time the patient presented to the ED on the day after their initial presentation.

E-9-1-1 138

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

Dr. Smith's ECG Blog

APRIL 6, 2018

He ended up requiring a total of 13 grams of CaCl in the ED to maintain rhythm and hemodynamics until our dialysis colleagues could start dialysis in the ED. He made it to the ICU, however the patient unfortunately expired approximately 24 hours after ICU admission. These patients cannot afford a delay.

Defibrillator 52

Defibrillator ICU EMS Plasma 52

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. Further diagnostic testing in the ICU identified salicylate toxicity.

Emergency Department 52

Emergency Department ICU ALS ACS 52

REBEL EM

AUGUST 29, 2022

Duration of mechanical ventilation, ICU, and percentage of vasopressor use were not significantly different. All intubations were performed on hospitalized patients, limiting application to the ED population. There was no information on the proportion of patients experiencing cardiovascular collapse before induction of anesthesia.

MICU 52

MICU ICU OR Emergency Department 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 Bottom Line: Hyperkalemia is an increasingly common ED diagnosis that must not be missed. At that time his diastolic blood pressure was also hovering between 45 and 55 mmHg.

Epinephrine 52

Epinephrine ICU Coronary EMS 52

ACEP Now

MAY 9, 2024

JHS’ chart review project, which identified 163 patients presenting to the ED with gluteal AFT complications in a 30-month period between 2020 and 2023, provides one of the most comprehensive and informative datasets on the breadth of AFT complications as they are currently being performed. units per patient.

Emergency Department 52

Emergency Department Operating Room Critical Care ICU 52

Dr. Smith's ECG Blog

MAY 5, 2022

Submitted and written by Destiny Folk MD , peer reviewed by Meyers, Smith, Grauer, McLaren A man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. On arrival in the ED, he was hypotensive with a systolic blood pressure in the 70s.

E-9-1-1 52

E-9-1-1 OR STEMI ED 52

The Overrun

MAY 18, 2020

Nor does it improve ED throughput, ICU stay, acuity, or a half-dozen other measurements. We need public information officers to take an active role in selling our profession. How about not using “response time” as a metric, and start using outcomes and science as measures of how well an EMS agency is doing? And that’s wrong.

EMS 52

EMS Firefighter Paramedicine Paramedicine 52

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 98

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

REBEL EM

NOVEMBER 11, 2024

They analyzed the electronic health records of patients presenting to the ED who met modified Center for Disease Control and Prevention (CDC) sepsis surveillance criteria and received empiric treatment with either vancomycin/piperacillin-tazobactam or vancomycin/cefepime. Comorbidity Index : Higher in the cefepime group (median 2 vs. 1).

E-9-1-1 108

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

REBEL EM

NOVEMBER 25, 2024

Intubation performed in all settings (out-of-hospital, emergency department, ICU, and operating room). Duration of intubation: Nine of thirteen studies reported slightly longer intubation times with a bougie, with a maximum average increase of 13 seconds in ED–based studies. in both groups in one study, and 1.1% in another study).

Operating Room 104

Operating Room Emergency Department ICU ALS 104

REBEL EM

DECEMBER 23, 2024

Volume of initial Resuscitation: As acknowledged by the authors, this study does not inform the best volume of early fluid resuscitation to provide, nor should the heterogeneity analysis be interpreted to suggest that a higher volume of fluid resuscitation is better. Sickle Cell Disease in the ED. 2021;16(2):e0247324.

ALS 128

ALS ED ACS EMR 128

Broome Docs

NOVEMBER 17, 2024

PMID: 31843324 Bottom line: This information is not new. Systematic Review: The Role of Intravenous and Oral Contrast in the Computed Tomography Evaluation of Acute Appendicitis. J Emerg Med. 2020 Jan;58(1):162-166. doi: 10.1016/j.jemermed.2019.10.034. 2019.10.034. Epub 2019 Dec 13. I was taught this in residency.

Epinephrine 61

Epinephrine Emergency Department Critical Care ICU 61

Dr. Smith's ECG Blog

APRIL 18, 2025

The patient waited in the ED, but remained free of chest pain. The ED physician began to arrange for transport to a PCI center. Angiography was performed at 10:31, just under 13 hours after the patients ED presentation: The red arrow shows a 50% distal stenosis of the left main coronary artery involving the ostium of the LAD.

ED 81

ED ACS ICU OR 81

Don't Forget the Bubbles

MARCH 3, 2025

This month, the team from Royal Manchester Childrens ED highlights the diversity of current paediatric literature, ranging from air pollution, wheeze, trauma, surgery, to sadly but inevitably, child death. This month, the team from ED highlights the diversity of current paediatric literature to reflect the versatility of RMCH ED.

Emergency Department 88

Emergency Department ED OR ALS 88

Don't Forget the Bubbles

MARCH 31, 2025

It was an observational multi-center study including >17,000 febrile children aged 0-18 across 12 European EDs over 1 year. In reality, children having blood taken in the ED for fever will likely have both an FBC and CRP taken. The study relied on Child Death Overview Panels (CDOP) to inform of their local contacts.

E-9-1-1 59

E-9-1-1 Emergency Department ICU OR 59