REBEL EM

FEBRUARY 19, 2024

PMID: 37611862 Clinical Question: In patients treated in the ICU, can a protocol of peripheral IV catheter vasopressors safely reduce the number of days of CVC use and frequency of placement? REBEL EM: Peripheral Vasopressors – Safe or Dangerous? Crit Care Med 2021.

ICU 137

ICU EMS ALS OR 137

Emergency Medicine Cases

SEPTEMBER 25, 2019

While community acquired pneumonia (CAP) is 'bread and butter' emergency medicine, and the diagnosis is often a 'slam dunk', it turns out that up one third of the time, we are wrong about the diagnosis; that x-rays are not perfect; that blood work is seldom helpful; that not all antibiotics are created equal and that deciding who can go home and who (..)

Emergency Management 130

Emergency Management Emergency Manager ICU EMS 130

ACEP Now

OCTOBER 13, 2023

“We want important community leaders to be aware that we are highly concerned about this announcement and the dire impacts that this could have on our community and our patients,” said on a post by Texas A&M/Spohn EM on X. “We We fear that this decision will negatively impact patient safety and quality of care.”

ICU 132

ICU Emergency Department EMS 132

REBEL EM

MAY 29, 2024

The idea behind abx is to prevent things like AOM and TSS but neither should be much of an issue with short term placement ICU Admission? Traditional teaching is that these patients are at risk for life-threatening bradydysrhythmias and should go to the ICU Literature here is non-existent. PMID: 7741333 Corrales CE, Goode RL.

ICU 102

ICU ALS ACS EMS 102

EMDocs

OCTOBER 21, 2023

We’ll keep it short, while you keep that EM brain sharp. 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. Lancet Neurol 2009; 8:724-730.

EMS 98

EMS ALS OR ACS 98

REBEL EM

JANUARY 18, 2024

PMID: 35387313 Clinical Question: Do prehospital antibiotics impact 28 day mortality, length of stay in the hospital and ICU length of stay for patients triggering sepsis compared to usual care (No prehospital antibiotics)? appeared first on REBEL EM - Emergency Medicine Blog. to 0.97; p = 0.02 to 2.07; p = 0.91 to 12.33; p = 0.26

ICU 132

ICU ALS EMS 132

ALiEM

OCTOBER 30, 2024

Case A patient arrives via EMS from the bus station complaining of fever, vomiting, and back pain. Our experience: It was not long ago that we instructed our staff that: ‘COWS >8, give ’em 8 (mg of buprenorphine).’ Their back has worsened significantly over the past 24 hours with radiation down the left leg.

E-9-1-1 161

E-9-1-1 Naloxone Emergency Department ALS 161

REBEL EM

FEBRUARY 8, 2024

PMID: 38215002 Clinical Question: In critically ill adults in the ICU is noninvasive blood pressure (NIBP) monitoring similar (≤10% difference) to invasive arterial blood pressure (IABP) monitoring? PMID: 32109843 For More Thoughts on This Topic Checkout: REBEL EM: Is ATLS Wrong About Palpable Blood Pressure Estimates?

ICU 123

ICU MICU ALS EMS 123

ALiEM

MAY 19, 2023

Esophageal Balloon Tamponade Devices – Linton-Nachlas, Sengstaken-Blakemore, Minnesota Tubes (image courtesy of Dr. Mark Ramzy at REBEL EM) What are esophageal balloon tamponade devices? It is time to MacGyver a method that allows you to know the esophageal balloon pressure that you are generating to avoid an esophageal rupture.

E-9-1-1 245

E-9-1-1 Emergency Department ICU OR 245

REBEL EM

OCTOBER 2, 2023

Mild to moderate DKA represents a subgroup of patients that often require admission to the ICU due to hospital policies not allowing insulin infusions outside of this clinical setting. to 19.3hrs); Reduction by 3.6hrs ED LOS was shorter for the SQuID cohort ICU Admissions: SQuID & Traditional (Post Intervention): 42.9%

ICU 102

ICU ED ALS OR 102

REBEL EM

APRIL 9, 2024

She’s helped to redesign the built environment of a Harvard ICU and an infectious diseases unit in Malawi. Rezaie, MD (Twitter/X: @srrezaie ) The post REBEL EM Book Club – MicroSkills appeared first on REBEL EM - Emergency Medicine Blog. Post Peer Reviewed By: Salim R.

EMS 58

EMS ICU 58

Dr. Smith's ECG Blog

JANUARY 2, 2025

Dodd KW, Elm KD, Dodd EM, Smith SW. CASE CONTINUED She was admitted to the ICU. New formula for evaluation of the QT interval in patients with left bundle branch block. Heart Rhythm [Internet]. 2014;11:22732277. Available from: [link] 2. 2017;236:14. LBBB, ventricular pacing, etc.)."

Coronary 116

Coronary OR Defibrillator ALS 116

The Skeptics' Guide to EM

JUNE 6, 2020

Max is then going to Georgetown to be an attending in both EM and ICU. Max Hockstein trained as an Emergency Medicine physician at University of Texas Southwestern and is finishing his Intensive Care fellowship at Emory. Case: It’s another day in your emergency department (ED).

EMR 130

EMR ALS ICU Emergency Department 130

REBEL EM

APRIL 22, 2024

Population: Adult patients ( > 18 years of age) admitted to the ICU with COVID-19 and severe hypoxemia (defined as receiving supplemental O2 with a flow rate of at least 10L/min or receiving mechanical ventilation or non-invasive ventilation. appeared first on REBEL EM - Emergency Medicine Blog.

Life Support 74

Life Support ICU EMS OR 74

The Skeptics' Guide to EM

MARCH 27, 2021

He has a passion for FOAMed and is the creator of the Danish EM platform www.akutmedicineren.dk. Recent guidelines recommend admitting the patient to the intensive care unit (ICU), but the patient is eager to return home to her husband who is also well, and whom she claims will be able to help her. Reference: Schuster et al.

ICU 100

ICU ALS Emergency Department ED 100

The Skeptics' Guide to EM

NOVEMBER 16, 2019

NEJM Oct 2019 Guest Skeptic: Dr. Laura Melville (@lmelville535) is an emergency physician in Brooklyn, New York, is a part of the New York ACEP Research Committee, ALL NYC EM, and is the NYP-Brooklyn Methodist Resident Research Director. Case: A 59-year-old woman comes is brought into your emergency department (ED) by EMS in cardiac arrest.

ALS 100

ALS CPR ICU EMS 100

AAEM RSA

JUNE 30, 2021

A combined Emergency Medicine (EM)/Internal Medicine (IM) residency program may allow for the best of both worlds. 2] The most popular fellowship pursued by combined training candidates is critical care (CC), and there are five all-inclusive combined EM/IM/CC programs in the United States. Welcome to LIJ EM/IM and EM/IM+CC.

EMS 52

EMS Critical Care ICU ED 52

Emergency Medicine Ireland

SEPTEMBER 20, 2021

There’s not a huge amount of notes on procedural stuff that I accumulated for the exams but I did collect some interesting bits on bronchoscopy, particularly because it was so novel to me as an EM trainee who really had no experience with bronchoscopy prior to starting to my critical care fellowship.

Critical Care 40

Critical Care ICU OR EMS 40

Critical Care Scenarios

OCTOBER 31, 2021

Boswell (EM and CCM) of the University of Maryland, perhaps the busiest center in the country for COVID-related ECMO. Boswell (EM and CCM) of the University of Maryland, perhaps the busiest center in the country for COVID-related ECMO. An overview of VV ECMO with a focus on COVID-19, with Dr. Kimberly A. Data remains slim,

Interfacility Transport 100

Interfacility Transport Plasma ICU EMS 100

ACEP Now

JANUARY 4, 2025

The specialty, he said, spoke to his interest in surgery and EMS in a way that family medicine did not. A closer look, though, also shows the technology of the daya bulky, two-way radio for communicating with EMS, metal gurneys, glass saline bottles, and portable ECG monitors the size of a small shopping cart. I like the excitement.

ED 52

ED Emergency Department Ambulance CPR 52

The Skeptics' Guide to EM

DECEMBER 16, 2017

Case: Johnny is a 22-year-old male patient who presents to the emergency department via EMS with a seizure. He is now stabilized, fosphenytoin is being infused, you are getting ready to ship him to the neuro-ICU and wonder if cooling him down would help. He is known to have poorly controlled epilepsy.

ALS 100

ALS ICU Emergency Department Paramedic 100

REBEL EM

JULY 17, 2023

PMID: For More Thoughts on This Topic Checkout: REBEL EM: Etomidate Vs. Ketamine – A Systematic Review and Meta-Analysis Post Peer Reviewed By: Anand Swaminathan, MD (Twitter: @EMSwami ) The post REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? appeared first on REBEL EM - Emergency Medicine Blog. Range 5 to 9) Etomidate: 7.0

ED 97

ED ICU Emergency Department Overdose 97

Dr. Smith's ECG Blog

OCTOBER 23, 2023

Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return of spontaneous circulation. She had an uneventful ICU course and was extubated for ongoing care with the inpatient psychiatric service.

ICU 130

ICU OR Defibrillator EMS 130

Emergency Medicine Ireland

DECEMBER 3, 2020

As an EM trainee doing intensive care I will confess that I struggle to work up the enthusiasm to cover a nutrition guideline. As an EM trainee doing intensive care I will confess that I struggle to work up the enthusiasm to cover a nutrition guideline. As with all ICU nutrition EN is preferred over PN. This is the first step.

Critical Care 52

Critical Care ICU EMS OR 52

EMDocs

SEPTEMBER 19, 2023

Episode 86: Tricky Cases Part 2 Case 3: 56-year-old female with history of seizures, actively seizing, EMS called. Patient seized for approximately 20 minutes prior to EMS arrival. Propofol utilized for sedation; patient admitted to ICU for EEG monitoring. They administer two doses of 10 mg midazolam IM.

STEMI 102

STEMI Coronary Emergency Department ICU 102

ACEP Now

MAY 4, 2023

EMS recognized a chest wall deformity with movement of the chest wall, and a splint was devised and taped around his chest for what was suspected to be a flail chest. The post Case Report: EMS Says Flail Chest, But Is It? The patient had been drinking with friends when he was witnessed to trip and fall a distance of one step.

EMS 52

EMS Operating Room ICU Emergency Department 52

EMDocs

APRIL 10, 2024

Authors: Alex Rogers, MD (EM Resident Physician, Christus Spohn/Texas A&M University School of Medicine, Corpus Christi, TX); J.D. Hemodynamics slowly begin to stabilize, and the patient is transferred to the ICU for further post-cardiac arrest care. The patient remains hemodynamically unstable, and bolus of 1.5

E-9-1-1 111

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

EMS 12-Lead

AUGUST 22, 2022

A 65 y/o Female was admitted to the ICU for septic shock. The combination of prolonged QT and deep T wave inversion throughout the precordium is typical of Takotsubo syndrome, or Stress Cardiomyopathy – which can occur in the context of a physiologically distressed ICU patient, further compromising their hemodynamics.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

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. 2019 Aug; PMID: 30954692 Clinical Question: What is the impact of system factors in the implementation of standard-of-care LPV in critically ill ED patients admitted to the ICU? Paper: Owyang CG, et al.

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

Critical Care 96

Critical Care ED EMS OR 96

Silk City Blog

JANUARY 20, 2022

The overall incidence of developing venous thromboembolism (VTE) is approximately 17% in patients diagnosed with COVID-19, with a significantly higher rate in the ICU setting (Jiménez 2021). Some of these papers have been reviewed on REBEL EM.

ICU 52

ICU EMS 52

Dr. Smith's ECG Blog

JANUARY 3, 2020

Cole , one of our EM faculty and unparalleled toxicologist, and director of the Minnesota Poison Control Center. The patient was admitted to the ICU. The potassium was repleted in the ICU to a total of 170 mEq with resolution of symptoms (this could be hazardous!). This case comes from Jon B. The K returned at 1.4

ICU 52

ICU EMS ED OR 52

REBEL EM

JANUARY 9, 2024

You decide she is stable to be discharged home on levofloxacin (See REBEL EM for antibiotic coverage in CAP ) but consider giving her a first dose intravenously. appeared first on REBEL EM - Emergency Medicine Blog. A CXR demonstrates a right middle lobe opacity. After acetaminophen, her HR is 82 and her temp is 98.5.

ALS 98

ALS ICU ED OR 98

REBEL EM

NOVEMBER 6, 2023

So with yet another confounding variable added (sicker patients at baseline in methylene blue group), the comparison of these two medications is yet again even more difficult There was no difference in ICU and hospital length of stays or hospital mortality between the two groups.

ICU 71

ICU Epinephrine ALS OR 71

Broome Docs

OCTOBER 31, 2022

Ketamine vs etomidate in ICU intubation ? PMID: 34904190 Not surprisingly, this paper has been covered by basically everyone who talks about research, so if you want to hear some other opinions, check out the SGEM , REBEL EM , or St. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial.

E-9-1-1 52

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

REBEL EM

AUGUST 31, 2023

ICU: 42.6% vs 0% ICU length-of-stay: 9 days vs 7 days In-Hospital Mortality: 28.2% ICU Mortality: 56.7% Conversely, it may be reasonable to withhold prophylactic platelets for patients in the ICU setting due to trends of lower bleeding risk noted as well as more intensive bleeding monitoring. Median hemoglobin: 8.2

ICU 58

ICU ALS OR EMS 58

REBEL EM

JUNE 8, 2023

The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Rezaie, MD (Twitter: @srrezaie ) The post The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults appeared first on REBEL EM - Emergency Medicine Blog. J Med Toxicol. Epub 2019 Jul 3. Intensive Care Med.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98