ALiEM

OCTOBER 30, 2024

That discussion can be deferred until the patient is stable, the risk of such an event is mitigated, and other medications can be given for their withdrawal symptoms and pain. Multi-Substance Use Substances such as cocaine, amphetamines, and benzodiazepines often are used concurrently, which can confound the management plan.

E-9-1-1 161

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

Critical Care Scenarios

APRIL 4, 2021

How to take the well-resuscitated critically ill patient, get fluid out of them, deescalate their antibiotics, wean their sedation, reduce vent support, extubate, and get them out of the ICU—with Dr. Matt Siuba (Twitter: @msiuba), an intensivist at the Cleveland Clinic with an abiding interest in “zentensivism,” the art of doing less.

ICU 100

ICU OR 100

REBEL EM

JUNE 8, 2023

From a safety standpoint this is a great thing, but also could be the reason we see such few adverse events Discussion: There is a recent “push” to utilize “Push dose pressors” as the correction of acute hypotension in a variety of clinical scenarios. In other words these were pre-made syringes and not mixed at the bedside. Am J Emerg Med.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

ESO

MARCH 7, 2024

Hospital Events: With 8% of patient encounters involving at least one hospital event, such as unexpected ICU admissions or delirium, the Index identifies a significant area to reduce for improvement in patient safety and care quality.

Operating Room 105

Operating Room ICU OR ED 105

Core EM

OCTOBER 16, 2024

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% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

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. 0.83 (0.66 – 1.13) NO Adverse Events 51.7% days (0.2 – 11.5)

Life Support 73

Life Support ICU EMS OR 73

EMS 12-Lead

AUGUST 22, 2022

A 65 y/o Female was admitted to the ICU for septic shock. Beats 9-12 : Continuation of the previously described events, all inducible by the pause (and thus, prolongation of refractoriness) created by the PVC of Beat 8. She was critically ill despite aggressive vasopressor therapy.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

Silk City Blog

FEBRUARY 24, 2022

Background:Patients diagnosed with COVID-19 have an increased risk of thromboembolic events, including pulmonary embolism and deep vein thrombosis (DVT). The INSPIRATION Trial investigated outcomes with an intermediate vs. standard prophylactic dose of anticoagulation in ICU patients.

ICU 52

ICU OR 52

Critical Care Scenarios

OCTOBER 31, 2021

Diurese until you develop flow problems (suction events) on the pump, a useful indicator of low intravascular volume.* Decannulate at the bedside when ready, watch them for 24 hours, then boot them out of the ICU; they’re ready.* Inhaled vasodilators can be continued or weaned depending on right heart function.

Interfacility Transport 100

Interfacility Transport Plasma ICU EMS 100

REBEL EM

AUGUST 31, 2023

ICU: 42.6% 4.70) in grade 2-4 bleeding event Subgroup analysis revealed a higher risk of grade 2-4 bleeding was noted with decreasing platelet counts, and the greatest benefit of platelet transfusion is likely to be in those patients with a lower platelet count. ICU: 42.6% ICU Mortality: 56.7% ICU Mortality: 56.7%

ICU 57

ICU ALS OR EMS 57

Silk City Blog

JANUARY 20, 2022

Background: Severely ill patients diagnosed with COVID-19 have an increased risk of cardiovascular complications, especially thromboembolic events (Bikdeli 2020). Multiple studies have investigated the use of antithrombotic agents in patients with COVID-19 admitted to various hospital settings (Talasaz 2021).

ICU 52

ICU EMS 52

Dr. Smith's ECG Blog

JANUARY 3, 2020

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!). mEq/L on discharge without telemetry events. Large U-waves confirm the diagnosis of hypokalemic periodic paralysis (HPP). The K returned at 1.4 mEq/L and K was given po and IV.

ICU 52

ICU EMS ED OR 52

Handtevy

AUGUST 15, 2022

Study Overview A recent research study titled “Sodium Bicarbonate Use During Pediatric Cardiopulmonary Resuscitation: A Secondary Analysis of the ICU-RESUScitation Project Trial” aimed to evaluate the associations between sodium bicarbonate use and outcomes during p-IHCA. 1.34; p = 0.621).

CPR 52

CPR ICU Overdose Critical Care 52

Dr. Smith's ECG Blog

OCTOBER 8, 2024

A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. KEY Point: The important distinction that has to be made in today's case, is between ECG findings consistent with this patient's prior LAD OMI — vs — ECG findings of a new acute event superimposed on these prior ECG findings.

OR 122

OR STEMI ICU Coronary 122

EMDocs

APRIL 10, 2024

While not specifically reviewed in this post, check out the methemoglobinemia tox card for more information about one of the other known events that can occur with local anesthetic administration. Hemodynamics slowly begin to stabilize, and the patient is transferred to the ICU for further post-cardiac arrest care.

E-9-1-1 111

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

REBEL EM

MARCH 23, 2023

The group that received phenobarbital had a higher maximum CIWA score than the group that received lorazepam, which could mean that phenobarbital was not as effective as lorazepam, although this is potentially confounded by patients who were transferred to the ICU were excluded from the study.

ICU 52

ICU Emergency Department ALS OR 52

Core EM

OCTOBER 2, 2024

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% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

Dr. Smith's ECG Blog

JULY 22, 2012

Course : A CT of the head, neck, chest, abdomen and pelvis showed no other unanticipated injuries and she was admitted to the ICU. Patients may have positive biomarkers (troponin) from the related stress of multisystem trauma, and low levels of troponin probably do not predict adverse events any better than the patients clinical condition.

Coronary 52

Coronary ICU OR ED 52

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. Once a sufficiently high level is achieved, modelling of behaviours and episodes of retaliation can perpetuate the behaviours far beyond the initial event. How do you manage this situation?

E-9-1-1 105

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

Emergency Medicine Ireland

OCTOBER 28, 2020

TTP is a lovely ICU diagnosis. TTP is a lovely ICU diagnosis. Welcome back to the tasty morsels of critical care podcast. Not so much for the patient but it’s one of those ones that is niche enough to not have been picked up via the. Read More » Welcome back to the tasty morsels of critical care podcast.

Critical Care 40

Critical Care Plasma FFP ICU 40

Emergency Medicine Ireland

FEBRUARY 6, 2023

Given that a lot of ICU bed days are given over to managing SAH, I felt it might have warranted its own chapter. Hydrocephalus is a relatively common event in SAH and the theory is that blood in the CSF space blocks up the arachnoid granulations preventing reabsorption and with ongoing production and failure to reabsorb you get hydrocephalus.

Critical Care 52

Critical Care ICU EMS OR 52

Emergency Medicine Ireland

JULY 26, 2021

Candidiasis is common in ICU patients. That being said knowing what’s there in the event of the patient getting super sick might be somewhat helpful in guiding therapy. These are work horses in the ICU with a low side effect profile and importantly cover the vast majority of candida likely to grow.

Critical Care 40

Critical Care ICU OR 40

ACEP Now

JULY 7, 2024

Neurology consultation should be initiated, and the patient should be admitted to the ICU. Alternatively, the Neurocritical Care Society defines it as a seizure with five minutes or more of continuous clinical or EEG seizure activity, or recurrent seizure activity without recovery between seizures.

Emergency Department 52

Emergency Department Critical Care ALS ICU 52

AAEM RSA

APRIL 8, 2021

We have already converted pediatric hospitals to accept adult patients, our backup docs are working full schedules, our nurses are working double time, the ED functions as an additional ICU, and we are stretched to our limits with no end in sight. The emotional toll that this is waging on many of us is very concerning.

ICU 52

ICU EMR OR ED 52

Emergency Medicine Ireland

JULY 5, 2021

Peak levels occur ~15-120 mins post event and decline predictably (T1/2 ~2hrs). Oh is quite pro IV infusions and certainly in the ICU and OT this is ubiquitous and generally well done in my experience.

Critical Care 40

Critical Care ICU ALS OR 40

Dr. Smith's ECG Blog

OCTOBER 28, 2022

He went into cardiogenic shock and is intubated in the cardiac ICU. The main premise of my qualitative approach — is to be suspicious of an acute cardiac event when you see ST-T wave findings that shouldn't be there. I just got the follow up that he had a near complete very proximal LAD occlusion , and a complete PDA occlusion.

Coronary 52

Coronary Paramedic ICU EMS 52

Dr. Smith's ECG Blog

MARCH 12, 2018

Wellens' is a syndrome of a painless period following an anginal (chest pain) event. She had an uneventful ICU course and improved steadily over the course of a week. Thus, it is critical to compare the ECG with the symptomatic state of the patient! Differences of Pulmonary Embolism T-waves from Wellens' T-waves: 1.

ACS 40

ACS Coronary ALS ICU 40

Dr. Smith's ECG Blog

MARCH 11, 2019

The patient was managed in the ICU and had serial troponins. (THE PM CARDIO OMI AI APP) If you want this bot to help you make the early diagnosis of OMI and save your patient and his/her myocardium, you can sign up to get an early beta version of the bot here. It is not yet available, but this is your way to get on the list. First was 2.9

OR 52

OR ACS ICU STEMI 52

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. Thats exactly what Shane George et al. George S, Williams T, Humphreys S, et al. Lancet Respiratory Medicine. Hypoxaemia occurred in 12.8% in the standard care group.

ICU 108

ICU Critical Care ED OR 108

Dr. Smith's ECG Blog

JULY 12, 2020

I found a well appearing young lady in the room with her parents who witnessed the event. She denied having any symptoms before or after the event, and she was asymptomatic on my initial exam. She was diagnosed with pericarditis and spent one day in the hospital without events.

E-9-1-1 40

E-9-1-1 ED STEMI OR 40

REBEL EM

FEBRUARY 29, 2024

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. To confirm VAP, events were defined in a standardized approach using the American Thoracic Society criteria. 4, 8 Paper: Dahyot-Fizelier, C.,

E-9-1-1 121

E-9-1-1 ICU ALS OR 121

REBEL EM

FEBRUARY 15, 2024

PMID: 38019968 Clinical Question: In patients with suspected acute poisoning and GCS <9, is a conservative airway strategy of withholding intubation associated with a reduction in death, ICU LOS, and hospital LOS compared with routine practice of intubation? References: Freund Y et al.

ICU 141

ICU ALS ED OR 141

REBEL EM

AUGUST 14, 2023

They consecutively enrolled 1,817 ICU patients from 45 sites across China. Population: Inclusion Criteria: Age 18-75 years old SOFA score 2-13 Admitted to the ICU with a diagnosis of sepsis 3.0, “ Life-threatening organ dysfunction caused by a dysregulated host response to infection.” 002) ICU-free days: Placebo 12.4%

ICU 98

ICU EMS OR ALS 98

REBEL EM

JUNE 26, 2023

This could potentially help improve thrombin generation, reduce blood product consumption, but also could increase the risk of thromboembolic events. Additionally, the use of 4F-PCC resulted in a higher rate of thromboembolic events compared to placebo. 4F-PCC contains factors II, VII, IX, X as well as Proteins S and C.

FFP 145

FFP Frozen Plasma ALS Plasma 145

REBEL EM

MAY 29, 2023

What They Did: Single-center, parallel, double blind, randomized controlled trial performed in a medical-surgical ICU (Mexico) Both groups received: Adjunctive vasopressin initiated at a dose of 0.03 It also reduced length of stay in ICU and hospital without adverse effects. NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9%

ICU 145

ICU ALS Epinephrine OR 145

Core EM

JANUARY 25, 2024

Disposition to ICU. Potassium Shifted intracellularly by insulin, total body potassium is normal Replete to goal 3-3.5 Reinforces importance of close monitoring and intervention. Takes 30 minutes to see effect, temporize with traditional vasopressors (norepinephrine, vasopressin). References: Yuan TH, Kerns WP, Tomaszewski CA, et al.

Overdose 246

Overdose ALS Epinephrine Critical Care 246

Dr. Smith's ECG Blog

JUNE 23, 2024

Given the presentation, the cardiologist stented the vessel and the patient returned to the ICU for ongoing critical care. (TIMI 3 means the rate of passage of dye through the coronary artery is normal by angiography.) Lesions less than 70% are generally considered to be non-flow limiting. Two subsequent troponins were down trending.

Coronary 118

Coronary CAD CPR Critical Care 118