ACEP Now

OCTOBER 13, 2023

Our residents are currently the primary staff members in our Shoreline emergency department, had of the medical ICU, and the entire Trauma ICU. Watch the ACEP Now website for more information as it becomes available. We fear that this decision will negatively impact patient safety and quality of care.”

ICU 132

ICU Emergency Department EMS 132

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

REBEL EM

FEBRUARY 8, 2024

In shocky patients, arterial lines are often used to monitor hemodynamic parameters and inform treatment decisions. 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? to 1.12; p = 0.03

ICU 125

ICU MICU ALS EMS 125

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

ALiEM

MAY 19, 2023

In our emergency department, the RTs do not spend a lot of time going around measuring cuff pressures and usually save that until the patient reaches the ICU. Hence, the RT’s are supposed to have them. It is convenient to use for the inflation of the esophageal balloon because it can inflate and measure pressure at the same time.

E-9-1-1 245

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

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? CT can provide important information. N Engl J Med.

ICU 96

ICU CAD ALS OR 96

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

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

The Skeptics' Guide to EM

DECEMBER 25, 2017

It does this by doing a structured critical review of a recent publication and then disseminates the information using the power of social media. The SGEM strives to make the information accessible with the right balance of education and entertainment. We want patients to get the best care based on the best evidence.

ICU 100

ICU ED 100

REBEL EM

AUGUST 12, 2024

Background Information: Acute kidney injury (AKI) is one of the most frequent complications of cardiac surgery and the cause is complex. Renal hypoperfusion from decreased glomerular filtration rate after cardiopulmonary bypass is a major contributor.

ICU 81

ICU Operating Room Critical Care ALS 81

ESO

MARCH 7, 2024

A retrospective look at aggregate data, the purpose of the following metrics is to both inform and ignite a conversation around best practices to help improve patient outcomes. To decide what metrics would be most helpful to include, ESO data scientists reviewed medical journals throughout the year, taking note of hot-button topics.

Operating Room 105

Operating Room ICU OR ED 105

The Skeptics' Guide to EM

MARCH 18, 2023

Population: Children <18 year from Pediatric Health Information System (PHIS) database hospitalized with Influenza from 2007-2020. Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020. JAMA Pediatr.

ICU 102

ICU Emergency Department OR 102

REBEL EM

NOVEMBER 30, 2023

Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. It’s not mentioned whether the authors attempted to identify additional studies by checking the references of the selected articles or by contacting the original paper authors for more information. 2.89, p = 0.01.

E-9-1-1 121

E-9-1-1 ALS ACS ICU 121

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

REBEL EM

NOVEMBER 6, 2023

Background Information: Vasoplegic shock is defined as hypotension with normal or increased cardiac output and can commonly occur in post-cardiac surgery patients having received cardiopulmonary bypass. This dysregulation of vasodilation is associated with a mortality of close to 25%.

ICU 71

ICU Epinephrine ALS OR 71

REBEL EM

JULY 17, 2023

PMID: Clinical Question: Does a single dose of ketamine or etomidate used for rapid sequence intubation (RSI) of critically adults in the ED impact the SOFA score within 3 days of hospitalization? Range 5 to 9) Etomidate: 7.0 Range 5 to 9) Diff -0.2; 95% CI -1.4

ED 98

ED ICU Emergency Department Overdose 98

REBEL EM

SEPTEMBER 14, 2023

We don’t know any of this information unfortunately and all are key in patient selection The median lactate level before revascularization was 6.9mmol/L (Range 4.6 Control: 53.4% D ECLS: 18.2% Control 8.7% Control 38.0% Control: 49.0% RR 0.98; 95% CI 0.80 to 1.19; p = 0.81 vs 13.9% (RR 0.58; 95% CI 0.33 vs 22.6% (RR 1.03; 95% CI 0.88

Life Support 136

Life Support Coronary CPR ICU 136

REBEL EM

JUNE 8, 2023

Background Information: Acute Hypotension is associated with increased morbidity and mortality. The retrospective design of this study omitted assessment of ventricular dysrhythmias related to push dose pressor administration, as they were reliant on information in the EMR. J Med Toxicol. Epub 2019 Jul 3. Intensive Care Med.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

REBEL EM

OCTOBER 31, 2022

Fujii 2022, Sevransky 2021) Contrary to the above trial, another RCT investigated patients in the ICU with sepsis and acute respiratory distress syndrome. Clinical Question: Does high-dose vitamin C improve survival and/or persistent organ dysfunction rates in septic patients in the ICU on vasopressors? Article: Lamontagne F et al.

ICU 52

ICU ALS OR EMS 52

REBEL EM

MARCH 23, 2023

Background information : Alcohol has potentiating effects on the inhibitory GABA neurotransmission system and inhibitory effects on the excitatory glutamate neurotransmission system. Limitations : More information would have been helpful regarding the statistical methods regarding propensity scores.

ICU 52

ICU Emergency Department ALS OR 52

REBEL EM

SEPTEMBER 26, 2022

It provides highly descriptive, real-time information on clot formation, clot strength, platelet function, and fibrinolysis, which is superior to traditional coagulation tests such as INR, aPTT, and platelet count. The TEG group had a shorter ICU length of stay in the first admission. Significant coagulopathy: INR > 1.8

FFP 52

FFP E-9-1-1 ICU ALS 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

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

Emergency Medicine Ireland

APRIL 4, 2022

As such it presents a fairly predictable work load and patient cohort for your ICU. Given the bewildering number of conditions that can present to a mixed ICU on a given day, knowing that you have a couple of hearts moving along the production line provides a degree of predictability to the workflow.

Critical Care 40

Critical Care ICU OR 40

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

AUGUST 21, 2023

Background Information: Cardiac arrest is a devastating event that imposes considerable human and financial burdens. While it is widely recognized that cardiac arrest leads to brain injury, what is often overlooked is the persistent cerebral hypoperfusion that continues even after circulation is restored. Paper: Eastwood G, et al.

E-9-1-1 98

E-9-1-1 Critical Care CPR ALS 98

EMDocs

AUGUST 15, 2023

Unified Treatment Algorithm for the management of crotalid snakebite in the United States: results of an evidence-informed consensus workshop. link] Highlights of prescribing information. If you are concerned for elevated compartment pressures, the patient needs to be treated with antivenom. BMC Emerg Med. 2011;3(11):2.

Emergency Department 98

Emergency Department OR EMS ED 98

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. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think?

E-9-1-1 139

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

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. Exposure impairs information sharing and overall team collaboration. While you are leading the resuscitation, one of your senior colleagues belittles a junior staff member for struggling to site an IV line. How do you manage this situation?

E-9-1-1 105

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

Emergency Medicine Ireland

JULY 3, 2023

Hopefully in a few minutes you’ll at least have a few morsels more of information to stave off all the trainees who are undoubtedly much smarter than you on the ward round. It is important to realise that a referral to ICU for refractory cardiorenal syndrome may simply be a sign that the patient is reaching end of life.

Critical Care 96

Critical Care ACS OR ALS 96

Don't Forget the Bubbles

NOVEMBER 15, 2023

You retrieve the below relevant information… Vital signs : T 40, HR 140, BP 75/40 (52) Examination : mucous membranes slightly dry, skin turgor normal, mild dependent pitting oedema Bloods: Na 146, K 5.2, A urinary catheter was also inserted. She has been commenced on broad-spectrum IV antibiotics. Intensive Care Med. 2018;44(4):409-417.

Plasma 80

Plasma ALS ICU Critical Care 80

ACEP Now

MAY 9, 2024

After developing encephalopathy and hypoxemic respiratory failure, the patient was transferred to the ICU. Further diagnostic testing in the ICU identified salicylate toxicity. Other examples included patients transferred between services whose failure to include complete handover information led to other delays in care.

Emergency Department 52

Emergency Department ICU ALS ACS 52

REBEL EM

MAY 18, 2023

Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4 Also ≈3300 eligible patients screened of which many not enrolled.

OR 104

OR ICU EMS ED 104

EMDocs

APRIL 22, 2024

Although POCUS exams are learned individually, scanning condition-related anatomic areas provides EPs with critical information, improving the opportunity to rule-in a diagnosis more confidently. Marino’s the ICU book, Wolters Kluwer Health, pgs 105-109, 4th ed., 10,11 Vid 1. 2014 May;145(5):950-957. doi: 10.1378/chest.13-1087.

ED 98

ED NARCAN ALS OR 98

REBEL EM

AUGUST 29, 2022

Duration of mechanical ventilation, ICU, and percentage of vasopressor use were not significantly different. There was no information on the proportion of patients experiencing cardiovascular collapse before induction of anesthesia. There was no quantitative information on the amount of preexisting IV fluids and vasopressor therapies.

MICU 52

MICU ICU OR Emergency Department 52

REBEL EM

MARCH 30, 2023

Comparator: Delayed CAG: Patients were admitted to the ICU, and CAG was performed after 48-96 hours. There is very little information on the methodology of the meta-analysis. Moreover, there is relatively little information regarding patient management outside the study intervention.

Coronary 66

Coronary CPR OR ICU 66

REBEL EM

MAY 8, 2023

Contacted authors of included studies for additional information when necessary Checked multiple trial registries for unpublished literature Included studies from multiple countries Included all ages Included all languages Investigators assessed quality with standardized critical appraisal instruments from the Joanna Briggs Institute (JBI).

E-9-1-1 58

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