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

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

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

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 97

ED ICU Emergency Department Overdose 97

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

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

Critical Care Scenarios

APRIL 16, 2025

We discuss the basics of EEG in the ICU, including when to do it, selecting the appropriate study, and the basics of bedside interpretation, with Carolina B Maciel, MD, MSCR, FAAN, triple boarded in neurology, neurocritical care, and critical care EEG. Learn more at the Intensive Care Academy! Find us on Patreon here! Find us on Patreon here!

ICU 158

ICU Critical Care ACS OR 158

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

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

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

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

Emergency Medicine Ireland

NOVEMBER 26, 2020

The main use of this information will come when some smug consultant corrects one of the team when they say PCP instead of PJP and then to rescuse the juniors from their shame you can bust out the ICNafp declaration on the two “i”s and arise victorious over said smug consultant.

Critical Care 40

Critical Care ICU OR 40

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

EMDocs

JANUARY 11, 2024

Evaluate and treat seizures or SE after CA in the context of other available clinical information because other systemic factors may influence the occurrence of seizures or SE and the effectiveness of treatment (90%, 18/20). Digestive Management Takeaway: Start enteral feeds when the patient gets to the ICU. Start low and go slow.

Critical Care 98

Critical Care E-9-1-1 OR ICU 98

Emergency Medicine Ireland

SEPTEMBER 18, 2023

A lot of that comes because it is a “syndrome”, ie a collection of clinical findings that someone has put into a big bucket and mixed around without paying too much attention to hard core diagnostic information like histology or a true pathological diagnosis. To start with we need context. To start with we need context.

Critical Care 52

Critical Care ICU OR 52

Emergency Medicine Ireland

OCTOBER 27, 2020

I have accumulated a large number of summarised and truncated notes across two specialties (three if you include the echo stuff…) and they exists as a useful compilation of information that I felt tricky enough and important enough to create a note for.

Critical Care 40

Critical Care ICU EMS OR 40

Medgadget

MAY 3, 2023

The goal, of course, is to provide clinicians with faster results, automate the analyses of patient data, and help them make better informed decisions about a patient’s care. AI is already playing a major role in medical imaging by helping to automate image analysis and reduce the amount of time needed to interpret scans.

Critical Care 80

Critical Care OR ICU 80

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. 15 DWI MRI sequence can show an acute brainstem or cerebellar infarct within seconds of the arterial occlusion.

EMS 98

EMS ALS OR ACS 98

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. Our THANKS to Dr. Meyers for presenting this informative case! I do not believe there is any finding here suggestive of OMI.

E-9-1-1 52

E-9-1-1 ACS Coronary CAD 52

Dr. Smith's ECG Blog

APRIL 20, 2018

However, this additional information was supportive. I took part in her ICU care and she was extubated and stable to transfer to a stepdown unit after a few days. Note that by current guidelines, this patient had a NSTEMI, but it would hard to argue that her condition would not have worsened if she was left to 'next day cath'.

Coronary 40

Coronary STEMI EMS ACS 40

Core EM

JANUARY 25, 2024

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. It was found that patients exposed to deep sedation in the ED had an independent higher incidence of continued deep sedation on ICU day one ( Fuller, 2019 ).

ICU 246

ICU Emergency Department Critical Care ALS 246

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

REBEL EM

AUGUST 7, 2023

Background Information: Delirium is a common and serious condition in patients in the intensive care unit (ICU). It is estimated to affect 30-50% of patients in the ICU and haloperidol is the most frequently used agent in treatment (3). Paper: Andersen-Ranberg NC,et al; AID-ICU Trial Group. N Engl J Med. 2022 Dec 29.

ICU 52

ICU ALS OR EMS 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. Its pragmatic design ensured that a broad range of clinical presentations were included across the ED and ICU settings. Thats exactly what Shane George et al.

ICU 108

ICU Critical Care ED OR 108

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

ICU 100

ICU CAD ALS OR 100

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

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

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