Critical Care Scenarios

MARCH 7, 2021

He is also director of their Outcomes After Critical Illness … Continue reading "Episode 26: ICU sedation, mobility, and delirium with Dale Needham" How to manage the intubated critically ill patient while keeping them awake, non-delirious, and mobile, with Dr. Dale Needham, FCPA, MD, PhD. More fentanyl is often needed early on.

ICU 100

ICU Critical Care OR 100

Emergency Medicine Ireland

MAY 27, 2024

Vasopressin has some animal data suggesting it causes less rise in PVR than our beloved noradrenaline but take that with an appropriately loosely defined portion of salt given that animal data is not ICU patients. Atrial fibrillation is something of a right of passage in the ICU. In terms of monitoring should we be reaching for a PAC?

Critical Care 52

Critical Care ICU OR ALS 52

EMOttawa

JANUARY 25, 2024

Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU. With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog.

ICU 142

ICU ED OR Critical Care 142

The Skeptics' Guide to EM

JULY 27, 2024

All of the secondary outcomes (mortality at 90 days, misdiagnoses, hospital length of stay, ICU admission rate, ICU length of stay, and quality of life) also did not show a statistical difference between the intervention group and the control group (SGEM#207). It needs to change physician practice for the better.

ICU 187

ICU ALS Ambulance OR 187

EMCrit Project

JANUARY 30, 2024

Polypharmacy is technically defined as taking five or more medications on a daily basis. Polypharmacy is increasingly becoming the norm among adults, due to several factors (an aging population, increasing numbers of medical problems, and increasingly complex regimens available to treat chronic disorders such as heart failure).

ICU 100

ICU OR 100

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

The patient states he has had multiple “diabetic emergencies” in the past and usually ends up in the intensive care unit (ICU) on a drip. He is wondering, “Hey doc, do I have to go back to the ICU strapped to an IV pole?” However, the ICU is full and the patient will likely be boarding in your ED for a bit before coming upstairs.

ICU 205

ICU ED Critical Care ALS 205

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 ).

Emergency Department 246

Emergency Department ICU Critical Care ALS 246

The Skeptics' Guide to EM

APRIL 27, 2024

Date: April 25, 2024 Guest Skeptic: Missy Carter is a PA working in an ICU in the Tacoma area and an adjunct faculty member with the Tacoma Community College paramedic program. Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation.

ICU 191

ICU Defibrillator CPR Paramedic 191

Emergency Medicine Ireland

JANUARY 4, 2021

So, from the ultra broad topic of AKI in the last podcast to the super specific question of when we should pursue an open lung biopsy in an ICU patient. So, from the ultra broad topic of AKI in the last podcast to the super specific question of when we should pursue an open lung biopsy in an ICU patient.

Critical Care 52

Critical Care ICU OR 52

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.

ICU 85

ICU ALS ACS EMS 85

Critical Care Scenarios

JULY 17, 2022

Takeaway lessons * Invasive aspergillosis is among the most common diseases identified on autopsy studies of ICU patients that was not recognized prior to death. Infection in the ICU patient arises when there are abnormalities in the flow of fluid, anatomical barriers, and/or the immune defenses (particularly neutrophil function).*

ICU 100

ICU Critical Care OR 100

Critical Care Scenarios

JANUARY 23, 2022

An overview of the role and contributions of a clinical pharmacist in the ICU, with Laura Means Ebbitt of the University of Kentucky, a clinical pharmacist specializing in colorectal/ENT surgery and critical care. Takeaway lessons A clinical pharmacist is a “knowledge pharmacist,” dispensing advice rather than medications.

ICU 130

ICU Critical Care OR 130

Emergency Medicine Ireland

FEBRUARY 18, 2021

HIV in the ICU is becoming a bit of a rare beast as the ID docs seem to have it so. HIV in the ICU is becoming a bit of a rare beast as the ID docs seem to have it so well controlled that it becomes a chronic co-morbidity rather than the cause of their presence in the ICU. Breaks in treatment can lead to resistance.

Critical Care 40

Critical Care ICU OR 40

Emergency Medicine Ireland

DECEMBER 14, 2020

This is a mammoth topic that listening to 5 mins of me rambling will in no way seriously prepare you to either practice clinically or write a semi coherent exam. Read More » Welcome back to the tasty morsels of critical care podcast. That being said here we go. That being said here we go.

Critical Care 40

Critical Care ICU OR 40

Emergency Medicine Ireland

SEPTEMBER 20, 2021

After 2 years of frequent, if not daily use of the bronch, I find it hard to see how I would manage in an ICU without it. Why might we pull out the bronch in the ICU? Now, when I say bronch I want to be clear that I’m talking about the flexible, disposable pieces of gear. Airway bleeding.

Critical Care 40

Critical Care ICU OR EMS 40

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? Prospective, multi center RCT. 1.40) Trial likely underpowered.

ICU 80

ICU CAD ALS OR 80

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Reference: Cashen K, Reeder RW, Ahmed T, et al. Pediatric Crit Care Med.

CPR 130

CPR ICU Critical Care Defibrillator 130

ALiEM

JUNE 1, 2023

Several studies have indicated that dosing with phenobarbital (PO or IV) is safe and effective at decreasing the need for escalating doses of benzodiazepines for EtOH withdrawal [1-6]. Because patients with hepatic encephalopathy experience excess GABA stimulation, they are very sensitive to GABAergic medications (e.g., 2017;35(7):1005-1011.

Emergency Department 246

Emergency Department ICU ED OR 246

The Skeptics' Guide to EM

JUNE 4, 2017

Outcome: * Primary: In-hospital mortality at initial hospital or secondary hospital if transfer occurred * Secondary: 24 hour and 30 day mortality, imaging time, time to diagnosis, length of stay (LOS) in the trauma room or ICU, number of days of mechanical ventilation. first appeared on The Skeptics Guide to Emergency Medicine.

OR 130

OR ALS CPR ICU 130

The Skeptics' Guide to EM

JANUARY 20, 2024

Her research interests include improving the diagnosis of urinary tract infections in children. Case: A 4-year-old girl comes to the emergency department complaining of pain with urination. She has not had any fevers or flank pain. You obtain a urinalysis that demonstrates 43 white blood cells, positive leukocyte esterase, and positive nitrites.

Emergency Department 172

Emergency Department ALS ICU OR 172

The Skeptics' Guide to EM

APRIL 22, 2023

Previous research has shown that HFNC can lower the rate of escalation of care but showed no impact on admission to the intensive care unit (ICU) or length of stay [1]. Some of these illnesses result in acute hypoxemic respiratory failure. We have covered the use of HFNC in pediatrics a few times on the SGEM including SGEM #228 and SGEM #379.

ICU 130

ICU Emergency Department ALS ED 130

The Skeptics' Guide to EM

JUNE 22, 2024

But like many interventions, there are potential harms and benefits. Yes, we purposely use the language of potential harms and benefits rather than risk and benefits. Using the term “risk” implies that a negative outcome may or may not happen. While the term “benefits” implies a positive outcome. It’s unbalanced.

Critical Care 129

Critical Care ICU Emergency Department ALS 129

EMDocs

AUGUST 17, 2024

Spoon Feed In ICU patients with traumatic brain injury (TBI) and anemia, transfusing blood to a liberal hemoglobin threshold (10 g/dL) compared to a restrictive threshold (7 g/dL) did not lead to better neurological outcomes at 6 months. We always work hard, but we may not have time to read through a bunch of journals.

ICU 69

ICU OR 69

The Bottom Line

JANUARY 10, 2024

In acutely ill adults (ED / ICU) does the administration of cefipime or piperacillin-tazobactam (pip-taz) result in an increased incidence of AKI or death by day 14?

ICU 62

ICU ED OR 62

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. Outcomes (secondary): 90-day all-cause mortality. Unclear how this bias affects outcomes.

Life Support 67

Life Support ICU EMS OR 67

Critical Care Scenarios

OCTOBER 17, 2021

Are antipsychotic (neuroleptic) agents a good treatment for ICU delirium? Are antipsychotic (neuroleptic) agents a good treatment for ICU delirium?* Bryan’s off this week, so Brandon flies solo to explain five wrong-headed notions that many people believe without thinking about them.

ICU 100

ICU OR 100

Core Ultrasound

MARCH 25, 2024

For example a pt in the ED with sepsis, and a collapsible IVC, dry lungs and no peripheral edema is more likely to benefit from fluid than be harmed Take that same pt, with the same US and physical exam findings and make it 72-hrs later in the ICU after 6-10 L. There is no one dichotomous test that will tell you whether to give fluid or not.

ICU 246

ICU ED OR 246

Critical Care Scenarios

DECEMBER 7, 2022

Signs of baseline and/or new RV strain, such as reduced TAPSE, septal bowing, etc, as well as pericardial effusion, suggest a poor reserve for the stresses of their new ICU course. Click here to claim your CME credit! Find us on Patreon here! Avoid intubation if at all possible, as this can easily provoke cardiovascular collapse. .

ICU 100

ICU Critical Care Epinephrine OR 100

Critical Care Scenarios

JULY 19, 2023

Takeaway lessons * One of the better indications for early dialysis in the ICU patient is to control volume, which in an oliguric patient you know is likely to keep accumulating. Realistically, most true indications for acute dialysis in the ICU are hyperkalemia, volume overload, or occasional toxicology. Find us on Patreon here!

ICU 100

ICU OR 100

Critical Care Scenarios

AUGUST 14, 2022

We look at the rib fracture patient requiring ICU admission, including a discussion of surgical repair, with Dr. Ron Barbosa (@rbarbosa91), Portland trauma surgeon and SICU director at Legacy Emmanual Medical Center. ICU admission in rib fracture patients is still most often a matter of clinician judgment and bed availability.*

ICU 100

ICU OR 100

Critical Care Scenarios

MARCH 20, 2022

A look at rehabilitation and mobility in the critically ill, from the perspective of our skilled therapists—with Heidi Engel, PT, DPT of UC San Francisco, long-term provider of acute care therapy, researcher in ICU rehabilitation, and founding member of the SCCM’s ICU Liberation program. Natural, indirect light is better.*

ICU 100

ICU OR 100

EMDocs

JULY 22, 2023

1: Macrolides and Long-Term Survival in ICU Patients with Community-Acquired Pneumonia Spoon Feed Empiric macrolide therapy was associated with improved six and twelve-month survival among ICU patients with community-acquired pneumonia (CAP). Originally published at JournalFeed , a site that provides daily or weekly literature updates.

ICU 73

ICU OR 73

Emergency Medicine Ireland

MAY 13, 2024

Part 1 will cover a broad overview of pulmonary hypertension and part 2 will focus on management strategies for a PH patient in the ICU. Saying a patient has PH does not really tell you very much. All we mean is that pressures in pulmonary circulation are higher than they should be. We also need some way of quantifying the severity of it.

Critical Care 98

Critical Care ICU OR 98

EMDocs

DECEMBER 9, 2023

Spoon Feed Advanced statistics emulating clinical trial protocols from an ICU database did not identify consistent differences in 30-day mortality when ICU patients were intubated early (within 8 hours of admission) or late (after 48 hours). Originally published at JournalFeed , a site that provides daily or weekly literature updates.

ICU 67

ICU ED OR 67

EMDocs

FEBRUARY 20, 2024

Fluids in Pancreatitis #1 : de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022 Sep 15;387(11):989-1000. cc/kg/hour of LR Control: LR Bolus of 20 cc/kg (regardless of fluid status) followed by 3.0

E-9-1-1 82

E-9-1-1 ICU ALS OR 82

EMDocs

JUNE 15, 2024

1: PREOXI RCT – Preoxygenation with Noninvasive Ventilation vs. Non-rebreather Mask Spoon Feed Noninvasive ventilation (NIV) was superior to a standard non-rebreather (NRB) oxygen mask for preoxygenation of critically ill ED or ICU patients requiring intubation, with a NNT of 11 to prevent 1 episode of hypoxemia <85%. . #3: 2024.7373.

ICU 75

ICU Emergency Department ED OR 75

Critical Care Scenarios

NOVEMBER 8, 2023

They should not be advanced or replaced by the ICU staff, as the stomach has been shortened, and advancing the tube may traumatize the anastomosis. . The benefit of this is not well-established. * It is almost always done for malignancy (or occasionally for other conditions like pre-malignant changes or pancreatitis with stricture).

ICU 130

ICU OR 130