Core EM

JANUARY 25, 2024

The standard of care of treating DKA is fluid resuscitation, electrolyte management, and intravenous insulin infusion in the intensive care unit (ICU) setting for close glucose and electrolyte monitoring. Recent research aims at investigating the treatment of DKA with subcutaneous insulin in non-ICU settings. Image from cited article.

EMS 246

EMS ICU ED OR 246

Critical Care Scenarios

JUNE 26, 2024

We discuss the field of rehabilitation psychology, and how it can help patients with persistent critical illness, with Dr. Megan Hosey (@DrMeganHoseyPhD), clinical psychologist and assistant professor at Johns Hopkins School of Medicine, where she practices in the medical ICU. Delirium often dominates the patient experience of the ICU.

ICU 169

ICU OR 169

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

The Skeptics' Guide to EM

OCTOBER 3, 2021

Clinical Question: Does administration of a balanced solution (Plasma-Lyte 148) during intensive care unit (ICU) stay, compared with saline solution, result in improved 90-day survival in critically ill patients? Date: September 28th, 2021 Reference: Zampieri et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9%

OR 130

OR Critical Care ICU Plasma 130

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 140

ICU ED OR Critical Care 140

The Skeptics' Guide to EM

NOVEMBER 16, 2024

These systems use real-time data from electronic health records (EHRs) and other sources to predict which patients are at risk of adverse outcomes, such as cardiac arrest or transfer to an intensive care unit (ICU) [1.2]. Despite the potential benefits, integrating AI into clinical workflows presents challenges.

ICU 142

ICU Emergency Department ALS EMS 142

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 201

ICU ED Critical Care ALS 201

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 97

ICU OR 97

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?

ICU 141

ICU ALS ED OR 141

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

Emergency Medicine Ireland

MARCH 27, 2023

Oh Chapter 37 is dedicated to NIV in the ICU and is probably worth some time given that this is a common respiratory support both in the ICU and throughout the hospital. On an ICU vent this would be described as 5/5. Welcome back to the tasty morsels of critical care podcast. Still to be proven but commonly tried.

Critical Care 52

Critical Care ICU OR 52

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

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

The use of direct oral challenges has been tried in the intensive care unit (ICU) setting to de-label patients. Koo et al showed that offering amoxicillin oral challenges to ICU patients with low-risk penicillin allergies. A pivotal study by Raja et al.

ICU 136

ICU Emergency Department ALS ED 136

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 105

ICU ALS ACS EMS 105

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

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 189

ICU Defibrillator CPR Paramedic 189

Critical Care Scenarios

JANUARY 3, 2024

The other common ICU indication is a free flap, a portion of tissue (potentially including skin, subcutaneous tissue, muscle, even bone) removed from a remote site and transplanted into the head and neck area, with vessels anastomosed. . * Takeaway lessons * Robotics has enabled much less invasive approaches to many head and neck procedures.

ICU 130

ICU OR 130

Dr. Smith's ECG Blog

OCTOBER 8, 2024

A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. She was worked as a full code, and ROSC was achieved. She was taken to the cath lab, where she was found to have 100% in-stent restenosis of the proximal LAD. Later the next day, she went into cardiac arrest again. She could not be resuscitated.

OR 107

OR STEMI ICU Coronary 107

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

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

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

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

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. 1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 4, 8 Paper: Dahyot-Fizelier, C.,

E-9-1-1 126

E-9-1-1 ICU OR ALS 126

Core EM

FEBRUARY 9, 2024

Population 18+-year-old patients admitted with septic shock to a Medical ICU in an academic hospital in Mexico. Length of ICU stay: 1.5 Clinical Question Does early and repeated administration of methylene blue in patients with septic shock achieve the following outcomes? Serum lactate >2 after adequate fluid resuscitation.

ICU 100

ICU EMS OR 100

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 105

ICU ED ALS OR 105

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

OCTOBER 29, 2024

He was started appropriately on vancomycin and cefepime and accepted for ICU admission but remains in the ED due to boarding and bed lock. Left ventricular outflow tract obstruction in ICU patients. He has clinically deteriorated and required intubation. m/s)—problematic and elevated > 50 mm Hg (2.5 Curr Opin Crit Care.

E-9-1-1 87

E-9-1-1 ICU Epinephrine EMS 87

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

REBEL EM

AUGUST 12, 2024

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

ICU 81

ICU Operating Room Critical Care ALS 81

Critical Care Scenarios

JUNE 19, 2022

Brandon walks Bryan through a case of new, unexplained hypotension in the ICU, with a focus on approaching shock, the use of POCUS, and risk stratifying unexplained problems. from sepsis), while among the most common causes of hypotension in the ICU, is a diagnosis of exclusion.* Distributive shock (e.g.

ICU 100

ICU OR 100

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

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? which was not statistically significant [2]. The biggest issue with this trial is there was only one blood pressure done per patient.

MICU 126

MICU ICU ALS EMS 126

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

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

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 179

Emergency Department ALS ICU OR 179