EMCrit Project

OCTOBER 24, 2023

Today we'll walk through some interesting bits of the new IDSA/SCCM guideline on evaluation of new fever in the adult ICU patient (available free here). how should temperature be evaluated? This is frankly a mess. Bladder catheter or esophageal probe are best, but usually not used.

ICU 120

ICU OR 120

Core EM

JANUARY 1, 2025

Supportive Care Intensive monitoring, often in an ICU setting. Types of Necrotizing Fasciitis Type I (Polymicrobial) Involves aerobic and anaerobic organisms (e.g., Bacteroides, Clostridium, Peptostreptococcus). Common in immunocompromised patients or those with comorbidities (e.g., diabetes, peripheral vascular disease).

Critical Care 130

Critical Care ICU OR 130

Critical Care Scenarios

OCTOBER 12, 2022

Emily Fridenmaker (@emily_fri), pulmonologist and intensivist at Charleston Area Medical Center in West Virginia. Continuing education for this episode CME credit provided courtesy of Academic CME. can be elevated by diuresis* Serum albumin/pleural > 1.2* Pleural LDH/serum LDH > 0.6* glucose <40 (or 60?) glucose <40 (or 60?),

ICU 130

ICU OR 130

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 231

ICU ALS Ambulance OR 231

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

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 166

ICU OR 166

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

Critical Care Scenarios

MAY 31, 2023

A brief overview and call to arms around the key concepts of ICU liberation. A brief overview and call to arms around the key concepts of ICU liberation.

OR 100

OR ICU 100

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

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 226

ICU Defibrillator Paramedic CPR 226

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 143

ICU ED OR Critical Care 143

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

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

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

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 139

ICU ALS ED OR 139

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Case: A 45-year-old female in the emergency department is being admitted to the intensive care unit (ICU) for septic shock secondary to urinary tract infection (UTI). You are ready to call the ICU and get her admitted. But you remember seeing in the news there was a study claiming vitamin C could cure sepsis. Reference: Putzu et al.

ICU 130

ICU Critical Care ALS Emergency Department 130

Dr. Smith's ECG Blog

JANUARY 2, 2025

CASE CONTINUED She was admitted to the ICU. T-waves are quite tall and possibly peaked (HyperK?), but potassium returned normal. I do not see OMI here and all trops were only minimally elevated, consistent with either chronic injury from cardiomyopathy or with acute injury from sepsis. What is the QT interval? Bogossian et al. (1)

Coronary 117

Coronary OR Defibrillator ALS 117

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 102

ICU OR 102

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

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 189

ICU ED OR 189

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 140

ICU Emergency Department ALS ED 140

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 186

Emergency Department ALS ICU OR 186

Core EM

JANUARY 25, 2024

95% CI (1.46, 2.84)) and the need for an emergent intervention (aOR 1.38, 95% CI (1.15, 1.66)). 95% CI (1.46, 2.84)) and the need for an emergent intervention (aOR 1.38, 95% CI (1.15, 1.66)).

Operating Room 246

Operating Room EMS ED ICU 246

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 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4

ICU 145

ICU ALS Epinephrine OR 145

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

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 124

OR STEMI ICU Coronary 124

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

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 Epinephrine 130

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. Another minor difference is that the gastric balloon in the Minnesota tube holds 450-500 ccs of air, while the SB gastric balloon holds 250 ccs of air [2].

E-9-1-1 245

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

Core EM

JANUARY 25, 2024

11 Geriatric trauma patients require increased immediate and delayed ICU resources compared to younger counterparts with the same injuries. More than 1/3 of geriatric trauma patients presenting to the ED after a fall return to the ED or die within one year of initial evaluation. 6 Assessment and Initial Evaluation: What’s different?

ALS 246

ALS ED ICU OR 246

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 96

ICU ALS ACS EMS 96

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

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

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

REBEL EM

FEBRUARY 19, 2024

PMID: 37611862 Clinical Question: In patients treated in the ICU, can a protocol of peripheral IV catheter vasopressors safely reduce the number of days of CVC use and frequency of placement? of patients not requiring CVC insertion. REBEL EM: Peripheral Vasopressors – Safe or Dangerous?

ICU 134

ICU EMS ALS OR 134

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-9-1-1 111

E-9-1-1 ICU ALS OR 111

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