Critical Care Scenarios

JULY 11, 2021

Takeaway lessons * Trauma patients who are hypotensive or otherwise unstable should be assumed to be bleeding, bleeding, bleeding until proven otherwise, and should have a very low threshold to proceed directly to the operating room for exploration.*

Operating Room 100

Operating Room ICU ED OR 100

The Skeptics' Guide to EM

SEPTEMBER 3, 2017

There have been some studies in various clinical settings (operating room, critical care and pre-hospital) that have demonstration benefit of apneic oxygenation. As such it has enjoyed widespread adoption throughout the Emergency Medicine and Critical Care world.

Emergency Department 130

Emergency Department Operating Room Critical Care ALS 130

Don't Forget the Bubbles

JUNE 19, 2024

Children in the validation cohort were admitted to the intensive care unit or operating room less frequently than those in the derivation cohort. They recruited 22,430 children with suspected or known blunt trauma (11,857 children in the derivation cohort and 10,573 in the validation cohort).

CPR 124

CPR Operating Room OR Emergency Department 124

Handtevy

SEPTEMBER 20, 2022

The standard care in North America for post-traumatic EDH involves decompressive craniotomy or trepanation via a burr hole, typically performed in an operating room by neurosurgery teams. EDH accompanies up to 4% of adult head injuries, leading to 10% mortality in adults and 5% mortality in children.

Operating Room 52

Operating Room Emergency Medical Services ED Emergency Department 52

Don't Forget the Bubbles

NOVEMBER 22, 2023

They concluded that propofol is safe, particularly in short-term sedation, but should be used with caution outside of the operating room, given some of the potentially severe adverse events (including PRIS) seen. Only one of these studies was undertaken in an intensive care setting, and it did not report any cases of PRIS.

E-9-1-1 126

E-9-1-1 Critical Care Operating Room ALS 126

The Skeptics' Guide to EM

FEBRUARY 2, 2018

Might his examination be enough to convince the urologists to take him straight to the operating room without a preceding diagnostic ultrasound? On examination, you find a firm, swollen right testicle, and the cremasteric reflex is notably absent on that side. Your index of suspicion for testicular torsion is high.

Operating Room 100

Operating Room Emergency Department ALS ED 100

ACEP Now

NOVEMBER 14, 2023

In 1901, UVA opened its first hospital with 25 beds and three operating rooms. The University of Virginia (UVA) School of Medicine was founded in 1819 by Thomas Jefferson and is one of the oldest medical schools in the United States.

Emergency Department 52

Emergency Department Operating Room ED OR 52

ACEP Now

MAY 9, 2024

A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operating room videos, recovery tips, and patients praising their plastic surgeon.

Emergency Department 52

Emergency Department Operating Room Critical Care ALS 52

EMDocs

JULY 17, 2023

In these cases, CT may not be feasible and a plain radiograph showing free air or bedside US showing free fluid may be useful to confirm serious abdominal pathology prior to transfer to the operating room. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome.

E-9-1-1 77

E-9-1-1 ED Operating Room ALS 77

ACEP Now

MARCH 14, 2024

18 The finger is inserted through the stoma alongside the endotracheal tube and, while 90 percent success rate has been reported with this method in controlling bleeding, the pressure must be maintained until the patient is transferred to the operating room.

E-9-1-1 52

E-9-1-1 ALS Operating Room OR 52

Medgadget

NOVEMBER 8, 2022

Greg Mielke, Preceptis Medical: Today, approximately one million children undergo ear tube procedures annually in an operating room in the United States. However, ear tube procedures conducted in an operating room under general anesthesia can be traumatic for both children and parents well before the procedure begins and after it ends.

Operating Room 95

Operating Room OR 95

EMDocs

JUNE 3, 2023

This is less critical in ED management of the unstable pelvic fracture, as the optimal site for identification of rectal or vaginal tears is the operating room. Preperitoneal Packing While most often done in the operating room, PPP may be done in the trauma bay in rare instances depending on the institution.

ED 54

ED Operating Room ALS Frozen Plasma 54

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)).

Operating Room 246

Operating Room EMS ED ICU 246

ALiEM

FEBRUARY 12, 2024

The patient was taken to the operating room for dilation and curettage and was discharged the following day. These images, taken by point of care ultrasound, show a heterogenic mass with mixed echogenicities within the uterine cavity consistent with gestational trophoblastic disease or molar pregnancy.

Operating Room 161

Operating Room Emergency Department ALS OR 161

FOAMfrat

DECEMBER 28, 2023

During Orientations, new crew members must do a minimum of 10 live intubations in the operating room before being cleared to intubate in the field. This flight service noted during orientations that new crew members are required to do a minimum of 10 live intubations in the operating room before being cleared to intubate in the field.

Paramedic 52

Paramedic Emergency Medical Services Operating Room OR 52

Pediatric EM Morsels

NOVEMBER 17, 2023

0.41), p < 0.001.

E-9-1-1 183

E-9-1-1 Operating Room Emergency Department ALS 183

Paramedic Training Spot

JANUARY 20, 2022

Students must complete a minimum of 250 hours of clinical experience in the hospital setting including the emergency room, operating room, and labor and delivery. This is followed by 250 hours of clinical externship, also called “ride time”, on an ambulance under the supervision of a licensed paramedic.

Paramedic 52

Paramedic Emergency Medical Technician Emergency Medical Services EMT 52

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 79

ICU Operating Room Critical Care ALS 79

ACEP Now

APRIL 4, 2024

Other exceptions are patient refusal, patient death or immediate transfer to the operating room. It is hoped that more emergency physicians will use point of care bedside US, which can be performed more rapidly than a CT.

Operating Room 40

Operating Room ALS ED Emergency Department 40

ACEP Now

JANUARY 12, 2024

The patient was admitted to the obstetrics service and underwent spinal anesthesia in the operating room to manually reduce the uterus. A pessary was inserted during that procedure. On the next day, the Foley catheter was removed and the patient was able to spontaneously void.

Operating Room 52

Operating Room Emergency Department OR ED 52

REBEL EM

JUNE 8, 2023

Epinephrine – 10ug/mL, 10mL syringe Phenylephrine – 100ug/mL, 10mL syringe Phenylephrine bolus doses from 100-200ug and epinephrine 10-20ug administered every 2-5 minutes pursuant to provider order Inclusion Criteria: Adults age >18 years old Received at least one bolus dose of phenylephrine or epinephrine pre-filled syringes Exclusion (..)

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

Emergency Medicine Ireland

APRIL 26, 2021

This is certainly outside the realm of intensive care but remains a somewhat magical act that my surgical and anaesthetistic colleagues perform in the operating room. Post op is where intensive care is subbed onto the field to take over the physiology of the fairly roughed up transplant patient.

Critical Care 40

Critical Care Operating Room OR 40

REBEL EM

MARCH 27, 2023

Inclusion Criteria: Adult emergency department patients 18 years or older Intubated by EMS in the field or ED providers Requiring continuous mechanical ventilation Exclusion Criteria: Intubated in the inpatient service Intubated for a procedure or in the operating room Patients on chronic mechanical ventilation Expired prior to ICU admission Those (..)

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

FOAMfrat

MARCH 11, 2024

However, we may need to temporize the patient before they can get to an operating room. The only real fix for placenta previa is cesarean delivery and possible hysterectomy if the patient has PAS. This is where intrauterine resuscitation comes into play.

Operating Room 65

Operating Room ALS OR Ambulance 65

Don't Forget the Bubbles

FEBRUARY 7, 2024

One systematic review of 1283 patients showed that if you got to the operating room within 6 hours, you had a 97% chance of saving the testicle. Time is testicle , reminding us that the sooner we get a definitive diagnosis and treatment, the more likely we are to save future generations. This dropped to 79.3%

Operating Room 111

Operating Room Emergency Department ALS OR 111

AAEM RSA

DECEMBER 3, 2020

A thorough physical exam, imaging, and laboratory studies can assist, but definitive diagnosis can only be made in the operating room. Conclusion: Positive outcomes in diagnosis and management of FG rely on rapid intervention as soon as it is suspected.

Emergency Department 52

Emergency Department E-9-1-1 ALS EMT 52