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. Riskin (2015) showed that rudeness accounted for a 12% reduction in diagnostic and procedural performance in a simulated resuscitation. 2015 May;30:656-74. 2015 Sep 1;136(3):487-95. How do you manage this situation? Pediatrics.

E-9-1-1 104

E-9-1-1 Critical Care CPR ICU 104

REBEL EM

JANUARY 9, 2024

Additionally, multiple studies demonstrate increased harm with IV antibiotics such as increased rate of diarrhea ( Haran 2014 ), complications from IV placement ( Li 2015 ), and increased length of stay or cost ( Lorgelly 2010 ). 2015; 12(5):e1001825. The American journal of emergency medicine. 2014; 32(10):1195-9. PLoS medicine.

ALS 98

ALS ICU ED OR 98

REBEL EM

MARCH 23, 2023

The group that received phenobarbital had a higher maximum CIWA score than the group that received lorazepam, which could mean that phenobarbital was not as effective as lorazepam, although this is potentially confounded by patients who were transferred to the ICU were excluded from the study.

ICU 52

ICU Emergency Department ALS OR 52

Core EM

OCTOBER 2, 2024

Philadelphia, PA: Wolters Kluwer; 2015:979-984. 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%

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

EMDocs

NOVEMBER 1, 2023

Disposition : Admission to ICU with potential GI, IR, and/or surgical management. McGraw-Hill Education; 2015. May not be an option. If there will be a delay in definitive management and there is evidence of intra-thoracic gastric contents, consider chest tube placement. Am J Emerg Med. 2022;53:29-36. doi:10.1016/j.ajem.2021.12.017

Critical Care 91

Critical Care ED EMS OR 91

Don't Forget the Bubbles

NOVEMBER 15, 2023

A 2015 study published in the Lancet demonstrated a reduction in hyponatraemia by adopting an isotonic strategy compared with a hypotonic strategy. doi:10.1016/S0140-6736(14)61459-8 Overview: Intravenous fluid therapy in children and Young People In Hospital: Guidance (2015) NICE. A fluid shift, if you will. Lancet (London, England).

Plasma 78

Plasma ALS ICU Critical Care 78

EMDocs

OCTOBER 21, 2023

All patients who receive thrombolytics for ischemic stroke should be admitted to a neurosurgical, neurologic, or medical ICU for management and monitoring, as this is shown to decrease mortality and length of stay. 2015 Jul;5(3):142-50. 2015 Jan;46(1):102-7. Available from: [link] Circle of Willis. link] January 24, 2007.

EMS 96

EMS ALS OR ACS 96

Emergency Medicine Ireland

MAY 3, 2021

. * the hyperaemic phase: about a quarter will have this at around day 3-7 and it seems ill defined but it’s suggestive you can lower your MAP targets here a bit Overall the basic bundle of interventions in the ICU for ICP include: * sedation – this is needed for the tube but also it reduces metabolic rate considerably and reduces ICP.

Critical Care 40

Critical Care ICU OR 40

ACEP Now

MARCH 13, 2024

2015):157-165. Conclusion/Recommendation ED crowding is a national patient safety issue driven by hospitals routinely operating over capacity. Hospitals have no financial incentive to reduce elective admissions to increase inpatient or ED capacity. Critical care medicine 40.8 2012): 2470-2478. Kindermann, Dana R., Published online 2021:26.

Emergency Department 52

Emergency Department ED ALS OR 52

ACEP Now

APRIL 3, 2024

1,2 However, the European TTM1 trial in 2013 showed similar outcomes for those cooled to 33 degrees Celsius compared to 36 degrees Celsius, leading to a 2015 AHA class I recommendation of “cooling between 32 degrees Celsius-36 degrees Celsius.” 5,6 In 2021, the TTM2 trial was published. Crit Care Med. 2020;48(3):362-9. Bray JE, Stub D, et al.

Advanced Life Support 40

Advanced Life Support ALS Life Support CPR 40

EMDocs

DECEMBER 18, 2024

2015; 17(6): 1-19. fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold Br J Addict. 1989; 84(11): 1353-1357. Yanta J, Swartzentruber G, Pizon A. Emerg Med Pract.

E-9-1-1 105

E-9-1-1 Emergency Department ICU ED 105

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 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. The low incidence could be a result of the systematic implementation of bundles known to decrease VAP incidence in the ICU. 4, 8 Paper: Dahyot-Fizelier, C.,

E-9-1-1 121

E-9-1-1 ICU ALS OR 121

Core EM

JANUARY 25, 2024

Background: An update to our 2015 post on HIET for beta-adrenergic receptor and calcium channel antagonists overdose. Disposition to ICU. Takes 30 minutes to see effect, temporize with traditional vasopressors (norepinephrine, vasopressin). Titrate to end organ perfusion as MAP may not change significantly.

Overdose 246

Overdose ALS Epinephrine ICU 246

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. 65 , 1976–1997 (2015). 31 , 369–385 (2015).

Critical Care 52

Critical Care ICU OR ALS 52

EMDocs

JUNE 22, 2024

2015 May;28(7):793-8. ” Am J Obstet Gynecol 201(5): 445 e441-413. link] Fong A, Chau CT, Pan D, Ogunyemi DA. Amniotic fluid embolism: antepartum, intrapartum and demographic factors. J Matern Fetal Neonatal Med. doi: 10.3109/14767058.2014.932766. Epub 2014 Jun 30. PMID: 24974876. Young BK, Florine Magdelijns P, Chervenak JL, Chan M.

EMS 111

EMS FFP Ambulance ICU 111

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

It is the leading cause of death in the intensive care unit (ICU) in the US and the most expensive diagnosis. Since 2015, the Centers for Medicare & Medicaid Services (CMS) have indexed the quality of hospital care for sepsis to the SEP-1 core measure. Worldwide sepsis contributes to the death of 5.3

EMR 100

EMR Emergency Department ICU ALS 100

EMDocs

MAY 25, 2023

population at large Enrollment was terminated at an interim analysis due to predefined futility criteria that suggested that there was a 1% chance that carrying the trial to completion would demonstrate a most effect or least effective treatment.

Emergency Department 87

Emergency Department ICU OR ALS 87

Broome Docs

MARCH 28, 2024

Casey wrote a protocol for peripheral noradrenaline 9 years ago… in 2015! Although I miss performing the procedure, these days I almost always leave the central line until the patient is stabilized and settled into their ICU bed. Is pregnancy a disease?

E-9-1-1 95

E-9-1-1 ICU Emergency Department ALS 95

REBEL EM

OCTOBER 31, 2022

Fujii 2022, Sevransky 2021) Contrary to the above trial, another RCT investigated patients in the ICU with sepsis and acute respiratory distress syndrome. Clinical Question: Does high-dose vitamin C improve survival and/or persistent organ dysfunction rates in septic patients in the ICU on vasopressors? Article: Lamontagne F et al.

ICU 52

ICU ALS OR EMS 52

EMDocs

SEPTEMBER 25, 2023

Despite the risk of hypotension and bradycardia, propofol has been shown in the ICU setting to be a safe and effective monotherapy intubation agent for hemodynamically unstable patients (19). WJEM 2015; 16(7): 1109 – 17. 2015 Dec;30(8):499-504. PMID: 25402500 Forsythe SM et al. Chest 2000; 117(1): 260 – 7. Am J Emerg Med.

ED 90

ED Emergency Department ALS Paramedic 90

REBEL EM

JULY 14, 2022

An example using a real case I had while on call in the ICU: A 61-year-old female had a post-induction arrest on the wards/hospital telemetry floor after being intubated for airway protection. In a PCAC 1 or 2, we may prioritize a cath and tolerate a couple hours without ICU Neuroresuscitation. Resuscitation. Resuscitation.

ICU 52

ICU ALS OR CPR 52

REBEL EM

MARCH 30, 2023

Background: Previous observational studies published in 2015 (Geri 2015)(Vyas 2015) indicated that early cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA) might improve mortality and result in more favorable neurological outcomes. Empana, J.-P., P., & Cariou, A. PMID: 26453685 Vyas, A.,

Coronary 66

Coronary CPR OR ICU 66

AAEM RSA

AUGUST 27, 2020

The 48-hour group had a significantly longer length of stay in the ICU and time on mechanical ventilation amongst survivors, both of which were expected since they were kept at target temperature for longer, requiring more resources. 2015 Nov 3. This trial carried several limitations. 2016;20:1–10. Circulation.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

Emergency Medicine Ireland

OCTOBER 16, 2023

The incidence of dynamic LVOTO in those with septic shock is remarkably high and is reported to be 20% in one study from ICU echo guru Michel Slama. Critical Care 19 , 1–8 (2015). Left ventricular outflow tract obstruction in ICU patients. Tribouilloy, C. & & Maizel, J. Pollick, C., Shmueli, H., Maalouf, N. &

Critical Care 52

Critical Care ICU OR ALS 52

Don't Forget the Bubbles

JUNE 30, 2023

They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups. 2015 Jul;115(1):76-83. Epub 2015 May 19. The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

REBEL EM

AUGUST 29, 2022

Another study reported an association with adrenocorticotropic hormone (ACTH) and slightly higher SOFA scores when etomidate was used, but there was no evidence of increased mortality (Bruder 2015). Duration of mechanical ventilation, ICU, and percentage of vasopressor use were not significantly different.

MICU 52

MICU ICU OR Emergency Department 52

REBEL EM

DECEMBER 17, 2024

One side argues that fever places additional physiological stress on patients, who are already ill ( Young 2015 ). On the other hand, fever may serve as a protective role by enhancing immune cell function and inhibiting pathogen growth and spread ( Young 2015 ). NEJM 2015; 373(23): 2215-24. PMID: 26436473 Schortgen F et al.

ICU 75

ICU ALS Emergency Department EMS 75

FOAMfrat

NOVEMBER 28, 2024

." When a critical care team transports a patient from an outlying ER to your ICU, do you automatically set your own ventilator settings, or do you ever use the vent settings the critical care transport team had dialed in for transport? "That’s We don’t seem to see Ketamine infusions in the ICU often. Why is that? "Ketamine

E-9-1-1 52

E-9-1-1 ICU Critical Care EMS 52

The Curious Clinicians

FEBRUARY 19, 2025

2015 May 21;22(5):611-8. It’s easy to think of bacteria as always “wanting” to infect a host as quickly and aggressively as possible (and if you’ve ever taken care of someone with an acute PA bloodstream infection, you know how fast they can go from healthy to needing the ICU). Drees SL, Fetzner S.

ACS 52

ACS ICU OR 52

EMDocs

JUNE 27, 2024

2015 May;169(4):492-505. Epub 2015 Mar 30. May substitute levofloxacin if allergic to cephalosporin Anti-viral medications if indicated Oseltamivir for influenza Patients >14 days old Remdesivir for COVID Patients >28 days old and at least 7lbs (3.2 Guideline on the management of acute chest syndrome in sickle cell disease.

E-9-1-1 97

E-9-1-1 ICU ACS EMS 97

EMDocs

JANUARY 20, 2025

Since the 2010s multiple trials have explored the feasibility of fluid restrictive resuscitation both on initial resuscitation in the ED, as well as in the intensive care unit (ICU). A volume-restrictive resuscitation strategy for patients admitted with sepsis to the ICU is equally effective compared to a traditional liberal approach.

ED 75

ED ALS Emergency Department Critical Care 75

EMDocs

JANUARY 16, 2025

2015 Sep 16;19(1):325. but PPV ranges from 25.1-39.5% years Internal validation cohort: 43,400 patients with mean age 3.7 years External validation cohort: 45,855 patients with mean age 2.6 0.38 (95% CI 0.20-0.39) 0.39) AUROC of 0.71-0.92 0.92 (95% CI 0.70-0.92) and PPV of 5.3-7.1% and PPV of 22.2% doi: 10.1186/s13054-015-1055-x.

ALS 93

ALS ICU Critical Care Emergency Department 93

Core EM

JANUARY 16, 2025

Figure 1: Cumulative success rate at intubation, modified from (Je, 2015) The ACGME-defined minimum of 35 intubations to graduate would suggest a failure rate of 20%, or 1 out of every 5 intubationsthis is obviously not an acceptable percentage for such a consequential procedure. Pre-oxygenate with BiPAP (Farkas 2015). Patel 2015).

E-9-1-1 130

E-9-1-1 EMS ALS OR 130

FEMinEM

JANUARY 26, 2021

As ACOG wrote in a 2015 Committee Opinion article, “Although there is a cognitive bias toward considering the risks of intervention, including the risk of inclusion in research, there is also a risk associated with failing to intervene and exclusion from research. It is still the norm for us to be excluded from clinical trials.

OR 52

OR ICU ED 52

Don't Forget the Bubbles

JULY 5, 2023

They should be admitted to hospital in case of clinical deterioration to receive ICU treatment. This treatment is usually done in the ICU setting. Blood transfusions are indicated in major surgical procedures, acute priapism > 3 hours not responsive to treatment, severe acute chest syndrome with hypoxia requiring ICU.

E-9-1-1 125

E-9-1-1 ACS OR ICU 125