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Date: October 28, 2024 Reference: Verma et al. Case: The Chief of Emergency Medicine (EM) at a large urban hospital recently approached the AI Committee at Unity Health, intrigued by the CMAJ article describing the apparent success of CHARTWatch in detecting early signs of patient deterioration. Reference: Verma et al.
My goal in this column is to share tips, tricks, and emerging concepts from the intensive care unit (ICU) that you can use on your next shift in the emergencydepartment (ED). He practices in both the ED and ICU. References Holden D, Ramich J, Timm E, et al. Ann Emerg Med. Am J Emerg Med.
Bupe Allergy Buprenorphine induction has been the mainstay of emergencydepartment treatment of opioid use disorder for more than a decade [11, 12]. Multimodal medication options for fentanyl-xylazine withdrawal management in London et al. PMID 35774687 D’Onofrio G, Chawarski MC, O’Connor PG, et al. 2024 study [16].
In emergencydepartments, determining a septic patient’s fluid responsiveness can be challenging, as both under- and over-resuscitation can lead to poor outcomes. It is an essential metric for estimating cardiac output without the need for invasive procedures within the emergencydepartment. F, and SpO₂ 92% on room air.
14,15 This suggest VExUS may be utilized as a marker for identifying emergent hemodialysis in patient’s presenting to the emergencydepartment. The patient is admitted to the ICU and slowly improves over time. References Beaubien-Souligny W, Rola P, Haycock K, et al. Ultrasound J. 2020;12(1):16. 2024;9(1):16-19.
A large observational study of > 2000 patients found an association with fever at presentation and ICU survival for patients with severe sepsis or septic shock ( Sunden-Culberg 2017 ). PMID: 26436473 Schortgen F et al. PMID: 22366046 Sunden-Culberg J et al. appeared first on REBEL EM - Emergency Medicine Blog.
Paper: von Hellmann R, Fuhr N, Maia IWA, et al. Ann Emerg Med. Included patients from out-of-hospital, emergencydepartment, intensive care unit, and operating-room intubations. Intubation performed in all settings (out-of-hospital, emergencydepartment, ICU, and operating room).
To assess the clinical impact and relevance of these concerns, Alwang et al. PMID: 28423290 Kidwell K, Albo C, Pope M, et al. PMID: 24066745 Self WH, Semler MW, Wanderer JP, et al. PMID: 29485926 Semler MW, Self WH, Wanderer JP, et al. PMID: 29485925 Self WH, Evans CS, Jenkins CA, et al. Sickle Cell Disease.
A 36-year-old male presents to the emergencydepartment after being found down at home by his spouse. Gortney J, Raub J, Patel P, et al. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. Management of drug and alcohol withdrawal. N Engl JMed. 2003; 348:1786-1795.
The photos that Dr. Clarke took from 19781980 provide a glimpse into working in an emergencydepartment in the years the specialty was being established. for a few years working as an emergency physician. Dr. Clarke was then hired as assistant director in the emergencydepartment (ED) at Pomona Valley Hospital, Pomona, Calif.
Article: Chanderraj R, Admon AJ, He Y, et al. What They Did: Investigators performed a retrospective cohort study in the EmergencyDepartment at the University of Michigan between July 1, 2014 through December 31, 2018. Imbalances Between Treatment Groups : ICU Admissions : Higher in piperacillin-tazobactam (33% vs. 30%).
84 All patients with severe malaria need inpatient admission, ideally to the intensive care unit (ICU). 57 Adapted from: Long B, MacDonald A, Liang SY, et al. Malaria: A focused review for the emergency medicine clinician. The American Journal of Emergency Medicine. link] Rother B, Pierre G, Lombardo D, et al.
But does it hold up in the unpredictable world of emergency paediatric intubation ? Thats exactly what Shane George et al. set out to explore in the Kids THRIVE study investigating whether NHF apnoeic oxygenation could improve intubation outcomes in critically unwell children needing emergency airway management.
Lower intubation, need for BPAP and ICU admission in bolus group (Levy 2007). Emergency medicine updates: Sympathetic crashing acute pulmonary edema. Am J Emerg Med. Heidenreich PA, Bozkurt B, Aguilar D, et al. Ann Emerg Med. Erratum in: Ann Emerg Med. Collins S, Storrow AB, Albert NM, et al.
In humans, its pharmacologic relative dexmedetomidine is used for procedural sedation and ICU management, but medetomidine itself has no approved human indication. Communicate with EmergencyDepartment teams: Let them know if you suspect medetomidine exposure, especially in cases of incomplete naloxone response or bradycardia.
and the patient was given more insulin/dextrose/calcium and admitted to ICU. Lindner et al. Acute hyperkalemia in the emergencydepartment: a summary from a Kidney Disease: Improving Global Outcomes conference. Eur J Emerg Med 2020. Durfey et al. West J Emerg Med 2017. Farkas et al.
Clinical Scenario: A 62 year old woman with a history of HTN, ESRD on MWF dialysis presents to the EmergencyDepartment with generalized weakness. Similar results were found for 219 paired samples from ICU patients with statistically significant but clinically meaningless differences for sodium and potassium ( Triplett 2016 ).
doi:10.1056/NEJMra1802529 Berry RB, Budhiraja R, Gottlieb DJ, et al. 2172 Fleming S, Thompson M, Stevens R, et al. doi:10.1016/S0140-6736(10)62226-X Rückert-Eheberg IM, Steger A, Müller A, et al. Myasthenia Gravis and Crisis: Evaluation and Management in the EmergencyDepartment. J Emerg Med. J Emerg Nurs.
Reference: Agnello et al. 2022 Date: February 21, 2025 Guest Skeptic: Dr. Aaron Skolnik is an Assistant Professor of Emergency Medicine at the Mayo Clinic Alix School of Medicine and Vice Chair of Critical Care Medicine at Mayo Clinic Arizona. Reference: Agnello et al.
Intubated patients in the ED should have soft, wrist restraints places without the need for arduous, high-risk documentation or sitters Intubation Checklist EMCrit 176 – Updated EMCrit Rapid Sequence Intubation Checklist Awareness during Paralysis EMCrit 331 – Awareness after Resus RSI and ICU Paralysis – It is Unacceptable!!!
Date: August 30, 2023 Reference: Griffey et al. She is an Assistant Professor and Director of Research in the Department of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. This is the last show for […] The post SGEM#414: The SQuID Protocol first appeared on The Skeptics Guide to Emergency Medicine.
[display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Fever in the EmergencyDepartment Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Guest Skeptic: Jesse Spurr works as a Nurse Educator in the EmergencyDepartment at Redcliffe Hospital in Australia.
Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehospital Emergency Care. first appeared on The Skeptics Guide to Emergency Medicine. Prehospital Emergency Care. Prehospital Emergency Care. February 2024.
Reference: Borgundvaag et al. Guidelines for Reasonable and Appropriate Care in the EmergencyDepartment (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergencydepartment. When we combine SGEMHOP with an SGEM Xtra I hope we get some…AMAZING knowledge translation for GRACE4.
Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the EmergencyDepartment (ED)? References Rosenson J, Clements C, Simon B, et al. The Journal of Emergency Medicine. Management of Alcohol Withdrawal in the EmergencyDepartment: Current Perspectives.
Reference: Zaoutis T, et al. Reference: Zaoutis T, et al. Ellie Hill is a pediatric emergency medicine physician at Children’s National Hospital in Washington, DC and Assistant Professor of Pediatrics and Emergency Medicine at George Washington University School of Medicine and Health Sciences. JAMA Pediatr. JAMA Pediatr.
Date: September 12, 2024 Reference: Anderson et al. Full dose challenge of moderate, severe and unknown beta-lactam allergies in the emergencydepartment. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. A pivotal study by Raja et al. AEM August 2024.
Reference: Cashen K, Reeder RW, Ahmed T, et al. 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. Background: We often manage patients in cardiac arrest in the ED or the intensive care unit (ICU).
2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. Over the past few years, there has been an increase in emergencydepartment (ED) volumes and lengths of stay. Paper: Owyang CG, et al. J Crit Care. J Crit Care.
Date: June 2nd, 2020 Reference: Permpikul et al. Guest Skeptic: Dr. Max Hockstein trained as an Emergency Medicine physician at University of Texas Southwestern and is finishing his Intensive Care fellowship at Emory. Date: June 2nd, 2020 Reference: Permpikul et al. Case: It’s another day in your emergencydepartment (ED).
Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Intensive Care Med 2021 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a professor of Emergency Medical Services at Tacoma Community College’s paramedic program. Reference: Matchett, G.
Emergencydepartments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. Dr. Kluesner is an emergency physician in Iowa City, Iowa, at UnityPoint Health-Iowa Methodist Medical Center. References Morley, Claire, et al. PloS one 13.8
Reference: Schuster et al. 2020 Case: A 74-year-old woman who suffered a fall earlier today presents to the emergencydepartment (ED) and is found to have five rib fractures to her right thorax, but no other injury. Reference: Schuster et al. J Trauma Acute Care Surg. J Trauma Acute Care Surg. J Trauma Acute Care Surg.
[display_podcast] Date: November 27th, 2017 Reference: Legriel et al. NEJM Dec 2016 Guest Skeptic: Dr. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. He is also a Faculty member of the Emergency Medicine and Acute Care Series 1986 to present. Reference: Legriel et al.
Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the EmergencyDepartment (ED). 2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). Paper: Mason JM, et al. 2022 Sep 7.
Date: November 6th, 2019 Reference: Lascarrou et al. NEJM Oct 2019 Guest Skeptic: Dr. Laura Melville (@lmelville535) is an emergency physician in Brooklyn, New York, is a part of the New York ACEP Research Committee, ALL NYC EM, and is the NYP-Brooklyn Methodist Resident Research Director. Reference: Lascarrou et al.
As loud as a construction site: Noise levels in the emergencydepartment. Australas Emerg Care. PMID: 37532590 Bottom line: Emergencydepartments are noisy, although not ridiculously so. Cook D, Deane A, Lauzier F, et al. Burton C, Mooney C, Sutton L, et al. 2024 Mar;27(1):26-29. doi: 10.1016/j.auec.2023.07.004.
Intravenous insulin infusions typically require treatment in highly monitored settings, such as an intensive care unit (ICU) or step-down unit for safety and due to the frequency and intensity of monitoring. ICU and step-down beds are a limited resource and generate higher hospital charges. ElSayed NA, Aleppo G, Aroda VR, et al.
Paper: Singer S, et al. Am J Emerg Med. If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergencydepartment pharmacist. Clinical Bottom Line: Acute hypotension must be treated emergently in order to decrease morbidity and mortality. 2022 Sep 5.
Background: Standard rapid sequence intubation (RSI) in the emergencydepartment involves administration of an induction agent and a neuroblocking agent in quick succession. Click here for Direct Download of the Podcast Paper: Knack SKS et al. References: Knack SKS et al. Range 5 to 9) Etomidate: 7.0 95% CI -1.4
Treatment options for alcohol withdrawal include benzodiazepines such as lorazepam, diazepam, or chlordiazepoxide, gabapentin, and phenobarbital (Buell et al.). Phenobarbital can be used as a monotherapy or in combination with benzodiazepines to treat alcohol withdrawal (Hawa et al.). Paper : Hawa F et al.
1 History and physical examination have been the cornerstone of seizure diagnosis in the emergencydepartment (ED). Neurology consultation should be initiated, and the patient should be admitted to the ICU. References Brophy GM, Bell R, Claassen J, et al. Zehtabchi S, Abdel Baki SG, Omurtag A, et al. Ann Emerg Med.
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. References: Gaillard F, Glick Y, Tatco V, et al. 61.4.496 Navi BB, Kamel H, Shah MP, et al. Arch Neurol.
Ketamine vs etomidate in ICU intubation ? Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. The PEACH trial: No body had a fit, so… we have no clue Peter-Derex L, Philippeau F, Garnier P, et al. Emerg Med J. 2018 Sep 11;362:k3843. doi: 10.1136/bmj.k3843. N Engl J Med.
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