ACEP Now

JUNE 29, 2025

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 emergency department (ED). He practices in both the ED and ICU. References Holden D, Ramich J, Timm E, et al. Tisdale JE, Patel R V, Webb CR, et al. Ann Emerg Med.

Emergency Department

EMDocs

DECEMBER 18, 2024

Gortney J, Raub J, Patel P, et al. Sullivan J, Sykora K, Schneiderman J, et al. Borgundvaag B, Bellolio F, Miles I, et al. Strayer RJ, Friedman BW, Haroz R, et al. Maldonado JR, Sher Y, Ashouri JF, et al. fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold

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REBEL EM

DECEMBER 23, 2024

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.

ALS

REBEL EM

NOVEMBER 25, 2024

Paper: von Hellmann R, Fuhr N, Maia IWA, et al. Intubation performed in all settings (out-of-hospital, emergency department, ICU, and operating room). Clinically Diverse Patient Population : The study included patients from varied clinical settings (ED, ICU, OR, and pre-hospital). PMID: 29800096 Driver BE et al.

Operating Room

ACEP Now

JANUARY 4, 2025

I am not one to sit down and look at an ECG or sodium potassium in the ICU, Dr. Clarke said. References Huecker MR, Shreffler J, Platt M, et al. Nelson DAF, Nelson MA, Shank JC, et al. Same Beating Heart Throughout all these changes over the decades, Dr. Clarke is still in love with the specialty. I like the excitement.

ED

The Skeptics' Guide to EM

JUNE 15, 2025

Reference: Ye et al. Preoxygenation strategies before intubation in patients with acute hypoxic respiratory failure: a network meta-analysis. Frontiers in Medicine. 2025 Feb Date: June 12, 2025 Guest Skeptic: Dr. Aine Yore is an Emergency Physician, practicing in the Seattle, Washington area for over twenty years.

ICU

REBEL EM

NOVEMBER 11, 2024

Article: Chanderraj R, Admon AJ, He Y, et al. Imbalances Between Treatment Groups : ICU Admissions : Higher in piperacillin-tazobactam (33% vs. 30%). For example, in this analysis, 33% of patients receiving piperacillin-tazobactam were admitted to the ICU, compared to 30% of those receiving cefepime. In 2021, Buckley et.

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EMDocs

JANUARY 6, 2025

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. link] Rother B, Pierre G, Lombardo D, et al. link] Franco JR, Cecchi G, Priotto G, et al. Biggs H, Behravesh CB, Bradley KK et al. 57 Table 2. 2024;77:7-16.

ED

Don't Forget the Bubbles

MARCH 21, 2025

Thats exactly what Shane George et al. George S, Williams T, Humphreys S, et al. Effectiveness of Nasal High-Flow Oxygen during apnoea on Hypoxaemia and Intubation Success in Paediatric Emergency and ICU Settings: a randomised, controlled, open-label trial. Lancet Respiratory Medicine. CASP checklist How good was the paper?

ICU

Broome Docs

JANUARY 27, 2025

100% seems too good to be true Morello et al., Clin Exp Allergy. 2024 Oct 9. doi: 10.1111/cea.14565. Epub ahead of print. PMID: 39383344 Profundus Trial – Can we actually exclude acute aortic syndromes with this protocol? Diagnosis of acute aortic syndromes with ultrasound and D-dimer: the PROFUNDUS study.

ED

EMDocs

JULY 21, 2025

Lower intubation, need for BPAP and ICU admission in bolus group (Levy 2007). Heidenreich PA, Bozkurt B, Aguilar D, et al. Collins S, Storrow AB, Albert NM, et al. Yancy CW, Jessup M, Bozkurt B, et al. Yancy CW, Jessup M, Bozkurt B, et al. Ponikowski P, Voors AA, Anker SD, et al. Am J Emerg Med. J Card Fail.

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JEMS

JUNE 13, 2025

In humans, its pharmacologic relative dexmedetomidine is used for procedural sedation and ICU management, but medetomidine itself has no approved human indication. Medetomidine is a central alpha-2 adrenergic agonist used in veterinary medicine to induce sedation and analgesia. apnews.com/article/40e02b935d1c37189da4b9cd6ccd3210 4.

Naloxone

REBEL EM

MAY 19, 2025

1 Three small noninferiority RCTs suggested that 7 days of antibiotics may be sufficient for patients with gram-negative bacteremiabut these trials had notable limitations: they excluded ICU patients, included only clinically improving individuals, and did not assess gram-positive infections. male Setting at enrollment: ICU: 55.0%

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EMDocs

JULY 26, 2025

9 Consider ICU if related to thyrotoxicosis as these patients require monitoring for cardiac arrhythmias. Rosh Review Website Link Further Reading Further FOAMed: [link] [link] [link] References: Statland JM, Fontaine B, Hanna MG, et al. 26009 Fu C, Wang Z, Wang L, et al. 2018.00430 Zhao X, Ning H, Liu L, et al.

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The Bottom Line

JUNE 11, 2025

Tight Blood-Glucose Control without Early Parenteral Nutrition in the ICU Gunst et al. N Engl J Med 2023;389:1180-1190 DOI: 10.1056/NEJMoa2304855 Clinical Question In ICU patients not receiving early parenteral nutrition, does liberal glucose control (initiating insulin when blood glucose level [BGL] >11.9

ICU

Dr. Smith's ECG Blog

FEBRUARY 10, 2025

and the patient was given more insulin/dextrose/calcium and admitted to ICU. Lindner et al. Durfey et al. Farkas et al. Rather than the numerical value of serum K+ it is the rate of change in serum K+ levels that is more important as a predisposing factor for hemodynamic deterioration ( Simon et al StatPearls, 2023 ).

ALS

EMDocs

JUNE 28, 2025

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. 160357 Lavonas EJ, Akpunonu PD, Arens AM, et al. 2016.02.058 Nates JL, Nunnally M, Kleinpell R, et al. N Engl J Med.

EMS

EMDocs

MARCH 4, 2025

Harder outside of an ICU setting) Therapeutic drainage of CSF? PMID: 2071396 Iguchi M, et al. PMID: 32524581 Tunkel AR, et al. PMID: 15494903 McGill F, et al. PMID: 26845731 van de Beek D, Cabellos C, Dzupova O, et al. PMID: 27062097 Glimker M, Johansson B, Bell M, et al. Mannitol: Give 1.5 Clin Infect Dis.

ALS

REBEL EM

APRIL 28, 2025

Similar results were found for 219 paired samples from ICU patients with statistically significant but clinically meaningless differences for sodium and potassium ( Triplett 2016 ). Read More LITFL: [link] REBEL EM: [link] References Jain A et al. PMID: 20157454 Menchine M et al. PMID: 21951652 Uysal E et al.

ALS

The Skeptics' Guide to EM

FEBRUARY 22, 2025

Reference: Agnello et al. Reference: Agnello et al. 2022 Population: Adults admitted to various clinical settings, particularly the ED, intensive care unit (ICU), and one infectious diseases unit (I dont have one of those Ken do you?). Clinical Chemistry and Laboratory Medicine 2022; 60(5):786-792 Clin Chem Lab Med.

Critical Care

EMCrit Project

JUNE 16, 2025

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!!!

Critical Care

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

Date: August 30, 2023 Reference: Griffey et al. Date: August 30, 2023 Reference: Griffey et al. 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?”

ICU

The Skeptics' Guide to EM

NOVEMBER 18, 2017

[display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Critical Care Medicine 2017.

ICU

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. He is board certified […] The post SGEM#368: Just A Normal Saline Day in the ICU – The PLUS Study first appeared on The Skeptics Guide to Emergency Medicine. Date: June 12th, 2022 Reference: Finfer et al. Reference: Finfer et al.

ICU

The Skeptics' Guide to EM

JULY 27, 2024

Reference: Knack et al. 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).

ICU

The Skeptics' Guide to EM

APRIL 27, 2024

Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. 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.

ICU

The Skeptics' Guide to EM

MAY 25, 2024

Reference: Borgundvaag et al. This is based, in large part, on indirect evidence illustrating the benefits of adjunctive phenobarbital including, but not limited to, reduction on the need for intubation, decreased hospital length of stay, decreased ICU admission and length of stay.

ED

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

Date: September 12, 2024 Reference: Anderson et al. A pivotal study by Raja et al. 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.

ICU

The Skeptics' Guide to EM

JANUARY 20, 2024

Reference: Zaoutis T, et al. Reference: Zaoutis T, et al. Reference: Zaoutis T, et al. Short-course Therapy for Urinary Tract Infections in Children: the SCOUT randomized clinical trial. JAMA Pediatr. Short-course Therapy for Urinary Tract Infections in Children: the SCOUT randomized clinical trial. JAMA Pediatr. JAMA Pediatr.

Emergency Department

ALiEM

JUNE 1, 2023

References Rosenson J, Clements C, Simon B, et al. 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]. More rigorous studies are needed determine dose thresholds that warrant hospital admission. 2012.07.056.

ICU

The Skeptics' Guide to EM

FEBRUARY 25, 2023

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).

CPR

REBEL EM

JANUARY 18, 2024

Paper: Varney J et al. PMID: 35387313 Clinical Question: Do prehospital antibiotics impact 28 day mortality, length of stay in the hospital and ICU length of stay for patients triggering sepsis compared to usual care (No prehospital antibiotics)? References: Varney J et al. Health Sci Rep 2022. to 0.97; p = 0.02 to 0.97; p = 0.02

ICU

REBEL EM

FEBRUARY 19, 2024

Paper: Yerke JR et al. 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? References: Yerke JR et al. PMID: 37611862 Evans L et al. CHEST 2024. CHEST 2024. Crit Care Med 2021.

ICU

The Skeptics' Guide to EM

JUNE 6, 2020

Date: June 2nd, 2020 Reference: Permpikul et al. Date: June 2nd, 2020 Reference: Permpikul et al. Max is then going to Georgetown to be an attending in both EM and ICU. Reference: Permpikul et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Respir Crit Care Med 2019.

EMR

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. PMID: 5569677 Zeyyan E et al.

ICU

REBEL EM

FEBRUARY 8, 2024

Paper: Haber, EN et al. 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? References: Haber, EN et al. PMID: 38215002 Kaufmann T et al. J Intensive Care Med 2024.

ICU

EMS 12-Lead

AUGUST 22, 2022

A 65 y/o Female was admitted to the ICU for septic shock. The combination of prolonged QT and deep T wave inversion throughout the precordium is typical of Takotsubo syndrome, or Stress Cardiomyopathy – which can occur in the context of a physiologically distressed ICU patient, further compromising their hemodynamics. Friedman, M.,

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