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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. Life In The Fast Lane Blog.].
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 ). Fever in the EmergencyDepartment predicts survival of patients with severe sepsis and septic shock admitted to the ICU.
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). Randomized controlled trials or comparative non-randomized observational studies.
The characteristics that were significantly different between the LR and NS exposure groups race, organ dysfunction at presentation, ICU admission, hemoglobin SS genotype, discharge year, and hydroxyurea use were appropriately included as confounders in the TMLE analysis. appeared first on REBEL EM - Emergency Medicine Blog.
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%). Sex : More males in piperacillin-tazobactam (57.1%
84 All patients with severe malaria need inpatient admission, ideally to the intensive care unit (ICU). World Bank Blogs. HIV Prevention and Treatment: The Evolving Role of the EmergencyDepartment. Ann Emerg Med. Use of Medical Interpreters in the EmergencyDepartment.; Int J Equity Health.
and the patient was given more insulin/dextrose/calcium and admitted to ICU. Acute hyperkalemia in the emergencydepartment: a summary from a Kidney Disease: Improving Global Outcomes conference. Eur J Emerg Med 2020. References 1. Lindner et al. Durfey 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 ).
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. Case: You are working night shift in the emergencydepartment.
Historically, it has been used more frequently in the ICU than in EmergencyDepartments, likely due to provider comfort. […] The post Is there a Precedence for Precedex in the ED? appeared first on EMOttawa Blog.
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.
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). Am J Emerg Med. Am J Emerg Med.
Background: Standard rapid sequence intubation (RSI) in the emergencydepartment involves administration of an induction agent and a neuroblocking agent in quick succession. appeared first on REBEL EM - Emergency Medicine Blog. Range 5 to 9) Etomidate: 7.0 Range 5 to 9) Diff -0.2; 95% CI -1.4
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. Am J Emerg Med. J Med Toxicol. Epub 2019 Jul 3.
She presented to the emergencydepartment after a couple of days of chest discomfort. The pacing rate was increased without clinical improvement and the patient was transferred to the ICU for closer monitoring/treatment. I have emphasized on many occasions in Dr. Smith's ECG Blog how AFlutter is by far (!)
The 30-day emergencydepartment readmission rate and all-cause 30-day readmission were significantly lower only when adjusted for propensity scores. Although CIWA has subjective components, when a patient has a CIWA in the 20s ICU transfer should be considered.
Background: Standard emergencydepartment management of acute pancreatitis has focused on aggressive hydration, analgesia and investigation for an underlying reversible cause (eg gallstones). Again: Speed of IV Fluid Administration in Pancreatitis (WATERFALL Trial) appeared first on REBEL EM - Emergency Medicine Blog.
Authors: Adam Roussas, MD, MBA, MSE // Reviewed by: Jamie Santistevan, MD ( @jamie_rae_EMdoc, EM Physician, Presbyterian Hospital, Albuquerque, NM); Manpreet Singh, MD ( @MPrizzleER ); and Brit Long, MD ( @long_brit ) Case A 40-year-old female presents to the emergencydepartment for palpitations and lightheadedness. What do you do?
Inclusion: Articles compared the safety and efficacy of etomidate compared to k etamine, in patients of all age groups, as induction agents for RSI in the EmergencyDepartment (ED) and prehospital settings. Pooled data from ED and prehospital were evaluated using an odds ratio with a 95% confidence interval.
A transvenous pacer was placed in the EmergencyDepartment by the emergency physicians. Nevertheless, clinicians involved in emergency care will periodically encounter pacemaker issues — which underscores the importance of today's blog post. A patient had 3rd degree AV block in the ED.
Salim is also the creator and founder of REBEL EM and REBEL Cast, a free, critical appraisal blog and podcast that try to cut down knowledge translation gaps of research to bedside clinical practice. Case: A 59-year-old woman presents to the emergencydepartment (ED) with fever, tachycardia, and hypotension.
A man in his 60s with a history of severe alcohol use disorder and epidural abscess on long-term ciprofloxacin presented to the emergencydepartment after an episode of syncope while standing in line at a grocery store. Written by Sean Trostel MD, peer reviewed by Meyers, Smith, Grauer, etc. He did not have chest pain.
Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the EmergencyDepartment via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. The patient was upgraded to the ICU for closer monitoring. What do you think? ng/mL, BNP 2790, and lactate 3.7.
ClinicalTrials.gov: NCT02517489 7 Clinical Question: In adult patients with severe community-acquired pneumonia admitted to the ICU, does early hydrocortisone treatment, compared to standard therapy, reduce mortality at 28 days? ICU-acquired infections were observed in: 9.8% Patients enrolled from 31 Intensive Care Units in France.
Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. The CAP-IT trial recruited children aged six months to 5 years with a diagnosis of community-acquired pneumonia on discharge from the emergencydepartment or ward. Which brings us to PARIS-2.
One of the most hair-raising presentations to the emergencydepartment (ED) can be massive hemoptysis with respiratory failure. The emergencydepartment evaluation and management of massive hemoptysis. Am J Emerg Med. J Emerg Med. EMCrit blog website. References Deshwal H, Sinha A, Mehta AC.
Duration of mechanical ventilation, ICU, and percentage of vasopressor use were not significantly different. Etomidate Use Is Associated With Less Hypotension Than Ketamine for EmergencyDepartment Sepsis Intubations: A NEAR Cohort Study. Acad Emerg Med. 2009 Jul 25;374(9686):293-300. Epub 2009 Jul 1. PMID: 19573904.
Background: The ongoing debate between video laryngoscopy (VL) and direct laryngoscopy (DL) has ignited intense debate within the emergency medicine and critical care communities. 11 medical centers in the United States enrolled 1417 patients from 17 sites, including 7 emergencydepartments and 10 intensive care units.
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.
Today, increased mortality rates, higher transfusion requirements, and lengthened ICU stays are recognized as proximate effects of the Trauma Triad. If all of that sounded like nonsense, you can read more about it in my ABG blog. Lactic acid collects in the blood stream leading to metabolic acidosis. respectively.
He presented to his local emergencydepartment for evaluation where EKG 2 was obtained, now chest pain free : This EKG is diagnostic of LAD occlusion, again likely subacute and possibly reperfusing based on the story prior to presentation. After the episode of chest pain resolved, he became anxious and felt his heart rate accelerate.
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