ACEP Now

JANUARY 4, 2025

I was about two months into a family practice internship when I went to visit my uncle whose neighbor happened to be an ED resident, Dr. Clarke said. ED attendings Dr. Gerald Whelan and Dr. Shumary Chow supervising a full arrest in C booththe main trauma roomwith an ED tech administering CPR. Click to enlarge.) Click to enlarge.)

ED

REBEL EM

NOVEMBER 25, 2024

Intubation performed in all settings (out-of-hospital, emergency department, ICU, and operating room). Duration of intubation: Nine of thirteen studies reported slightly longer intubation times with a bougie, with a maximum average increase of 13 seconds in ED–based studies. in both groups in one study, and 1.1% in another study).

Operating Room

Broome Docs

JANUARY 27, 2025

European Journal of Internal Medicine , [link] You can listen to my 27-minute rant on Youtube here: [link] This multinational trial looked at a three-pronged diagnostic protocol in the ED for adults with suspected acute aortic syndromes. The protocol used the ADD score, a POCUS echo protocol and D-dimer to try and exclude AAS in the ED.

ED

REBEL EM

NOVEMBER 11, 2024

They analyzed the electronic health records of patients presenting to the ED who met modified Center for Disease Control and Prevention (CDC) sepsis surveillance criteria and received empiric treatment with either vancomycin/piperacillin-tazobactam or vancomycin/cefepime. Comorbidity Index : Higher in the cefepime group (median 2 vs. 1).

E-9-1-1

EMDocs

JANUARY 6, 2025

ED Evaluation Transport to the ED from the refugee reception center takes 1 hour. Labs Laboratory workup in the ED is notable for a leukocytosis of 41,000/L, hemoglobin of 6.5 She is sent to the medical ward after three days in the ED with the diagnoses of resolving septic shock, severe malaria, and AKI.

ED

Don't Forget the Bubbles

MARCH 21, 2025

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. A total of eleven intensive care units (ten PICUs and one non-maternity NICU) and four emergency departments (EDs) took part in the study.

ICU

EMDocs

JULY 21, 2025

Lower intubation, need for BPAP and ICU admission in bolus group (Levy 2007). ACEP level C recommendation that while there is no specific timing for diuretic therapy, physicians can consider earlier administration of diuretics in ED patients with HF (ACEP). In ED population, diuretics have not demonstrated clear benefit in mortality.

E-9-1-1

Dr. Smith's ECG Blog

NOVEMBER 16, 2016

A prehospital ECG was similar to the first ED ECG, which is shown below. Here is her initial ED 12-lead ECG: There is atrial fibrillation with a rate of approximately 114. She was admitted to the ICU on an amiodarone drip and continued to improve. 911 was called. An initial lactate was elevated at 5.5.

ACS

ACEP Now

JUNE 24, 2025

For example, discharge risk stratification tools, such as the emergency department (ED) revisit algorithm or the SHOUT scoring system (see Table 1 ), provide structured approaches to identifying patient risk levels for readmission, follow-up failure, or adverse outcomes. No external validation. No external validation. No external validation.

ED

GEDC

JUNE 30, 2025

Throughout her career as a pharmacist, Jennifer Esch, PharmD, MBA, BCPS, has worked in a variety of hospital settings from the ICU to the emergency department. Esch started in the emergency department during the COVID-19 pandemic when her hospital’s ED was overwhelmed with patients. If we find anything, we write a note.

Emergency Department

Core EM

JULY 1, 2025

Granulomatosis with Polyangiitis (GPA) – Recognition and Management in the ED Hosts: Phoebe Draper, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Rheumatology Show Notes Background A vasculitis affecting small blood vessels causing inflammation and necrosis Affects upper respiratory tract (sinusitis, otitis media, saddle nose deformity), (..)

Plasma

EMDocs

JULY 26, 2025

He had a similar episode three months prior which resolved quickly during his ED visit. Consider endocrinology consultation in the ED for hyperthyroidism treatment recommendations including propranolol, methimazole, and propylthiouracil (PTU). Diagnosing thyrotoxic periodic paralysis in the ED. Episodes triggered by stressors.

E-9-1-1

EMDocs

JULY 23, 2025

Author: Chuck Pilcher, MD FACEP (Editor, Med Mal Insights) // Reviewers: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit) Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. She is intubated, resuscitated and admitted to the ICU.

ICU

Dr. Smith's ECG Blog

FEBRUARY 10, 2025

normal glucose, and mild acute on chronic renal failure (Creatinine from 140 to 170 umol/L), and the following ECG, and they were sent to the ED. The patient was seen three hours later in the ED, with triage vitals showing BP 50 and BP 106/60. ED labs showed a repeat K of 6.6 Labs showed a non-hemolyzed potassium of 6.2,

ALS

Broome Docs

NOVEMBER 17, 2024

Palatinus HN, Johnson MA, Wang HE, Hoareau GL, Youngquist ST. Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Resuscitation. 2024 Aug;201:110266. doi: 10.1016/j.resuscitation.2024.110266. 2024.110266. Epub 2024 Jun 9.

Epinephrine

EMDocs

JUNE 28, 2025

Jarcho JA, ed. Longo DL, ed. ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research. The patient’s caregivers noticed that the patient had become more short of breath over the last 12 hours and seemed confused. N Engl J Med.

EMS

EMDocs

MARCH 4, 2025

Cerebrospinal fluid analysis (ideally within 1 hour of presentation to ED) is necessary. Harder outside of an ICU setting) Therapeutic drainage of CSF? Not typically done in the ED. Hypertonic saline: Give a bolus 250 mL of 3%. Mannitol: Give 1.5 Recurrent LP or lumbar drain thats placed by neurosurgery.

ALS

EMDocs

DECEMBER 6, 2024

On arrival to the ED the patient’s initial vital signs are temperature 38.5C, BP 102/48, HR 106, RR 20. 6 Patients who receive deferoxamine, have significant metabolic abnormalities, or hypotension should be admitted to an intensive care unit (ICU). She was initiated on deferoxamine and admitted to the ICU. Tenenbein M.

E-9-1-1

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 ). How reliable are electrolytes and metabolite results measured by a blood gas analyzer in the ED? for potassium and 0.85 for sodium ( Uysal 2016 ).

ALS

The Skeptics' Guide to EM

FEBRUARY 22, 2025

Case: A 62-year-old male presents to the Emergency Department (ED) with fever, confusion, and shortness of breath. This parameter has the advantage of being available very quickly without additional blood draws, which could be helpful in the fast-paced ED setting.

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

Dr. Smith's ECG Blog

JANUARY 6, 2016

Patient had a negative head CT and was admitted to the ICU for further work-up. In the ED, after intubation due to AMS, he was found to be hypotensive and tachycardic to the 160s.

CAD

The Skeptics' Guide to EM

NOVEMBER 18, 2017

Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Outside his family and work, Jesse pours […] The post SGEM#195: Some Like It Hot – ED Temperature and ICU Survival first appeared on The Skeptics Guide to Emergency Medicine. Critical Care Medicine 2017.

ICU

The Skeptics' Guide to EM

MAY 25, 2024

He has been involved in ED-based clinical research examining ways to improve care for patients with alcohol use disorder in the ED for over two decades. Case 1: A patient presents to the ED with nausea, vomiting and some abdominal pain complaining of alcohol withdrawal. This is an SGEM HOP but with a twist.

ED

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. He is wondering, “Hey doc, do I have to go back to the ICU strapped to an IV pole?” He is otherwise healthy.

ICU

Core EM

JANUARY 25, 2024

The SQuID Protocol (Subcutaneous Insulin in Diabetic Ketoacidosis): Impacts on ED Operational Metrics. The standard of care of treating DKA is fluid resuscitation, electrolyte management, and intravenous insulin infusion in the intensive care unit (ICU) setting for close glucose and electrolyte monitoring. Image from cited article.

ICU

EMOttawa

OCTOBER 24, 2024

Historically, it has been used more frequently in the ICU than in Emergency Departments, likely due to provider comfort. […] The post Is there a Precedence for Precedex in the ED? It offers a unique profile of sedation without respiratory depression, making it an attractive option in various clinical scenarios.

ED

Critical Care Scenarios

MAY 22, 2022

Discussing ICU triage, risk stratification, and patient disposition with intensivist Eddy Joe Gutierrez (@eddyjoemd) of the Saving Lives Podcast. Takeaway lessons * When a patient has borderline indications for requiring the ICU, generally, in the real world, they should go to the ICU.

ICU

The Skeptics' Guide to EM

JUNE 12, 2022

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. Then, the BaSICS trial (a multicentred RCT done in 75 Brazilian ICUs) came along and compared saline to Plasma-Lyte at what the authors deemed slow and fast infusion rates. .

ICU

EMOttawa

JANUARY 25, 2024

Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU. There is certainly a need for more practical application for the ED doc or initial setup of patients on the vent.

ICU

The Skeptics' Guide to EM

JULY 27, 2024

They were randomized to ceftriaxone 2gm intravenous (IV) in the ambulance or usual cares (fluids and supplementary oxygen) until arrive to the ED. The primary outcome reported was no statistical difference in mortality at 28 days (8% in both groups) despite giving antibiotics 96 minutes earlier [2].

ICU

ALiEM

JUNE 1, 2023

Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? Is phenobarbital safe for the treatment of EtOH withdrawal in the ED? If not, you probably should be. Another old drug for a new indication, right? Well not exactly. In short, yes.

ICU

The Skeptics' Guide to EM

APRIL 27, 2024

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. When emergency department (ED) staff roll her to remove her clothing her humeral intraosseous (IO) is dislodged. Prehospital Emergency Care. February 2024.

ICU

Core EM

JANUARY 25, 2024

A narrow pulse pressure has been shown to predict the need for hemorrhage control in the ED setting but has not been assessed as a predictor in the prehospital setting. A narrow pulse pressure occurs due to compensatory increased systemic vascular resistance in the setting of decreased cardiac output.

Operating Room

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

Case: It’s another day, another dollar in the emergency department (ED). You wonder if she could have an allergy challenge dose of ceftriaxone in the ED. Emergency Physicians frequently encounter ED patients with self-reported penicillin allergies. AEM August 2024. The next patient is a 63-year-old woman with a cough and fever.

ICU

EMCrit Project

AUGUST 26, 2022

It is unacceptable to have the rates of Awareness during Paralysis seen in a recent ED sedation study--We are better than this. EMCrit Project by Scott Weingart, MD FCCM.

ICU

REBEL EM

JULY 17, 2023

REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? PMID: Clinical Question: Does a single dose of ketamine or etomidate used for rapid sequence intubation (RSI) of critically adults in the ED impact the SOFA score within 3 days of hospitalization? Click here for Direct Download of the Podcast Paper: Knack SKS et al.

ED