Dr. Smith's ECG Blog

JANUARY 2, 2025

CASE CONTINUED She was admitted to the ICU. Smith has provided excellent overview of measuring and correcting QT interval in scenarios where QRS duration is prolonged (e.g., LBBB, ventricular pacing, etc.)." In the middle of the night, a "code" was called, and multiple rhythms like this were recorded.

Coronary

EMDocs

JUNE 18, 2025

The patient is admitted to the ICU and slowly improves over time. Doppler study of portal vein and renal venous velocity predict the appropriate fluid response to diuretic in ICU: a prospective observational echocardiographic evaluation. References Beaubien-Souligny W, Rola P, Haycock K, et al. Ultrasound J. 2023;15(1):24.

E-9-1-1

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.

Emergency Department

Dr. Smith's ECG Blog

JANUARY 15, 2025

Pt was extubated a day later and continues her recovery in the ICU. Pt had thrombotic nearly occlusive LM lesion with TIMI 1 flow in the LAD, Ramus, and Left Circumflex, and she was transferred for emergency CABG x 3. Etiology possible thromboembolic and less likely due to atherosclerosis or plaque rupture. We are hopeful for her recovery.

STEMI

Critical Care Scenarios

JULY 30, 2025

Archives (by date) Special announcement: ICA 1-year anniversary July 30, 2025 Academy bites: Specialization is breadth, not depth July 23, 2025 Lightning rounds 55: APP fellowships with Melissa Bridges July 9, 2025 Lightning rounds 54: Medical musicians with Andrew Schulman June 25, 2025 Lightning rounds 53: GI Q&A with Elliot Tapper June 11, 2025 (..)

Critical Care

The Skeptics' Guide to EM

JUNE 15, 2025

Outcomes included incidence of desaturation (SpO₂ < 80%) during intubation, lowest SpO2 during intubation, post-intubation complication rate, intensive care unit (ICU) length of stay (LOS) and ICU Mortality Type of Study: Network Meta-Analysis (NMA) Authors’ Conclusions: “Preoxygenation with HFNC appears to be the safest and most effective approach (..)

ICU

REBEL EM

NOVEMBER 25, 2024

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). Randomized controlled trials or comparative non-randomized observational studies.

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. Same Beating Heart Throughout all these changes over the decades, Dr. Clarke is still in love with the specialty. I like the excitement. Emergency medicine allows physicians to be wanderers, Dr. Clarke said.

ED

REBEL EM

NOVEMBER 11, 2024

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. Comorbidity Index : Higher in the cefepime group (median 2 vs. 1). vs. 52.2%).

E-9-1-1

EMDocs

JANUARY 6, 2025

84 All patients with severe malaria need inpatient admission, ideally to the intensive care unit (ICU). Severe malaria is typically caused by P. Uncomplicated malaria patients who are able to access prescription medication can be discharged home.

ED

REBEL EM

DECEMBER 23, 2024

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.

ALS

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. Its pragmatic design ensured that a broad range of clinical presentations were included across the ED and ICU settings. Thats exactly what Shane George et al.

ICU

Critical Care Scenarios

APRIL 16, 2025

We discuss the basics of EEG in the ICU, including when to do it, selecting the appropriate study, and the basics of bedside interpretation, with Carolina B Maciel, MD, MSCR, FAAN, triple boarded in neurology, neurocritical care, and critical care EEG. Learn more at the Intensive Care Academy! Find us on Patreon here! Find us on Patreon here!

ICU

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.

Naloxone

The Bottom Line

JUNE 27, 2025

A pilot randomized controlled study Journal of Critical Care Effect of Ketamine Analgosedation on Neurological Outcome in patients with Severe Traumatic Brain Injury: A Randomized Controlled Pilot Study Neurocritical Care Effects of a general practitioner-led brief narrative exposure intervention on symptoms of post-traumatic stress disorder after (..)

Critical Care

EMDocs

JULY 21, 2025

Lower intubation, need for BPAP and ICU admission in bolus group (Levy 2007). May include 500-2000 micrograms over 2 minutes or an infusion of 400-800 micrograms per minute for 2-2.5 minutes (Wang, Mathew, Siddiqua, Houseman, Stemple, Paone, Levy, Wilson). Feasibility study evaluated 2 mg boluses every 3 minutes compared to 30 mcg per minute.

E-9-1-1

Broome Docs

JANUARY 27, 2025

Welcome to the first episode of the Broomedocs podcast for 2025. Justin and I are back for more nerdy goodness to make you smarter in the Resus room, or at a pub trivia night more likley… wether it is about salt correction, dissection or infection we can help you out! Listen in and learn!

ED

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%

E-9-1-1

ACEP Now

JUNE 24, 2025

No external validation. 75% of data was the derivation sample and 25% was the validation sample.

ED

Dr. Smith's ECG Blog

NOVEMBER 16, 2016

She was admitted to the ICU on an amiodarone drip and continued to improve. Her condition continued to improve, with decreased chest pain and improving hemodynamics. She became hypotensive at one point, with collapsing IVC on ultrasound, and improved with IV fluids. Here is her ECG at 6 hours after arrival: There is sinus rhythm.

ACS

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. This series highlights members of the GEDC community who are clinical champions for older adults in the emergency department.

Emergency Department

EMDocs

JULY 26, 2025

9 Consider ICU if related to thyrotoxicosis as these patients require monitoring for cardiac arrhythmias. Long-term: will need follow-up with endocrinology and neurology for EMG to rule out any other causes of paralysis. 5 Avoid aggressive electrolyte replacement as this can cause rebound hyperkalemia. 8 Admit for electrolyte monitoring.

E-9-1-1

EMDocs

JUNE 21, 2025

PMID: 40378193 #2: OPTPRESS – High MAP Goal in Older Patients with Septic Shock Spoon Feed — This randomized control trial of older ICU patients with septic shock in Japan showed higher mortality and more frequent adverse events in patients randomized to a high MAP goal (80-85 mmHg) compared to usual care (65-70 mmHg). Clin Infect Dis.

ICU

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 to 6.1 […]

ICU

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

EMCrit Project

JUNE 24, 2025

Furthermore, the ICU team often has never met the patient before the onset of severe illness. Family meetings are often necessary to communicate with families and determine the next steps in caring for patients. For most of these family meetings, the patient may be too ill to participate.

ICU

The Bottom Line

JUNE 27, 2025

2025.9663 Clinical Question In mechanically ventilated adult patients in the ICU, does a strategy of conservative oxygen therapy, targeting a SpO2 of 90% (Range 88-92%) compared with usual care, reduce mortality at 90 days? Conservative Oxygen Therapy in Mechanically Ventilated Critically Ill Adult Patients Martin.

ICU

EMDocs

JULY 23, 2025

She is intubated, resuscitated and admitted to the ICU. An abdominal CT is ordered, during which the patient vomits, aspirates, develops bradycardia and has a PEA cardiac arrest. The non-contrast CT scan shows a very large, distended fluid-filled stomach above the diaphragm suggesting the presence of a gastric volvulus.

ICU

EMDocs

JUNE 28, 2025

ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research. Int J Bipolar Disord. 2015;3(1):23. doi:10.1186/s40345-015-0040-2 Kraut JA. Approach to the Treatment of Methanol Intoxication. Am J Kidney Dis. 2016;68(1):161-167. doi:10.1053/j.ajkd.2016.02.058

EMS

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

DECEMBER 6, 2024

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. 1 Picture 1: Vin ros appearance of urine after treatment with deferoxamine.

E-9-1-1

Critical Care Scenarios

JULY 23, 2025

Archives (by date) Academy bites: Specialization is breadth, not depth July 23, 2025 Lightning rounds 55: APP fellowships with Melissa Bridges July 9, 2025 Lightning rounds 54: Medical musicians with Andrew Schulman June 25, 2025 Lightning rounds 53: GI Q&A with Elliot Tapper June 11, 2025 Special announcement: Academy CME accreditation June 1, (..)

Critical Care

Dr. Smith's ECG Blog

FEBRUARY 10, 2025

and the patient was given more insulin/dextrose/calcium and admitted to ICU. Two hours later the patient became somnolent and the monitor showed the following rapid changes: ECG after ROSC Repeat K was 6.4

ALS

EMDocs

MARCH 4, 2025

Harder outside of an ICU setting) Therapeutic drainage of CSF? Hypertonic saline: Give a bolus 250 mL of 3%. Mannitol: Give 1.5 g/kg and then place a foley to track urine output and match the output with IV fluids. Not typically done in the ED. Recurrent LP or lumbar drain thats placed by neurosurgery.

ALS

The Bottom Line

JULY 31, 2025

Background Critical illness weakness is a common complication within the ICU population […] JAMA 2025; doi: 10.1001/jama.2025.9110

ICU

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 ). Paired samples from over a thousand patients showed strong correlation between blood gas and standard samples with correlation coefficients of 0.82

ALS

Critical Care Scenarios

JUNE 11, 2025

Octreotide is not the treatment of choice for HRS in the ICU; use norepinephrine and titrate up until you see an increase in urine output (or it doesn’t work). Terlipressin works too but is pricey and more appropriate for outside the ICU. Otherwise, challenge with fluid (albumin is not a magical choice, use anything).

ICU