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The Latest in Critical Care, 2/5/24 (Issue #28)

PulmCCM

Fever in the ICU: Guideline Update The Society of Critical Care Medicine (SCCM) and the Infectious Diseases Society of America (IDSA) issued an interim update to their 2008 recommendations for the management of fever in the ICU. You can read the document here. Read the original document here. What’s a Fever?

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Episode 14: Thoracotomy

PHEM Cast

Emergency Department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. Injury; 2008 (39): 967-969. Emergency thoracotomy in thoracic trauma: a review. Injury; 2006 (37): 1-19. Clay et al. World Journal of Emergency Surgery; 2006: 1:4. Rhee et al. J Am Coll Surg; 2000. J Am Coll Surg.

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High Pressure Injection Injury

Cook County EM Blog

Further document handedness, occupation, site of injury, and thorough review of systems to evaluate for potential complications ○ Complications as distant as pneumomediastinum following air injection of the hand have been reported5,6. ➢ 2008 Apr;3(1):27-33. Epub 2008 Feb 2. 2008 Jan;12(1):33-6. 2008 Dec;3(4):340-5.

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Compare these two ECGs. Do either, neither, or both show anything important?

Dr. Smith's ECG Blog

Full case details and outcomes are below. His HEAR score (before troponin resulted) was documented at 3, with documentation stating "low suspicion for ACS." Chest pain is documented as ongoing. de Winter et al in N Engl J Med 359:2071-2073, 2008. Case 1: Case 2: Case 1: What do you think? See text ).

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See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

Dr. Smith's ECG Blog

When Pendell and I are coding ECGs for the Queen's training, this is one category: "Definite ischemia, difficult to differentiate between posterior OMI and subendocardial ischemia." Yet this is rarely followed, and patient outcomes like this are the result once in a while. Smith : I think it looks more like posterior OMI.

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Acute OMI or "Benign" Early Repolarization?

Dr. Smith's ECG Blog

Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present." Comparative early and late outcomes after primary percutaneous coronary intervention in st-segment elevation and Non–St-segment elevation acute myocardial infarction (from the Cadillac trial). Stuckey, T.,

EKG/ECG 129
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A "normal ECG" on a busy night

Dr. Smith's ECG Blog

Diagnosis of acute myocardial infarction in angiographically documented occluded infarct vessel: limitations of ST-segment elevation in standard and extended ECG leads. Angiographic and clinical outcomes among patients with acute coronary syndromes presenting with isolated anterior ST-segment depressions. mm for women, 2.0 Pride et al.

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