Rebellion21: 5 Things Your Intensivist Wishes You did in the ED for Critically Ill Patients via Sara Gray, MD

In this 15-minute talk from Rebellion in EM 2021, Dr. Sara Gray, MD uses a case-based discussion to look at ED care from the intensivists perspective and includes quick pearls that make patient care better in the ICU.

Sara Gray, MD
Emergency Medicine/Critical Care
Associate Professor at the University of Toronto
St. Michael’s Hospital
Twitter: @EmICUcanada

Presentation Objectives 

1. We will review simple strategies for delivering better clinical care in the ED to critically ill patients
2. We will discuss communication strategies: what does your intensivist really want to know?

Delivering Excellent Care to Critically Ill Patients in the ED

1. Optimize Resuscitation
   1. POCUS to assess fluid resuscitation
   2. Adequate IV access
   3. Foley
   4. NG tube
   5. HOB elevation
   6. Early antibiotics in appropriate cases
2. Optimize Ventilator Parameters
   1. Wean FiO2 as tolerated (Avoid hyperoxia)
   2. TV 4 – 8cc/kg ideal body weight
   3. Continuous EtCO2 tracing
3. Sedation Strategy
   1. Optimize pain control – Analgesia 1^st strategy
   2. Add sedation 2^nd
4. Peripheral Pressors Safely
   1. Big (≥18g) IV in a proximal site to prevent extravasation
   2. Check site q1hr for color, temperature, and perfusion (Compare to contralateral side)
5. Communication
   1. What is patients code status? Who did you confirm code status with?
   2. Easy or difficult airway? Has ramifications for how quickly/safely extubation can occur

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)

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