The Skeptics' Guide to EM

JUNE 15, 2018

Usually they just shock me and send me home.” It is like normal saline vs. Ringer’s lactate for fluid resuscitation, steroids vs. no steroids for sepsis, or Coke vs. Pepsi. Case: A 62-year-old Canadian is on vacation in up-state Michigan, and after a celebratory evening, presents to your emergency department with palpitations.

Emergency Department 52

Emergency Department Fluid Resuscitation Hospitals Sepsis 52

Mind The Bleep

FEBRUARY 9, 2024

48 hours) to help her through the initial period of sepsis while her antibiotics take time to work. Circulation Is there evidence of shock – think hypoperfusion; confusion, chest pain, rising lactate, low BP.What is the most likely cause of this? 2011 Dec;11(6):601-4. Breathing Is there evidence of respiratory failure?If

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52

PulmCCM

SEPTEMBER 9, 2021

Yet in 2011 a landmark randomized, controlled trial measured the effect that an intravenous bolus had on mortality in children with severe febrile illness in 3 African countries. sepsis – defined as suspected or confirmed infection plus acute organ dysfunction; d.] needed at least 1 fluid expansion, 2.] older than 65 years; b.]

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis Outcomes 40

PHEM Cast

APRIL 10, 2016

[link] We hope you enjoyed our sepsis podcast. St Emlyns Induction podcast on Sepsis. A great summary of what to do when a patient with suspected sepsis first arrives in the ED. A great summary of what to do when a patient with suspected sepsis first arrives in the ED. March 2016.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Dr. Smith's ECG Blog

APRIL 15, 2019

A previous ECG from 4 years prior was normal: This looks like an anterior STEMI, but it is complicated by tachycardia (which can greatly elevate ST segments) and by the presentation which is of fever and sepsis. In this abstract from 2011, we found that 4%(4 of 99) type 2 MI and 38% of type 1 MI had ST Elevation.

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Shock 52

Taming the SRU

AUGUST 30, 2023

A 2011 meta-analysis in the journal of Academic Emergency Medicine found ESR, CRP, and PCT were not acutely useful in the diagnosis of septic arthritis due to wildly varying sensitivities and specificities between studies. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear.

Infectious Diseases 86

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 86

Pediatric Emergency Playbook

NOVEMBER 1, 2015

Case 1: Sepsis Laura is a 2-month-old baby girl born at 32 weeks gestational age who today has been “breathing fast” per mother. She is in respiratory failure from bronchiolitis and likely viral sepsis. Induction Agent in Sepsis The consensus recommendation for the induction agent of choice for sepsis in children is ketamine.

Shock 40

Shock Sepsis Airway Management Pediatrics 40

Pediatric Emergency Playbook

AUGUST 1, 2017

2011; 364(3):255-264. 2011; 29:1136-1140.:205-211. 2011; 523-527. 2011; 24: 552-561. 2011; 146(6):660-665. Necrotizing Enterocolitis. N Eng J Med. Niño DF et al. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. 2016; 13:590-600. Walsh MC et al. Am J Emerg Med. Chien M et al. J Emerg Med.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension: A Scientific Statement from the American Heart Association. PMID: 21422387 Wan S et al. Circ 2004.

Stroke 133

Stroke Outcomes Hospitals Administration 133

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. This patient’s severe aortic stenosis (AS) and associated severe cardiogenic shock likely created the ECG pattern, resulting in a very difficult challenge for our inpatient team. Fundamentally, cardiogenic shock is an issue of decreased cardiac output.

EKG/ECG 52

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 52

Pediatric Emergency Playbook

MAY 1, 2017

He will be dehydrated – possibly in shock. Check the bilirubin in any neonate you are working up for sepsis. 2011; 128(4):825-31. 2011; 32(8):341-9. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home. He will be irritable. Emerg Med Clin North Am.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

RebelEM

MARCH 27, 2023

4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. 2011 Feb 15; Epub 2010 Aug 27. Patients at risk for ARDS were stratified by the Lung Injury Prevention Score (LIPS) which predicts the probability of developing ARDS and subsequent mortality.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

RebelEM

NOVEMBER 3, 2022

Albert 2011, Jabre 2009) However, the existing literature comparing etomidate and ketamine is conflicting. The groups were unbalanced, with more patients with sepsis and more patients with difficult airway characteristics in the ketamine group. Van Berkel 2017) In 2020 the NEAR study reported peri-intubation hypotension rates of 18.3%

Outcomes 52

Outcomes Emergency Department Sepsis Hospitals 52

RebelEM

MAY 15, 2024

Antibiotics are effectively the only thing standing between these patients and overwhelming sepsis. Improving the immediate management of neutropenic sepsis in the UK: Lessons from a national audit. 2011 Jun;153(6):773-9. Epub 2011 Apr 22 Coyne CJ, Le V, Brennan JJ, Castillo EM, Shatsky RA, Ferran K, Brodine S, Vilke GM.

Infectious Diseases 96

Infectious Diseases Administration Sepsis Anaphylaxis 96

Taming the SRU

APRIL 26, 2023

Mil Med 2011. Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. Misdiagnosis of exertional heat stroke and improper medical treatment. Epstein Y, Yanovich R. Heatstroke. N Engl J Med 2019. Gaudio FG, Grissom CK. J Emerg Med 2016.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52