Taming the SRU

MARCH 30, 2023

Many clinical decision-making tools have been developed and validated in their use to identify and define those who are in sepsis or septic shock, as well as predict a patient’s overall risk of morbidity and mortality, including tools like the SIRS criteria and SOFA score. decreased DSI values). References Vincent JL, De Backer D.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

EM Curious

JULY 29, 2015

MYTHBUSTING AZITHROMYCIN DOES NOT CAUSE TORSADES OR INCREASE MORTALITY [BLOG]: Since the 2012 NEJM article on azithromycin we have become quite fearful of the potential life threatening cardiac side effects. If you weren't there, you still should listen to this discussion on sepsis 3.0. Read on here.

Sepsis 52

Sepsis EMS Emergency Department Ultrasounds 52

Taming the SRU

AUGUST 30, 2023

Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. A 2013 meta-analysis of 30 studies including 3,244 patients published in The Lancet found PCT to have a pooled sensitivity of 77% and specificity of 79% for sepsis in critically ill patients [52]. 2012 Jul 23;2(1):32.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

Pediatric Emergency Playbook

APRIL 1, 2016

Lactate A sick child with sepsis syndrome? In the adult literature, we know that a lactate level above 4 mmol/L in patients with severe sepsis was associated with the need for critical care. The acute recognition and treatment of sepsis is first and foremost, clinical. The short answer – yes.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Pediatric Emergency Playbook

AUGUST 1, 2017

2012; 43(1):49-51. BMJ 2012; 345:e5521. 2012; 3:247-250. 2012; 92:527-39. 2012; 30:426-431. 2012; 29:231-236 Blakely ML et al. Intestinal Malrotation – Not Just the Pediatric Surgeon’s Problem. J Am Coll Surg. 2004; 199(4):628-635. Lee HC et al. Intestinal Malrotation and Catastrophic Volvulus in Infancy.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

RebelEM

JANUARY 25, 2023

J Trauma Acute Care Surg 2012; 73(5): S362-9. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

EMDocs

MAY 11, 2024

Cavernous sinus syndrome (B) usually presents with cranial nerve deficits, diplopia, periorbital cellulitis, and facial swelling that may progress to meningitis or sepsis. 2012) 43:2904–9. anatomic region). 10.1161/STROKEAHA.112.665331 112.665331 Spronk E, Sykes G, Falcione S, et al. Front Neurol. 2021 May 14;12:661955. 2021.661955.

Stroke 111

Stroke EMS EKG/ECG Radiology 111

Mind The Bleep

SEPTEMBER 14, 2024

Management Immediate management: Consider ABCDE approach and Sepsis 6 pathway including early empirical IV antibiotics. 2012; 17 (2):199–203. Blood tests: FBC (leukocytosis), CRP, serum urate if suspecting gout as differential. Hand Xray: identify foreign bodies, osteomyelitis/bone changes. Consider tetanus booster if applicable.

Operations 52

Operations Sepsis Documentation/Coding 52

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

Emlyn’s blog and podcast since 2012. Non-invasive methods are preferable for all but those at risk of neonatal sepsis or the ill ap. She’s been there for the last 18 months working in prehospital and retrieval medicine and then in Emergency Medicine.

Pediatrics 52

Pediatrics Emergency Department Sepsis Wellness 52

Don't Forget the Bubbles

FEBRUARY 12, 2024

Complications include corneal ulceration, meningitis, or sepsis. Swabs should be sent for (urgent) gram stain and culture, and the baby should be started immediately on IV cefotaxime. Chloramphenicol drops can also be given. What do the guidelines say about the management of infective conjunctivitis in children? The Lancet. cks.nice.org.uk/topics/conjunctivitis-infective/management/management-in-primary-care/

Sepsis 59

Sepsis 59

Emergency Medicine Ireland

OCTOBER 17, 2022

I’m going to skip over the most common presentation to us , that of neutropaenic sepsis from a beaten down bone marrow, and instead focus on the niche ones. I’ve noticed our chemo protocols have specific note not to use gentamicin in neutropaenic sepsis associated with platinum based chemo agents. 2012 Nov;295(11):1837-50.

Blood Transfusions 40

Blood Transfusions Sepsis 40

ACEP Now

JULY 7, 2023

Patients with sepsis get antibiotics. 2012 Feb;13(1):17-25. 2012 Feb;13(1):26-34. This month, we are discussing the medical management of patients with mild to moderate agitation. Emergency departments (EDs) focus on rapid initiation of medical treatment. Patients with opiate overdose get naloxone. Patients in DKA get insulin.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Pediatric status epilepticus is analogous to the multi-organ dysfunction syndrome in severe sepsis. 2012; DOI 10.1007/s12028-012-9695-z Capovilla G et al. 2012; 79:2355-2358. This is the second reason to act quickly and avoid this kindling effect. In other words – time is brain. Or… is it something else as well? Boston, MA.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

PulmCCM

NOVEMBER 11, 2021

evaluated phenylephrine in 7 critically-ill patients with ‘hyperdynamic’ sepsis [defined as sepsis with CO above 6.0 Journal of applied physiology 2012, 113(6):984-984. Yamazaki T, Shimada Y, Taenaka N, Oshumi H, Takezawa J, Yoshiya I: Circulatory responses to afterloading with phenylephrine in hyperdynamic sepsis.

Stroke 40

Stroke Sepsis Administration Wellness 40

ACEP Now

AUGUST 25, 2023

However, a 2012 systematic review and meta-analysis (SRMA) reported that etomidate was associated with adrenal insufficiency and increased mortality in septic patients. Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis*. References Chan CM, et al. Crit Care Med. 2012;40(11):2945-53.

Outcomes 52

Outcomes Emergency Department Sepsis Hospitals 52

Pediatric Emergency Playbook

JUNE 1, 2016

Distributive Shock The most common cause of distributive shock is sepsis, followed by anaphylactic, toxicologic, adrenal, and neurogenic causes. Children with sepsis come in two varieties: warm shock and cold shock. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.

Shock 40

Shock Sepsis Pediatrics Ultrasounds 40

Pediatric Emergency Playbook

MAY 1, 2017

Check the bilirubin in any neonate you are working up for sepsis. 2012; 129(4). 2012 Aug;130(2):e352-7. The neonate may be sleepy but hypotonic or have a high-pitched cry; he maybe irritable or inconsolable, jittery or lethergic. The dehydration and neurologic dysfnction from the hyperbilirubinemia may even cause fever.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Pediatric Emergency Playbook

JANUARY 1, 2016

Think meningitis, UTI, or sepsis. Effortless tachypnea may be a sign of acidosis or sepsis. 2012; 43(1): e49–e51. In the stable patient, get an upper GI contrast study. Rapid-fire word association for other vomiting emergencies in a neonate : Fever, irritability and vomiting? Premature, unwell, and vomiting? J Emerg Med.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

Northwestern EM Blog

MAY 16, 2022

were hospitalizations during f/u period; 26.4% vs. Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States. Kidney international , 83 (3), 479-486. Coursey, C. Casalino, D. Arellano, R. Bishoff, J. Dighe, M., & Leyendecker, J. Ultrasound quarterly, 28(3), 227-233. Smith-Bindman, R.,

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

PulmCCM

FEBRUARY 19, 2024

In my anecdotal experience, these phrases have an impressively high positive predictive value for badness (early sepsis, often). I learned a long time ago to become highly vigilant if a family member says “something’s different,” “she’s not right,” “something’s wrong,” etc.

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

Thinking Critical Care

MAY 18, 2023

To everybody outside Glasgow glucocorticoids seemed to be the answer and Chicago surgeon William Schumer was their chief flag waver, claiming in 1976 that steroid therapy reduced the mortality of saline-treated sepsis in his service from 33% to around 10%. [5] We did not achieve a publishable consensus until 2020.

Shock 40

Shock Research Sepsis Resuscitation 40

Mind The Bleep

FEBRUARY 7, 2024

This can be caused by high cardiac output in sepsis, uncoupled respiratory chain not producing ATP in hypermetabolic states Relationship between delivery, consumption and extraction of oxygen. Hypoxia can be caused by insufficient oxygen supply, V:Q mismatch, anaemia, poor circulation, ischaemia or sepsis. References Biorender.

Wellness 52

Wellness Sepsis Stroke Shock 52

EMDocs

OCTOBER 5, 2024

4 The incidence of ESBL-E identified in bacterial cultures in the United States increased by 53% from 2012 to 2017. 8 Workup and Diagnosis Evaluation should be tailored to the patient presentation, but may include studies such as: CBC, CMP, UA, lactate (if concern for sepsis), Cultures (blood, urine, etc.)

EMS 98

EMS Infectious Diseases Sepsis Hospitals 98

Taming the SRU

APRIL 26, 2023

Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. Intensive Care Med 2012. Heat-Related Illnesses. Am Fam Physician 2019; 99:482. Klein Klouwenberg PM, Ong DS, Bonten MJ, Cremer OL. Pileggi DJ, Cook AM. Neuroleptic Malignant Syndrome.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

EMDocs

OCTOBER 23, 2023

This may also predispose a patient to sepsis, peritonitis, or bowel infarction, which need to be recognized quickly. 2012 APR; 52(2): 121-7. It may present with vaginal bleeding (the most common presenting symptom) (3), or watery vaginal discharge (2,6). Aust N Z J Obstet Gynaecol. Tan JJ, Tsaltas J, Hengrasmee P, Lawrence A, Najjar H.

OB/GYN 95

OB/GYN Operations EMS Ultrasounds 95

PulmCCM

SEPTEMBER 23, 2021

Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S et al : Diastolic dysfunction and mortality in severe sepsis and septic shock. European heart journal 2012, 33(7):895-903. Marik P, Bellomo R: A rational approach to fluid therapy in sepsis. BJA: British Journal of Anaesthesia 2016, 116(3):339-349.

Stroke 40

Stroke Sepsis Shock Ultrasounds 40

Taming the SRU

JULY 21, 2023

In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. October 2012 revision. 2012 Jan 29. 2012; 22(1): 1-8 Sweeney A.R., Herpes Simplex Keratitis”, EyeRounds.org; 31 Dec 2012. HOW DOES TREATMENT BETWEEN INFANTS (< 1 year old) AND ADULTS DIFFER? O’Brien TP.

Emergency Department 88

Emergency Department EMS Burns Wellness 88

Don't Forget the Bubbles

SEPTEMBER 18, 2023

This is true in life-threatening conditions such as sepsis. However, when children do not have features of sepsis, oral antibiotics are equally effective. The take home is that although IV antibiotics are key in sepsis management, oral antibiotics are equally as effective as IV antibiotics for children without critical illness.

Emergency Department 143

Emergency Department Infectious Diseases Pediatrics Sepsis 143

Don't Forget the Bubbles

FEBRUARY 24, 2025

Because of this possible diagnosis, they were commenced on a macrolide antibiotic (azithromycin) in addition to treatment for neonatal sepsis +/- meningitis (ceftriaxone and acyclovir). We know that vaccination is key for protection, as there were 63 deaths in just one year before the vaccination was recommended in pregnancy in 2012.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

Sensible Medicine

AUGUST 14, 2024

This sort of sepsis would produce many of the common autopsy findings. They looked at 770 sudden unexpected infant deaths (SUID) across seven states between 2010 and 2012 to see how comprehensive the autopsies and death-scene investigations were. Every death had an autopsy performed, but the quality of the investigations varied widely.

CDC 92

CDC Sepsis Research Pediatrics 92

RebelEM

DECEMBER 17, 2024

Bottom Line Up Top: There doesnt appear to be a morbidity or mortality benefit to treating fever in sepsis and fever may have a protective effect. A large observational study of > 2000 patients found an association with fever at presentation and ICU survival for patients with severe sepsis or septic shock ( Sunden-Culberg 2017 ).

Sepsis 74

Sepsis Shock EMS Emergency Department 74

Taming the SRU

OCTOBER 31, 2024

Ann Emerg Med 2024; Big Picture Current screening tools for pediatric septic shock and sepsis are highly specific but lack sensitivity. This study substituted age adjusted vital sign measures and a pediatric shock index into currently existing pediatric sepsis scoring systems to create the qPS4.When

Sepsis 72

Sepsis Shock Pediatrics Administration 72

EMDocs

JANUARY 20, 2025

Sepsis There has been much controversy over the last two decades around the various nuances of volume resuscitation in ED patients with suspected sepsis, much of which goes beyond the scope of this limited review. 9 In terms of assessing volume status in general, Joseph et al. 11 A study by Stephan et al. Andrews et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Don't Forget the Bubbles

FEBRUARY 17, 2025

He has received 20ml/kg in 5 to 10ml/kg aliquots in the ED, as his blood pressure keeps dropping, and the ED team is concerned about possible sepsis. Pediatr Crit Care Med, 2012. As the PICU Registrar, you are called to review him. He has been started on timely broad-spectrum antibiotics according to hospital protocol. 175 (1): p.

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78

Don't Forget the Bubbles

JANUARY 13, 2025

Often, these babies are managed as more common neonatal illnesses initially, such as persistent pulmonary hypertension of the newborn, sepsis, or respiratory distress syndrome. Ann Thorac Surg, 2012. Obstructed TAPVD These patients become unwell shortly after birth with cyanosis, respiratory distress and haemodynamic compromise.

Operations 59

Operations Outcomes Pediatrics EKG/ECG 59

PulmCCM

MARCH 28, 2025

In 2021, the Surviving Sepsis Campaign issued a weak recommendation that vasopressin also be infused when the dose of norepinephrine is between 0.25 and France ( Kalimouttou et al JAMA 2025 ) began with a tranche of EMR data from 3,608 patients with “septic shock” in the UCSF system between 2012 and 2023.

Shock 40

Shock Sepsis Administration Outcomes 40

Advanced Emergency Nursing from AENJ

FEBRUARY 27, 2015

died of sepsis from an infected blister on his foot resulting from a tennis game at the White House. June 5, 2012 News report and transcript of the manuscript “true copy” of Dr. Leale’s report of the assassination and medical care of President Lincoln. He succeeded to the Presidency upon Harding’s death by heart attack.

Stroke 40

Stroke COPD Emergency Nursing Sepsis 40