Taming the SRU

AUGUST 30, 2023

In a small study involving 79 hospitalized children, PCT was found to be elevated in bacterial infections, with a decrease after appropriate antibiotic therapy, and decreased in viral infections [24]. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. Cleland DA, Eranki AP.

Infectious Diseases 89

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

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).

Shock 52

Shock Outcomes Sepsis Resuscitation 52

RebelEM

AUGUST 12, 2024

Hospitals should be cautious in deciding to put their efforts towards them when the data from this trial has actually shown that it works in a diversified patient population such as that which exists in the United States. Contemp Clin Trials. Epub 2022 Aug 28. PMID: 36038001 Levi TM, et al. Rev Bras Ter Intensiva.

Outcomes 81

Outcomes Hospitals Operations Shock 81

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

PulmCCM

JULY 10, 2023

Continuous meropenem infusion for critically ill patients with sepsis Antibiotics have a time-dependent effect on bacteria; maintaining bacteriocidal concentrations of antibiotics should help subdue infections better than intermittent dosing. Mortality was about 30% in each group, and most patients had hospital-acquired sepsis.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

Pediatric Emergency Playbook

AUGUST 1, 2017

2013; 95(6): 474-477. 2013; 48:1789-1793. Management of the child after enema-reduced intussusception: hospital or home? 2013; 44(1):53-57. 2013; 200:969-973. 2013; 50:54-86 Intestinal Obstruction Babl FE et al. Mercer AE, Phillips R. Arch Dis Child. 2012; 92:527-39. Peters B et al. 2014; 8(5):533-541.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Don't Forget the Bubbles

JANUARY 10, 2024

Severe anaemia is a common and life-threatening cause of hospital admission in children in sub-Saharan Africa. 8% die in hospital, with a further 12% dying in the six months following discharge. Population 6171 children from three hospitals in Uganda and one in Malawi were assessed for eligibility. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

PulmCCM

FEBRUARY 19, 2024

Let Families Activate Rapid Response Teams, Says SCCM The Society of Critical Care Medicine (SCCM) issued a new guideline on how hospitals and care teams should respond to emergencies outside the ICU or ED (i.e., SCCM now suggests this should be a standard practice at most hospitals. on the medical and surgical wards). Read it here.

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

PEMBlog

OCTOBER 18, 2023

rectally, prompting a sepsis workup given his age. This patient was hospitalized for 4 days where he remained well-appearing. Initially in the emergency department he was generally well-appearing with normal vital signs. His rash is pictured here: He subsequently developed a fever to 38.2C Labs were notable for: WBC 9.1

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

Taming the SRU

FEBRUARY 5, 2024

2018) Epidemiology of lumbar punctures in hospitalized patients in the United States. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. Journal of the history of the neurosciences, 6(2), 147–153. PLOS ONE 13(12): e0208622. Clin Infect Dis.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

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. 2013 Oct;132(4):663-7. 2013; 41:580-637. 2013; 17:R246. Look at the volume status – the FILL.

Shock 40

Shock Sepsis Pediatrics Ultrasounds 40

Northwestern EM Blog

MAY 16, 2022

were hospitalizations during f/u period; 26.4% were hospitalizations during f/u period; 26.4% were hospitalizations during f/u period; 26.4% There also were no significant differences in pain scores, hospitalizations, ED readmissions among the groups. vs. US 31.2% References Fwu, C. Eggers, P. Kimmel, P. Coursey, C.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

ACEP Now

OCTOBER 10, 2023

Hospitals should incorporate this approach into clinical practice as part of active management for this serious condition.” Results A total of 7,036 patients were recruited from 121 hospitals that could be included in the modified intention-to-treat analysis. link] Published June 30, 2013. Reference Ma LM, Hu X, Song L, et.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

Northwestern EM Blog

APRIL 25, 2022

Violation of the joint capsule exposes the sterile intra-articular space to the environment which can result in a deep infection and sepsis. Figure 4: Traumatic arthrotomy on CT scan Source: Konda et al, 2013 Saline Load Test (SLT): Though not strongly backed by the literature, SLT is a standard tool used to assess for traumatic arthrotomy.

Soft Tissue Injuries 52

Soft Tissue Injuries Fractures Sepsis Documentation/Coding 52

ACEP Now

JULY 7, 2024

2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus). Patients with status epilepticus require hospital admission, often to an intensive care setting.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

Pediatric Emergency Playbook

MAY 1, 2017

Check the bilirubin in any neonate you are working up for sepsis. Hospital Stay for Healthy Term Newborn Infants. 2013 Apr-Jun; 2(2): 61–69. The neonate may be sleepy but hypotonic or have a high-pitched cry; he maybe irritable or inconsolable, jittery or lethergic. References Benitz WE. Pediatrics. 2015; 135(5):948-53.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

Chris' comments/questions: "Every "ST elevation in aVR" case I've ever seen has been triple vessel, insufficiency, or demand/global subendocardial ischemia secondary to some underlying sepsis/increased metabolic demand." "My Current Emergency and Hospital Medicine Reports 2013;1:43-52. American heart journal 2010;160:995-1003,e1-8.

EKG/ECG 52

EKG/ECG Shock Emergency Department Wellness 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

ST elevation (STE) in lead augmented vector right (aVR), coexistent with multilead ST depression, was endorsed as a sign of acute occlusion of the left main or proximal left anterior descending coronary artery in the 2013 STEMI guidelines. Thirty-two patients (40%) had mild to moderate or no significant disease.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58). For instance: sepsis, bleeding, dehydration, hypoxia, and mild ACS. N Engl J Med 2003; 348:1756-1763, 5/1/2013. Circulation 1970;41:623-627 9. Khot, MD; et al.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

RebelEM

MAY 15, 2024

Antibiotics are effectively the only thing standing between these patients and overwhelming sepsis. Pathogens ( Gudiol 2013 ) : The pathogens responsible for neutropenic fever have changed over time. Follow your hospital’s protocol (if available). High Risk Patients will need hospitalization and IV antibiotics.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

Don't Forget the Bubbles

JULY 22, 2024

They conclude that their IPD meta-analysis shows that “ children with acute preschool wheeze who received oral corticosteroids had statistically significant improvement in WSS at 4 hours and length of hospital stay.” 2013 Jun 4;2013(6):CD004878. But how can we apply these findings in everyday practice? Cochrane Database Syst Rev.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

EMDocs

OCTOBER 17, 2023

These risk factors are immunosuppression, recent or current antibiotic use, signs of sepsis, symptoms > 5 days, unstable comorbidity, vomiting, CRP > 14 mg/dL or 140 mg/L, or if there are signs of perforation, bleeding, obstruction, or abscess. Patients with complicated acute diverticulitis should be admitted to the hospital.

Radiology 94

Radiology Radiology Operations Best Practices 94

EMDocs

OCTOBER 23, 2023

Operative complications requiring surgical intervention or hospitalization occur in about 3-6% of all hysterectomies (5). This may also predispose a patient to sepsis, peritonitis, or bowel infarction, which need to be recognized quickly. 2013 Mar; 121 (3): 654-673. References Ramdhan R, Loukas M, Tubbs R. Clarke-Pearson D.

OB/GYN 93

OB/GYN Operations EMS Ultrasounds 93

EMDocs

JUNE 27, 2024

768: Epidemiology of Hospital Based ED Visits due to Sickle Cell Crisis and Acute Chest Syndrome in Kids. Critical Care Medicine 41(12):p A191, December 2013. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. C or 100.4 mg/kg, max 0.4 C or 100.4 mg/kg, max 0.4

Pediatrics 97

Pediatrics Dehydration EMS Hospitals 97

Pediatric EM Morsels

FEBRUARY 2, 2024

Hospitalization for travel-related illness are around 10% for both VFR and tourists (Leuthard 2015) Multiple studies have reported the most common travel infections in various countries. Infectious Disease Acquisition in Pediatric International Travelers: A 10-Year Review at a Canadian Tertiary Care Hospital. Pediatr Emerg Care.

Infectious Diseases 164

Infectious Diseases Pediatrics Sepsis Documentation/Coding 164

Taming the SRU

JULY 21, 2023

In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. Hospitalization and emergent ophthalmology consultation are warranted, in addition to IV broad spectrum antibiotics. Jama 310.16 (2013): 1721. Demystifying the Ocular Herpes Simplex Virus”, EyeNet Magazine ; Jan 2013.

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

AUGUST 4, 2024

The Bubble Wrap Plus is a monthly Paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital). Reviews and opinion articles Implementing Acute Hospital Care at Home in Pediatrics. Neonatal bacterial sepsis. Brewster RCL, et al.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics Burns Sepsis 52

PEMBlog

JANUARY 17, 2024

Camargo, Clinical Trial: Comparative Effectiveness of Cephalexin Plus Trimethoprim-Sulfamethoxazole Versus Cephalexin Alone for Treatment of Uncomplicated Cellulitis: A Randomized Controlled Trial, Clinical Infectious Diseases, Volume 56, Issue 12, 15 June 2013, Pages 1754–1762, [link] Liu C, Bayer A, Cosgrove SE, et al. Bilateral red limbs?

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

EMDocs

JANUARY 16, 2025

Today we cover the Phoenix Sepsis Criteria. years Best performing criteria identified by AUPRC and AUROC 4-organ-system model translated into the Phoenix Sepsis Score had best mortality prediction characteristics AUPRC of 0.23-0.38 Well provide summaries of the evidence to support your decisions at the bedside. but PPV ranges from 25.1-39.5%

Sepsis 95

Sepsis Pediatrics Shock Hospitals 95

Don't Forget the Bubbles

FEBRUARY 24, 2025

Two-month-old Isla presents to their local hospital following a prolonged apnoea at home. Because of this possible diagnosis, they were commenced on a macrolide antibiotic (azithromycin) in addition to treatment for neonatal sepsis +/- meningitis (ceftriaxone and acyclovir). They had a two-day history of reduced feeding.

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. The Roberts Program on Unexpected Death in Pediatrics at Boston Children’s Hospital does approach SIDS in this meticulous way in order to bring medical closure to families (and to prevent future tragedy in the case of, for example, inherited epilepsy).

CDC 94

CDC Sepsis Research Pediatrics 94

Dr. Smith's ECG Blog

DECEMBER 23, 2024

Written by Willy Frick A woman in her 70s is hospitalized with undifferentiated shock after being found down at home. She was resuscitated and admitted to ICU for presumed sepsis. In an effort to reinforce these measures presented by Dr. Frick in his above discussion I've reproduced the following Section from my ACLS-2013-ePub.

EKG/ECG 114

EKG/ECG Shock Ultrasounds Sepsis 114

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. 2024, 33 use of ultrasound may lead to a reduction in mortality, less volume of fluids given, and decreased hospital stay.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Don't Forget the Bubbles

SEPTEMBER 23, 2024

You are working in the paediatric emergency department of a busy District General Hospital. Infections are the most common reason for hospitalization within the first two years of transplant and are much more likely than rejection. Have there been any previous episodes of hospitalization since receiving the transplant?

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

Mind The Bleep

SEPTEMBER 17, 2024

Epidemiology The number of animal bites presented to A&E is largely underestimated, as many who are bit don’t present to receive medical care 1 or won’t receive treatment in a hospital setting so they are not counted in the statistics for bites 2. Always consider management as per ATLS protocol and SEPSIS 6 if relevant.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

EMDocs

MARCH 24, 2025

comes back positive, they will receive a call from the hospital (if follow-up calls are available) or from the health department. AIDS Patients with AIDS should be admitted to the hospital. Those with sepsis should receive broad-spectrum antibiotics based on local hospital antibiograms. chlamydia, gonorrhea, etc.)

CDC 91

CDC Blood Transfusions Infectious Diseases Sexual Assault 91