Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear.

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

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

RebelEM

JANUARY 25, 2023

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. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

EMDocs

DECEMBER 18, 2024

2013; 88(9): 589-595. Alcohol withdrawal syndrome: improving outcomes through early identification and aggressive treatment strategies. fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold Alcohol withdrawal syndrome in medical patients. Cleve Clin J Med. 2016; 83(1): 67-79.

Seizures 79

Seizures Hyperthermia / Hypothermia Emergency Department EMS 79

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

Don't Forget the Bubbles

JANUARY 10, 2024

Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. Outcomes Primary outcome Mortality at 28 days after randomisation. The authors chose a patient-centred, primary outcome in keeping with their pragmatic design. What were the research questions? The study asked TWO questions: 1.

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

EMDocs

JUNE 27, 2024

Critical Care Medicine 41(12):p A191, December 2013. 2013 Jan-Mar;16(1):91-5. Epub 2013 Aug 7. Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02

Pediatrics 76

Pediatrics Dehydration EMS Hospitals 76

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. Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. Endovascular and Clinical Outcomes of Vertebrobasilar Intracranial Atherosclerosis-Related Large Vessel Occlusion.

Stroke 90

Stroke EMS EKG/ECG Radiology 90

Pediatric Emergency Playbook

AUGUST 1, 2017

Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. 2013; 95(6): 474-477. 2013; 48:1789-1793. 2013; 44(1):53-57. J Med Genet 2008; 45:1. Arshad A, Powell C, Tighe MP.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Mind The Bleep

AUGUST 5, 2023

Common signs and symptoms include: Abdominal distention with prominent veins and discolouration Umbilical flaring Poor feeding Bilious vomiting Abdominal tenderness Bowel changes, including diarrhoea, blood and mucus Lethargy, apnoea, bradycardia Sepsis Risk factors of low birth rate, prematurity and formula feeding. (1, Updated 2022 Aug 8].

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

Don't Forget the Bubbles

AUGUST 4, 2024

They used servo-controlled therapeutic hypothermia (versus passive hypothermia) and found no major difference in outcome. Neonatal bacterial sepsis. The Role of Family Support in Moderating Mental Health Outcomes for LGBTQ+ Youth in Primary Care. More studies on this topic will surely follow. Beaulieu E, Beno S. JAMA Pediatr.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics Burns Sepsis 52

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. Would you be satisfied with only US and no follow-up CT?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 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

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). Early and established status epilepticus: the impact of timing of intervention, treatment escalation and dosing on outcome. J Pharm Pract.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

Pediatric Emergency Playbook

JANUARY 1, 2016

Think meningitis, UTI, or sepsis. Effortless tachypnea may be a sign of acidosis or sepsis. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. 2013; (34)7: 307-321. In the stable patient, get an upper GI contrast study. Premature, unwell, and vomiting?

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Pediatric status epilepticus is analogous to the multi-organ dysfunction syndrome in severe sepsis. 2013; 54 Suppl 7:23-34 Chin RFM et al., Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. In other words – time is brain. Or… is it something else as well?

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

EB Medicine

JULY 8, 2019

Jeff: Do note, however that 2013 guidelines do not recommend one procedure over another and leave that decision up to local surgical expertise, patient specific risk factors, and treatment goals. Some may present with isolated tachycardia while others may present with profound sepsis – tachycardia, hypotension, and fever.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

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 ST Elevation Myocardial Infarction Due To LEFT Main Culprit Lesions: Percutaneous Coronary Intervention Outcomes.

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. BOTTOM Line from Today’s Case: As per Drs.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

ACEP Now

OCTOBER 10, 2023

Both INTERACT-2 and ATACH-2 showed no statistical difference in their primary outcome between intensively lowering the BP and a less-intensive strategy. Background There have been a couple of large and influential trials published on BP management after an intracranial hemorrhage (ICH). Reference Ma LM, Hu X, Song L, et.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

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. Improving the immediate management of neutropenic sepsis in the UK: Lessons from a national audit. Support Care Cancer.

Infectious Diseases 104

Infectious Diseases Administration Sepsis Anaphylaxis 104

EMDocs

OCTOBER 17, 2023

However, no included studies compared patient health outcomes between CT-guided care and care without the use of routine CT for suspected diverticulitis. 2013 May 1;87(9):612-20. 2013 May;15(5):621-6. Clinicians should err on the side of imaging in patients with predictors of progression to complicated diverticulitis.

Radiology 68

Radiology Radiology Operations Best Practices 68

Don't Forget the Bubbles

SEPTEMBER 23, 2024

Consider sepsis and treat it accordingly. Consider CMV, EBV and BK-polyoma virus infections: Patients are often on prophylaxis for a variable length of time, with differing outcomes. Obesity: Obesity, whether before or after transplant, is linked to worse outcomes. CAKUT, catheterization requirement). Prytuła, A. Chandran, M.M.

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

EMDocs

OCTOBER 23, 2023

This may also predispose a patient to sepsis, peritonitis, or bowel infarction, which need to be recognized quickly. 2013 Mar; 121 (3): 654-673. Morbidity outcomes of 78,577 hysterectomies for benign reasons over 23 years. A patient may experience pelvic pressure or a bulge in the vagina if bowel evisceration occurs (1,7).

OB/GYN 68

OB/GYN Operations EMS Ultrasounds 68