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. Intensive care medicine 39 (2013): 165-228. Circulatory shock.

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Shock Outcomes Sepsis Resuscitation 52

Taming the SRU

AUGUST 30, 2023

Similarly, a 2013 meta-analysis of 6 studies with 1,006 patients published in the American Journal of Emergency Medicine showed neither CRP nor PCT are sufficient to rule-in or rule-out infective endocarditis, with PCT having a pooled sensitivity of 64% and specificity of 73% and CRP having a pooled sensitivity of 75% and specificity of 73% [40].

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

Don't Forget the Bubbles

APRIL 22, 2024

Sepsis: The spread of infection through the bloodstream, known as sepsis, is a critical condition that can lead to organ failure and death if not promptly treated. 2013 Jun 1:E158-62. Acute dacryocystitis in pediatric patients and frequency of nasolacrimal duct patency. 2021 Jan 2;40(1):18-23. Isaza G, Arora S.

Infectious Diseases 85

Infectious Diseases Sepsis Pediatrics Operations 85

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

Sensible Medicine

AUGUST 14, 2024

This sort of sepsis would produce many of the common autopsy findings. in 2013); fewer teen births ; and new childhood vaccinations. Most SIDS babies have congested lungs, and 75% have a history of a recent cold, or an existing cold. from 57% in 1993 to 82.5%

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CDC Sepsis Research Pediatrics 73

Taming the SRU

AUGUST 27, 2024

Mortality rates related to bullous skin lesions are typically related to disruption of the skin barrier and include subsequent dehydration, electrolyte imbalances, hypothermia, increased metabolic needs, and secondary infection leading to bacteremia and/or sepsis. J Invest Dermatol 2013; 133:1197. Roujeau JC, Kelly JP, Naldi L, et al.

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Emergency Department Dehydration Burns Sepsis 83

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].

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Sepsis Ultrasounds Radiology Radiology 52

Don't Forget the Bubbles

AUGUST 4, 2024

Neonatal bacterial sepsis. Water bead injuries by children presenting to emergency departments 2013-2023: An expanding issue. Diagnostic Performance of Machine Learning-based Models in Neonatal Sepsis: A Systematic Review. Beaulieu E, Beno S. Paediatr Child Health. 2024 Jul 22;29(4):255-269. Gray SA, Thompson LA. JAMA Pediatr.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics Burns Sepsis 52

Don't Forget the Bubbles

FEBRUARY 12, 2024

Complications include corneal ulceration, meningitis, or sepsis. 2013 Oct 23;310(16):1721-30. 2013 Oct 23;310(16):1721-30. 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. References Azari AA, Barney NP. cks.nice.org.uk/topics/conjunctivitis-infective/management/management-in-primary-care/

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PEMBlog

OCTOBER 18, 2023

rectally, prompting a sepsis workup given his age. 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 x 10E+09/L with ANC 4.46 Neonatal toxic shock syndrome-like exanthematous disease (NTED).

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

Broome Docs

AUGUST 2, 2022

Vitamin C in sepsis: STOP IT, we do not LOVE IT Lamontagne F, Masse MH, Menard J, et al; LOVIT Investigators and the Canadian Critical Care Trials Group. Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. PMID: 35704292 Bottom line: Sepsis is not treated with vitamins. 2013 Mar 25;173(6):407-16.

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Sepsis Emergency Department Radiology Radiology 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

JUNE 27, 2024

Critical Care Medicine 41(12):p A191, December 2013. 2013 Jan-Mar;16(1):91-5. Epub 2013 Aug 7. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02 mg/kg, max 0.4

Pediatrics 75

Pediatrics Dehydration EMS Hospitals 75

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

FEBRUARY 19, 2024

Over six years of study (2007-2013): There were 83 MET calls activated by parents (~1.2 In my anecdotal experience, these phrases have an impressively high positive predictive value for badness (early sepsis, often). per month, about 3% of all MET calls).

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

RebelEM

AUGUST 12, 2024

Contemp Clin Trials. Epub 2022 Aug 28. PMID: 36038001 Levi TM, et al. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients. Rev Bras Ter Intensiva. PMID: 24553510 Iacone R, et al. Macronutrients in Parenteral Nutrition: Amino Acids.

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Outcomes Hospitals Operations Shock 81

RebelEM

JANUARY 29, 2024

Am J Cardiol 2013. A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Reisk Pulmonary Embolism: The OPTALYSE PE Trial. JACC Cardiovasc Interv 2018. PMID: 30025734 Sharifi M et al. Moderate Pulmonary Embolism Treated with thrombolysis (from the “MOPETT” Trial). Clin Exp Emerg Med 2023.

Stroke 137

Stroke Outcomes Hospitals Administration 137

Pediatric Emergency Playbook

AUGUST 1, 2017

2013; 95(6): 474-477. 2013; 48:1789-1793. 2013; 44(1):53-57. 2013; 200:969-973. 2013; 50:54-86 Intestinal Obstruction Babl FE et al. Mercer AE, Phillips R. Can a conservative approach to the treatment of hypertrophic pyloric stenosis with atropine be considered a real alternative to pyloromyotomy? Arch Dis Child.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Mind The Bleep

SEPTEMBER 17, 2024

Always consider management as per ATLS protocol and SEPSIS 6 if relevant. Management The management is guided by the examination findings which are covered in the respective chapter, this section will delve into the importance of a number of those steps, as well as further long-term care. Ensure the wound has been adequately washed out.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

Taming the SRU

FEBRUARY 5, 2024

The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. Clin Infect Dis. 2018;66(3):321-328. doi:10.1093/cid/cix806 5. Glimåker, M., Johansson, B., Ericsson, M., Bläckberg, J., Lindquist, L., & Sjölin, J. Heyderman, R. C., & Solomon, T.

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Infectious Diseases Seizures Ultrasounds Sepsis 97

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).

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Seizures Emergency Department Outcomes EMS 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. Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. anatomic region). Brainstem stroke: anatomy, clinical and radiological findings. doi: 10.1053/j.sult.2013.01.004.

Stroke 88

Stroke EMS EKG/ECG Radiology 88

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

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.

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Shock Sepsis Pediatrics Ultrasounds 40

Don't Forget the Bubbles

JANUARY 10, 2024

These were presented as hazard ratios and included fever at presentation, previous transfusion ever, haemoglobinuria, malaria, sickle cell disease on enrolment, HIV, evidence of sepsis, malnutrition, shock, hypothermia, and dehydration. Sepsis indicators and malaria positivity did not modify the risk. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

Don't Forget the Bubbles

JULY 22, 2024

There is an increased risk of pneumonia and sepsis in the 31-90 days after prescription and an increased risk of fractures, GI bleeds and sub-optimal growth. 2013 Jun 4;2013(6):CD004878. Whilst the incidence of adverse events was low in this meta-analysis, this reflects adverse event reporting in RCTs rather than reality.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

Pediatric Emergency Playbook

MAY 1, 2016

meningoencephalitis, overwhelming alternate source of sepsis) T – Toxins (e.g. sludge phenomenon, secondary sepsis, hypoglycemia from supply-demand mismatch) S – Seizure (e.g. meningoencephalitis, overwhelming alternate source of sepsis) T – Toxins (e.g. 2013; 28:145–284. V – Vascular (e.g. V – Vascular (e.g.

Seizures 40

Seizures Sepsis Stroke Pediatrics 40

Northwestern EM Blog

MAY 16, 2022

were hospitalizations during f/u period; 26.4% vs. Additionally, although rare, renal infarct can present with acute flank pain and is diagnosed with a contrast CT. References Fwu, C. Eggers, P. Kimmel, P. W., & Kirkali, Z. Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States. Coursey, C.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Check a glucose ad drug screen Sepsis - Saved for last - You'll almost always treat the sick neonate empirically for sepsis - think of congenital and acquired etiologies. Before you decide on sepsis, ask yourself, could this be a cardiac problem?* ACEP/McGraw-Hill, 2013. When in doubt, perform the hyperoxia test.*

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Seizures Sepsis Pediatrics Shock 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

Taming the SRU

JULY 21, 2023

In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. Jama 310.16 (2013): 1721. Demystifying the Ocular Herpes Simplex Virus”, EyeNet Magazine ; Jan 2013. HOW DOES TREATMENT BETWEEN INFANTS (< 1 year old) AND ADULTS DIFFER? References Azari, Amir A., and Neal P.

Emergency Department 87

Emergency Department EMS Burns Wellness 87

Pediatric Emergency Playbook

JANUARY 1, 2016

Think meningitis, UTI, or sepsis. Effortless tachypnea may be a sign of acidosis or sepsis. 2013; (34)7: 307-321. 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? 2002; 141(6):793-7.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

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.

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EKG/ECG Shock Sepsis Emergency Department 52

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., 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? Status epilepticus affects almost every organ system.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 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 My question is this: we are taught that aVR elevation with diffuse ST depression can be indicative of LMCA."

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EKG/ECG Shock Emergency Department Wellness 52

Pediatric Emergency Playbook

MAY 1, 2017

Check the bilirubin in any neonate you are working up for sepsis. 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. The dehydration and neurologic dysfnction from the hyperbilirubinemia may even cause fever. Pediatrics. 2004; 114(1).

Dehydration 52

Dehydration Pediatrics Wellness Seizures 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 105

Infectious Diseases Administration Sepsis Anaphylaxis 105