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. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. 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.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Taming the SRU

AUGUST 27, 2024

This differential is broad and reflects the clinical diversity of their presentations - in this post we will parse through the specifics of bullous lesions as well as what there is to do for them acutely. Bacteremia and sepsis occur in 30-50% of patients, with a 3-4x increase in mortality rates. J Invest Dermatol 2013; 133:1197.

Emergency Department 83

Emergency Department Dehydration Burns Sepsis 83

PEMBlog

OCTOBER 18, 2023

The night prior to presentation, mom noticed he was not feeding as well and seemed fussy. Initially in the emergency department he was generally well-appearing with normal vital signs. rectally, prompting a sepsis workup given his age. This patient was hospitalized for 4 days where he remained well-appearing.

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

Taming the SRU

FEBRUARY 5, 2024

The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). As may be seen in the table below, there are several themes as well a range of stringency. WHO - Who Needs an LP in the ED? Patients with concern for infection (i.e., Clin Infect Dis. 2018;66(3):321-328.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

Pediatric Emergency Playbook

AUGUST 1, 2017

2013; 95(6): 474-477. 2013; 48:1789-1793. 2013; 44(1):53-57. 2013; 200:969-973. 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. 2012; 92:527-39. Peters B et al. 2014; 8(5):533-541.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

RebelEM

AUGUST 12, 2024

Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability. 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

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.*

Seizures 40

Seizures Sepsis Pediatrics Shock 40

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

This definition includes clinically apparent seizures as well as those seen only on EEG.) Or… is it something else as well? Pediatric status epilepticus is analogous to the multi-organ dysfunction syndrome in severe sepsis. 2013; 54 Suppl 7:23-34 Chin RFM et al., In other words – time is brain. Neurocrit Care.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

ACEP Now

OCTOBER 10, 2023

We have seen other bundles, in conditions like sepsis, that did not ultimately turn out to be better than usual care (ARISE, ProMISe and ProCESS). link] Published June 30, 2013. Bundle: The bundle treatment included addressing hypertension, hyperglycemia, pyrexia, and hypercoagulability. N Engl J Med. 2014;371(16):1496-506. Spiegel R.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. 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.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

PulmCCM

FEBRUARY 19, 2024

Well … no. 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

Pediatric Emergency Playbook

MAY 1, 2017

Home care The neonate who is safe to go home is well appearing, and not dehydrated. Make sure to enlist the family's help and support to keep Mom hydrated, eating well, and resting whenever she can. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home.

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. Consider surgical causes of forceful vomiting, especially if the child does not look anything other than well. 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

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. Groups were well matched at baseline. Geneva: World Health Organization; 2013.

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

Dr. Smith's ECG Blog

AUGUST 9, 2019

His comments/questions are inserted below the ECG: A 50-something woman presented with 3 days of intermittent chest pain that became worse on the day of presentation, with diaphoresis and radiation to the left arm, as well as abdominal pain. This is her ECG: An obvious STEMI, but which artery?

EKG/ECG 52

EKG/ECG Shock Emergency Department Wellness 52

Northwestern EM Blog

MAY 16, 2022

The above study was well summarized and bears repeating that, in this multicenter randomized study assessing CT vs POCUS vs radiology performed US in patients with suspected renal colic in the ED setting, initial US reduced radiation exposure without adversely affecting patient-centered outcomes. were hospitalizations during f/u period; 26.4%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 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.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

As for other invasive therapies , intra-aortic balloon counterpulsation (12, 13) appears to work well in non-randomized studies, and this would also make sense: the balloon in the aorta inflates in diastole, increasing diastolic pressure and thus coronary flow. For instance: sepsis, bleeding, dehydration, hypoxia, and mild ACS.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

RebelEM

MAY 15, 2024

The loss of these cells leads to immunosuppression as well as decreased responsiveness of the immune system as a whole Patients with neutropenia will not only get very sick very quickly, but also will have blunted immune response and may not localize signs of infection well Fever or malaise may be their only presenting symptoms.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

Don't Forget the Bubbles

JULY 22, 2024

Using a score that’s not used in clinical practice may seem like it reduces the applicability of the findings, but ultimately, the authors have translated the studies to the well-established PRAM score. 2013 Jun 4;2013(6):CD004878. Corticosteroids impact the child’s immune system. Cochrane Database Syst Rev.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

EMDocs

OCTOBER 23, 2023

She had been feeling well until yesterday when she had a follow-up with her surgeon, at which time she reported that they performed an internal exam and inserted a ‘medication disk’ into her vagina. The patient is noted to be mildly tachycardic as well as febrile. 2013 Mar; 121 (3): 654-673. Clinical Anatomy 30:946-952 (2017).

OB/GYN 93

OB/GYN Operations EMS Ultrasounds 93

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. Critical Care Medicine 41(12):p A191, December 2013. 2013 Jan-Mar;16(1):91-5.

Pediatrics 97

Pediatrics Dehydration EMS Hospitals 97

Taming the SRU

JULY 21, 2023

In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. Patients will often have objective visual acuity impairment as well as a fever or leukocytosis. Corneal ulcers are most frequently caused by Pseudomonas (especially if they wear contact lens), as well as S. and Neal P.

Emergency Department 88

Emergency Department EMS Burns Wellness 88

Pediatric EM Morsels

FEBRUARY 2, 2024

While there is no “right” work up for these patients, hopefully this morsel will help illuminate your evaluation of Travel-Related Illness in Children: Travel-related Illness: Basics International travel has been significantly increasing since commercial airlines made travel much easier.

Infectious Diseases 164

Infectious Diseases Pediatrics Sepsis Documentation/Coding 164

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. What is it?

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

EMDocs

JANUARY 16, 2025

Well provide summaries of the evidence to support your decisions at the bedside. 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 0.38 (95% CI 0.20-0.39)

Sepsis 95

Sepsis Pediatrics Shock Hospitals 95

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). They were a well-grown, term infant born in good condition. The other investigations are unremarkable, including a normal CT head. Ann Intensive Care.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. This sort of sepsis would produce many of the common autopsy findings. in 2013); fewer teen births ; and new childhood vaccinations.

CDC 94

CDC Sepsis Research Pediatrics 94

PulmCCM

MARCH 13, 2025

Catecholamine toxicity has been postulated to worsen the organ failure associated with severe sepsis. A new meta-analysis by Sota et al ( Chest 2025 ) brings together the eight randomized trials published since 2013, and made a crucial decision to stratify them by single- vs. multicenter designs. Just the opposite, in fact: Ibid.

Shock 98

Shock Sepsis Stroke Wellness 98

EMDocs

JANUARY 20, 2025

1,2 For hypervolemia in heart failure patients, orthopnea >2 pillows is the most reliable clinical finding, 3,4 though an increase in peripheral edema and increased weight can be useful as well. 6-8 In patients who are on long-term hemodialysis, typical non-invasive signs of volume assessment seem to be unreliable as well.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Don't Forget the Bubbles

SEPTEMBER 23, 2024

This is particularly crucial in younger children who have received a large adult kidney and typically have relatively low creatinine levels when stable and well. Consider sepsis and treat it accordingly. Hebert MF et Al (2013) Interpreting tacrolimus concentrations during pregnancy and postpartum.Transplantation 95:908–915 Liverman, R.,

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

Mind The Bleep

SEPTEMBER 17, 2024

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. Always consider management as per ATLS protocol and SEPSIS 6 if relevant. C., & Westgarth, C. link] Evgeniou, E.,

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

Advanced Emergency Nursing from AENJ

FEBRUARY 27, 2015

There are increasingly many writings upon the health of our Presidents either factual or speculative, and even in contention whether the office is inherently detrimental to wellness and longevity of its occupants. died of sepsis from an infected blister on his foot resulting from a tennis game at the White House. His son, Calvin, Jr.,

Stroke 40

Stroke COPD Emergency Nursing Sepsis 40