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

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

Northwestern EM Blog

FEBRUARY 14, 2022

ICU length of stay, hospital length of stay, ventilator-dependent days, or rate of renal replacement therapy: these are all things that matter to our patients and to our health systems and they are more fruitful targets when we investigate interventions. Crit Care 2014; 18(5): 534. References Chawla LS et al.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Pediatric Education

AUGUST 20, 2023

per 100,000 hospitalizations in 2014. In the US study, the most common underlying PLA risk factor was liver transplant with biliary disease, malignancy and intrabdominal pathology and severe sepsis being other common factors in this population. Mortality rate was 0.8%. .” Questions for Further Discussion 1.

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Pediatrics Infectious Diseases Wellness Sepsis 40

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Methods STEMI activations between January 2014 and April 2018 at the University of Arizona Medical Center were identified. However, STE-aVR with multilead ST depression was associated with 31% in-hospital mortality compared with only 6.2% Thirty-two patients (40%) had mild to moderate or no significant disease.

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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). 10 The 2014 ACC/AHA guidelines for the Management of Patients with Valvular Heart Disease , referencing this article, gives this recommendation: "CLASS IIb 1.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

EMDocs

DECEMBER 18, 2024

2014; 28(5): 401-410. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold Management of drug and alcohol withdrawal. Muncie H, Yasinian Y, Oge L. Am Fam Physician.

Seizures 105

Seizures Hyperthermia / Hypothermia Emergency Department EMS 105

EMDocs

DECEMBER 18, 2023

Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician.

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Sepsis Fluid Resuscitation Resuscitation Shock 90

Don't Forget the Bubbles

NOVEMBER 1, 2023

This month, Bubble Wrap has teamed up with Sheffield Children’s Hospital Emergency Department to have a look at what’s new in paediatric literature. Sheffield Children’s Hospital is a stand-alone tertiary children’s hospital in the heart of Sheffield with a paediatric MTC. mmol/L with the median of 2.6

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

RebelEM

MAY 15, 2024

Antibiotics are effectively the only thing standing between these patients and overwhelming sepsis. Follow your hospital’s protocol (if available). High Risk Patients will need hospitalization and IV antibiotics. Improving the immediate management of neutropenic sepsis in the UK: Lessons from a national audit. Clarke, R.

Infectious Diseases 98

Infectious Diseases Administration Sepsis Anaphylaxis 98

EMDocs

JUNE 22, 2024

Epub 2014 Jun 30. “Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation.” J Matern Fetal Neonatal Med. 2015 May;28(7):793-8. doi: 10.3109/14767058.2014.932766. PMID: 24974876. Young BK, Florine Magdelijns P, Chervenak JL, Chan M. Amniotic fluid embolism: a reappraisal. J Perinat Med.

EMS 111

EMS Resuscitation Seizures Blood Transfusions 111

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge. Guest Skeptic: Dr. Jess Monas is a Consultant in the Department of Emergency Medicine at the Mayo Clinic Hospital, Phoenix, Arizona. Background: We have covered sepsis many times on the SGEM since 2012.

Sepsis 40

Sepsis Emergency Department COPD Hospitals 40

Taming the SRU

MAY 5, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. 2014, Hjortrup, Haase et al. N Engl J Med.

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Sepsis Shock Administration Resuscitation 52

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. We have a special episode for you this month… We’ve brought Dr. Jeremy Rose, one of the peer reviewers, and a sepsis expert, on with us to talk through the content this month. Jeff : Sepsis chair. We like it that way.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). CHEST 2010. PMID: 19741062 Kucher N et al. Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. PMID: 24226805 Piazza G et al.

Stroke 136

Stroke Outcomes Hospitals Administration 136

Don't Forget the Bubbles

JUNE 30, 2023

Importantly, there were no differences between the groups regarding complications, including acute respiratory distress syndrome, multiple organ failure, venous thromboembolism, sepsis, and transfusion-related complications. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016.

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Resuscitation Operations Sepsis Pediatrics 139

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% Ultrasound quarterly, 28(3), 227-233. Smith-Bindman, R.,

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

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 93

Radiology Radiology Operations Best Practices 93

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

Mind The Bleep

MAY 12, 2023

These include infection & sepsis, GI bleeding, dehydration, AKI, alcohol consumption, constipation, and certain medications. A Gastroenterology or Hepatology specialist review should ideally be sought within 24 hours of admission to the hospital. 2014 Jan;16(1):362. 2014 Jan;16(1):362. and cirrhotic eating patterns.

Fluid Resuscitation 52

Fluid Resuscitation Dehydration Resuscitation Administration 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. Published November 10, 2014. Reference Ma LM, Hu X, Song L, et.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

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. March 2014. Severe complications of hysterectomy: the VALUE study. 57 (1) 43-57.

OB/GYN 92

OB/GYN Operations EMS Ultrasounds 92

Don't Forget the Bubbles

JUNE 10, 2024

Systemic Infections : Sepsis and other systemic infections can predispose infants to NEC by compromising the gut barrier and promoting inflammation. Differential diagnoses include septic ileus, and infection causes such as sepsis, meningitis and pneumonia. How do we diagnose necrotising enterocolitis? Gordon, P. Hunter, C.J.,

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

PEMBlog

MARCH 27, 2024

Her name is Emily Groopman, and she’s a current resident at Children’s National Hospital. Now the important thing for EM providers to know is that this can mimic the presentation of sepsis. She did her MD/PhD at Columbia University, where she investigated the diagnostic utility of exome sequencing for kidney disease.

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

Taming the SRU

APRIL 3, 2023

Cardiac Arrest in Pregnancy 1 in 30,000 pregnancies 800 maternal deaths globally Rates have nearly doubled between 1989 and 2009 Survival to hospital discharge after maternal in-hospital cardiac arrest 58.9% Do not transport to an alternative location.

Blood Transfusions 40

Blood Transfusions Fluid Resuscitation Resuscitation Stroke 40

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

RebelEM

NOVEMBER 11, 2024

Background: Patients with sepsis are routinely treated with empiric broad-spectrum antibiotics while awaiting source identification, as recommended by the surviving sepsis campaign.2 Mortality of Patients With Sepsis Administered Piperacillin-Tazobactam vs Cefepime. address in the article discussed below. JAMA Intern Med.

Sepsis 108

Sepsis Outcomes Administration Shock 108

PulmCCM

DECEMBER 3, 2024

Maintaining a mean arterial pressure (MAP) of 65 mm Hg has been advised for patients with sepsis and other forms of vasodilatory shock. The following table summarizes three high-quality RCTs performed in the past ten years, enrolling 3,352 patients at 103 hospitals in the U.K., 2014 Apr 24;370(17):1583-93. Epub 2014 Mar 18.

Shock 75

Shock Sepsis Outcomes Hospitals 75

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. However, the destination of travel is also important as helminths have distinct geographical distribution.

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. Accessed November 10, 2014. HOW DOES TREATMENT BETWEEN INFANTS (< 1 year old) AND ADULTS DIFFER?

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Emergency Department EMS Burns Wellness 89

PEMBlog

JANUARY 17, 2024

Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:e10. Full blown sepsis and toxic shock syndrome. So when do you want to think about admission to the hospital or short stay unit versus discharge?

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%

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Sepsis Pediatrics Shock Hospitals 94

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

EMDocs

JUNE 27, 2024

768: Epidemiology of Hospital Based ED Visits due to Sickle Cell Crisis and Acute Chest Syndrome in Kids. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1

Pediatrics 97

Pediatrics Dehydration EMS Hospitals 97

Don't Forget the Bubbles

JULY 17, 2023

The Bubble Wrap Plus is a monthly paediatric journal club reading list from Anke Raaijmakers, working with Professor Jaan Toelen and his team at the University Hospitals in Leuven. Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. Can’t get enough of Bubble Wrap? Paediatr Child Health. 2023 Jun 15.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

Taming the SRU

FEBRUARY 3, 2025

Patients with TLS should be admitted to the hospital with concurrent management from the oncology and renal teams. Academic Press; 2014:39-64. Texas SEK PharmD, BCOP Clinical Pharmacy Specialist Pediatric Hematology/Oncology/Stem Cell Transplant, Childrens Cancer Hospital, University of Texas MD Anderson Cancer Center Houston.

Fluid Resuscitation 56

Fluid Resuscitation Seizures Dehydration Emergency Department 56

Don't Forget the Bubbles

JULY 5, 2023

GPs and local hospitals should provide easy access to medication and vaccinations to ensure good compliance. Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis. What medications would you give to control pain in hospital?

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Blood Transfusions Stroke Dehydration Sepsis 126