RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 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 134

Stroke Outcomes Hospitals Administration 134

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. We should use lactate to detect occult shock.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Taming the SRU

AUGUST 30, 2023

Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. A 2013 meta-analysis of 30 studies including 3,244 patients published in The Lancet found PCT to have a pooled sensitivity of 77% and specificity of 79% for sepsis in critically ill patients [52]. Epub 2014 Dec 3.

Infectious Diseases 87

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

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation. were more likely to respond.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Don't Forget the Bubbles

JULY 5, 2023

Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis. Pneumococcal sepsis B. Pneumococcal sepsis.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EMDocs

NOVEMBER 1, 2023

1 , 4 If presenting later in course or with an intra-abdominal perforation, patients are more likely to show signs of sepsis and hemodynamic instability. VBG with lactate 4 – may show low pH with elevated lactate Cardiac biomarkers – to evaluate for cardiac etiology in those presenting with chest pain or type II NSTEMI in those with sepsis.

Operations 67

Operations Radiology Radiology Fluid Resuscitation 67

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

Pediatric Emergency Playbook

JANUARY 1, 2016

Be aware that later stages of malrotation may present as shock – they present in hypovolemic shock due to third-spacing from necrotic bowel and/or septic shock from translocation or perforation. Think meningitis, UTI, or sepsis. Effortless tachypnea may be a sign of acidosis or sepsis. 2014; (38): 1275–1281.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

Pediatric Emergency Playbook

AUGUST 1, 2017

J Pediatr Surg 2014; 49:1619. 2014; 8(5):533-541. 2014; 15(4):859-871. J Pediatr Surg 2005; 40:197. Sulkowski JP, Cooper JN, Congeni A, et al. Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. Pyloric Stenosis Aspelund G, Langer JC. Semin Pedaitr Surg. Applegate KE.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. This patient’s severe aortic stenosis (AS) and associated severe cardiogenic shock likely created the ECG pattern, resulting in a very difficult challenge for our inpatient team. Fundamentally, cardiogenic shock is an issue of decreased cardiac output.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

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. You’re concerned about SIRS or sepsis. Clin Infect Dis 2011; 52:e18.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Methods STEMI activations between January 2014 and April 2018 at the University of Arizona Medical Center were identified. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? Knotts et al.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Don't Forget the Bubbles

JANUARY 10, 2024

3,950 children were recruited between September 2014 to May 2017. 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. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

EMDocs

JUNE 27, 2024

2014 Feb;69(2):144-51. -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 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02

Pediatrics 76

Pediatrics Dehydration EMS Hospitals 76

EB Medicine

JULY 8, 2019

Jeff: A 2014 study even showed an up to 80% reduction in the likelihood of developing DM2 postoperatively at the 7-year mark. overall, these surgeries are relatively safe with one 2014 review publishing a 10-17% overall complication rate and a perioperative 30 day mortality of less than 1%. Nachi: So we have a lot to cover!

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. 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. vs. 0.91), positive predictive value (0.27

Sepsis 65

Sepsis Fluid Resuscitation Resuscitation Shock 65

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. More than a dozen randomized controlled trials (RCTs) have sought to identify whether higher or lower MAP targets produce better outcomes in critically ill patients with shock.

Shock 75

Shock Sepsis Outcomes Hospitals 75

RebelEM

MAY 15, 2024

Antibiotics are effectively the only thing standing between these patients and overwhelming sepsis. Improving the immediate management of neutropenic sepsis in the UK: Lessons from a national audit. 2014 Aug 21;124(8):1251-8; quiz 1378. doi: 10.1182/blood-2014-02-482612. Epub 2014 May 28. Support Care Cancer.

Infectious Diseases 93

Infectious Diseases Administration Sepsis Anaphylaxis 93

RebelEM

FEBRUARY 7, 2024

Philadelphia, PA: Elsevier Saunders; 2014:2331-2350. Philadelphia, PA: Elsevier Saunders; 2014: 2282-2299. Triple antibiotic coverage is recommended. Gorgas, D. “Infections related to pregnancy.” ” Emerg Med Clin North Am 26 (2): 345-366, viii. PMID: 18406978 Houry, D and B. Acute Complications of Pregnancy.

Sepsis 93

Sepsis Shock Hospitals Ultrasounds 93

EMDocs

JULY 15, 2023

sepsis), immunocompromised patients, IV drug users, patients with prosthetic heart valves or any intravascular device Clinical features may not abe enough to differentiate erysipelas from cellulitis, and in such cases the treatment should be targeted towards cellulitis Labs No laboratory evaluation is required for the diagnosis of erysipelas.

EMS 66

EMS Infectious Diseases Shock Ultrasounds 66

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). Goal-directed resuscitation for patients with early septic shock. Published November 10, 2014. Which part of the intervention caused the benefit? N Engl J Med. 2014;371(16):1496-506.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

PulmCCM

SEPTEMBER 23, 2021

Guarracino F, Ferro B, Morelli A, Bertini P, Baldassarri R, Pinsky MR: Ventriculoarterial decoupling in human septic shock. Critical Care 2014, 18(2):R80. Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S et al : Diastolic dysfunction and mortality in severe sepsis and septic shock.

Stroke 40

Stroke Sepsis Shock Ultrasounds 40

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. In 2021, Buckley et. 3 The same year, Ross et. JAMA Intern Med.

Sepsis 84

Sepsis Outcomes Administration Shock 84

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 69

Sepsis Pediatrics Shock Hospitals 69

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. Patients were enrolled in these trials if they had signs of shock, with mortality ranging from 18-29%. Inwald et al.

Dehydration 40

Dehydration Fluid Resuscitation Sepsis Resuscitation 40