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. Sepsis-3!!

Sepsis 40

Sepsis Shock Fluid Resuscitation 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.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. High serum procalcitonin concentrations in patients with sepsis and infection. days (secondary endpoint) [51].

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

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. Crit Care Med 2014; 42:118.

Emergency Department 83

Emergency Department Dehydration Burns Sepsis 83

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

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. 2014; (38): 1275–1281. ISPAD Clinical Practice Consensus Guidelines 2014. 2014 Sep;15 Suppl 20:154-79.

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

Pediatric Education

AUGUST 20, 2023

Patient Presentation An 8-year-old male came to clinic for his well-child care after moving to the area. Patients needed prolonged treatment and followup (up to 88 days) but did well without recurrences. per 100,000 hospitalizations in 2014. Patients presented with fever (83%), abdominal pain (58%) and hepatomegaly (38%).

Pediatrics 40

Pediatrics Infectious Diseases Wellness Sepsis 40

Northwestern EM Blog

MAY 16, 2022

This is a great summary of the landmark randomized trial published in NEJM in 2014 assessing CT vs two types of US for patients with suspected renal colic in the ED setting. were hospitalizations during f/u period; 26.4% vs. ACR Appropriateness Criteria® acute onset flank pain–suspicion of stone disease. Ultrasound quarterly, 28(3), 227-233.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

PEMBlog

MARCH 27, 2024

Or, well, the ringer called me. However, sometimes you might hear of siblings or other relatives who had early onset neurologic or GI dysfunction or died early in life, and this can often be attributed to sepsis or sudden infant death syndrome because the symptoms of these overlap with IEMs. Available from: [link] Rice GM, Steiner RD.

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Jeff: A 2014 study even showed an up to 80% reduction in the likelihood of developing DM2 postoperatively at the 7-year mark. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. While it was < 15% in 1990, by 2016 it reached 40%.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

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 Research Outcomes Hospitals 78

Don't Forget the Bubbles

JUNE 10, 2024

Baby A, a preterm infant, appears to be faring well for the moment—requiring minimal respiratory support, on full feeds, without IV access, and generally in an okay condition. Systemic Infections : Sepsis and other systemic infections can predispose infants to NEC by compromising the gut barrier and promoting inflammation. Gordon, P.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

PulmCCM

FEBRUARY 19, 2024

Well … no. In my anecdotal experience, these phrases have an impressively high positive predictive value for badness (early sepsis, often).

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

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. MY Clinical Impression: The ECG in Figure-1 — shows sinus tachycardia — incomplete RBBB — with marked ST depression in multiple leads ( with ST elevation in lead aVR , as well as in leads V1 and aVL ).

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

10 The 2014 ACC/AHA guidelines for the Management of Patients with Valvular Heart Disease , referencing this article, gives this recommendation: "CLASS IIb 1. For instance: sepsis, bleeding, dehydration, hypoxia, and mild ACS. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

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. vs. 0.91), positive predictive value (0.27

Sepsis 83

Sepsis Fluid Resuscitation Shock Resuscitation 83

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 90

Infectious Diseases Administration Sepsis Anaphylaxis 90

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 84

EMS Infectious Diseases Shock Ultrasounds 84

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). Published November 10, 2014. Bundle: The bundle treatment included addressing hypertension, hyperglycemia, pyrexia, and hypercoagulability. Which part of the intervention caused the benefit?

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

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 101

Sepsis Outcomes Administration Shock 101

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. March 2014. She is status post (s/p) hysterectomy 2 weeks ago.

OB/GYN 86

OB/GYN Operations EMS Ultrasounds 86

Pediatric EM Morsels

FEBRUARY 2, 2024

2014 Dec;31(6):678-87. PMID: 35397349 Hagmann SHF, Han PV, Stauffer WM, Miller AO, Connor BA, Hale DC, Coyle CM, Dahill JD, Marano C, Esposito DH, Kozarsky PE. Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel.

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. 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. O’Brien TP.

Emergency Department 88

Emergency Department EMS Burns Wellness 88

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. 2014 Feb;69(2):144-51. C or 100.4 mg/kg, max 0.4 C or 100.4 mg/kg, max 0.4

Pediatrics 94

Pediatrics Dehydration EMS Hospitals 94

Don't Forget the Bubbles

JULY 17, 2023

Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study. 2023 Jun 14;46:8-23 One-year survival and outcomes of infants born at 22 and 23 weeks of gestation in Sweden 2004-2007, 2014-2016 and 2017-2019.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

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. You can also see petechiae and hemorrhage, as well as superficial bulla, vesicles, or even echemosis. Full blown sepsis and toxic shock syndrome.

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 88

Sepsis Pediatrics Shock Hospitals 88

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

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 73

Dehydration Fluid Resuscitation Sepsis Resuscitation 73

RebelEM

FEBRUARY 7, 2024

Philadelphia, PA: Elsevier Saunders; 2014:2331-2350. Philadelphia, PA: Elsevier Saunders; 2014: 2282-2299. 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. In: Marx, J et al, ed. Rosen’s Emergency Medicine.

Sepsis 91

Sepsis Shock Hospitals Ultrasounds 91

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. Changes in TAC concentrations related to changes in haematocrit should not lead to a prompt dose adjustment. and Hirsch, H.H.,

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. Lewis, K., & Pay, J. Wound Irrigation.

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. February 16, 2014.

Stroke 40

Stroke COPD Emergency Nursing Sepsis 40