Don't Forget the Bubbles

MAY 6, 2024

Reviewed by: Tasnim Ransome and Spyridon Karageorgos Article 3: Which Sepsis Scoring Tools Perform Best? Organ Dysfunction in Children With Blood Culture-Proven Sepsis: Comparative Performance of Four Scores in a National Cohort Study. Each patient was scored using the four sepsis tools. Schlapbach, L.J., Hagenbuch, N.,

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

EMDocs

JULY 13, 2024

A) Administer ceftriaxone 500 mg IM and doxycycline 100 mg PO B) Consult OB/GYN for incision and drainage C) Establish IV access and administer clindamycin and gentamicin D) Prescribe doxycycline with metronidazole and ensure close OB/GYN follow-up Answer: C Most postpartum infections are identified after hospital discharge. PMID: 4073137.

OB/GYN 89

OB/GYN EMS Sepsis Fluid Resuscitation 89

RebelEM

JANUARY 29, 2024

JACCC Cardiovasc Interv 2015. 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). A prospective, Single-Arm Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study.

Stroke 136

Stroke Outcomes Hospitals Administration 136

EMDocs

JUNE 22, 2024

2015 May;28(7):793-8. “Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation.” ” Am J Obstet Gynecol 201(5): 445 e441-413. link] Fong A, Chau CT, Pan D, Ogunyemi DA. Amniotic fluid embolism: antepartum, intrapartum and demographic factors. J Matern Fetal Neonatal Med. link] j.ajog.2016.03.012

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EMS Resuscitation Blood Transfusions Seizures 111

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. But this was all done in adults, and no comparable prospective trials in children exist.

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Resuscitation Operations Sepsis Pediatrics 139

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp! Am J Emerg Med.

Operations 93

Operations Radiology Radiology Fluid Resuscitation 93

RebelEM

OCTOBER 31, 2022

Vitamin C can function as an antioxidant and may mitigate endothelial oxidative stress in sepsis. Amrein 2018) A small, single-center, before-and-after study utilized a sepsis cocktail consisting of IV thiamine, hydrocortisone, and vitamin C and discovered a significant decrease in mortality compared to the control group.

Sepsis 52

Sepsis Outcomes Research Shock 52

Taming the SRU

JULY 24, 2023

He was transitioned to cefdinir and fluconazole for a full 7-day course of antibiotics and discharged from the hospital on day three, with instructions to follow up with general surgery for an outpatient cholecystectomy. In those with concern for sepsis, blood cultures, broad spectrum IV antibiotics and fluids should be given as needed.

Ultrasounds 79

Ultrasounds Sepsis Radiology Radiology 79

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

The Skeptics' Guide to EM

JUNE 15, 2018

Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation. AEM June 2018 Guest Skeptic: Dr. Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario.

Emergency Department 52

Emergency Department Fluid Resuscitation Sepsis Hospitals 52

The Skeptics' Guide to EM

FEBRUARY 2, 2019

Their workup reveals a multifocal pneumonia with signs of sepsis. Background: The liberal use of supplemental oxygen therapy in acutely ill adults has a long history in the hospital, but high-quality therapy supporting its practice is unclear. This study expands upon that investigation to patients with other conditions as well.

Poisoning 52

Poisoning Administration Hospitals Sepsis 52

Northwestern EM Blog

MARCH 1, 2025

There are several etiologies including viral pneumonia, bacterial pneumonia, sepsis, trauma, and pancreatitis. Maren Leibowitz, MD Critical Care Fellow Mount Sinai Hospital How To Cite This Post: [Peer-Reviewed, Web Publication] Goins, E. How safe is the prone position in acute respiratory distress syndrome at late pregnancy.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

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

Don't Forget the Bubbles

NOVEMBER 15, 2023

Jasmine, a hypothetical case Jasmine is a 5-year-old girl weighing 18kg admitted to PICU with suspected sepsis. Many years ago, there was a large body of evidence in reports from Northern Irish hospitals showing children who received large volumes of hypotonic IV fluids subsequently developed hyponatraemic encephalopathy and cerebral oedema.

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Resuscitation Dehydration Administration Shock 80

Taming the SRU

FEBRUARY 5, 2024

2018) Epidemiology of lumbar punctures in hospitalized patients in the United States. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. REFERENCES 1. Zambito Marsala, S., Gioulis, M., & Pistacchi, M. PLOS ONE 13(12): e0208622.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

Pediatric Emergency Playbook

AUGUST 1, 2017

2015; 18 Gilmore AW et al. Management of the child after enema-reduced intussusception: hospital or home? 2015 Jun;50(6):923-7 Herliczek TW et al. Acute Intestinal Obstruction in children: Experience in a Tertiary Care Hospital. 2015; 3(5):53-56. J Ultrasound. Am J Emerg Med. 2011; 29:1136-1140.:205-211.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

RebelEM

MARCH 9, 2023

Pain / Additional Complaints : Alcohol can weaken the immune system with only moderate use, predisposing individuals to pneumonia, soft tissue infections, and sepsis. Suicide attempts in which alcohol is involved: a special group in general hospital emergency rooms. Epub 2015 Sep 14. Annals of Emergency Medicine. 2014 Mar;6(2).

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

Northwestern EM Blog

FEBRUARY 14, 2022

The study was designed as a phase III multicenter randomized placebo control trial taking place across 75 intensive care units in the United States from 2015 to 2017. There’s been some study of angiotensin II in the years since it has landed in our hospital formularies and there has not been robust data supporting its use.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Pediatric Emergency Playbook

MAY 1, 2017

Check the bilirubin in any neonate you are working up for sepsis. Hospital Stay for Healthy Term Newborn Infants. 2015; 135(5):948-53. The neonate may be sleepy but hypotonic or have a high-pitched cry; he maybe irritable or inconsolable, jittery or lethergic. References Benitz WE. Pediatrics. Bhutani V et al. Pediatrics.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

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. 9 Encephalopathy Look closely for a precipitant and treat accordingly!

Fluid Resuscitation 52

Fluid Resuscitation Dehydration Resuscitation Administration 52

EB Medicine

JUNE 6, 2019

Taylor and Shaukat of Emory and Coney Island Hospital respectively for their efforts in peer reviewing this huge topic. Jeff: An interesting question for your abdominal pain patient is to ask about the ride to the hospital. was sensitive for 28-day mortality in sepsis. So fairly sensitive, but not too specific.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EB Medicine

NOVEMBER 1, 2018

It was peer reviewed by Dr. O’Keefe and Dr. Silverberg from Florida State University College of Medicine and Kings County Hospital, respectively. Jeff: And unlike past issues covering more common pathologies, like, say, sepsis, this month’s team reviewed much more literature than just the past 10 years. That’s -- high.

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Emergency Department Burns EKG/ECG Shock 40

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). For instance: sepsis, bleeding, dehydration, hypoxia, and mild ACS. 2015 Oct; 66(4):355-362. Annals of Emergency Medicine. De Backer D et al. Folland ED, et al.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

EB Medicine

SEPTEMBER 1, 2018

As some background, from 2006-2015 there were almost 66,000 reported snake exposures and 31 deaths from snake envenomation in the US. Nachi: Right, but in Australia, not only are the snakes more venomous but the hospital transport distances are much longer, so, basically they sacrifice the limb to potentially save a life.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

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 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

EMDocs

FEBRUARY 17, 2024

12 Differential Diagnosis: Bacteremia Cellulitis/Abscess Endocarditis Epidural abscess HIV Meningitis Opioid withdrawal Osteomyelitis Pneumonia Sepsis Viral syndrome Management : Serious bacterial infection should be excluded before diagnosing cotton fever. Cotton fever: an evanescent process mimicking sepsis in an intravenous drug abuser.

EMS 98

EMS Sepsis Hospitals Wellness 98

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. 2020 Sep;127(10):1269-1279. Spilsbury K, Hammond I, Bulsara M, Semmens JB. BJOG 2008; 115:1473.

OB/GYN 93

OB/GYN Operations EMS Ultrasounds 93

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. In the 1950’s travel accounted for 25 million international tourists. A study of swiss tourists found they compromised 53.4%

Infectious Diseases 164

Infectious Diseases Pediatrics Sepsis Documentation/Coding 164

Taming the SRU

SEPTEMBER 1, 2023

2015) reported a sensitivity of 98.9% to divert the plane). Lane & Mcdonough Definition of an immediate whole body CT (iWBCT) scan Shortly after patient arrival.

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

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

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

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 95

Sensible Medicine

AUGUST 14, 2024

This sort of sepsis would produce many of the common autopsy findings. The Roberts Program on Unexpected Death in Pediatrics at Boston Children’s Hospital does approach SIDS in this meticulous way in order to bring medical closure to families (and to prevent future tragedy in the case of, for example, inherited epilepsy).

CDC 94

CDC Sepsis Research Pediatrics 94

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?

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

RebelEM

DECEMBER 17, 2024

Bottom Line Up Top: There doesnt appear to be a morbidity or mortality benefit to treating fever in sepsis and fever may have a protective effect. What The Evidence Says: Antipyretics are commonly given to patients with fever suspected to be caused by an infection in both at home and in the hospital setting. Sat 93% on RA.

Sepsis 75

Sepsis Shock EMS Emergency Department 75

Don't Forget the Bubbles

FEBRUARY 24, 2025

Two-month-old Isla presents to their local hospital following a prolonged apnoea at home. 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 had a two-day history of reduced feeding.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

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